CFS-101, PART II: ANNUAL SUMMARY OF CHILD AND FAMILY SERVICES

OMB APPROVAL # 0980-0047
Approved Through 5/31/2002

State or IT ___________________________________________ For FY OCTOBER 1, ____ TO SEPTEMBER 30, ____ DUE JUNE 30, ____

(k)

NUMBER TO BE SERVED

[ ] Families

[ ]
Individuals

(l)

POP.

TO BE SERVED

(m)

GEOG.

AREA

TO BE

SERVED

SERVICES/ACTIVITIES

TITLE IV-B

(d)
ILP*

(e)
TITLE IV-E

(f)
TITLE XX(SSBG)

(g)
TITLE IV-A

(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)

Reports of abuse/neglect

Statewide/
Reservation

2) PROTECTIVE SERVICES

3) CRISIS INTERVENTION (FAMILY PRESERVATION)

(A) PREPLACEMENT PREVENTION

All Children in foster care

Statewide/ Reservation

(B)REUNIFICATION SERVICES

4. TIME-LIMITED FAMILY REUNIFICATION

5. ADOPTION PROMOTION AND SUPPORT

All egligible children

Statewide/ Reservation

6) FOSTER CARE MAINTENANCE:
(A) FOSTER FAMILY & RELATIVE FOSTER CARE

(B) GROUP/INST CARE

Statewide/ Reservation

7) ADOPTION SUBSIDY PMTS.

8) ADMIN & MGMT

9) STAFF TRAINING

10) FOSTER PARENT RECRUITMENT & trAINING

11) ADOPTIVE PARENT RECRUITMENT & TRAINING

12) CHILD CARE RELATED TO EMPLOYMENT/trAINING

13) TOTAL