| ACF Administration for Children and Families |
U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES |
|||
| 1. Log No.: ACYF-PI-92-11 | 2. Issuance Date: August 21, 1992 | |||
| 3. Originating Office: ACF, OFM, DFEBG, Family Support Branch | ||||
| 4. Key Word: Title IV-E Financial Form IV-E-12 | ||||
PROGRAM INSTRUCTION
TO: STATE AGENCIES ADMINISTERING OR SUPERVISING THE ADMINISTRATION OF TITLE IV-E OF THE SOCIAL SECURITY ACT.
SUBJECT: Extension of Form IV-E-12 for reporting financial information for Foster Care and Adoption Assistance.
BACKGROUND: The fiscal forms for reporting financial information on the Foster Care and Adoption Assistance Programs have received extended approval for use by the office of Management and Budget through January 31, 1995. There are no changes to the form.
Attachment:
- Copy of Form IV-E-12.
- Instructions for Completion of Form IV-E-12.
ACTION REQUIRED: State agencies are requested to photocopy sufficient copies of the form and instructions included as attachments to this Program Instruction to meet their reporting requirements.
EFFECTIVE DATE: State agencies are to use this revised form to report expenditures for the quarter ending September 30, 1992 and to submit estimates for the quarter ending March 31, 1993. These reports are due to be submitted no later than October 30, 1992.
SUBMISSION: There is no change in the submittal schedule.
Form IV-E-12 is to be submitted by State agencies within thirty days of the end of each fiscal quarter.
The copy with an "original signature" of the completed Form IV-E-12 must be submitted to:
Administration for Children and Families
Office of Financial Management
Division of Formula, Entitlement and Block Grants
370 L'Enfant Promenade, S.W.
Mail stop: OFM/DFEBG
Washington, D.C. 20447
An additional copy should be submitted to the ACF Regional Administrator.
SUPERSEDED MATERIAL: Program Instruction ACYF-PI-90-07, dated April 4, 1990.
INQUIRIES TO: ACF Regional Administrator.
Michael L. Sturman
Director
Office of Financial Management
Administration for Children and Families
Attachments:
Attachment A: Copy
of Form IV-E-12
Attachment
B: Instructions for Completion of Form
IV-E-12
