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Updated: 2020-1-8
SECOND COUNTY
DATAPACKET
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 1 of 30
COUNTY NAME: SecondCERTIFIED
IN-HOME AND INTAKE 2,631,951 COMMUNITY BASED PLACEMENT 4,510,536
INSTITUTIONAL PLACEMENT 3,313,911 ADMINISTRATION 585,360
TOTAL EXPENDITURES 11,041,758
REVENUESState Act 148 4,582,060
State Share YDC 922,250 SUBTOTAL STATE FUNDS 5,504,310
Title XX 72,768 Title IV-E 2,051,939 Title IV-B 25,930
TANF Transition Funds/IV-A/TANF 388,062
Medical Assistance 19,471 SUBTOTAL FEDERAL FUNDS 2,558,170
PROGRAM INCOME 442,151
County Program (Reimbursable) 1,586,904 County Share YDC 614,834
County Program (NON-Reimb.) 335,389 SUBTOTAL COUNTY FUNDS 2,537,127
TOTAL REVENUES 11,041,758
CERTIFIED LETTER DATED 3/11/2016
Budget Summary
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 2 of 30
Tina L. Long TELEPHONE NUMBER
DIRECTOR (717) 705-2288
October 26, 2016RE: Second County
Dear Chief County Probation Officer:
REIMBURSMENT RATES State Share County Share
TOTAL
Secure/ResidentialState 60% and County 40% $72,695.40 $48,463.60 $121,159.00
TOTAL $72,695.40 $48,463.60 $121,159.00
Sincerely,
Tina L. Long, DirectorDivision of Financial Policy & OperationsBureau of Financial Operations
Attachments
cc: County Children and Youth Director File
Please be advised that state and county share participation should be reduced by any program income applicable to these services.
If you have any questions, concerning this invoice, please contact Wendy Naigle at (717) 789-5501.
The amounts listed below indicate a charge of $121,159 to your county for use of Commonwealth Youth Development Centers (YDC) and Youth Forestry Camps (YFC) during the months of July, August and September 2016. We have included a cost breakdown showing these charges at the various reimbursement rates. These YDC and YFC charges should be used in the calculation of cumulative YDC/YFC amounts and are to be reported on your Fiscal Year 2016-2017, First Quarter CY-348 Fiscal Summary.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF FINANCIAL POLICY AND OPERATIONS
3rd Floor, Bertolino Building
Harrisburg, Pennsylvania 17105 - 2675
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 3 of 30
County Name Second
SECUREFacility Name Client ID Days Perdiem Total Cost State Share County ShareNCSTU Loysville B00922 73 268.00 19,564.00 11,738.40 7,825.60NCSTU Loysville B00872 63 268.00 16,884.00 10,130.40 6,753.60NCSTU Loysville B00891 91 268.00 24,388.00 14,632.80 9,755.20
Facility Total 227 60,836.00 36,501.60 24,334.40 60,836.00
Facility Name Client ID Days Perdiem Total Cost State Share County ShareNew Castle -High J04679 24 337.00 8,088.00 4,852.80 3,235.20New Castle -High J04461 63 337.00 21,231.00 12,738.60 8,492.40New Castle -High J04575 92 337.00 31,004.00 18,602.40 12,401.60
Facility Total 179 60,323.00 36,193.80 24,129.20 60,323.00
Totals 406 121,159.00 72,695.40 48,463.60 121,159.00
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 4 of 30
TYPES IV-E/IV-DSum of RD TOTAL DEP DELREMARK Total 1ST QUARTER 27926.95 3526.83HSDF 19694 2ND QUARTERINTEREST 50 3RD QUARTERIV-D 72355.5 4TH QUARTEROTHER 4500 TOTAL IV-E/IV-D 27926.95 3526.83SS 15208 31453.78SSI 17204Grand Total 129011.5
AGENCY/TYPESum of RD TOTALAGENCY REMARK TotalCYA IV-D 58481.25
SS 9876SSI 14789
CYA Total 83146.25JPP IV-D 13874.25
SS 5332SSI 2415
JPP Total 21621.25Grand Total 104767.5
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 5 of 30
RESULTING FACTORS
1 = 1 = 0.039%
2 = 4 = 0.156%
3 = 2 = 0.508%
4 = 11 = 5.278%
5 = 135 = 5.551%
6a = 9 = 27.873%
6b = 17 = 2.306%
6c = 7 = 0.039%
6d = 19 = 0.704%
6e = 13 = 1.681%
6f = 71 = 0.000%
6g = 6 = 31.196%
Total 6 = 142 = 24.668%
7a = 20 100%
7b = 103 = 73.65%
7c = 28
7d = 90
7e = 62
7f = 360
7g = 50
Total 7 = 713
8a = 1
8b = 8
8c = 2
8d = 5
8e = 17
8f = 25
8g = 1
Total 8 = 59
9a = 0
9b = 0
9c = 1
9d = 0
9e = 0
9f = 0
9g = 0
Total 9 = 1
10a = 1
10b = 2
10c = 3
10d = 3
10e = 8
10f = 1
10g = 0
Total 10 = 18
11 = 43
12 = 0
13a = 0
13b = 0
13c = 3
13d = 305
13e = 334
13f = 6
13g = 2
13h = 12
13i = 5
13j = 0
13k = 131
Total 13 = 798
14a = 107
14b = 148
14c = 376
Total 14 = 631
X Total = 2558
0.05%
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 invoiceand then by 50%.
