INSTRUCTIONS FOR FORM ACF‑4125
ANNUAL STATISTICAL REPORT ON CHILDREN IN
FOSTER HOMES
AND CHILDREN IN FAMILIES RECEIVING PAYMENTS
IN EXCESS
OF THE POVERTY INCOME LEVEL FROM A STATE
PROGRAM FUNDED
UNDER PART A OF TITLE IV OF THE SOCIAL
SECURITY ACT
PURPOSE
The formula for computing grants for local education agencies to
provide compensatory education services for educationally deprived children,
contained in Section 1124 of Title I of the Elementary and Secondary Education
Act, as amended by Public Law 107-110, includes October caseload data for
children in foster homes supported with public funds, and children in families
receiving annual payments in excess of the current poverty income level from a
State program funded under part A of Title IV of the Social Security Act (Block
Grants to States for Temporary Assistance for Needy Families (TANF)). The purpose of this annual survey is to
provide these data for each local educational agency (LEA) or county so that
funds may be allocated on an equitable basis.
An electronic (MS Excel) version of this report is available on the Office
of Family Assistance’s Home Page >TANF Programs>Data &
Reports>ACF-4125: HUhttp://www.acf.hhs.gov/programs/ofa/data-reports/ACF4125/FormACF.htmU
REQUIREMENT
This report is required annually of all State agencies administering or
supervising administration of TANF and child welfare programs, including the
INSTRUCTIONS
Complete both Parts I and II. Data should be provided for each LEA or
county in the lists provided with this report form. If data are provided by LEA, it is not
necessary to provide them by county also.
For purposes of this form, a child who
reaches the age of five years during October should be included in the
count. A child who attains 18 during
October should not be counted.
Part I.
Report, by LEA, the number of children aged 5‑17
(inclusive) living in foster homes supported by public funds during the month
of October. If the data are not
available by LEA, report by county.
Include foster homes of all types and under all programs, i.e., public
agency foster homes; group homes and foster homes where care is purchased by
public agencies. "Public
funds" is defined as monies (Federal, State and/or local) which are used
by public assistance agencies to support foster children.
Children
receiving foster care in institutions operated primarily for the care of
neglected or delinquent children should not be included in this report because
a separate survey [
Report only the children who reside within
the State and report the children by LEA in which they reside. If the LEA of residence is not known, the LEA
of school attendance may be used. If the
LEA of residence changes during the month of October, the last known location
should be used.
Please
assure that the sum of the data reported on attached pages is equal to the
State total shown on the form.
Part II.
Report, by LEA, the number of children aged 5‑17
(inclusive) in families which, during the month of October, had a cash
assistance payment in excess of the amount specified for this report
period. If data are not available by
LEA, report by county. (The "amount
specified" is based on poverty income guidelines for a family of four and
will be provided annually to the States by the Administration for Children and
Families via Program Instruction or other appropriate means.)
If no family received an assistance payment
exceeding the amount specified, enter zero.
Do not include under this part children in foster care or those in
institutions for neglected or delinquent children. Include cash assistance
only;
non-monetary assistance and services, vendor payments of all kinds, and
income from any other sources should be excluded. Consider multiple cases in the same dwelling
as separate families.
Please
assure that the sum of the data reported on attached pages is equal to the
State total shown on the form.
SUBMITTAL
PROCEDURE
Please submit this report to the addresses
given below. Also, please send a copy to
the appropriate HHS/ACF Regional Office.
Please
include on the front page the contact information (the name, telephone number
and email address) of the person who compiled the report.
If
you have questions or need further information, please contact:
Yun Song,
ACF/OFA/Division of Data Collection and Analysis:
Phone: 202/401-5293
FAX: 202/401-5554
FAX: 202/205-5887
E-mail: yun.song@acf.hhs.gov
Mail: 370 L'Enfant Promenade,
SW
ACF/OFA
5th Floor East
OR
Holly Higgins,
ACF/OFA/Division of Data Collection and Analysis:
Phone: 202/401-5032
FAX: 202/401-5554
FAX: 202/205-5887
E-mail: holly.higgins@acf.hhs.gov
Mail: 370 L'Enfant Promenade,
SW
ACF/OFA
5th Floor East
This report
must be received in
"PAPERWORK
REDUCTION ACT OF 1995"
Public reporting burden for this collection
of information is estimated to average 264 hours per response, including the
time for reviewing instructions, searching existing data sources, gathering the
data needed, and completing and reviewing the collection of information.
An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it
displays a currently valid OMB control number.