act 148: invoicing - university of pittsburgh act 148 invoicing...mechanicsburg, pa 17055 phone...

The Pennsylvania Child Welfare Resource Center University of Pittsburgh, School of Social Work

403 East Winding Hill Road Mechanicsburg, PA 17055

Phone (717) 795-9048 Fax (717) 795-8013 www.pacwrc.pitt.edu

Act 148: Invoicing

Participant Guide

The Pennsylvania Child Welfare Resource Center

University of Pittsburgh, School of Social Work

November 2019

The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide of 62

http://www.pacwrc.pitt.edu/

Copyright 2019, The University of Pittsburgh

This material is copyrighted by The University of Pittsburgh. It may be used freely for training and other educational purposes by public child welfare agencies and other not- for-profit child

welfare agencies that properly attribute all material use to The University of Pittsburgh. No sale, use for training for fees, or any other commercial use of this material in whole or in part is permitted without the express written permission of The Pennsylvania Child Welfare Resource

Center of the School of Social Work at The University of Pittsburgh. Please contact the Resource Center at (717) 795-9048 for further information or permissions.

The Resource Center Instructional Design Team Lead Monica Teles-Carr

The Resource Center Instructional Design Team: Amber Snyder

Andrea Bowersox Elizabeth Neail

Jessie Stockwell Jenny Gardner

Katie Jones PomeroyMaryann Marchi


http://www.pacwrc.pitt.edu/

Acknowledgements

The Pennsylvania Child Welfare Resource Center would like to thank the following people for their assistance in the creation of the course:

Barb Benedict Venango County Children and Youth Services

Claudia T. Conrad Fiscal Officer, Huntingdon County Children’s Services

Cliff Crowe Division of County Support, Office of Children, Youth & Families

Michelle Dotts Division of Fiscal Compliance, Office of Children, Youth & Families

Rhonda Farley Northumberland County Children and Youth

Sandra Flanders Westmoreland County Children’s Bureau

Gloria Gilligan Director - Bureau of Budget & Fiscal Support, Office of Children, Youth & Families

Pedro Gonzales Lancaster County Children and Youth Services

Nadine Grim Adams County Children and Youth Services

Sharon Hahn Somerset County Children and Youth Services

Trudy Hewitt Snyder County Children and Youth Services

Leslie Hoye Mifflin County Children and Youth Services

Jonathan Hudson Fiscal Management Specialist, Office of Children, Youth, & Families

Beverly Kerrigan West Central Regional Training Center

Mary Krestar Cambria County Children and Youth Services

Patrick Kutzler Philadelphia Department of Human Services

Ralph Lee Jr. Crawford County Children and Youth Services

Barbara Robbins Pennsylvania Children and Youth Administrators

David Schwille Venango County Children and Youth Services

Robin Simpson Huntingdon County Children’s Services


Table of Contents

Learning Objectives and Related Child Welfare Competencies .................................................................6

Agenda.........................................................................................................................................................7 What’s In It For Children and Families…………………………………………………………………………………………………….…...….…9

PPT Handout………………………………………………………………………………………………….….…10

Fiscal Flow Chart…………………………………………………………………………………………………...21

Objects of Expenditure………………………………………………………………………………………….….24

Expenditure Report…………………………………………………………………………………......................26

Revenue Report with Reimbursable Expenditure……………………………………………………………….27

Providers List……………………………………………………………………………………………….….……29

Federal Revenue Eligible CC………………………………………………………………………………….…..30

State Participation Rates …………………...………………………………………………………………....….31

Chart of Account……………………………………………………………………………………………………32

RMTS Results………………………………………………………………………………………………………33

RMTS Worksheet………………………………………………………………………………………...………...35

Program Income by Cost Center………………………………………………………………………………….36

Title IV-E Maintenance Expense by Cost Center……………………………………………………………….37

CY-63 AA……………………………………………………………………………………………………………38

CY-63 SPLC………………………………………………………………………………………………………...39

CY-63 FC……………………………………………………………………………………………………….……40

CY-64 AA……………………………………………………………………………………………………….……41

CY-64 SPLC………………………………………………………………………………………………………...42

CY-64 FC……………………………………………………………………………………………………………43

TANF by Cost Center Worksheet………………………………………………………………………………...44

TANF Invoice…………………………………………………………………………………………………….….45

CY-69………………………………………………………………………………………………………………...46

Title XX-IV-B by Cost Center……………………………………………………………………………………...47

Administrative Cost Pool Calculation………………………………………………………………………….….48

Title IV-E Admin & Training by Cost Center Worksheet……………………………………………….……….49

Medicaid Administrative Invoice/Claim…………………………………………………………………….….….50

CY 348 – Fiscal Summary………………………………………………………………………….……………...51


CY 969 Dep/Del. Summary…………………………………………………………………….…………….……52

Completed Revenue Report…………………………………………………………………………….….….….53

Invoice Completion Check Sheet……………………………………………………………....…………...…....54

References…………………………………………………………………………………………….………….…60


Learning Objectives & Related Child Welfare Competencies

Learning Objectives

At the conclusion of this module, you will be able to:

Recognize the laws that regulate the fiscal responsibilities of child welfare professionals

Describe the elements of the child welfare fiscal invoicing policies and procedures

Recognize the processes necessary to complete the Act 148 Invoice.

Child Welfare Competencies

Law and Policy: The child welfare professional identifies, understands, and appropriately applies relevant federal, state, and local laws, policies, and regulatory requirements to child welfare practice to protect the fundamental rights of children, youth, and families. Planning: Planning: The child welfare professional facilitates the planning, development, and coordination of relevant information to a well-reasoned sequence of strategies and goals to achieve sustainable and beneficial results.


Agenda

Day 1

Content

Section I: Welcome and Introductions

Section II: Readiness Assurance Process (RAP)

Section III: Revenues Overview

Section IV:

Program Income

Section V: IV-E Maintenance

Section VI:

TANF

Section VII: Title IV-B and Title XX

Section VIII: Day 1 Conclusion


Day 2

Content

Section I: Welcome back and Agenda

Section II: Title IV-E Admin and Training

Section III: Medical Assistance

Section IV: State and Local Match Calculation

Section V: CY-348 Calculation and Invoice Completion

Section VI: Review

Section VII: Second County Invoice Completion

Section VIII: CY-383 Fee for Service Schedule Completion

Section IX: Third County Data Completion

Section X: Conclusion and Evaluation


What’s in it for Children and Families?

Consider the following questions:

What’s in it for children and families when I learn about the competencies of Law & Policy, and Planning along with Act 148: Invoicing? What have I learned in the online module that will support my work here today? What’s in it for children and families when I participate in this skills-based training module?

Before we begin our work today, please record how these skills can directly support children, youth, and families.


411: Act 148 Invoicing

Copyright © 2019, The University of PittsburghThis material is copyrighted by The University of Pittsburgh. It may be used freely for training and other

educational purposes by public child welfare agencies and other not-for-profit child welfare agencies that properly attribute all material use to The University of Pittsburgh. No sale, use for training for fees, or any

other commercial use of this material in whole or in part is permitted without the express written permission of The Pennsylvania Child Welfare Resource Center of the School of Social Work at The University of

Pittsburgh. Please contact the Resource Center at (717) 795-9048 for further information or permissions.

All names and identities used in this module are fictitious. Any resemblance to actual persons, living or dead, is coincidental.

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Slide 2

Act 148 Invoicing Agenda: Day One

• Welcome and Introductions• Online Prerequisite Review

through Readiness AssuranceTest (RAT)

• Revenues Overview• Program Income• Title IV-E Placement• TANF• Title IV-B and Title XX

• Title IV-E Placement• Administration and Training• Medical Assistance• State and County Match

Calculation• Fiscal Summary Calculation and

Invoice Completion• Day 1 Review and Day 2

Preview

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Act 148 Invoicing Agenda: Day Two

• Day 1 Review and Day 2 Preview• Second County Data Completion• CY-383: Fee for Service Schedule Completion• Third County Data Completion• Summary and Evaluation

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Learning Objectives

• Recognize the laws that regulate the fiscal responsibilities of child welfare professionals

• Describe the elements of the child welfare fiscal invoicing policies and procedures

• Recognize the processes necessary to complete the Act 148 Invoice.

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Slide 5

Revenue is applied in the following manner:

1st• Program Income (Parental Support, SS, etc.)

2nd• Federal Revenue (Title IV-E, TANF, etc.)

3rd• State Revenue (Act 148)

4th• Local Revenue (County Portion)

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Slide 6

TOTAL

EXPENSES=

TOTAL

REVENUES

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Revenue Breakdown

Total Revenues

Total Expenses = PI Federal State Local

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Slide 8

Examples of Program Income (PI)

• Parental Support (Title IV-D)• Social Security Income: Social Security Disability (SSD), Survivors Benefits,

etc.• Supplemental Security Income (SSI)• Veterans (VA) Benefits• Human Services Development Fund (HSDF) grant• Donations• Interest Income• Other private funds

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Slide 9

Federal Revenue

• Title IV-E Maintenance – Reimburses a portion of eligible expenses related to

maintaining an eligible child in an eligible placement. Uncapped

• TANF – Reimburses for certain expenses relating to prevention and treatment

activities and those related to emergency shelter placements for eligible clients.

Capped

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Federal Revenue (cont’d)• Title IV-B – Reimburses the child welfare agency for expenses, which are not funded with

TANF, Medicaid or Title IV-E funds, and are related to any In-Home Services – with the

exception of costs centers used to report investigation services. It may also be applied to

Community Based, Institutional (excluding secure facilities) and Administration costs.

Capped

• Title XX – Reimbursement used to offset the costs for any IH services (excluding Adoption

services and Adoption Assistance) and the non-maintenance (i.e. non-Title IV-E allowable)

portion of the Community Based and Institutional per diems (excluding secure facilities) that

are not funded by Title IV-E, TANF, or Medicaid. Capped

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Slide 11

Federal Revenue• Title IV-E Admin & Training – Reimburses the child welfare agency for a portion of

expenses related to staff and agency performing Title IV-E eligible activities. Uncapped

• Medical Assistance (MA) – Based on state-wide RMTS results, MA reimburses for a portion of expenses related to staff and agency performing MA eligibility determinations. Uncapped

- It is also possible to receive MA funds to pay for the care of medically fragile children, if your county is an approved MA provider.

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Slide 12

State Revenue

• After deducting PI and Federal Revenues from Total Expenses, the resulting NetExpense amount is used to calculate the amount of State Revenue that the county may apply to expenses.

• The State reimburses counties according to the type of expenditure (State Participation Rates). Capped

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Local Revenue

All of the remaining expense is reimbursed with county funds. The county must commit to reimburse this remaining portion of the Child Welfare Expense

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Slide 14

Group Home DemonstrationTotal (GH) Expense: 100

Total PI for GH -10

Net Expense 90

Title IV-E Maintenance -20

Net Remaining Expense 70

State (80%) -56 County (20%) -14

0 Total Revenues = 100

Expenses= 100

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Slide 15

Types of Program Income

• Client SpecificoParental SupportoRetirement, Survivors, and

Disability Insurance (RSDI)oSupplemental Security Income

(SSI)oSocial Security Disability

Insurance (SSDI)oVA Benefits

• Non-Client SpecificoSpecial Grantso InterestoDonationsoOther Private Funding

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Title IV-E

• Title IV-E Maintenance is a federal revenue source available to Child Welfare Agencies for reimbursement of specific expenses related to maintaining an eligible child in an eligible, federally defined foster caresetting, Adoption Assistance payments for special needs children, and Subsidized Permanent Legal Custodianship (SPLC) payments.

• The Agency must determine the child’s eligibility and continually monitorthe child’s eligibility and “reimbursability” status.

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Slide 17

If a child is Title IV-E eligible and reimbursable…

1st• Program Income is applied;

2nd• A percentage of the remaining expenses are paid by Title IV-E;

3rd• A percentage of the remaining expense is paid by the State (Act 148); and

4th• Finally, Local Revenue pays for the remainder of the expenses.

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Slide 18

Federal Medical Assistance Participation (FMAP) Rates

• Set by the Federal Department of Health and Human Services

• Used to determine the percentage of eligible expenses to be reimbursed with Title IV-E funds

• Percentage that Title IV-E reimburses depends on the FMAP in effect on the date the child received the service

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Temporary Assistance to Needy Families (TANF)• Capped federal revenue• Pays for 100% of an eligible client’s eligible expenses• Must be used to reimburse eligible expenses not funded with Program

Income or Title IV-E revenues• Used for Emergency Shelter costs and all In-Home service costs, except

Adoption Assistance, SPLC, and Juvenile Act Proceedings

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Title XX and Title IV-B

• Title XX: Federal revenue source available to Child Welfare Agencies forreimbursement of expenditures relating to specific In-Home cost centers and NON-MAINTENANCE ONLY portions of Specific Community Based and Institutional Placement cost centers. Capped

• Title IV-B: Federal revenue source available to Child Welfare Agencies forreimbursement of expenditures relating to specific In-Home cost centers, all Community Based, specific Institutional Placement cost centers and Administration. Capped

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Slide 21

How to Apply Title XX and Title IV-B

Title XX and Title IV-B should first be applied to eligible purchased services expenses NOT funded with Program Income or Federal Revenues in order to avoid reducing the Administrative cost pool.