54.55%
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%.
TOTAL
N Subtotal Services (X-11-14/X)
Information Technology Grant (ITG) for Invoice Computation
3.08%
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%.
K Treatment Counseling (12/X)
L Other Services (13/X)
M General Administration (14/X)
H Permanent Legal Custodianship (9/X)
I Independent Living (10/X)
J Training (11/X)
E Prevention (Pre-Placing Activities) (6/X)
F Case Planning and Management (7/X)
G IV-E Adoption Ass't. Case Mgmt. (8/X)
B IV-E Eligibility (2/X)
C XIX Medicaid (3+4/X)
D Non-Client Specific Administration (5/X)
A Support Enforcement (1/X)
COMMONWEALTH OF PENNSYLVANIA
Department of Human Services
Office of Children, Youth and Families
RMTS Final Results April-May 2015
STATEWIDE CODE COUNTS
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 6 of 30
Days in Qtr 92
July DaysAug DaysSep Days Average
Adoption AssistanceUnder Age 18
Total Children Rec Adopt As 3,294 3,325 3,278 108Total IV-E Children Rec AA (CY 63) 8,857 96
Over Age 18Total Children Rec Adopt As 0 0 0 0Total IV-E Children Rec AA ( 0 0 0 0
0 0 0 0
Subsidized Permanent Legal Custodian (SPLC)Under Age 18
Total Children Rec SPLC 124 124 124 4Total IV-E Children Rec SPLC (CY 63) 568 4
Over Age 18Total Children Rec SPLC 0 0 0 0Total IV-E Children Rec SPL 0 0 0 0
0 0 0 0
TITLE IV-E ADMINISTRATION QUARTER 1 - FY 2016/17
Service Type
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 7 of 30
Days in Qtr 92
July DaysAug DaysSep Days AverageTotal Children in Placement
Under Age 18Foster Monthly Billings 2,087 2,085 2,039 68CYA Purchased 6,262 68JPP -CY63 (Jul-Sep 11) IVE 923 10
TOTAL QTR 1 PLACEMENTS 11,050 146
Over Age 18Foster Monthly Billings 0 0 0 0CYA Purchased 0 0 0 0JPP -CY63 (Jul-Sep 11) IV-E 0 0 0 0
TOTAL QTR 1 PLACEMENTS 0
Total IV-E PlacementsUnder Age 18
Foster Monthly Billings - IV-E 4,453CYA Purchased - IV-E 3,872CYA SSI Children 368
Total CYA IV-E 8,693JPP / IV-E 877JPP SSI Youth 46
Total JPP / IV-E 923TOTAL IV-E PLAC MAIN UNDER 18 9,616 105
Over Age 18Foster Monthly Billings - IV-E 0 0 0CYA Purchased - IV-E 0 0 0CYA SSI Children 0 0 0
Total CYA IV-E 0 0 0JPP / IV-E 0 0 0JPP SSI Youth 0 0 0
Total JPP / IV-E 0 0 0TOTAL IV-E PLAC MAIN OVER 18 0
TITLE IV-E ADMINISTRATION QUARTER 1 - FY 2016/17
Service Type
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 8 of 30
ACF COUNTS BY MONTH FOR QUARTERLY ACT 148 INVOICING
Additional data for ACF: July August September October November December January February March Aprlil May June
107 110 109110 112 111150 150 152120 127 134
95 97 98109 108 107
1 0 0
4 4 44 4 40 0 0
Adoption Assistance-Children receiving Title IV-E Non-Recurring Administrative Cost Payments (line 47 on CB 496)
SPLC-Children receiving Title IV-E Subsidy Payments (line 48 on CB 496)
SPLC-Children receiving ANY type of SPLC Subsidy Payments (line 49 on CB 496)
SPLC-Children receiving Title IV-E Non-Recurring Administrative Cost Payments (line 50 on CB 496)
Foster Care-Children In Placement receiving Title IV-E Maintenance Payments (line 41 on CB 496)
Foster Care-Children In Placement receiving Title IV-E Maintenance administrative funding (line 42 on CB 496)
