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Attachment D

CFS-101, PART II: ANNUAL SUMMARY OF CHILD AND FAMILY SERVICES OMB APPROVAL # 0980-0047
Approved through: 07/31/2005

State or IT __________________________________ For FFY OCTOBER, ____ TO SEPTEMBER 30, ____

                    (k)
Number
to be
Served
[ ]Families
[ ]Individuals
(l) Pop. to be Served (m)Geog Area to be Served
Services/Activities Title IV-B (c)
CAPTA*
(d)
CFCIP
(e)
Title IV-E
(f)
Title XX(SSBG)
(g)
Title IV-A(TANF)
(h)
Title XIX(Medicaid)
(i)
Other Fed Prog
(j)
State Local Donated Funds
     
(a)
I-CWS
(b)
II-PSSF
1) Prevention & Support Services (Family Support)       Shaded Cell Shaded Cell             Reports of abuse/neglect Statewide/ Reservation
2) Protective Services   Shaded Cell   Shaded Cell Shaded Cell                
3) Crisis Intervention (Family Preservation)       Shaded Cell Shaded Cell                
    (A) Preplacement Prevention       Shaded Cell Shaded Cell             All Children in foster care Statewide/ Reservation
    (B) Reunification Services       Shaded Cell Shaded Cell                
4)Time-Limited Family Reunification Services       Shaded Cell Shaded Cell                
5.) Adoption Promotion and Support Services     Shaded Cell Shaded Cell Shaded Cell             All eligible children Statewide/ Reservation
6) Foster Care Maintenance:
     (A) Foster Family & Relative Foster Care
  Shaded Cell Shaded Cell Shaded Cell   Shaded Cell              
(B) Group/Inst Care   Shaded Cell Shaded Cell Shaded Cell   Shaded Cell             Statewide/ Reservation
7) Adoption Subsidy Pmts.   Shaded Cell Shaded Cell Shaded Cell   Shaded Cell Shaded Cell Shaded Cell Shaded Cell        
8) Independent Living Services     Shaded Cell     Shaded Cell Shaded Cell Shaded Cell Shaded Cell   Shaded Cell Shaded Cell Shaded Cell
9) Admin & Mgmt     Shaded Cell Shaded Cell   Shaded Cell Shaded Cell Shaded Cell Shaded Cell   Shaded Cell Shaded Cell Shaded Cell
10) Staff Training             Shaded Cell Shaded Cell     Shaded Cell Shaded Cell Shaded Cell
11) Foster Parent Recruitment & Training   Shaded Cell   Shaded Cell     Shaded Cell Shaded Cell     Shaded Cell Shaded Cell Shaded Cell
12) Adoptive Parent Recruitment & Training   Shaded Cell   Shaded Cell     Shaded Cell Shaded Cell     Shaded Cell Shaded Cell Shaded Cell
13) Child Care Related to Employment/Training   Shaded Cell Shaded Cell Shaded Cell   Shaded Cell Shaded Cell Shaded Cell          
14) Total                     Shaded Cell Shaded Cell Shaded Cell

* States Only, Indian Tribes are not required to include information on these programs

Attachments

PI-02-05