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Reimbursement Rate by Cost Center Demo 1

Exp IV-B

% State

Reimb STATE LOCAL

100 80% 80 20100 100 90% 0 0100 60% 60 40

TOTAL 140 60

Scenario # 1 - IV-B used in 90% reimbursement cost center

Residential Service

Counseling

Emergency Shelter

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Slide 23


Exp IV-B

% State

Reimb STATE LOCAL

100 100 80% 0 0100 90% 90 10100 60% 60 40

TOTAL 150 50

Counseling

Emergency Shelter

Residential Services

Scenario #2- IV-B used in 80% reimbursement cost center

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Slide 24


Exp IV-B

% State

Reimb STATE LOCAL

100 80% 80 20100 90% 90 10100 100 60% 0 0

TOTAL 170 30

Counseling

Residential Services

Emergency Shelter

Scenario # 3 - IV-B used in 60% reimbursement cost center

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Title IV-E Administration and Training

• Title IV-E funds are also available to reimburse expenses resulting from Child Welfare Agency staff performing specific Title IV-E eligible activities

• Requires the same State and Local matching funds as the Title IV-E Maintenance Revenues

• Expenses are accumulated in the wages, benefits, operating, and fixedassets objects of expenditure

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Slide 26

Random Moment Time Study (RMTS)• Statewide time study that determines percentage of time child welfare staff

spend engaged in Title IV-E eligible activities - e.g., Case Planning &Management, Eligibility Determinations, Pre-Placement Activities, Other Administration, and Training.

• Provides a justifiable method to determine portion of county operating expensesreimbursed with Title IV-E funds

• Unlike the County Time Study, RMTS is performed constantly and the resulting statewide percentages are distributed to counties on a quarterly basis.

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Slide 27

RMTS Counts vs ACF Data Counts

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FY 15-16 Q2 Case Counts & Penetration Rates

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Slide 29

Medicaid Administrative Invoice/Claim

Calculated to reimburse a portion of child welfare agency expenses for staff time spent engaged in children’s Medicaid eligibility determination activities

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Slide 30

Total Revenues

Total Expenses = PI Federal State Local

TOTAL

EXPENSES=

TOTAL

REVENUES

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Questions and Answers

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Each child’s payment is individually classified and recorded

TOTAL Accumulated, Revenue Report by Cost Center

Eligible clients’ Expenses are accumulated and recorded

Eligible clients’ Revenues are accumulated and recorded

(INCLUDING YDC EXPENSES)

CLIENT SPECIFIC Accumulated, Revenue Report

TOTAL Accumulated, Expense Report by Cost Center

Each expense is individually classified and recorded

Each client’s expense is individually classified and recorded

CLIENT SPECIFIC Accumulated, Expense Report

REVENUE

Each payment is individually classified and recorded

EXPENSES

CLIENT SPECIFIC Expense by cost center Report

CLASSIFYING EXPENSES AND REVENUE

CLIENT SPECIFIC Program income by cost center

PROCESS

PROCESS

Pennsylvania Child Welfare Resource Center Act 148: InvoicingPennsylvania Child Welfare Resource Center Act 148: InvoicingPennsylvania Child Welfare Resource Center Act 148: InvoicingPennsylvania Child Welfare Resource Center Act 148: InvoicingPennsylvania Child Welfare Resource Center Act 148: InvoicingPennsylvania Child Welfare Resource Center Act 148: Invoicing


FISCAL SUMMARY

IDENTIFY ALLOWABLE

EXPENSES FOR

FUNDING SOURCES

TITLE IV-B REVENUE

TITLE XX

ADMIN COST POOL

CALCULATION

REVENUE REPORT

RMTS WORKSHEET

CY63 AA

CY64 AA

EXPENDITURE REPORT

SOURCE DOCUMENTATION

CY64 FC

SOURCE DOCUMENTATION

CY63 FC

MEDICAL ASSISTANCE CY886

CY64 SPLC

PRODUCED DOCUMENTATION

CY63 SPLC

CY63 AA

COST CENTER SPECIFIC Accumulated, Expense Report

COST CENTER SPECIFIC Accumulated, Revenue Report

COMPLETING THE ACT 148 INVOICE

CHILD COUNTS

RMTS FACTORS

CY69 TANF

ADMIN COST POOL


CY63 & CY64 Title IV-E AA, SPLC & PM, CY69 CY68

Cost Pool Calculation CY918

RMTS Worksheet

Revenue Report CY370A

Expenditure Report CY370

ACT 148 INVOICE SUBMISSION PACKET

YTD Fee for Service Schedule CY383

CY63 & CY64 Title IV-E AA, SPLC & PM; CY69 & CY68 TANF; MA

Dependent/Delinquent Summary CY969

Fiscal Summary CY348


• 110 – WAGES AND SALARIESo Includes all program staff’s earned wages and salaries, including

overtime and on-call time

• 120 – EMPLOYEE BENEFITSo Includes the program’s actual costs for employee benefits including

Social Security, retirement, insurance, and other benefit contributionsfor staff costs related to Wages and Salaries

• *130 – MISCELLANEOUS PERSONNELo Includes staff development/training costs and purchased personnel

service, such as temporary hires due to regular staff being unavailableor student interns. DO NOT INCLUDE fees for attorneys and otherprofessionals who are not employees of the CCYA.

• 200 – SUBSIDIESo Includes adoption assistance subsidies, independent living stipends

and subsidies for Subsidized Permanent Legal Custodians (SPLC)

• 300 – OPERATINGo Includes the combined total of intermediate objects of expenditures

denoted with a *. Although, objects of expenditures are combined forreporting purposes, the county must continue to account for allexpenditures by intermediate objects.

• *310 – OCCUPANCYo Includes rent, utilities, insurance related to the building, and

housekeeping expenses.

• *320 – COMMUNICATIONSo Includes communication expenses such as telephone, internet,

postage, printing, duplicating, and advertising.

• *330 – ADMINISTRATIVE SUPPLIESo Include costs including office supplies, minor equipment, office

equipment maintenance, and rental.

• *340 – SERVICE SUPPLIESo Includes the costs for supplies used in providing services to clients.

These costs include clothing, allowances, recreational, schoolsupplies, and personal care expenditures for clients.

• *350 – TRANSPORTATIONo Includes staff travel (meals, lodging, and transportation) costs and

client transportation expenses.


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Objects of Expenditure

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• 360 – PURCHASED SERVICESo Include the cost incurred from the delivery of services to children and

their families, both dependent and delinquent, provided by anindividual or an approved agency under contract to the county agency.

• *370 – CONSULTANT SERVICESo Includes administrative and program consultants such as best practice

advisers and information system designers.

• (*)380 – COURT RELATED COSTSo Includes only court ordered/related costs as defined in §3140.23 of

Title 55 (medical and other examinations/treatment ordered by thecourt and not paid through Medical Assistance, reasonable costsrelated to court appointed Guardian Ad Litem, Summons, Warrants,Subpoenas, and Witness travel costs) are reported ONLY in the“Juvenile Act Proceedings” cost centers as operating or purchasedservices.

• *390 – OTHER OPERATINGo Includes operating costs that are not included in objects 310 through

370, such as: advisory board expenses; bonding expenses;subscriptions and agency library costs; professional membership dues;moving expense (relocation of agency); recruitment expense; interestexpenses (complying with §3170.61(e)); audit expense (complying with§3170.61(f)); and insurance.

• *394 – COUNTY INDIRECT COSTSo Includes the charge for general county support of the program from the

county’s cost allocation plan as defined in Chapter 3170 §3170.60(b)of Title 55. The department will reimburse the program up to twopercent (2%) of the plan-approved State Act 148, state Title IV-B andstate Special Grant allocations. Examples might include county Payrollor Accounts Payable system expenses, County vehicle maintenanceexpense, and County insurance expense. Reported ONLY in theAdministration cost center as an operating expense.

• 400 – FIXED ASSETSo Purchased assets with an expected useful life of more than one year

and have a purchase price of $300 or more are included and items asdefined by the department’s regulations. Also includes amortizationpayments of buildings, major renovations, and equipment purchasesnot expensed to the department. Include costs of repair orimprovement of fixed assets.


ORIGINAL SUBMISSION DATE: November 15, 2016 COUNTY NAME: First CountyREVISED SUBMISSION DATE:

REVISION # REPORT PERIOD: 7/1/2016-9/30/2016

IN-HOME

WAGES and SALARIES

EMPLOYEE BENEFITS SUBSIDIES OPERATING PURCHASED

SERVICESFIXED

ASSETSTOTAL

EXPENDITURESChildren Served

(by County)Children Served

(Purchased)

Non-Reimbursables NON PS/SUB

Non-Reimbursables Purchased Serv./

Subsidies

Program Income related to all Non-

Reimbursables

1-A ADOPTION SERVICE 1,433 430 1,8631-B ADOPTION ASSISTANCE 7,334 7,334 91-C SUBSIDIZED PERMANENCT LEGAL CUSTODIANSHIP 1,860 1,860 21-D COUNSELING - DEPENDENT 62 19 174 680 200 1,135 31-E COUNSELING - DELINQUENT 2,015 2,015 41-F DAY CARE 01-G DAY TREATMENT - DEPENDENT 01-H DAY TREATMENT - DELINQUENT 01-I HOMEMAKER SERVICE 01-J INTAKE & REFERRAL 2,008 601 1,200 3,8091-K LIFE SKILLS - DEPENDENT 124 37 349 900 400 1,810 31-L LIFE SKILLS - DELINQUENT 01-M PROTECTIVE SERVICE - CHILD ABUSE 248 74 698 800 1,8201-N PROTECTIVE SERVICE - GENERAL 248 74 698 800 1,8201-O SERVICE PLANNING 01-P JUVENILE ACT PROCEEDINGS - DEPENDENT 2,500 2,500 101-Q JUVENILE ACT PROCEEDINGS - DELINQUENT 01-R SUBTOTAL IN-HOME 4,123 1,235 9,194 1,919 6,095 3,400 25,966 0 0 0

COMMUNITY BASED PLACEMENT WAGES and SALARIES


SERVICESFIXED

ASSETSTOTAL

EXPENDITURES DAYS OF CARE

Children Served (Purchased)



Subsidies


Reimbursables

2-A ALTERNATIVE TREATMENT - DEPENDENT 02-B ALTERNATIVE TREATMENT - DELINQUENT 02-C COMMUNITY RESIDENTIAL - DEPENDENT 124 37 349 19,770 400 20,680 148 72-D COMMUNITY RESIDENTIAL - DELINQUENT 21,420 21,420 160 62-E EMERGENCY SHELTER - DEPENDENT 124 37 349 400 9102-F EMERGENCY SHELTER - DELINQUENT 1,485 1,485 11 22-G FOSTER FAMILY - DEPENDENT 1,549 465 459 806 400 3,679 31 12-H FOSTER FAMILY - DELINQUENT 02-I KINSHIP CARE - DEPENDENT

2-J KINSHIP CARE - DELINQUENT

2-K SUPERVISED IND. LIVING - DEPENDENT 771 232 174 930 200 2,307 31 12-L SUPERVISED IND. LIVING - DELINQUENT 02-M SUBTOTAL CBP 2,568 771 0 1,331 44,411 1,400 50,481 381 17 0 0 0

INSTITUTIONAL PLACEMENT WAGES and SALARIES


SERVICESFIXED

ASSETSTOTAL

EXPENDITURES DAYS OF CARE

Children Served (Purchased)



Subsidies


Reimbursables

3-A JUVENILE DETENTION SERVICE 03-B RESIDENTIAL SERVICE - DEPENDENT 124 37 349 400 9103-C RES. SERV. - DELINQUENT (EXCEPT YDC) 10,785 10,785 60 33-D SECURE RES. SERVICE (EXCEPT YDC) 03-E YDC SECURE 1,000 1,000 5 13-F SUBTOTAL INSTITUTIONAL 124 37 0 349 11,785 400 12,695 65 4 0 0 0