Foster Care-Children in Foster Care receiving ANY type of funding for maintenance or administrative costs (line 43 on CB 496)
Foster Care-Children receiving Title IV-E Candidate administrative funding (line 44 on CB 496)
Adoption Assistance-Children receiving Title IV-E Subsidy Payments (line 45 on CB 496)
Adoption Assistance-Children receiving ANY type of Adoption Assistance Payments (line 46 on CB 496)
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 9 of 30
IH370.WK
SECOND COUNTY
ADOPTION SERVICES - 10002
STATE COST CENTER 1-A
CC CD TOTAL
10002 110 1674110002 120 669610002 310 398 Operating Total10002 320 163 1237710002 350 72010002 370 11096
ADOPTION ASSISTANCE - 10003
STATE COST CENTER 1-B
10003 210 152823.75
SPLC - 10000
STATE COST CENTER 1-C
10000 210 4840
GRAND TOTAL 1-A, 1-B AND 1-C 193478
COUNSELING INTERVENTION 10004, 40004
STATE COST CENTER 1-D
CC CD TOTAL
10004 320 2310004 350 196 Operating Total10004 360C 22525 999210004 370 9773JPP - 1-E
40004 360J 45455
GRAND TOTAL 1-D AND 1-E 77972
DAY CARE -10005
STATE COST CENTER 1-F
CC CD TOTAL
10005 360C 946
GRAND TOTAL 1-F 946
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 10 of 30
DAY TREATMENT - 40006
STATE COST CENTER 1-H
CC CD TOTAL
40006 360J 1870
GRAND TOTAL 1-H 1870
INTAKE AND REFERRAL -10006
STATE COST CENTER 1-J
CC CD TOTAL
10011 110 3348310011 120 1339310011 130 797 Operating Total10011 320 122 106310011 330 12610011 350 18
GRAND TOTAL 1-J 47939
LIFESKILLS 10007
STATE COST CENTER 1-K
CC CD TOTAL
10007 310 1410007 320 3210007 330 5 Operating Total10007 340 287 162810007 350 129010007 360C 26775HUMAN SV DEV FUNDS
10008 360C 19694
GRAND TOTAL 1-K 48097
GRAND TOTAL HSDF 19694
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 11 of 30
PROTECTIVE CHILD ABUSE - 10009
STATE COST CENTER 1-M
CC CD TOTAL
10009 110 6696610009 120 2678610009 130 1594 Operating Total10009 320 146 1050310009 330 16210009 350 106710009 370 7534
GRAND TOTAL 1-M 104255
CHILD PROTECTIVE GENERAL 10010
STATE COST CENTER 1-N
CC CD TOTAL
10010 110 6696610010 120 2678610010 130 1594 Operating Total10010 310 1576 1684910010 320 161710010 330 28910010 340 314010010 350 676310010 360C 5197510010 370 182710010 390 43
GRAND TOTAL 1-N 162576
SERVICE PLANNING -10011
STATE COST CENTER 1-O
CC CD TOTAL
10011 110 3348310011 120 1339310011 130 797 Operating Total10011 320 122 106310011 330 12610011 350 18
GRAND TOTAL 1-O 47939
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 12 of 30
JUVENILE ACT -10003
STATE COST CENTER 1-P
CC CD TOTAL
10003 360C 10500
GRAND TOTAL 1-P 10500
COMMUNITY BASED 10012,40012,GIG YDC'S
STATE COST CENTERS 2-C AND 2-D
CC CD TOTAL
10012 110 3348310012 120 1339310012 130 797 Operating Total10012 320 172 220410012 330 29310012 340 16910012 350 76210012 360C 19803510012 370 11JPP 2-D
40012 340 174 Operating Total40012 360J 69477 174
GRAND TOTAL 2-C AND 2-D 316766
GRAND TOTAL CYA 247115GRAND TOTAL JPP 69651
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 13 of 30
EMERGENCY SHELTER -10013,40013
STATE COST CENTER 2-E AND 2-F
CC CD TOTAL
10013 360C 29068JPP 2-F
40013 360JY 37876
GRAND TOTAL 2-E AND 2-F 66944
