OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

IV-E Foster Care and Adoption Assistance Quarterly Financial Report

ICR 201507-0970-008 · OMB 0970-0205 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CB-496 Form CB-496, "Title IV-E Program Quarterly Financial Report Form Modified Available
Supporting Statement - Form CB-496 - July 2015 - Oct 2015 UPDATE (00000003).docx Supporting Statement A Uploaded 2015-10-19 Available
IC Document Collections
IC IDCollectionTypeStatusForm
10037 Form CB-496, "Title IV-E Program Quarterly Financial Report Form Modified
ICR Details
0970-0205 201507-0970-008
Historical Active 201306-0970-003
HHS/ACF OA
IV-E Foster Care and Adoption Assistance Quarterly Financial Report
Revision of a currently approved collection   No
Regular
Approved with change 10/21/2015
Retrieve Notice of Action (NOA) 08/04/2015
  Inventory as of this Action Requested Previously Approved
10/31/2018 36 Months From Approved 08/31/2016
268 0 248
5,628 0 4,960
0 0 0
This form is used by States (including DC and PR)and Tribes to report the Total and Federal share of program expenditures made during the preceding quarter and to report the estimated Total and Federal share of the same expenditures to be made in the upcoming quarter for the Foster Care, Adoption Assistance and Guardianship Assistance programs under Title IV-E of the Social Security Act. This information is used to calculate quarterly grant awards and the collected data is available to the general public. Respondents are limited to the designated Title IV-E agency in each State or Tribe.
PL: Pub.L. 110 - 351 101 Name of Law: Fostering Connections to Success and Increasing Adoptions Act of 2008
  
PL: Pub.L. 113 - 183 473 Name of Law: Preventing Sex Trafficking and Strengthening Families Act
Not associated with rulemaking
  80 FR 1663 03/30/2015
80 FR 43093 07/02/2015
No
1
IC Title Form No. Form Name
Form CB-496, "Title IV-E Program Quarterly Financial Report CB-496 Quarterly Financial Report
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 268 248 0 20 0 0
Annual Time Burden (Hours) 5,628 4,960 0 668 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Burden increase due to program change in the instrument and instructions.
$0
No
No
No
No
No
Uncollected
Robert Sargis 2026907275
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/04/2015