4 ADMINISTRATION 2,325 425 2,750

5 TOTAL EXPENDITURES 9,140 2,468 9,194 3,599 62,291 5,200 91,892 0 0 0

County Children & Youth Social Service Programs EXPENDITURE REPORT

FY: 2016/2017

MAJOR SERVICE CATEGORIES & COST CENTERS OBJECTS OF EXPENDITURE

Number of Children receiving only NON-PURCHASED IN-Home Services

County Indirect Costs = $




IN-HOME TOTAL

REIMBURSABLE EXPENDITURES

PROGRAM INCOME TITLE IV-E Maintenance

TITLE IV-E Administration TANF TITLE XX TITLE IV-B OTHER FUNDING MEDICAL

ASSISTANCE

NET REIMBURSABLE EXPENDITURES

STATE ACT 148 LOCAL SHARE

1-A ADOPTION SERVICE 1,863

1-B ADOPTION ASSISTANCE 7,334

1-C SUBSIDIZED PERMANENCT LEGAL CUSTODIANSHIP 1,860

1-D COUNSELING - DEPENDENT 1,135

1-E COUNSELING - DELINQUENT 2,015

1-F DAY CARE 0

1-G DAY TREATMENT - DEPENDENT 0

1-H DAY TREATMENT - DELINQUENT 0

1-I HOMEMAKER SERVICE 0

1-J INTAKE & REFERRAL 3,809

1-K LIFE SKILLS - DEPENDENT 1,810

1-L LIFE SKILLS - DELINQUENT 0

1-M PROTECTIVE SERVICE - CHILD ABUSE 1,820

1-N PROTECTIVE SERVICE - GENERAL 1,820

1-O SERVICE PLANNING 0

1-P JUVENILE ACT PROCEEDINGS - DEPENDENT 2,500

1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT 0

1-R SUBTOTAL IN-HOME 25,966

County Children & Youth Social Service Programs REVENUE REPORT

FY: 2016/2017

MAJOR SERVICE CATEGORIES & COST CENTERS REVENUE SOURCES


COMMUNITY BASED PLACEMENTTOTAL


PROGRAM INCOME

TITLE IV-E Maintenance


ASSISTANCE


STATE ACT 148

LOCAL SHARE

2-A ALTERNATIVE TREATMENT - DEPENDENT 02-B ALTERNATIVE TREATMENT - DELINQUENT 02-C COMMUNITY RESIDENTIAL - DEPENDENT 20,6802-D COMMUNITY RESIDENTIAL - DELINQUENT 21,4202-E EMERGENCY SHELTER - DEPENDENT 9102-F EMERGENCY SHELTER - DELINQUENT 1,4852-G FOSTER FAMILY - DEPENDENT 3,6792-H FOSTER FAMILY - DELINQUENT 02-I KINSHIP CARE - DEPENDENT


2-K SUPERVISED IND. LIVING - DEPENDENT 2,3072-L SUPERVISED IND. LIVING - DELINQUENT 02-M SUBTOTAL CBP 50,481

INSTITUTIONAL PLACEMENTTOTAL


PROGRAM INCOME



ASSISTANCE


STATE ACT 148

LOCAL SHARE

3-A JUVENILE DETENTION SERVICE 03-B RESIDENTIAL SERVICE - DEPENDENT 9103-C RES. SERVICE - DELINQUENT (Non YDC/YFC) 10,7853-D SECURE RES. SERVICE (EXCEPT YDC) 03-W YDC SECURE 1,0003-F SUBTOTAL INSTITUTIONAL 12,695

4 ADMINISTRATION 2,750

5 TOTAL REVENUES 91,892



VEN ID COC# Provider Name

UNIT ID Program Cost Center Per Diem/Rate Unit IV-E Per Diem

23 Black,Grace Adoption Adoption Assistance 30.00 daily 30.00

10 BPI Electronics Electronic Monitoring Counseling 15.00 daily 0.00

14 Coleman,George Adoption Adoption Assistance 30.00 daily 30.00

17 Dietrich,Charles Adoption Adoption Assistance 26.00 daily 26.00

8 Families That Care A Group Counseling 50.00 hourly 0.00

8 Families That Care B Individual Counseling 65.00 hourly 0.00

8 Families That Care C Family Intervention Counseling 95.00 hourly 0.00

5 Family Services Counseling Counseling 75.00 hourly 0.00

20 Greer,Darlene Adoption Adoption Assistance 26.00 daily 26.00

18 Hollens,Pamela Adoption Adoption Assistance 26.00 daily 26.00

22 Hubert,Nathan Adoption Adoption Assistance 30.00 daily 30.00

11 333333 Interventions AA Drug & Alcohol Program Residential 175.00 daily 160.00

11 333333 Interventions BB Sexual Offender Program Residential 180.00 daily 160.00

11 333333 Interventions CC Firestarters Program Residential 180.00 daily 160.00

2 Jackson,Jule Subsidized PLC Subsidized PLC 30.00 daily 30.00

26 Loysville Intermediate YDC YDC/YFC Secure 200.00 daily 0.00

25 McBride, Samuel Guardian Pente Lite Juv Act Proc-dep 2,500.00 monthly 2,500.00

1 111111 Parsings, Henry AA County FC Foster Care 26.00 daily 26.00

1 111111 Parsings, Henry BB County FC Foster Care 30.00 daily 30.00

15 Powell,Amanda Subsidized PLC Subsidized PLC 30.00 daily 30.00

19 Shaffer,Carol Adoption Adoption Assistance 30.00 daily 30.00

3 222222 Solutions Group Home AA Boys Group Home Group Home 130.00 daily 125.00

3 222222 Solutions Group Home BB Emergency Shelter Emergency Shelter 135.00 daily 130.00

3 222222 Solutions Group Home CC Girls Group Home Group Home 140.00 daily 135.00

6 Stepping Stones A Counseling Counseling 80.00 hourly 0.00

6 Stepping Stones B Parenting 101 Lifeskills 300.00 course 0.00

21 Weigel,Robert Adoption Adoption Assistance 26.00 daily 26.00

24 Woolf,Erica Adoption Adoption Assistance 30.00 daily 30.00

35 111111 Johnson, Mary BB Host Home Independent Living/Dep 30.00 daily 30.00


MOT17

Typewritten Text

Providers List

TANF Title XX * Title IV-B

CAPPED CAPPED CAPPED1st 2nd 3rd 4th 5th 6th 7th

IN-HOME SERVICES IN-HOME SERVICES IN-HOME SERVICES IN-HOME SERVICES IN-HOME SERVICES IN-HOME SERVICESADOPTION SERVICE ADOPTION SERVICE ADOPTION SERVICE ADOPTION SERVICE

ADOPTION ASSISTANCE ADOPTION ASSISTANCE ADOPTION ASSISTANCE ADOPTION ASSISTANCE

SUBSIDIZED PLC SUBSIDIZED PLC SUBSIDIZED PLC SUBSIDIZED PLC

COUNSELING - DEP COUNSELING - DEP COUNSELING - DEP COUNSELING - DEP COUNSELING - DEP

COUNSELING - DEL COUNSELING - DEL COUNSELING - DEL COUNSELING - DEL COUNSELING - DEL

DAY CARE DAY CARE DAY CARE DAY CARE DAY CARE

DAY TREAT - DEP DAY TREAT - DEP DAY TREAT - DEP DAY TREAT - DEP DAY TREAT - DEP

DAY TREAT - DEL DAY TREAT - DEL DAY TREAT - DEL DAY TREAT - DEL DAY TREAT - DEL

HOMEMAKER SERVICE HOMEMAKER SERVICE HOMEMAKER SERVICE HOMEMAKER SERVICE HOMEMAKER SERVICE

INTAKE & REFERRAL INTAKE & REFERRAL INTAKE & REFERRAL INTAKE & REFERRAL INTAKE & REFERRAL

LIFE SKILLS - DEP LIFE SKILLS - DEP LIFE SKILLS - DEP LIFE SKILLS - DEP LIFE SKILLS - DEP

LIFE SKILLS - DEL LIFE SKILLS - DEL LIFE SKILLS - DEL LIFE SKILLS - DEL LIFE SKILLS - DEL

PROT SERV - CHILD PROT SERV - CHILD PROT SERV - CHILD PROT SERV - CHILD PROT SERV - CHILD

PROT SERVI - GENERAL PROT SERVI - GENERAL PROT SERVI - GENERAL PROT SERVI - GENERAL PROT SERVI - GENERAL

SERVICE PLANNING SERVICE PLANNING SERVICE PLANNING SERVICE PLANNING SERVICE PLANNING

JUV ACT PROC - DEP JUV ACT PROC - DEP JUV ACT PROC - DEP

JUV ACT PROC- DEL JUV ACT PROC- DEL JUV ACT PROC- DEL

COMM BASED PLCMT COMM BASED PLCMT COMM BASED PLCMT CBP NON-MAINTENANCE COMM BASED PLCMT COMM BASED PLCMTALT TREAT - DEP ALT TREAT - DEP ALT TREAT - DEP ALT TREAT - DEP ALT TREAT - DEP

ALT TREAT - DEL ALT TREAT - DEL ALT TREAT - DEL ALT TREAT - DEL ALT TREAT - DEL

COMM RES - DEP (GH) COMM RES - DEP (GH) COMM RES - DEP (GH) COMM RES - DEP (GH) COMM RES - DEP(GH)

COMM RES - DEL (GH) COMM RES - DEL (GH) COMM RES - DEL (GH) COMM RES - DEL (GH) COMM RES - DEL (GH)

EMERG SHELT - DEP EMERG SHELT - DEP EMERG SHELT - DEP EMERG SHELT - DEP EMERG SHELT - DEP EMERG SHELT - DEP

EMERG SHELT - DEL EMERG SHELT - DEL EMERG SHELT - DEL EMERG SHELT - DEL EMERG SHELT - DEL EMERG SHELT - DEL

FOSTER FAM - DEP FOSTER FAM - DEP FOSTER FAM - DEP FOSTER FAM - DEP FOSTER FAM - DEP

FOSTER FAM - DEL FOSTER FAM - DEL FOSTER FAM - DEL FOSTER FAM - DEL FOSTER FAM - DEL

KINSHIP CARE - DEP KINSHIP CARE - DEP KINSHIP CARE - DEP KINSHIP CARE - DEP KINSHIP CARE - DEP

KINSHIP CARE - DEL KINSHIP CARE - DEL KINSHIP CARE - DEL KINSHIP CARE - DEL KINSHIP CARE - DEL

SUP IND. LIV - DEP SUP IND. LIV - DEP SUP IND. LIV - DEP SUP IND. LIV - DEP SUP IND. LIV - DEP

SUP IND. LIV - DEL SUP IND. LIV - DEL SUP IND. LIV - DEL SUP IND. LIV - DEL SUP IND. LIV - DEL

INST PLCMT INST PLCMT INST PLCMT IP-NON-MAINTENANCE INST PLCMT INST PLCMTJUV DET SERV

RES SERV - DEP RES SERV - DEP RES SERV - DEP RES SERV - DEP RES SERV - DEP

RES. SERV. - DEL (EX YDC) RES. SERV. - DEL (EX YDC) RES. SERV. - DEL (EX YDC) RES. SERV. - DEL (EX YDC) RES. SERV. - DEL (EX YDC)

SEC RES. SERV (EX YDC)

YDC SECURE

ADMINISTRATION ADMINISTRATION ADMINISTRATION ADMINISTRATION

* IV-B excludes any cost center where the costs of investigation services are reported

FEDERAL REVENUES - ELIGIBLE COST CENTERS

Program Income Title IV-E Maintenance

Title IV-E Admin & Training MA FROM RMTS


Cost Center Reimbursement RateADOPTION SERVICE 100%ADOPTION ASSISTANCE 80%SUBSIDIZED PERMANENT LEGAL CUSTODIANSHIP 80%COUNSELING - DEPENDENT 80%COUNSELING - DELINQUENT 80%DAY CARE 80%DAY TREATMENT - DEPENDENT 80%DAY TREATMENT - DELINQUENT 80%HOMEMAKER SERVICE 80%INTAKE & REFERRAL 80%LIFE SKILLS - DEPENDENT 80%LIFE SKILLS - DELINQUENT 80%PROTECTIVE SERVICE - CHILD ABUSE 80%PROTECTIVE SERVICE - GENERAL 80%SERVICE PLANNING 80%JUVENILE ACT PROCEEDINGS - DEPENDENT 50%JUVENILE ACT PROCEEDINGS - DELINQUENT 50%ALTERNATIVE TREATMENT - DEPENDENT 80%ALTERNATIVE TREATMENT - DELINQUENT 80%COMMUNITY RESIDENTIAL - DEPENDENT 80%COMMUNITY RESIDENTIAL - DELINQUENT 80%EMERGENCY SHELTER - DEPENDENT 90%EMERGENCY SHELTER - DELINQUENT 90%FOSTER FAMILY - DEPENDENT 80%FOSTER FAMILY - DELINQUENT 80%KINSHIP CARE - DEPENDENT 80%KINSHIP CARE - DELINQUENT 80%SUPERVISED INDEPENDENT LIVING - DEPENDENT 80%SUPERVISED INDEPENDENT LIVING - DELINQUENT 80%JUVENILE DETENTION SERVICE 50%RESIDENTIAL SERVICE - DEPENDENT 60%RESIDENTIAL SERVICE - DELINQUENT (EXCEPT YDC) 60%SECURE RESIDENTIAL SERVICE (EXCEPT YDC) 60%YDC SECURE 60%SUBTOTAL INSTITUTIONAL 60%ADMINISTRATION 60%

STATE PARTICIPATION RATES


1 IN-HOME 110000 WAGES1-A ADOPTION SERVICE 111000 HOURLY WAGES-NON UNION1-B ADOPTION ASSISTANCE 112000 HOURLY WAGES-UNION1-C SUBSIDIZED PERMANENT LEGAL CUSTODIANSHIP 115000 SALARIED WAGES-NON-UNION1-D COUNSELING - DEPENDENT 116000 SALARIED WAGES-UNION1-E COUNSELING - DELINQUENT 120000 BENEFITS1-F DAY CARE 121000 FICA1-G DAY TREATMENT - DEPENDENT 122000 HEALTH INSURANCE1-H DAY TREATMENT - DELINQUENT 123000 DENTAL INSURANCE1-I HOMEMAKER SERVICE 124000 WORKMAN'S COMP1-J INTAKE & REFERRAL 210000 SUBSIDIES1-K LIFE SKILLS - DEPENDENT 300000 OPERATING EXPENSES1-L LIFE SKILLS - DELINQUENT 310000 OCCUPANCY1-M PROTECTIVE SERVICE - CHILD ABUSE 311000 RENT1-N PROTECTIVE SERVICE - GENERAL 312000 UTILITIES1-O SERVICE PLANNING 313000 INSURANCE1-P JUVENILE ACT PROCEEDINGS - DEPENDENT 320000 COMMUNICATION1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT 321000 TELEPHONE