GRAND TOTAL CYA 29068GRAND TOTAL JPP 37876
FOSTER FAMILIES 10014, 40014
STATE COST CENTERS 2-G AND 2-H
CC CD TOTAL
10014 110 5022410014 120 2009010014 130 1195 Operating Total10014 310 867 3203710014 320 84310014 330 138510014 340 404610014 350 1005510014 370 1364610014 360C 396809JPP 2-H
40014 340 874 Operating Total40014 360J 3695 874
GRAND TOTAL 2-G AND 2-H 503729
GRAND TOTAL CYA 499160GRAND TOTAL JPP 4569
JUVENILE DETENTION C1411
STATE COST CENTER 3-A
CC CD TOTAL
40019 350 884 Operating Total40019 360J 151699 884
GRAND TOTAL 3-A 152583
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 14 of 30
RESIDENTIAL - 10017,40017
STATE COST CENTERS 3-B, 3-C
CC CD TOTAL
10017 340 276 Operating Total10017 360C 45157 276JPP 3-C
40017 340 330 Operating Total40017 360J 117470 330
GRAND TOTAL 3-B AND 3-C 163233
SECURE - 40018 - YDC SECURE
STATE COST CENTERS 3-E
CC CD TOTAL
40018 360J 121159
GRAND TOTAL 3-E 121159
ADMINISTRATION - 10001
STATE COST CENTER 4
CC CD TOTAL
10001 110 6696610001 120 2678610001 130 1593 Operating Total10001 310 5098 3782310001 320 166310001 330 134610001 340 010001 350 7810001 370 119210001 390 92810001 394 25925
GRAND TOTAL ADMIN 4 131575
TOTAL EXPENDITURES 2,151,561
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 15 of 30
FEE FOR SERVICE SCHEDULE -CY 383
SECOND COUNTY07/01/2016 - 09/30/2016
J & A Sept. Oct.
P.O. P.O. P.O.
Cost Center ACCT CD PROVIDERCERT
# UNIT ID Target Population DescriptionContracted
RateRateDef JULY AUG SEPT Units
TotalCost
Days of Care
4 6583 C Stepping Stones A Dep Youth/FamiliesGeneral Counseling 80.00 hr 480 240 320 13.0 1,040.00 7
4 6583 C Stepping Stones B Dep Youth/FamiliesGeneral Counseling 45.00 1/2 hr 3285 2700 2700 193.0 8,685.00 6
4 6583 C Stepping Stones C Dep Youth/FamiliesGeneral Counseling 100.00 grp sessio 2000 1800 1600 54.0 5,400.00 20
4 6583 C Manno, Inc. IN Dep Youth/FamiliesGeneral Counseling 150.00 Ind 1350 1500 1800 31.0 4,650.00 10
4 6583 C Manno, Inc. GR Dep Youth/FamiliesGeneral Counseling 125.00 Group 875 1000 875 22.0 2,750.00 8
4 6583 C 22,525.00 51
4 6584 J Stepping Stones A Del YouthGeneral Counseling 80.00 hr 1360 960 800 39.0 3,120.00 15
4 6584 J Stepping Stones B Del YouthGeneral Counseling 45.00 1/2 hr 3375 2880 2880 203.0 9,135.00 9
4 6584 J Stepping Stones C Del YouthGeneral Counseling 100.00 grp sessio 2100 2000 1800 59.0 5,900.00 10
4 6584 J Manno, Inc. IN Del YouthGeneral Counseling 150.00 Ind 3600 4500 3750 79.0 11,850.00 11
4 6584 J Manno, Inc. FA Del YouthGeneral Counseling 200.00 Family 3200 3600 3400 51.0 10,200.00 9
4 6584 J Manno, Inc. GR Del YouthGeneral Counseling 125.00 Group 1750 1875 1625 42.0 5,250.00 11
4 6584 J 45,455.00 65
5 6681 C YMCA Dep YouthDay Care ages 0-6 86.00 week 344.00 344.00 258.00 11.00 946.00 1
5 6681 C 946.00 1
6 6735 J Mid-Point Services A Del YouthLicensed DT 5 day/wk 66.80 day 668.00 935.20 267.20 28.00 1,870.40 4
6 6735 J 1,870.40 4
9 6954 C PPL Electric Service reasonable quarter 1.00 19,694.00
9 6954 C Family Services HSD Dep Youth/Famliles LS Educ Services 175.00 session 9,100.00 11,375.00 6,300.00 153.00 26,775.00 479 6954 C 46,469.00 47
GPS
