Form No. IV-E (or IV-A-FC)-2
Department of Health and Human Services
Office of Human Development Services
Administration for Children, Youth and Families
Quarterly Statement of Expenditures for Foster Care and Adoption Assistance Under Title IV, Part E or Part A (Foster Care only) of the Social Security Act.
a. State:
b. Agency:
c. Quarter ended :
I. Non-Voluntary Foster Care (Section 472 or 408)
| This Quarter (a) |
Adjustments This FY (b) |
Adjustments Prior FY (c) |
Total (d) |
|
| 1. Average Monthly number of Eligible Children for Whom Payments Were Made: Payments - Computable Amounts Only: |
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| 2. Total Computable Amounts | ||||
| 3. Federal Share Training Expenditures - Computable Amounts: |
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| 4. Total Computable Amounts | ||||
| 5. Federal Share Administrative Expenditures - Computable Amounts: |
||||
| 6. Total Computable Amounts | ||||
| 7. Federal Share |
II. Voluntary Foster Care
Expenditures and Recipient Data Report for Quarter Being Reported on
| This Quarter (a) |
Adjustments This FY (b) |
Adjustments Prior FY (c) |
Total (d) |
|
| 1. Average Monthly Number of Eligible Children for Whom Payments Were Made Payments - Computable Amounts Only: |
||||
| 2. Total Computable Amounts | ||||
| 3. Federal Share Training Expenditures - Computable Amounts: |
||||
| 4. Total Computable Amounts | ||||
| 5. Federal Share Administrative Expenditures - Computable Amounts: |
||||
| 6. Total Computable Amounts | ||||
| 7. Federal Share |
III. Adoption Assistance
Expenditures and Recipient Data Report for Quarter Being Reported on
| This Quarter (a) |
Adjustments This FY (b) |
Adjustments Prior FY (c) |
Total (d) |
|
| 1. Average Monthly Number of Eligible Children for Whom Payments Were Made Payments - Computable Amounts Only: |
||||
| 2. Total Computable Amounts | ||||
| 3. Federal Share Training Expenditures - Computable Amounts: |
||||
| 4. Total Computable Amounts | ||||
| 5. Federal Share Administrative Expenditures - Computable Amounts: |
||||
| 6. Total Computable Amounts | ||||
| 7. Federal Share |
Attachments:
Attachment 1 - Program Instruction
Attachment 2 - Forms No. IV-E (or IV0A0FC)-1 (Quarterly Estimate of Expenditures)