322000 POSTAGE2 COMMUNITY BASED PLACEMENT 323000 PRINTING AND DUPLICATING

2-A ALTERNATIVE TREATMENT - DEPENDENT 324000 ADVERTISING2-B ALTERNATIVE TREATMENT - DELINQUENT 330000 ADMINISTRATIVE SUPPLIES AND MINOR EQUIP2-C COMMUNITY RESIDENTIAL - DEPENDENT 331000 OFFICE SUPPLIES AND MINOR OFFICE EQUIPMENT2-D COMMUNITY RESIDENTIAL - DELINQUENT 340000 SERVICE SUPPLIES2-E EMERGENCY SHELTER - DEPENDENT 341000 MEDICAL SUPPLIES2-F EMERGENCY SHELTER - DELINQUENT 342000 CLOTHING2-G FOSTER FAMILY - DEPENDENT 343000 FOOD2-H FOSTER FAMILY - DELINQUENT 350000 TRANSPORTATION2-I KINSHIP CARE - DEPENDENT 351000 STAFF TRAVEL2-J KINSHIP CARE - DELINQUENT 352000 CLIENT TRANSPORTATION2-K SUPERVISED INDEPENDENT LIVING - DEPENDENT 353000 COURT RELATED TRAVEL COSTS FOR WITNESSES2-L SUPERVISED INDEPENDENT LIVING - DELINQUENT 354000 COURT RELATED TRANSPORTATION OF CHILDREN

360000 PURCHASED CLIENT SERVICES3 INSTITUTIONAL PLACEMENT 361000 CLIENT PURCHASED SERVICES

3-A JUVENILE DETENTION SERVICE 362000 AGENCY PURCHASED SERVICES3-B RESIDENTIAL SERVICE - DEPENDENT 363000 COURT-RELATED COSTS3-C RESIDENTIAL SERVICE - DELINQUENT (EXCEPT YDC) 363100 MEDICAL AND OTHER EXAMINATIONS3-D SECURE RESIDENTIAL SERVICE (EXCEPT YDC) 363200 GUARDIAN PENDENTE LITE3-E YDC SECURE 363300 SUMMONS, WARRANTS, NOTICES,SUBPOENAS

370000 CONSULTANT SERVICES4 ADMINISTRATION 371000 ADMINISTRATIVE CONSULTANTS

372000 PROGRAM SERVICE CONSULTANTS390000 MISCELLANEOUS OPERATING EXPENSES391000 ADVISORY BOARD EXPENSE394000 MEMBERSHIP FEES400000 FIXED ASSETS410000 PURCHASE OF ASSETS411000 BUILDINGS AND LAND412000 SERVICES AND OFFICE EQUIPMENT413000 DATA PROCESSING EQUIPMENT414000 MOTOR VEHICLES

CHART OF ACCOUNTSCOST CENTERS OBJECTS OF EXPENDITURE


(rev 6/11)

1 = 0 = 0.00%2 = 1 = 0.04%3 = 0 = 0.04%4 = 1 = 3.95%5 = 104 = 5.21%

6a = 4 = 21.97%6b = 8 = 1.06%6c = 2 = 0.11%6d = 8 = 0.38%6e = 1 = 1.41%6f = 96 = 0.23%6g = 18 = 30.63%

Total 6 = 137 = 34.97%7a = 8 100%7b = 90 = 63.63%7c = 237d = 297e = 157f = 3237g = 90

Total 7 = 5788a = 08b = 68c = 08d = 08e = 08f = 148g = 8

Total 8 = 289a = 09b = 19c = 09d = 09e = 09f = 29g = 0

Total 9 = 310a = 010b = 010c = 210d = 210e = 110f = 410g = 1

Total 10 = 1011 = 3712 = 6

13a = 113b = 013c = 113d = 51313e = 20913f = 813g = 313h = 1313i = 213j = 113k = 55

Total 13 = 80614a = 12914b = 32014c = 471

Total 14 = 920

X Total = 2631

0.18%ITG - IV-E (PLC) To calculate the Title IV-E portion of the ITG Invoice, Section B, Multipy this percentage by the sum of case count "Y" your RMTS worksheet then multiply the results by A of the ITG invoice and then by 50%.

Information Technology Grant (ITG) for Invoice Computation

TOTALN Subtotal Services (X-11-14/X)

1.65%ITG - IV-E (AA) To calculate the Title IV-E portion of the ITG Invoice, Section B, Multipy this percentage by the sum of case count "X" of your RMTS worksheet then multiply the results by A of the ITG invoice and then by 50%.

J Training (11/X)K Treatment Counseling (12/X)L

General Administration (14/X)

50.29%ITG - IV-E (FC) To calculate the Title IV-E portion of the ITG Invoice, Section B, Multipy this percentage by the sum of case count "Z" of your RMTS worksheet then multiply the results by A of the ITG invoice and then by 50%.

MOther Services (13/X)

G IV-E Adoption Ass't. Case Mgmt. (8/X)H Permanent Legal Custodianship (9/X)I Independent Living (10/X)

C XIX Medicaid (3+4/X)

STATEWIDE CODE COUNTS

D Non-Client Specific Administration (5/X)E Prevention (Pre-Placing Activities) (6/X)

RESULTING FACTORS

F Case Planning and Management (7/X)

A Support Enforcement (1/X)B

COMMONWEALTH OF PENNSYLVANIA

Department of Human ServicesOffice of Children, Youth, and Families

RMTS Final Results July-September 2016

IV-E Eligibility (2/X)


(rev 6/11)

RESULTING FACTORS

1 = 1 = 0.04%2 = 0 = 0.00%3 = = 4 = = 8.31%5 = 207 = 2.33%

6a = 0 = 6.87%6b = 12 = 6c = 0 = 6d = 5 = 6e = 0 = 0.12%6f = 37 = 0.44%6g = 4 = 40.84%

Total 6 = 58 = 41.04%7a = 0 100%7b = 31 = 58.84%7c = 77d = 157e = 207f = 837g = 15

Total 7 = 1718a = 8b = 8c = 8d = 8e = 8f = 8g =

Total 8 = 9a = 9b = 9c = 9d = 9e = 9f = 9g =

Total 9 = 10a = 10b = 10c10d = 10e = 10f = 10g =

Total 10 = 11 = 312 = 11

13a = 13b = 13c = 913d = 21113e = 66213f = 8413g = 1313h = 613i = 013j = 513k = 27

Total 13 = 101714a = 33114b = 25014c = 441

Total 14 = 1022

X Total = 2490

A Support Enforcement (1/X)B IV-E Eligibility (2/X)

COMMONWEALTH OF PENNSYLVANIA

Juvenile Probation Offices

RMTS Final Results July-September 2016

STATEWIDE CODE COUNTS

Department of Human Services

E Prevention (Pre-Placing Activities) (6/X)F Case Planning and Management (7/X)

C XIX Medicaid (3+4/X)D Non-Client Specific Administration (5/X)

I Independent Living (10/X)J Training (11/X)

G IV-E Adoption Ass't. Case Mgmt. (8/X)H Permanent Legal Custodianship (9/X)

M General Administration (14/X)TOTAL

N Subtotal Services (X-11-14/X)

K Treatment Counseling (12/X)L Other Services (13/X)


rev (16/17)

COUNTY NAME:

7/1/16-9/30/16

STATEWIDE CODE COUNTS:

RESULTING FACTORS:RESULTING FACTORS RELATED TO CASE COUNTS

1 = 0A = 0.000% Support Enforcement

(1/X)O = 69 IV-E Adoption Ass't

Children Under Age 18U = 0.758242 % IV-E Adoption Ass't Under Age

18 to all Adoption Ass't (O/P+P1)

2 = 1B = 0.038% IV-E Eiligibility (2/X) O1 = 0 IV-E Adoption Ass't

Children Age 18 and OverU1 = 0.000000 % IV-E Adoption Ass't Age 18 and

Over to all Adoption Ass't(O1/P+P1)

3 = 0C = 0.038% XIX Medicaid ((3+4)/X) P = 90 All Adoption Ass't

Children Under Age 18V = 0.200000 % IV-E PLC Under Age 18 to all

PLC (Q/R+R1)

4 = 1D = 3.953% Non-Client Specific

Administration (5/X)P1 = 1 All Adoption Ass't Children

Age 18 and Over V1 = 0.000000 % IV-E PLC Age 18 and Over to all PLC (Q1/R+R1)

5 = 104E = 5.207% Prevention (pre-Placing

Activities) (6/X)Q = 3 IV-E Children in PLC

Under Age 18W = 0.636364 % IV-E Foster Care Under Age 18

to all Foster Care (S/T+T1)

6 = 137F = 21.969% Case Planning and

Management (7/X)Q1 = 0 IV-E Children in PLC Age

18 and Over W1 = 0.030303 % IV-E Foster Care Age 18 and Over to all Foster Care (S1/T+T1)

7 = 578G = 1.064% IV-E Adoption Ass't.

Case Mgmt. (8/X)R = 11 All Children in PLC

Under Age 18X = 0.496403 % IV-E AA Under Age 18 to all

children (O/(P+P1+R+R1+T+T1))

8 = 28H = 0.114% Permanent Legal

Custodianship (9/X)R1 = 4 All Children in PLC Age 18

and Over X1 = 0.000000 % IV-E AA Age 18 and Over to all children (O1/(P+P1+R+R1+T+T1))

9 = 3I = 0.380% Independent Living

(10/X)S = 21 IV-E Children in Foster

Care Under Age 18Y = 0.021583 % IV-E PLC Under Age 18 to all

children (Q/(P+P1+R+R1+T+T1))

10 = 10J = 1.406% Training (11/X) S1 = 1 IV-E Children in Foster

Care Age 18 and Over Y1 = 0.000000 % IV-E PLC Age 18 and Over to all children (Q1/(P+P1+R+R1+T+T1))

11 = 37K = 0.228% Treatment/Counseling

(12/X)T = 30 All Children in Foster

Care Under Age 18.Z = 0.151079 % IV-E FC Under Age 18 to all

children (S/(P+P1+R+R1+T+T1))

12 = 6L = 30.635% Other Services (13/X) T1 = 3 All Children in Foster Care

Age 18 and Older. Z1 = 0.007194 % IV-E FC Age 18 and Over to all children (T1/P+P1+R+R1+T+T1))

13 = 806M = 34.968% General Administration

(14/X)

14 = 920PST = 0.000% Preventing Sex

Trafficking (15/X) 20,297

15 = 0100.00% TOTAL

X = 2,631 N = 63.63% Subtotal: Services ((X-11-14)/X)

Case Planning & Management Case Planning & Management Case Planning & Management

12,972.68 CP*[F*(W+W1)]

37135.12 CP*[(F*W1)]

672,837.55 CP*[(F*W)]

21,633.73 CP*[(M*(F*(W+W1)/N)]=admin

3874.26 CP*[(M*(F*W1)/N)]=admin

681,559.47 CP*[(M*(F*W)/N)]=admin

34,606.41 LINE 1+ LINE 2

39209.38 LINE 37+ LINE 38

694,397.02 LINE 67 + LINE 68

42,303.21 LINE 3 *50%

40104.69 LINE 39 *50%

702,198.51 LINE 69 *50%

Pre-Placement Activities Pre-Placement Activities Pre-Placement Activities

5704.60 CP*[(E*(W+W1))]

4132.03 CP*[(E*W1)]

71672.57 CP*[(E*W)]

6387.23 CP*[(M*(E*(W+W1)/N)]=admin

4217.60 CP*[(M*(E*W1)/N)]=admin

72369.63 CP*[(M*(E*W)/N)]=admin

71,091.83 LINE 5+ LINE 6

4349.63 LINE 41 + LINE 42

731,042.20 LINE 71 + LINE 72

8545.92 LINE 7 *50%

4424.82 LINE 43 *50%

74521.10 LINE 73 *50%

Eligibility Determinations Eligibility Determinations Eligibility Determinations

9 7.71 CP*[B] 45 0.70 CP*[B]*(T1/(T+T1)) 75 7.01 CP*[B]*(T/(T+T1))10 4.24 CP*[(M*(B)/N)]=admin 46 0.39 CP*[(M*(B)/N)*(T1/(T+T1))]=admin 76 3.85 CP*[(M*(B)/N)*(T/(T+T1))]=admin11 11.95 LINE 9+ LINE 10 47 1.09 LINE 45 + LINE 46 77 10.86 LINE 75 + LINE 7612 5.98 LINE 11 *50% 48 0.55 LINE 47 *50% 78 5.43 LINE 77 *50%

Other Administration Other Administration Other Administration13 534.88 CP*[A+(D*(W+W1)] 49 24.31 CP*[A+(D*W1)] 79 510.56 CP*[A+(D*W)]14 293.96 CP*[M*((A+(D*(W+W1)))/N)]=admin 50 13.36 CP*[M*((A*(T1/(T+T1)))+(D*W1)/N)]=admin 80 280.60 CP*[M*((A*(T/(T+T1)))+(D*W)/N)]=admin