11 7189 C Family Services INV Dep FamiliesIn Home Support Serv 225.00 visit 16,875.00 18,900.00 16,200.00 231.00 51,975.00 74
11 7189 C 51,975.00 74
13 7333 C Gerg & Associates Dep YouthLegal Representation 3,500.00 month 1.00 1.00 1.00 3.00 10,500.00 154
13 7333 C 10,500.00 154Community-Based Residential
15 7442 C Children's Home of Reading 111111 CC Dep Fem, Age 14-18Moderate Beh Issues 207.50 Day 31 31.0 6,432.50
15 7442 C Children's Home of York 111112 DD Dep Males, Age 14-18Level 2 Beh Issues 214.17 Day 5 22 12 39.0 8,352.63
15 7442 C Children's Home of York 111112 CC Dep Males, Age 14-18Level 1 Beh Issues 191.16 Day 62 80 74 216.0 41,290.56
Day Treatment Delinquent
Life Skills
Juvenile Act Proceedings
Children Served
Counseling
Day Care
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 16 of 30
J & A Sept. Oct.
P.O. P.O. P.O.
Cost Center ACCT CD PROVIDERCERT
# UNIT ID Target Population DescriptionContracted
RateRateDef JULY AUG SEPT Units
TotalCost
Days of Care
Children Served
15 7442 C Children's Home of York 111112 BB Dep Fem, Age 13-15Level 1 Beh Issues 148.89 Day 93 93 68 254.0 37,818.06
15 7442 C Children's Home of York 111112 AA Infant With MotherInfant Placed with Mom 36.16 Day 62 73 135.0 4,881.60
15 7442 C Clear Vision 111113 AA Dep Fem, Age 14-18Moderate Beh Issues 175.86 Day 12 8 20.0 3,517.20
15 7442 C COBYS 111114 BB Dep Fem, Age 15-18Level 1 Beh Issues 123.00 Day 54 37 20 111.0 13,653.00
15 7442 C COBYS 111114 AA Infant with MotherInfant Placed with Mom 57.00 Day 74 67 40 181.0 10,317.00
15 7442 C Families United Network 111115 AA Dep Fem, Age 13-18Level 1 Beh Issues 184.35 Day 16 14 30.0 5,530.50
15 7442 C Kidspeace 111116 BB Dep Males, Age 13-16Level 2 Beh Issues 253.00 Day 44 21 2 67.0 16,951.00
15 7442 C Kidspeace 111116 AA Dep Males, Age 14-18 Lev 1 Beh Issues 234.00 Day 31 31 30 92.0 21,528.00 15 7442 C There's Room in the Inn 111117 AA Dep Fem, Age 15-18 Lev 1 Beh Issues 125.00 Day 31 31 30 92.0 11,500.00 15 7442 C UMHC-Residential/Mechanicsburg 111118 AB Dep Malles, Age 13-18 Lev 1 Beh Issues 176.77 Day 31 31 30 92.0 16,262.84 15 7442 C 1360 198,034.89 1,360 18
15 7442 J Children's Home of York 111112 DD Del Males, Age 14-18Level 2 Beh Issues 214.17 Day 36 54 6 96.0 20,560.32
15 7442 J Children's Home of York 111112 EE Dep Fem, Age 13-15 Lev 1 Beh Issues 168.10 Day 106 93 92 291.0 48,917.10 15 7442 J 387 69,477.42 387 6
Emergency Shelter
16 7442 C Boys Club & Girls Club 111119 AA Dep Youth Age 12-18Emer Shelter 30 day 133.69 Day 10 10.0 1,336.90
16 7442 C Children's Home of York 111112 FF Dep Youth Age 12-18Emer Shelter 30 day 146.03 Day 10 12 15 37.0 5,403.11
16 7442 C Cornell Abraxas 111120 AA Dep Youth Age 12-18Emer Shelter 30 day 208.74 Day 18 12 30.0 6,262.20
16 7442 C Families United Network 111115 BB Dep Youth Age 12-18Emer Shelter 30 day 164.68 Day 6 20 15 41.0 6,751.88
16 7442 C Foster Families 111110 AA Dep Youth Age 12-18Emer Shelter 30 day 25.00 Day 45 45 37 127.0 3,175.00
16 7442 C UMHC-Emergency Shelter/Daron 111121 AA Dep Youth Age 12-18Emer Shelter 30 day 161.55 Day 25 13 38.0 6,138.90
16 7442 C 283 29,067.99 283 7
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 17 of 30
J & A Sept. Oct.
