IV-E Foster Care and Adoption Assistance Quarterly Financial Report

Forms and Documents

Document Name	Status
Form CB-496 Form CB-496, "Title IV-E Program Quarterly Financial Report Form	Modified
Instructions - FINAL DRAFT - Form CB-496 - May 2010.pdf Supplementary Document	2010-05-11
Supporting Statement - Form CB-496 - May 2010 (3).doc Supporting Statement A	2010-05-25

IC Document Collections

IC ID	Document Title	Status
10037	Form CB-496, "Title IV-E Program Quarterly Financial Report Form	Modified

ICR Details

OMB Control No: 0970-0205	ICR Reference No: 201006-0970-001
Status: Historical Active	Previous ICR Reference No: 200902-0970-004
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: IV-E Foster Care and Adoption Assistance Quarterly Financial Report
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/11/2010
	Date Received in OIRA: 06/07/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	36 Months From Approved	06/30/2012
Responses	248	0	208
Time Burden (Hours)	4,216	0	3,328
Cost Burden (Dollars)	0	0	66,560

---

Abstract: 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.

---

Authorizing Statute(s): PL: Pub.L. 110 - 351 101 Name of Law: Fostering Connections to Success and Increasing Adoptions Act of 2008
  

Citations for New Statutory Requirements: PL: Pub.L. 110 - 351 101 Name of Law: Fostering Connections to Success and Increasing Adoptions Act of 2008

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 22749	05/14/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 27788	05/18/2010
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Form CB-496, "Title IV-E Program Quarterly Financial Report	CB-496	IV-E, Program Quarterly Financial Report

---

ICR Summary of Burden

	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	248	208	40	0	0	0
Annual Time Burden (Hours)	4,216	3,328	888	0	0	0
Annual Cost Burden (Dollars)	0	66,560	0	0	-66,560	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: We are proposing a burden increase of 888 hours and 40 responses due to a program change required by a new statute. There is an adjustment that removes the dollar burden to respondents which was assigned in error. Under recent legislation, title IV-E of the Social Security Act was amended, effective with FY 2009, to add the "Guardianship Assistance Program" to the existing "Foster Care" and "Adoption Assistance" programs. An additional amendment, effective FY 2010, also opened these programs to participation by Tribes, Tribal Organizations and consortia. Each State is required to have its existing title IV-E State Plan amended and approved to participate and be eligible for Federal funding in the new Guardianship Assistance Program. Likewise, to participate in these programs and be eligible for Federal funding, a Tribe must have a title IV-E Tribal Plan developed and approved.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/07/2010

---