15 828.84 LINE 13+ LINE 14 51 37.67 LINE 49 + LINE 50 81 791.16 LINE 79 + LINE 8016 414.42 LINE 15 *50% 52 18.84 LINE 51 *50% 82 395.58 LINE 81 * 50%

Foster Care Training Foster Care Training Foster Care Training17 45.18 CP*(J*(Z+Z1)) 53 2.05 CP*(J*Z1) 83 43.12 CP*(J*Z118 22.59 LINE 17 *50% 54 1.03 LINE 53 *50% 84 21.56 LINE 83 *50%

Administrative Administrative Administrative19 163.79 CP*(G*(U+U1) 55 0.00 CP*(G*U1) 85 163.79 CP*(G*U)20 90.01 CP*(M*(G*(U+U1))/N)=admin 56 0.00 CP*(M*(G*U1)/N)=admin 86 90.01 CP*(M*(G*U)/N)=admin21 253.80 LINE 19 + LINE 20 57 0.00 LINE 55 + LINE 56 87 253.80 LINE 85 + LINE 8622 126.90 LINE 21 * 50% 58 0.00 LINE 57 * 50% 88 126.90 LINE 87 * 50%

Adoption Assistance Training23 141.69 CP*(J*X) Adoption Assistance Training Adoption Assistance Training24 70.85 LINE 23 * 50% 59 0.00 CP*(J*X) 89 141.69 CP*(J*X)

60 0.00 LINE 59 * 50% 90 70.85 LINE 89 * 50%Administrative

25 4.63 CP*(H*(V+V1))26 2.54 CP*(M*(H*(V+V1))/N)=admin Administrative Administrative27 7.17 LINE 25 + LINE 26 61 0.00 CP*(H*V1) 91 4.63 CP*(H*V)28 3.59 LINE 27 * 50% 62 0.00 CP*(M*(H*V1)/N)=admin 92 2.54 CP*(M*(H*V)/N)=admin

PLC Training 63 0.00 LINE 61 + LINE 62 93 7.17 LINE 91 + LINE 9229 6.16 CP*(J*(Y+Y1)) 64 0.00 LINE 63 * 50% 94 3.59 LINE 93 * 50%30 3.08 LINE 29 * 50%

INDEPENDENT LIVING SERVICE PLC Training PLC Training31 42.40 CP*((M*I)/N) 65 0.00 CP*(J*Y1) 95 6.16 CP*(J*Y)

66 0.00 LINE 65 * 50% 96 3.08 LINE 95 * 50%32 77.15 (CP*I)

XIX MEDICAID 33 7.71 CP*C Non Claimable Activities34 4.24 CP*((M*C)/N)=admin 6,264.22 CP*(K+L)35 11.95 LINE 33 + LINE 34 3,442.70 CP*((M*(K+L))/N)=admin36 5.98 LINE 35 *50% Non Claimable State Foster Care

2,106.07 CP*((E+D+F)*(1-(W+W1)))1,157.46 CP*(M*((E+D+F)*(1-(W+W1)))/N)

97 0.00 CP*[PST] Non ClaimableState AA & PLC & FC Training98 0.00 CP*[(M*(PST)/N)]=admin 92.41 CP*(J(1-(X+Y+Z+X1+Y1+Z1)))99 0.00 LINE 97+ LINE 98 Non Claimable State Adoption

100 0.00 LINE 99 *50% 52.22 CP*(G*(1-(U+U1))28.70 CP*(M*(G*(1-(U+U1)))/N)=admin

3,496.54 Non Claimable State PLC18.51 CP*(H*(1-(V+V1)))10.18 CP*(M*(H*(1-(V+V1)))/N)=admin

$0.00 Rounding Difference?

CP = NET COST POOL

Random Moment Time Study (RMTS)WORKSHEET

First

RESULTS FOR PERIOD:

CASE COUNTS:

ADMINISTRATIVE REVENUE CALCULATIONS:

FOSTER CARE PROGRAM - All Children 0-21NON DEMONSTRATION PROJECT COUNTIES

FOSTER CARE PROGRAM - over 18 ONLY DEMONSTRATION PROJECT COUNTIES ONLY

FOSTER CARE PROGRAM - under 18 ONLYINFORMATIONAL PURPOSES ONLY

NO CLAIMS

7,124.53

PLC PROGRAM- All Children 0-21

PLC PROGRAM - over 18 ONLY PLC PROGRAM - under 18 ONLY

PREVENTING SEX TRAFFICKING - ALL COUNTIES

TOTAL Title IV-E Revenue claims from Cost Pool:

ADOPTION ASSISTANCE PROGRAM - All Children 0-21 ALL COUNTIES

ADOPTION ASSISTANCE PROGRAM - over 18 ONLY - INFORMATION ONLY NO CLAIM

ADOPTION ASSISTANCE PROGRAM - under 18 ONLY

TOTAL NON CLAIMABLE PORTION OF COST POOL: 13,172.47

TOTAL CLAIMABLE PORTION OF COST POOL:

The PA Child Welfare Resource CenterAct 148: Invoicing - Participant Guide

of 62

A B C D E F G H I J K L M N O P

ChildProgram Income

Adoption Assistance

Subsidized PLC

Alt Treat-Dep

Alt Treat-Del

Comm Res-Dep

(GH)Comm Res-Del (GH)

Emerg Shelt-Dep

Emerg Shelt-Del

Foster Fam-Dep

Foster Fam-Del

Ind Living-Dep

Ind Living-Del

Res Serv-Dep

Res Serv-Del

Dykens, Jerry 202.00 202.00Eagan, Nathan 56.00 56.00Garrity, Daryl 20.50 20.50Giles, Cameron 342.00 342.00Manross, Patrick 22.00 22.00O'Brien, Gage 12.00 12.00Preston, Matthew 5.60 5.60Sullivan, Jeremy 68.00 68.00Horton, Mikal 82.50 82.50Taft, Shaunna 0.25 0.25Brandon, Sydney 100.50 100.50Daly, Kiersten 12.00 12.00Feroz, Michelle 15.00 15.00Giles, Cassie 3.05 3.05Warner, Charity 8.60 8.60Kelser, Brianna 120.00 120.00Provone, Chad 157.00 157.00

Totals 1,227.00 0.00 0.00 0.00 0.00 690.15 121.10 0.00 82.75 120.00 0.00 0.00 0.00 0.00 213.00

Completed Program Income by Cost Center


A B C D E F G H I J K L M N O P Q

Child

IV-E Allowable Cost from Client-Specific

Packets FMAPIV-E revenue

B * CAdoption

Assistance SPLCAlt Treat-

DepAlt Treat-

DelComm. Res. -Dep (GH)

Comm. Res. -Del

(GH)Emerg

Shelt-DepEmerg

Shelt-DelFoster

Fam-DepFoster

Fam-DelInd Living-

DepInd Living-

DelRes Serv-

Dep

Courtney Black 750.00 55.64% 417.3 417.30

Jared Dietrich 806.00 55.64% 448.46 448.46

Michelle Feroz 2,700.00 55.64% 1502.28 1,502.28

Cameron Giles 3,875.00 55.64% 2156.05 2,156.05

Kerilyn Greer 806.00 55.64% 448.46 448.46

Mikal Horton 260.00 55.64% 144.66 144.66

Nicole Hubert 750.00 55.64% 417.3 417.30

Tyrone Jackson 930.00 55.64% 517.45 517.45

Patrick Manross 3,875.00 55.64% 2156.05 2,156.05

Eileen Powell 930.00 55.64% 517.45 517.45

Matthew Preston 1,500.00 55.64% 834.6 834.60

Ariel Shaffer 930.00 55.64% 517.45 517.45

Jeremy Sullivan 3,875.00 55.64% 2156.05 2,156.05

Charity Warner 4,185.00 55.64% 2328.53 2,328.53

Joseph Weigel 806.00 55.64% 448.46 448.46

Brenna Woolf 750.00 55.64% 417.3 417.30

Brianna Kelser 916.00 55.64% 509.66 509.66

Jason Kelser 930.00 55.64% 517.45

Sara Hollens 806.00 55.64% 448.46 448.46

Lester Coleman 930.00 55.64% 517.45 517.45

Total IV-E Eligible Expenses 31,310.00 16,903.42 4,080.64 1,034.90 0 0 6,648.98 4,484.58 0 144.66 509.66 0 517.45 0 0

ChildIV-D Eligible Collections FMAP

IV-E program income B * C

Adoption Assistance SPLC

Alt Treat-Dep

Alt Treat-Del

Comm. Res. -Dep (GH)

Comm. Res. -Del

(GH)Emerg

Shelt-DepEmerg

Shelt-DelFoster

Care-DepFoster

Care-DelInd Living-

DepInd Living-

DelRes Serv-

Dep

Cameron Giles -342.00 55.64% -190.29 -190.29

Patrick Manross -22.00 55.64% -12.24 -12.24

Matthew Preston -5.60 55.64% -3.12 -3.12

Jeremy Sullivan -68.00 55.64% -37.84 -37.84

Mikal Horton -82.50 55.64% -45.90 -45.90

Michelle Feroz -15.00 55.64% -8.35 -8.35

Charity Wagner -8.60 55.64% -4.79 -4.79

Kelser, Brianna -120.00 55.64% -66.77 -66.77Total IV-E Eligible Program Income -663.70 -369.28 0.00 0.00 0.00 -213.99 -42.62 0.00 -45.90 -66.77 0.00 0.00 0.00 0.00

Title IV-E Maint Revenue by Cost Center

(w/FMAP applied) 16534.14 4080.64 1034.90 0.00 0.00 6434.99 4441.96 0.00 98.76 442.89 0.00 517.45 0.00 0.00

Eligible Expenses less Eligible Program Income

w/out FMAP applied) 7334.00 1860.00 11565.40 7983.40 177.50 796.00 930.00

Title IV-E Maintenance Expenses by Cost Center

IV-E Eligible Program Income by Cost Center

Title IV-E Maintenance Revenue by Cost Center

The PA Child Welfare Resource CenterAct 148: Invoicing - Participant Guide

of 62

MOT17

Typewritten Text

MOT17

Typewritten Text

MOT17

Typewritten Text

County Code: 68

7334.00

Program Child's MCI Number Child's Last Name Child's First Name MIJudicial Docs

Status1-Dependent 2-Delinquent

Reimbursable From Date

Reimbursable To Date

Residential Facility Certification

Unit ID

Total Cost of Care

Title IV-E Allowable Maintenance

Title IV-E Allowable Administration

Group Home /Institution Maximum Allowable

Group Home /Institution Previously Paid CAPS

ΑΑ 000000025 Weigel Joseph x 1 8/1/2016 8/31/2016 999999 806.00 806.00ΑΑ 000000023 Shaffer Ariell x 1 8/1/2016 8/31/2016 999999 930.00 930.00ΑΑ 000000024 Greer Kerilyn x 1 8/1/2016 8/31/2016 999999 806.00 806.00ΑΑ 000000026 Hubert Nicole x 1 8/7/2016 8/31/2016 999999 750.00 750.00ΑΑ 000000027 Black Courtney x 1 8/7/2016 8/31/2016 999999 750.00 750.00ΑΑ 000000028 Woolf Breanna x 1 8/7/2016 8/31/2016 999999 750.00 750.00ΑΑ 000000018 Coleman Lester x 1 8/1/2016 8/31/2016 999999 930.00 930.00ΑΑ 000000021 Dietrich Jarred x 1 8/1/2016 8/31/2016 999999 806.00 806.00ΑΑ 000000022 Hollens Sarah x 1 8/1/2016 8/31/2016 999999 806.00 806.00

NOTE: Please calculate CAPS to be able to submit this invoice.Insert

Submission Date: 11/15/2016 Quarter Ending Date: 9/30/2016

TITLE IV-E INVOICE

OCYF Approval for Payment: Reviewer:

County Address:

First County 111 Front St

PROGRAM (Check One)Foster Care (FC)Adoption Assistance (AA) / Non-Recurring (NR)Subsidized Permanent Legal Custodianship (SPLC)

CY 64 Save Delete

Grand Total: Total Cost of

CareGrand Total: Title IV-E Allowable Maintenance

Grand Total: Title IV-E Allowable Administration

Grand Total: Group Home/Institution Maximum

Allowable

Total Title IV-E Claim: 7334.00

Cancel Print


County Code: 68

1860.00


Status1-Dependent 2-Delinquent



Residential Facility Certification

Unit ID

Total Cost of Care

Title IV-E Allowable Maintenance

Title IV-E Allowable Administration



SPLC 000000020 Jackson Tyrone x 1 8/1/2016 8/31/2016 555555 930.00 930.00SPLC 000000019 Powell Eileen x 1 8/1/2016 8/31/2016 555555 930.00 930.00

NOTE: Please calculate CAPS to be able to submit this invoice.