P.O. P.O. P.O.
Cost Center ACCT CD PROVIDERCERT
# UNIT ID Target Population DescriptionContracted
RateRateDef JULY AUG SEPT Units
TotalCost
Days of Care
Children Served
16 7442 J Adelphoi 111122 AA Del Youth Age 12-18Emer Shelter 30 day 180.31 Day 42 25 32 99.0 17,850.69
16 7442 J Bethany 111123 AA Del Youth Age 12-18Emer Shelter 30 day 152.00 Day 22.0 15.0 22.0 59.0 8,968.00
16 7442 J Boys Club & Girls Club 111119 BB Del Youth Age 12-18Emer Shelter 30 day 131.07 Day 5.0 5.0 25.0 35.0 4,587.45
16 7442 J Children's Home of York 111112 GG Del Youth Age 12-18Emer Shelter 30 day 137.66 Day 10 22 15 47.0 6,470.02
16 7442 J 1,790.79 240 37,876.16 240 5Foster Family
17 7399 C Foster Families 111110 AA Foster Home Age 0-12Level 1 Traditional 25.00 Day 2,148 3,338 3,156 8,642 216,050.00
17 7442 C Children's Home of York 111112 HH Foster Home Age 13-18Level 1 Traditional 63.48 Day 715 702 748 2165.0 137,434.20
17 7442 C Families United Network 111115 CC Foster Home Age 13-18Level 1 Traditional 65.00 Day 45 30 75.0 4,875.00
17 7442 C Hope for Kids 111124 AA Foster Home Age 0-12Special Needs, Lev 1 74.00 Day 155 153 120 428.0 31,672.00
17 7442 C Northwestern Human Svcs. 111125 AA Foster Home Age 0-18R&B, CRR Host Home 28.72 Day 236 236.0 6,777.92
17 7442 C 11546 396,809.12 11,546 149
17 7442 J Bair Foundation 111126 AA Del Home Age 13-18Level 1 Traditional 61.59 Day 12 31.0 17.0 60.0 3,695.40
17 7442 J 60 3,695.40 60 1Juvenile Detention
19 J CCYC 111127 JD Del Youth Age 12-18Temporary Secure Det 274.58 Day 74.00 98.00 66.00 238.00 65,350.04
19 J YIC 111128 AB Del Youth Age 12-18Temporary Secure Det 324.62 Day 104.00 64.00 98.00 266.00 86,348.92
19 7318 J Day 504 151,698.96 504 17Residential Services
20 7442 C Bradley Center 111129 AA Dep Youth Age 13-18Level 2 Beh Issues 279.52 Day 5 31.0 30 66.0 18,448.32
20 7442 C Kidspeace 111116 CC Dep Youth Age 14-18Level 3 Beh Issues 316.00 Day 31 31 30 30.0 9,480.00
20 7442 C Laurel Youth Services 111130 AA Dep Youth Age 14-18Level 1 Beh Issues 223.75 Day 31 31 15 77.0 17,228.75
20 7442 C 173 45,157.07 173 4
20 7442 J Clear Brook 111131 AA Del Youth Age 14-18 Institutional Lev 1 159.00 Day 31 31 28 90.0 14,310.00
20 7442 J Cornell Abraxas 111132 AA Del Youth Age 14-18 Institutional Lev 2 287.17 Day 92 92 90 274.0 78,684.58 20 7442 J Drug and Alcohol Rehab 111133 AA Del Youth Age 14-18 D&A R&B 89.00 Day 131 140 4 275.0 24,475.00 20 7442 J 639 117,469.58 639 25
YDC
21 Y YS Loysville NCSTU Del Youth Age 14-18Repeat/violent offenders 268.00 Day 73 63 91 227 60,836.00
21 Y YS New Castle High Sec Del Youth Age 14-18Repeat/violent offenders 337.00 Day 24 63 92 179 60,323.00
406.00 121,159.00 406 6Grand Total "360"Purchased Services 1,350,185.99
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 18 of 30