Allowable

Total Title IV-E Claim: 1860.00

CY 64 Save Delete

CY 64 Save Delete

Grand Total: Total Cost of

CareGrand Total: Title IV-E Allowable Maintenance

County Address:




TITLE IV-E INVOICE



County Code: 68

$22,906.00


Status 1-Dependent 2-Delinquent



Residential Facility Certification Unit ID Total Cost of Care

Title IV-E Allowable

Maintenance

Title IV-E Allowable

Administration



FC 000000001 Giles Cameron x 1 8/1/2016 8/31/2016 222222 AA 4030.00 3875.00FC 000000002 Preston Matthew x 1 8/1/2016 8/13/2016 222222 AA 1560.00 1500.00FC 000000004 Manross Patrick x 1 8/1/2016 8/31/2016 222222 AA 4030.00 3875.00FC 000000007 Feroz Michelle x 1 8/2/2016 8/21/2016 222222 CC 2800.00 2700.00FC 000000016 Kelser Brianna x 1 8/1/2016 8/31/2016 111111 AA 806.00 806.00FC 000000016 Kelser Brianna x 1 8/1/2016 8/31/2016 000000 110.00 110.00FC 000000008 Horton Mikal x 2 8/1/2016 8/3/2016 222222 BB 270.00 260.00FC 000000011 Sullivan Jeremy x 2 8/1/2016 8/31/2016 222222 AA 4030.00 3875.00FC 000000012 Warner Charity x 2 8/1/2016 8/31/2016 222222 CC 4340.00 4185.00A 000000017 Kelser Jason x 1 8/1/2016 8/31/2016 111111 BB 930.00 930.00

NOTE: Please calculate CAPS to be able to submit this invoice.Insert


TITLE IV-E INVOICE


County Address:



CY 64 Save Delete

Grand Total: Total Cost of Care

Grand Total: Title IV-E Allowable Maintenance

Cancel Print



Allowable

Total Title IV-E Claim: $22,116.00


SAP VENDOR#: DOCUMENT#:PAYMENT DOCUMENT#:

Federal ID#:

ADOPTION ASSISTANCE

ACH Bank Code Invoice Period

Bank Account # Child Service Months

Submission Date

1 2 3

4 5 6

7 8 9

10 11 12

13 14 15

Title IV-E Eligible Children # $

State Only Eligible Children # $

16

Service Costs:

Increased Federal Share Related to American Recovery Reinvestment:

Maintenance without Enhanced FFP:

SUBTOTAL FEDERAL SHARE

All eligibility pathways except "Applicable Child ONLY"

(from CY-63)

COMPTROLLER'S USE ONLY:

TITLE IV-E ADOPTION ASSISTANCE - SUMMARY INVOICE

Name and Address of the County Executive Officers

Indicate with "X" if SUPPLEMENTAL

SECTION B: COMPUTATION OF PAYMENT

ADOPTION ASSISTANCENET

ALLOWABLE COST

FMAP or FFP RATE

For Comptroller's Office Use Only:

"Applicable Child ONLY" (from CY-63)

Administrative Cost

Training Cost

Non-recurring Special Needs adoption incident costs

(separate CY-63 attached)

GRAND TOTAL FEDERAL SHARE

7334.00 .5564 4080.64

.5564

253.80

141.69 .50 70.85

4278.39

.50 126.90

Submit Save Reset Delete

Accept Reject



Federal ID#:

SPLC



Submission Date

1 2 3

4 5 6

7 8 9

10 11 12

Title IV-E Eligible Children # $

13

Service Costs:

Increased Federal Share Related to American Recovery Reinvestment:

Maintenance without Enhanced FFP:

For Comptroller's Office Use Only:

TRAINING COST

Non-Recurring SPLC Incident Costs (separate CY-63 attached)

GRAND TOTAL FEDERAL SHARE

ADMINISTRATIVE COST


SPLC(from Grand Total Column 6

Page 1 of CY-63)

NET ALLOWABLE COST

FMAP or FFP RATE



TITLE IV-E SUBSIDIZED PERMANENT LEGAL CUSTODIANSHIP SUMMARY INVOICE

Name and Address of the County Executive Officers Indicate with "X" if SUPPLEMENTAL

2

9/30/2016

11/15/2016

1,860.00 .5564 1,034.90

3.59.507.17

6.16 .50 3.08

1,053.33

Submit Save Reset Delete



Federal ID#: FOSTER CARE



Submission Date

FOSTER CARE

OTHER INCOME(Non-Title IV-D)

2 3 4 5

TITLE IV-D COLLECTION 6 7 8

From CY63 From RMTSCASE PLANNING AND

MANAGEMENT 9 10 11 12

PRE PLACEMENT ACTIVITIES

From Direct Claim Worksheet 13 14 15

ELIGIBILITY DETERMINATIONS 16 17 18 19

OTHER ADMINISTRATION 20 21 22 23

TRAINING COSTS 24 25 26 27

PREVENTING SEX TRAFFICKING 28 29 30 31

GRAND TOTAL FEDERAL SHARE 32

Allowable Service Costs

Net Allowable Costs

Maintenance without Enhanced

FMAP

Increased Federal Share Related to American Recovery

Reinvestment

Title IV-D Collections

Total

Foster Family and Incidentals - IV-E

Foster Family and Incidentals - NON IV-E

Group Home/Institutional – Maximum Allowable Payment - IV-

EGroup Home/

Institutional – Maximum Allowable Payment -

NON IV-E

Group Home/ Institutional – Deferred

Payment

For Comptroller's Office Use Only :


TITLE IV-E FOSTER CARE - SUMMARY INVOICEName and Address of the County Executive Officers

Indicate with "X" if SUPPLEMENTAL


1NET

ALLOWABLE COST

FMAP or FFP RATE


ALLOWABLE SERVICE COSTS

(from Grand Total Column-6 Page 1 of CY-63)

ADMINISTRATIVE COSTS

Eligible Expenditure

9

9/30/2016

11/15/2016

22,116.00

0.00 22,116.00 .5564 12,305.34

663.70 .5564 (369.28)

4,606.41 2303.21

1,091.83 .50 545.92

.50

11.95 .50 5.98

828.84 .50 414.42

45.15 .50 22.58

15,228.20

Submit Save Delete

Accept Reject

Reset


Last Name First Name From To Total Cost Couns-Dep Couns-Del Day Tr-Del Lifeskills-Dep ES-Del

Brandon Sydney 8/1/2016 8/31/2016 300 300

Giles Cassie 8/1/2016 8/31/2016 130 130

Preston Matthew 8/1/2016 8/31/2016 250 250

Eagan Nathan 8/1/2016 8/31/2016 65 65

Gilbert Alissa 8/1/2016 8/31/2016 300 300

O'Brien Gage 8/1/2016 8/31/2016 100 100

Norris Kyle 8/1/2016 8/31/2016 405 405

Ruthers Byron 8/1/2016 8/31/2016 465 465

Sullivan Jeremy 8/1/2016 8/31/2016 570 570

Taft Shaunna 8/1/2016 8/31/2016 1215 1215

Feroz Michelle 8/1/2016 8/31/2016 300 300

Kelser Brianna 8/1/2016 8/31/2016 300 300

Totals 4400 680 1905 0 600 1215

TANF by Cost Center Worksheet


First County Children, Youth and Families

Invoice Period:

(2) (4)

From ToPreston Matthew In-home 8/1/2016 8/31/2016 250.00Brandon Sydney In-home 8/1/2016 8/31/2016 300.00

Giles Cassie In-home 8/1/2016 8/31/2016 130.00Eagan Nathan In-home 8/1/2016 8/31/2016 65.00Gilbert Alissa In-home 8/1/2016 8/20/2016 300.00O'Brien Gage In-home 8/1/2016 8/31/2016 100.00Norris Kyle In-home 8/5/2016 8/31/2016 405.00

Ruthers Byron In-home 8/1/2016 8/31/2016 465.00Sullivan Jeremy In-home 8/1/2016 8/31/2016 570.00

Taft Shaunna Emergency 8/1/2016 8/10/2016 1,215.00Feroz Michelle In-home 8/1/2016 8/31/2016 300.00Kelser Brianna In-home 8/1/2016 8/31/2016 300.00

4,400.004,400.00

CY-68Grand Total

County Children & Youth Agency:

TANF INVOICE

Totals This Page

(Temporary Assistance for Needy Families) 8/1/16-8/30/16

(3)

Last Name Type of ServiceDates of Service Allowable TANF

ExpendituresFirst Name

(1)


OCYF BULLETIN3140-00-03ATTACHMENT A

NAME AND ADDRESS OF THE COUNTY EXECUTIVE OFFICERSFROM: 8/1/2016TO: 8/31/2016

FEDERAL ID #:

TANF CFDA #: 93.558

ME#:

Signature and Title of the Designated County Official Date

FUND DEPT APP YEAR LDG. ORG COST FUNCTION OBJ SUB-OBJ AMOUNT

001 021 986 7 1600 631001 021 986 7 1600 631001 021 986 7 1600 631001 021 986 7 1600 631

TANF program for the periods indicated and that this is an accurate statement of the costs of

TANF SUMMARY INVOICE Temporary Assistance for Needy Families

INVOICE PERIOD

SECTION A - COUNTY CERTIFICATIONI certify that the children listed on the attached CY-68 are eligible under the child welfare

of services and of related administrative costs incurred for the children.

SECTION B - COMPUTATION OF PAYMENT

(1) (2) (3) (4) (5)Child Welfare TANF

ServiceNumber of Children

Served Allowable TANF

Service CostsProgram Income (related to

claimed expenditures) Net Allowable Cost

IN HOME SERVICES 11 3,185.00 0.00 3,185.00

ACCOUNT CODEFOR COMPROLLER'S OFFICE USE ONLY

EMERGENCY SHELTER SERVICES 1 1,215.00 0.00 1,215.00

DETENTION SERVICES 0 0.00 0.00 0.00

TOTAL 12 4,400.00 0.00 4,400.00


IN-HOME Title XX Title IV-B1-A ADOPTION SERVICE

1-B ADOPTION ASSISTANCE

1-C SUBSIDIZED PLC

1-D COUNSELING - DEPENDENT

1-E COUNSELING - DELINQUENT

1-F DAY CARE

1-G DAY TREATMENT - DEPENDENT

1-H DAY TREATMENT - DELINQUENT

1-I HOMEMAKER SERVICE

1-J INTAKE & REFERRAL

1-K LIFE SKILLS - DEPENDENT

1-L LIFE SKILLS - DELINQUENT

1-M PROTECTIVE SERVICE - CHILD ABUSE

1-N PROTECTIVE SERVICE - GENERAL

1-O SERVICE PLANNING

1-P JUVENILE ACT PROCEEDINGS - DEPENDENT

1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT

COMMUNITY BASED PLACEMENT2-A ALTERNATIVE TREATMENT - DEPENDENT

2-B ALTERNATIVE TREATMENT - DELINQUENT

2-C COMMUNITY RESIDENTIAL - DEPENDENT 2772-D COMMUNITY RESIDENTIAL - DELINQUENT

2-E EMERGENCY SHELTER - DEPENDENT

2-F EMERGENCY SHELTER - DELINQUENT

2-G FOSTER FAMILY DEPENDENT

2-H FOSTER FAMILY - DELINQUENT

2-I KINSHIP CARE - DEPENDENT


2-K SUPERVISED INDEPENDENT LIVING - DEPENDENT

2-L SUPERVISED INDEPENDENT LIVING - DELINQUENT

INSTITUTIONAL PLACEMENT3-A JUVENILE DETENTION SERVICE

3-B RESIDENTIAL SERVICE - DEPENDENT

3-C RESIDENTIAL SERVICE - DELINQUENT (EXCEPT YDC) 5363-D SECURE RESIDENTIAL SERVICE (EXCEPT YDC)

3-E YDC SECURE

4 ADMINISTRATIONTotal

Title XX and IV-B by CC Worksheet


ORIGINAL SUBMISSION DATE: November 15, 2016 COUNTY NAME: First

REVISED SUBMISSION DATE:


(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

Eligible Expenses Co. Provided Services

Maintenance Expenditures

Assets exceeding $25,000

PROGRAM INCOME

TANF TITLE XX

TITLE IV-B

DIRECT Administrative

CHARGES

NET COST POOL

Allocation of IV-E Revenue

IV-E Revenue from RMTS Worksheet

IV-E Administrative Revenue from FF

homes & Non-recurring

IV-E Revenue fromDirect

Administrative Charges

1-A ADOPTION SERVICE 1,863 1,863 9.18% 321

1-B ADOPTION ASSISTANCE 0 0 0.00% 0

1-C SUBSIDIZED PERMANENT LEGAL CUSTODIANSHIP 0 0 0.00% 0

1-D COUNSELING - DEPENDENT 455 455 2.24% 78

1-E COUNSELING - DELINQUENT 0 0 0.00% 0

1-F DAY CARE 0 0 0.00% 0

1-G DAY TREATMENT - DEPENDENT 0 0 0.00% 0

1-H DAY TREATMENT - DELINQUENT 0 0 0.00% 0

1-I HOMEMAKER SERVICE 0 0 0.00% 0

1-J INTAKE & REFERRAL 3,809 3,809 18.77% 656

1-K LIFE SKILLS - DEPENDENT 910 910 4.48% 157

1-L LIFE SKILLS - DELINQUENT 0 0 0.00% 0

1-M PROTECTIVE SERVICE - CHILD ABUSE 1,820 1,820 8.97% 314

1-N PROTECTIVE SERVICE - GENERAL 1,820 1,820 8.97% 314

1-O SERVICE PLANNING 0 0 0.00% 0

1-P JUVENILE ACT PROCEEDINGS -DEPENDENT 0 0 0.00% 0

1-Q JUVENILE ACT PROCEEDINGS -DELINQUENT 0 0 0.00% 0

2-A ALTERNATIVE TREATMENT - DEPENDENT 0 0 0.00% 0

2-B ALTERNATIVE TREATMENT - DELINQUENT 0 0 0.00% 0

2-C COMMUNITY RESIDENTIAL - DEPENDENT 910 910 4.48% 157

2-D COMMUNITY RESIDENTIAL - DELINQUENT 0 0 0.00% 0

2-E EMERGENCY SHELTER - DEPENDENT 910 910 4.48% 157

2-F EMERGENCY SHELTER - DELINQUENT 0 0 0.00% 0

2-G FOSTER FAMILY - DEPENDENT 2,873 110 2,763 13.61% 476

2-H FOSTER FAMILY - DELINQUENT 0 0 0.00% 0

2-I KINSHIP CARE - DEPENDENT


2-K SUPERVISED IND. LIVING - DEPENDENT 1,377 1,377 6.78% 237

2-L SUPERVISED IND. LIVING - DELINQUENT 0 0 0.00% 0

3-A JUVENILE DETENTION SERVICE 0

3-B RESIDENTIAL SERVICE - DEPENDENT 910 910 4.48% 157

3-C RES. SERVICE - DELINQUENT (EXCEPT YDC) 0 0 0.00% 0

3-D SECURE RES. SERVICE (EXCEPT YDC) 0

3-E YDC SECURE 0

4 ADMINISTRATION 2,750 2,750 13.55% 474

TOTAL 20,407 0 110 0 0 0 0 20,297 100% 3,497 0 0

COST CENTERS

County Children & Youth Social Service ProgramsADMINISTRATIVE COST POOL CALCULATION