Children Served In-Home Services PURCHAS AGENCY PROVIDED
1-A ADOPTION SERVICE 15 1-B ADOPTION ASSISTANCE 111 1-C SUBSIDIZED PLC 4 1-D COUNSELING - DEPENDE 51 1-E COUNSELING - DELINQUE 65 1-F DAY CARE 1 1-G DAY TREATMENT - DEPENDENT 1-H DAY TREATMENT - DELIN 4 1-I HOMEMAKER SERVICE 1-J INTAKE & REFERRAL 245 1-K LIFE SKILLS - DEPENDEN 47 1-L LIFE SKILLS - DELINQUENT 1-M PROTECTIVE SERVICE - CHILD ABU 130 1-N PROTECTIVE SERVICE - G 74 162 1-O SERVICE PLANNING 261 1-P JUVENILE ACT PROCEED 154 1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT
TOTAL 511 813
Unduplicated number of children served with ONLY Non-Purchased Services 396
Unduplicated number of children documented at imminent risk 354
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 19 of 30
Non-Reimbursable Expenses 1st Quarter 2016-2017
$93.00 meal in excess of State Rateallocated according to Agency time study as follows
% amount1-A ADOPTION SERVICE 0.0753% 7.001-B ADOPTION ASSISTANCE
1-C SPLC
1-D COUNSELING - DEPENDENT 0.0215% 2.001-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 0.1398% 13.001-L LIFE SKILLS - DELINQUENT
1-M PROTECTIVE SERVICE - CHILD ABUS 0.1183% 11.001-N PROTECTIVE SERVICE - GENERAL 0.6344% 59.001-O SERVICE PLANNING
1-P JUVENILE ACT PROCEEDINGS - DEPENDENT
1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT
4 ADMINISTRATION 0.0108% 1.00
Non-Reimbursable Placement Expenses- Facility unlicensed2-A ALTERNATIVE TREATMENT - DEPENDENT 2-B ALTERNATIVE TREATMENT - DELINQUENT 2-C COMMUNITY RESIDENTIAL - DEPENDENT 365.50 2-D COMMUNITY RESIDENTIAL - DELINQUENT 61.25 2-E EMERGENCY SHELTER - DEPENDENT 223.00 2-F EMERGENCY SHELTER - DELINQUENT 447.75 2-G FOSTER FAMILY - DEPENDENT 170.75 2-H FOSTER FAMILY - DELINQUENT 2-I SUPERVISED INDEPENDENT LIVING - DEPENDENT 2-J SUPERVISED INDEPENDENT LIVING - DELINQUENT 3-A JUVENILE DETENTION SERVICE 2033.00 3-B RESIDENTIAL SERVICE - DEPENDENT 3-C RESIDENTIAL SERVICE - DELINQUENT (EXCEPT YDC) 3-D SECURE RESIDENTIAL SERVICE (EXCEPT YDC) 3-E YDC/YFC (NON-SECURE)-Institutional 3-F YDC SECURE
Total Non-Reimbursable Expenses 3394.25 411: Act 148 Invoicing Handout #15, Page 20 of 0
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 20 of 30
PROGRAM INCOME FOR FISCAL YEAR 2016-2017
REVENUE BREAKDOWN BY CC AGENCY/TYPESum of RD TOTAL Sum of RD TOTALAGENCY NAME Total TYPES AGENCY REMARK TotalCYA ADMIN 0 Sum of RD TOTAL CYA IV-D 58481.25
CR-DEP-GH 14178 REMARK Total SS 9876ES-DEP 3308 HSDF 19694 SSI 14789FF-DEP 66110 INTEREST 50 CYA Total 83146.25LIFESKILLS 19694 IV-D 72355.5 JPP IV-D 13874.25RS-DEP 4050.25 OTHER 4500 SS 5332GPS 50 SS 15208 SSI 2415
CYA Total 107390.25 SSI 17204 JPP Total 21621.25JPP CR-DEL-GH 10145.75 Grand Total 129011.5 Grand Total 104767.5
ES-DEL 268.25FF-DEL 125.75MONITORING 2037.5RS-DEL 7546.25YDC-SEC 426.75
JPP Total 21621.25JDC JD 1071Grand Total 129011.5