FY: 2016/2017

ADJUSTMENTS


6,994.00 *TOTAL IV-E CLAIMABLE PORTION OF COST POOL from RMTS worksheet(9)

NET COST POOL

{Eligible Expenses}

(10)

Allocation of IV-

E Revenue

Eligible

Admin/Training

Expenses

IV-E Revenue

From RMTS

ADOPTION SERVICE 1,863 9.18% 642 321

COUNSELING - DEPENDENT 455 2.24% 157 78

INTAKE & REFERRAL 3,809 18.77% 1,313 656

LIFE SKILLS - DEPENDENT 910 4.48% 314 157

PROTECTIVE SERVICE - CHILD ABUSE 1,820 8.97% 627 314

PROTECTIVE SERVICE - GENERAL 1,820 8.97% 627 314

COMMUNITY RESIDENTIAL - DEPENDENT 910 4.48% 314 157

EMERGENCY SHELTER - DEPENDENT 910 4.48% 314 157

FOSTER FAMILY - DEPENDENT 2,763 13.61% 952 476

SUPERVISED INDEPENDENT LIVING - DEPENDENT 1,377 6.78% 474 237

RESIDENTIAL SERVICE - DEPENDENT 910 4.48% 314 157

ADMINISTRATION 2,750 13.55% 948 474

TOTAL 20,297 100% 6,994 3,497

Title IV-E Admin & Training by Cost Center Worksheet


County:Federal I.D.Number:

Routing #:

Vendor Code:

DATE

DATE

DATE

CY 886 (rev 14/15)

OCYF APPROVAL

2. Percentage 50%

3. Invoice / Claim Total 5.98

SIGNATURES/APPROVAL

COUNTY C&Y ADMINISTRATOR/DESIGNEE

COUNTY C&Y FISCAL OFFICER/DESIGNEE

INVOICE/CLAIM CALCULATIONS1. Total Amount Claimable

$11.95(From RMTS Worksheet, CALCULATION: 35)

Bank Account #:

Name and Address of the County Executive Officers

Office of Children, Youth and FamilyMEDICAID ADMINISTRATIVE INVOICE/CLAIM

Date of Claim:

Report Period:


ORIGINAL SUBMISSION DATE: November 15, 2016 COUNTY NAME: FirstREVISED SUBMISSION DATE:

REVISION # 7/1/2016-9/30/2016

A B C D E F G H I J K

NET CHILD WELFARE EXPEND.01. 100% REIMBURSEMENT 1,863 0 321 0 0 0 0 0 2,184 2,184 002. 90% REIMBURSEMENT 2,395 83 256 1,215 0 0 0 0 3,949 3,554 39503. 80% REIMBURSEMENT 69,689 931 19,342 3,185 277 0 0 0 93,424 74,739 18,68504. 60% REIMBURSEMENT 14,445 213 631 0 0 536 0 6 15,831 9,499 6,33205. 50% REIMBURSEMENT 2,500 0 0 0 0 0 0 0 2,500 1,250 1,25006. TOTAL CHILD WELFARE EXP. 90,892 1,227 20,550 4,400 277 536 0 6 117,888 91,226 26,662

YDC/YFC PLACEMENT COSTS07. 60% DHS PARTICIPATION 1,000 0 1,000 600 400

08. NON-Reimbursable Expend. 0 0 0 0 0

09. TOTAL EXPENDITURES 91,892 1,227 20,550 4,400 277 536 0 6 118,888 91,826 27,062

1,227 990

12. STATE ACT 148 - Line 6 91,226 84,872 84,872(lower of 12. or 13.)

CY-348 (Rev. 7/11)

GRAND TOTAL PROGRAM INCOME TITLE IV-E

10. TOTAL TITLE IV-D COLLECTIONS 11. TITLE IV-D Collections for IV-E Eligible Children

13. STATE ACT 148 ALLOCATION 14. ADJUSTED STATE SHARE

County Children & Youth Social Service ProgramsFISCAL SUMMARY

FY: 2016/2017

REPORT PERIOD:

NET TOTAL STATE ACT 148 LOCAL SHARETANF TITLE XX TITLE IV-B OTHER FUNDING

MEDICAL ASSISTANCE


ORIGINAL SUBMISSION DATE: November 15, 2016 COUNTY NAME: First

REVISED SUBMISSION DATE:


Section I

IN-HOME WAGES and SALARIES


SERVICESFIXED

ASSETSTOTAL

EXPENDITURESNon-Reimbursables

NON PS/SUBNon-

ReimbursablesRevenues related to Non-Reimbursables

DEPENDENT 4,123 1,235 9,194 1,919 4,080 3,400 23,951 0 0 0DELINQUENT 0 0 0 0 2,015 0 2,015 0 0 0

COMMUNITY BASED PLACEMENTDEPENDENT 2,568 771 0 1,331 21,506 1,400 27,576 0 0 0DELINQUENT 0 0 0 0 22,905 0 22,905 0 0 0

INSTITUTIONAL PLACEMENTDEPENDENT 124 37 0 349 0 400 910 0 0 0DELINQUENT 0 0 0 0 11,785 0 11,785 0 0 0

ADMINISTRATIONDEPENDENT 2,325 425 0 0 0 0 2,750 0 0 0

TOTAL EXPENDITURESDEPENDENT - Total 9,140 2,468 9,194 3,599 25,586 5,200 55,187 0 0 0DELINQUENT - Total 0 0 0 0 36,705 0 36,705 0 0 0

Section II

IN-HOME TOTAL


PROGRAM INCOME


TITLE IV-E ADMIN. TANF TITLE XX TITLE IV-B OTHER

FUNDINGMEDICAL

ASSISTANCE


STATE ACT 148 LOCAL SHARE

DEPENDENT 23,950 0 5,116 1,840 1,280 0 0 0 0 32,186 12,130 3,585DELINQUENT 2,015 0 0 0 1,905 0 0 0 0 3,920 88 22

COMMUNITY BASED PLACEMENTDEPENDENT 27,576 810 7,395 1,027 0 277 0 0 0 37,085 14,529 3,538DELINQUENT 22,905 204 4,541 0 1,215 0 0 0 0 28,865 13,565 3,380

INSTITUTIONAL PLACEMENTDEPENDENT 910 0 0 157 0 0 0 0 0 1,067 452 301DELINQUENT 11,785 213 0 0 0 0 536 0 0 12,534 6,622 4,414

ADMINISTRATIONDEPENDENT 2,750 0 0 474 0 0 0 0 6 3,230 1,362 908

TOTAL REVENUESDEPENDENT - Total 55,186 810 12,511 3,498 1,280 277 0 0 6 73,568 28,473 8,332DELINQUENT - Total 36,705 417 4,541 0 3,120 0 536 0 0 45,319 20,275 7,816

CY-969 (Rev. 7/11)

County Children & Youth Social Service ProgramsDEPENDENT/DELINQUENT SUMMARY

FY: 2016/2017

EXPENDITURES

REVENUES




IN-HOME TOTAL


PROGRAM INCOME NET EXPENSE TITLE IV-E

MaintenanceTITLE IV-E

Administration TANF TITLE XX TITLE IV-B OTHER FUNDING

MEDICAL ASSISTANCE

NET REIMBURSABLE EXPENDITURES STATE ACT 148 LOCAL SHARE

1-A ADOPTION SERVICE 1,863 1,863 321 1,542 1,542 0

1-B ADOPTION ASSISTANCE 7,334 7,334 4,081 0 3,253 2,602 651

1-C SUBSIDIZED PERMANENCT LEGAL CUSTODIANSHIP 1,860 1,860 1,035 0 825 660 165

1-D COUNSELING - DEPENDENT 1,135 1,135 78 680 377 302 75

1-E COUNSELING - DELINQUENT 2,015 2,015 0 1,905 110 88 22

1-F DAY CARE 0 0 0 0 0 0

1-G DAY TREATMENT - DEPENDENT 0 0 0 0 0 0

1-H DAY TREATMENT - DELINQUENT 0 0 0 0 0 0

1-I HOMEMAKER SERVICE 0 0 0 0 0 0

1-J INTAKE & REFERRAL 3,809 3,809 656 3,153 2,522 631

1-K LIFE SKILLS - DEPENDENT 1,810 1,810 157 600 1,053 842 211

1-L LIFE SKILLS - DELINQUENT 0 0 0 0 0 0

1-M PROTECTIVE SERVICE - CHILD ABUSE 1,820 1,820 314 1,506 1,205 301

1-N PROTECTIVE SERVICE - GENERAL 1,820 1,820 314 1,506 1,205 301

1-O SERVICE PLANNING 0 0 0 0 0 0

1-P JUVENILE ACT PROCEEDINGS - DEPENDENT 2,500 2,500 0 2,500 1,250 1,250

1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT 0 0 0 0 0 0

1-R SUBTOTAL IN-HOME 25,966 0 25,966 5,116 1,840 3,185 0 0 0 0 15,825 12,218 3,607

COMMUNITY BASED PLACEMENTTOTAL





MEDICAL ASSISTANCE


2-A ALTERNATIVE TREATMENT - DEPENDENT 0 0 0 0 0 02-B ALTERNATIVE TREATMENT - DELINQUENT 0 0 0 0 0 02-C COMMUNITY RESIDENTIAL - DEPENDENT 20,680 690 19,990 6,435 157 277 13,121 10,497 2,6242-D COMMUNITY RESIDENTIAL - DELINQUENT 21,420 121 21,299 4,442 0 16,857 13,486 3,3712-E EMERGENCY SHELTER - DEPENDENT 910 910 157 753 678 752-F EMERGENCY SHELTER - DELINQUENT 1,485 83 1,402 99 0 1,215 88 79 92-G FOSTER FAMILY - DEPENDENT 3,679 120 3,559 443 476 2,640 2,112 5282-H FOSTER FAMILY - DELINQUENT 0 0 0 0 0 02-I KINSHIP CARE - DEPENDENT


2-K SUPERVISED IND. LIVING - DEPENDENT 2,307 2,307 517 237 1,553 1,242 3112-L SUPERVISED IND. LIVING - DELINQUENT 0 0 0 0 0 02-K SUBTOTAL CBP 50,481 1,014 49,467 11,936 1,027 1,215 277 0 0 0 35,012 28,094 6,918

INSTITUTIONAL PLACEMENTTOTAL





MEDICAL ASSISTANCE


3-A JUVENILE DETENTION SERVICE 0 0 0 0 0

3-B RESIDENTIAL SERVICE - DEPENDENT 910 910 157 753 452 301

3-C RES. SERVICE - DELINQUENT (Non YDC/YFC) 10,785 213 10,572 0 536 10,036 6,022 4,014

3-D SECURE RES. SERVICE (EXCEPT YDC) 0 0 0 0 0

3-E YDC SECURE 1,000 1,000 1,000 600 400

3-F SUBTOTAL INSTITUTIONAL 12,695 213 12,482 0 157 0 0 536 0 0 11,789 7,073 4,716

4 ADMINISTRATION 2,750 2,750 474 6 2,270 1,362 908

5 TOTAL REVENUES 91,892 1,227 90,665 17,052 3,498 4,400 277 536 0 6 64,896 48,748 16,149

County Children & Youth Social Service Programs REVENUE REPORT

FY: 2016/2017



Fiscal Management Completion

Cell B3 - Enter two-digit County Code

Certified Expenditure Levels and Allocations Cell B12 – Enter Fiscal Year in format: 2011/2012 Cell B15 – Enter Date of Certification Letter Cells B18:B21 - Enter Certified Expenditure Levels from Certif Letter Cells B25:B36 - Certified Revenue Levels from Certification Letter Check to ensure Cell B22 (Expenditures) equals Cell B37 (Revenues)

Youth Development Center Charges – Subsequent quarters are entered in Rows 19, 21 and 23 Cell F17 – Enter date of Letter Cell I17 – Enter information from letter indicating charges for the quarter for State Share of YDC/YFC Expenses Cell J17 - Enter information from letter indicating charges for the quarter for County Share of YDC/YFC Expenses Cell L17 - Enter information from letter indicating the total days of care for the quarter in YDC/YFC Cell M17 - Enter information from letter indicating the total number of unduplicated children served for the quarter in YDC/YFC Verify totals in Cells I25, J25, L25 and M25 with letter.

Title IVD (Child Support) – Subsequent quarters entered in columns I-K Cell H31 – Enter the total amount of Title IV-D Collections for the quarter. This is the support income received by Domestic Relations. Cell H32 – Enter the portion of the Title IV-D collections entered above that was received for Title IV-E eligible children.

RMTS – subsequent quarter entered in columns D, E and F Cells C42:C55 – Enter the RMTS State-Wide Counts from the letter for the appropriate quarter. Cell C59 – Enter the number of children receiving Title IV-E adoption Assistance Subsidies for the quarter


MOT17

Typewritten Text

Invoice Completion Check Sheet

Cell C60 – Enter the total number of children receiving Adoption Assistance Subsidies for the quarter. Cell C61 – Enter the number of children receiving Title IV-E PLC for the quarter Cell C62 – Enter the total number of children in PLC settings for the quarter. Cell C63 – Enter the number of Title IV-E eligible children in a foster care (federal definition) placement who have received Title IV-E Maintenance payments or SSI in lieu of Tile IV-E Maintenance payments for the quarter. Include first 60 days of care for children placed with emergency caregivers who are in the process of being approved as a foster family as well as up to one calendar month for eligible children transitioning from an unlicensed/unapproved home to a licensed/approved foster care placement. Cell C64 – Enter the total number of children in foster care (federal definition) placement for the quarter. This number excludes delinquent children who do not have Shared Case Responsibility (SCR).

Individual Quarter Completion

Expenditure Report Cell C3 – Enter the date the quarterly report will be submitted. This will populate to remaining quarterly reports.

Expenditures Columns Cells C9:C25 – Enter the Wages and Salaries Expense for each of the In-Home Cost Centers. Notice Cells C24 and C25, Dependent and Delinquent Cost Centers for Juvenile Act Proceedings are shaded. This indicates wages and salaries expenses for these two cost centers are unallowable expenses. Cells C30:C39 - Enter the Wages and Salaries Expense for each of the Community-Based Placement Cost Centers. Cells C43:C47 - Enter the Wages and Salaries Expense for each of the Institutional Placement Cost Centers. Cell C50 - Enter the Wages and Salaries Expense for the Administration Cost Center. Repeat the above entries in columns D through H for each of the remaining Major Objects of Expenditure being certain to note the shaded cells indicating non-allowable expenses.

Total Expenditures Column No entry is required for this column. Column I is populated with the sum of columns C – H for each cost center.

Children Served by County/ Days of Care Column Cells J9:J25 – Enter the number of children who received services provided by the Agency Staff during the quarter for each cost center.


Cell G27 – Enter the unduplicated number of children receiving ONLY In-Home services provided by C&Y Staff. Do not include any children receiving purchased services in this number. Cell K27 – Enter the unduplicated number of children documented to be at imminent risk of placement into foster care absent preventative services. Cell J30:J39 – Enter the number of Days of Care associated with the Purchased Services expense for each Community-Based Placement cost center. Cell J43:J46 - Enter the number of Days of Care associated with the Purchased Services expense for each Institutional Placement cost center. YDC/YFC populates based on Fiscal Management entry.

Children Served Purchased Column Cells K9:K25 – Enter the number of children services were purchased for during the quarter for each cost center. Any entry in the Purchased Services column should have a corresponding entry in the Children Served Purchased column. Cell K30:K39 – Enter the number of Days of Care associated with the Purchased Services expense for each Community-Based Placement cost center. Cell K43:K46 - Enter the number of Days of Care associated with the Purchased Services expense for each Institutional Placement cost center. YDC/YFC populates based on Fiscal Management entry.

Non Reimbursable Non-PS/SUB Expenses Column Cell L9:L25, L30:L39, L43:L47, L50 – Enter the portions of the Wages, Benefits, Operating and Fixed Assets columns that are not reimbursable with State funds such as:

a. Travel exceeding the State Rateb. Unapproved Staff Positions

Non Reimbursable Purchased Services /Subsidies Expenses Column Cell M9:M25, M30:M39, M43:M47, M50 – Enter the portions of the Purchased Services and Subsidies columns that are not reimbursable with State funds such as:

a. Placements in Un-Licensed facilities

Non-Reimbursable Program Income Column Cell N9:N25, N30:N39, N43:N47, N50 – Enter the amount of Program Income related to the Non-Reimbursable Expense received for the quarter such as:

a. Funds raised specifically for Non-Reimbursable Costsb. Child Specific Income for children in Non-reimbursable placement

facilities.

County Indirects Costs Cell Cell F53 – enter the portion of the Operating Expense column associated with County Indirect Costs.


Note: Amount in excess of the State 2% limit needs to be recorded in the Non-Reimbursable column.

Revenue Report Total Reimbursable Expenditures Column

No entry is required in this column. Column C is populated with the result of calculating Total Expenditures Column less the Non-Reimbursable Expenses Column from the Expenditure Report.

Revenue Sources Columns Completion Cells D65:D81,D85:D94,D98:D102, D105 – Enter the Program Income by Cost Center. Revenues that may be included in this column include but are not limited to Parental Support Income, SS and SSI Income, VA benefits, HSDF funds and Interest Income. Cells E65:E81, E85:E94, E98:E102, E105 – Enter the Title IV-E Direct Revenue by Cost Center. Notice that most of the IH cost centers, Juvenile Detention, YDC/YFC and the YDC cost centers are shaded. This indicates expenses in these cost centers are not eligible to reimbursement with Title IV-E funds. No entry is required for the Title IV-E Admin column F. This column is populated from the results of the CY918 Administrative Cost Pool Calculation. Cells G65:G81, G85:G94, G98:G102, E105 – Enter the TANF Revenue by Cost Center. Take note of the shaded cells. Cells H65:H81, H85:H94, H98:H102, H105 – Enter the Title XX Revenue by Cost Center. Take note of the shaded cells Cells I65:I81, I85:I94, I86:I102, E105 – Enter the Title IV-B Revenue by Cost Center. Take note of the shaded cells. Other Funding Column: Make no entries into this column. It is reserved for future use. Cells K65:K81, K85:K94, K98:K102– Enter any Medical Assistance Revenue received. Cell K105 will be populated with the results form the Title XIX section of the RMTS worksheet, so no entry is required in this cell. No entry is required for Columns L, M and N. These columns are calculated by the program. They are the result of subtracting all program income and Federal Revenues from the Total Reimbursable Expenses and multiplying the result by the appropriate participation rate for each cost center.

CY918 – Administrative Cost Pool Calculation Completion No entry required for Column C Eligible Expenses. This column is populated by the total of Wages, Benefits, Operating and fixed Asset Expense Columns of the CY370 Expenditures Report less Non-Reimbursable Non-PS/SUB expenditures. Adjustment Columns D164:I197. Expense items required to be deducted from the Eligible Expenses include:

a. Co. Provided Servicesb. Maintenance Expenditures


a. Any expenses associated with maintaining a child in a placementsetting including clothing, incidentals, etc.

c. Assets exceeding $25,000d. PROGRAM INCOME

a. Any Eligible Expenses reimbursed with Program Income,e. TANF,TITLE XX, TITLE IV-B

a. Any Eligible Expenses reimbursed with TANF, Title XX, or TitleIV-B

f. DIRECT Administrative CHARGESa. Direct Administrative claims included in the Title IV-E PM claim

(ex. Wages and benefits of staff performing Title IV-E eligibleactivities.

No entry is required for Column J - Net Cost Pool. This column is populated with the results of subtracting all adjustments in columns D though I from the Eligible Expenses in column C by the program. No entry is required for Column K - Allocation of IV-E revenue. This column is populated with the resulting percentage of dividing each cost center’s Net cost pool expenses by the total Net Cost Pool for all of the cost centers. No entry is required for Column L - IV-E Revenue from RMTS. This column is populated with the results of multiplying the RMTS total Admin and Training Revenue by the percentage in Column L Allocation of IV-E Revenue. Cells M164:M167 and M188:M189 – Enter in these cells any administrative IV-E revenue generated from purchased foster family homes and non-recurring costs on the Title IV-E CY-64s. Cells N165:N197 – Enter in these cells any IV-E revenue generated from claiming direct administrative Charges on the Title IV-E CY-64-FC.

Direct Claim Worksheet Enter in Column R the position number for each OCYF approved position eligible for Direct administrative Claiming. Enter in Column S the STAFF NAME for each OCYF approved position eligible for Direct administrative Claiming. Enter in Column T the position or title for each OCYF approved position eligible for Direct administrative Claiming. Enter in Column U the program code (2-Eligibility Determinations or 5-Other Administration) associated with the each OCYF approved position eligible for Direct administrative Claiming. Enter in Column V, W, X, and Y the wages, benefits, operating expense or fixed asset expense associated with the each OCYF approved position eligible for Direct administrative Claiming.


CY969 Dependent/Delinquent Summary No entry is required for this form. It is entirely generated by the program.

CY348 Fiscal Summary No entry is required for this form. It is entirely generated by the program.

YTD Invoice Completion

Expenditure Report – Ensure the YTD worksheet is active. Cells J9:J25 – Enter number of children served YTD with services provided by Agency Staff. These counts do not accumulate from the individual quarter worksheets since the number should reflect the unduplicated number of children served. Cell G27 – Enter the number of unduplicated children served YTD with ONLY Agency provided services. Cells K9:K25 enter the number of children served YTD associated with the purchased services in cells G9:G25. These counts do not accumulate from the individual quarter worksheets since the number should reflect the unduplicated number of children served. Cells K30:K39 – enter the number of children served YTD associated with the purchased services in cells G30:G39. These counts do not accumulate from the individual quarter worksheets since the number should reflect the unduplicated number of children served. Cells K439:K47 – Enter number of children served YTD associated with the purchased services in cells G49:G47. These counts, including the YDC/YFC, do not accumulate from the individual quarter worksheets since the number should reflect the unduplicated number of children served. Cell K27 – Enter the number of unduplicated children YTD who are documented at imminent risk of placement into foster care absent preventative services.

Revenue Report No entry is required for this YTD report. All cells accumulate and total the individual quarters’ reports.

CY348 – Fiscal Summary No entry is required for this YTD report. All cells accumulate and total the individual quarters’ reports.

CY969 Dependent/Delinquent Summary No entry is required for this form. It is entirely generated by the program.

Fee for Service Schedule Cells C160:C176 – No entry required. These cells populate based on entries in Cells C192:C10000.


Cells H160:H178 – No entry required. These cells populate based on entries in Cells C192:C10000. Row192- Group providers together by each cost center from the YTD Expenditure Report with purchased service costs. Enter the cost center in Column C. Enter the name of the provider in column D. Enter the Residential FacilityCertification associated with the provider in column H. Enter the Unit ID incolumn I. Enter the contracted rate in column J. Define the rate in column K.Report the number of units served in column L. Report the total cost for that rowin column M.Repeat the step above until there is an accurate reporting of all purchased servicecosts. This schedule must tie to the YTD expenditure report.

Printing the Report

Print Macros have been written in to the program for almost every report. Use the macro buttons found on the Fiscal Management page and throughout the workbook. The FFS Schedule must be printed manually. Select the area you wish to print and print the selection.


References

3140-12-01, Children, Youth and Families Bulletin, Title IV-E Invoicing

Procedures

3140-08-01 Children, Youth and Families Bulletin, Title IVE Foster Care

Maintenance and Adoption Assistance Program Costs Allowable for

Federal Financial Participation (FFP)

3140-14-02 Children, Youth and Families Bulletin, Fiscal Year 2014/15 Act 148

Invoicing and Medicaid Procedures for County Child Welfare Services

PENNSYLVANIA CONSOLIDATED STATUTES, Title 55. Public

Welfare, Chapter 3140 (related to Planning and Financial Reimbursement

Requirements for County Children and Youth Social Service Programs)

PENNSYLVANIA CONSOLIDATED STATUTES, Title 55. Public

Welfare, Chapter 3170 (related to Allowable Costs and Procedures for

County Children and Youth)

The Social Security Act, Title IV (Grants to States for Aid and Services to

Needy Families with Children and for Child-Welfare Service), Part B –

Child and Family Services Subpart 1 – Stephanie Tubbs Jones Child

Welfare Services Program Sec. 421 [42 U.S.C.621]


3140-13-04 Children, Youth and Families Bulletin, County Children and Youth

Program Title XX and Title IV-B Procedures

3140-03-09 Children, Youth and Families Bulletin, Child Welfare TANF

Services Policies and Procedures Manual

00-15-01 Children, Youth and Families Bulletin, County Children and Youth

Indirect Cost Guidelines

Special Transmittal, Act 80 of 2012 and Act 91 of 2012

3130-14-01, Children, Youth and Families Bulletin, Youth

Independent Living Services Guidelines


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