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 21 of 30
Title IV-E by Cost Center
REVENUE BREAKDOWN BY CC Sum of 1ST FEDERAL TYPECENTER DIRECTAA 74,827.45CR-DEL-GH 13,817.26CR-DEP-GH 41,451.78ES - DEL 7,676.26ES-DEP 6,141.00FF-DEL 1,535.25FF-DEP 82,903.55GPSRS-DELRS-DEPSILSIL-DELSPLC 2,692.76Grand Total 231,045.31
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 22 of 30
Federal ID#:
ADOPTION ASSISTANCE
ACH Bank Code Invoice Period
Bank Account # Child Service Months
Submission Date
7334.00 2 3
4 5 6
7 8 9
10 11 12
Title IV-E Eligible Children # $ State Only Eligible Children # $
13
Service Costs:
Increased Federal Share Related to American Recovery Reinvestment:
Maintenance without Enhanced FFP:
For Comptroller's Office Use Only:
ADMINISTRATIVE COST
TRAINING COST
Non-Recurring Special Needs Adoption Incident Costs (separate CY-
63 attached)
COMPTROLLER'S USE ONLY: SAP VENDOR#: DOCUMENT#:
TITLE IV-E ADOPTION ASSISTANCE - SUMMARY INVOICE
SECTION B: COMPUTATION OF PAYMENT
ADOPTION ASSISTANCE Adoption Assistance
(from Grand Total Column 6 Page 1 of CY-63)
GRAND TOTAL FEDERAL SHARE
NET ALLOWABLE
COST FFP RATE SUBTOTAL FEDERAL
SHARE
Name and Address of the County Executive Officers Indicate with "X" if SUPPLEMENTAL
343
9/30/16
11/15/2016
.5564 $74827.45
17115.78 .50 8557.89
3911.65 .50 1955.83
$ 85,341.17
134485.00
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 23 of 30
Federal ID#:
SPLC
ACH Bank Code Invoice Period
Bank Account # Child Service Months
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:
COMPTROLLER'S USE ONLY: SAP VENDOR#: DOCUMENT#:
TITLE IV-E SUBSIDIZED PERMANENT LEGAL CUSTODIANSHIP SUMMARY INVOICE
Name and Address of the County Executive Officers Indicate with "X" if SUPPLEMENTAL
For Comptroller's Office Use Only:
SECTION B: COMPUTATION OF PAYMENT
SPLC (from Grand Total Column 6
Page 1 of CY-63)
NET ALLOWABLE
COSTFFP RATE
SUBTOTAL FEDERAL SHARE
ADMINISTRATIVE COST
TRAINING COST
Non-Recurring SPLC Incident Costs (separate CY-63 attached)
GRAND TOTAL FEDERAL SHARE
12
9/30/16
11/15/2016
4840.00 .5564 $ 2692.76
326.36 .50 $ 163.18
162.99 .50 $ 81.50
$ 2937.44
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 24 of 30
Federal ID#:
FOSTER CARE
ACH Bank Code Invoice Period
Bank Account # Child Service Months
Submission Date
FOSTER CARE
OTHER INCOME (Non-Title IV-D) 2 3 4 5
TITLE IV-D COLLECTION 6 7 8
From CY-63 From RMTSCASE PLANNING AND MANAGEMENT 9 10 11 12
PRE PLACEMENT ACTIVITIES
From Direct Claim
Worksheet13 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 FFP
Increased Federal Share Related to ARRA Title IV-D Collections
TotalFoster Family and Incidentals
GH/Institutional - Maximum Allowable PaymentGH/Institutional - Deferred Payment
For Comptroller's Office Use Only:
SECTION B: COMPUTATION OF PAYMENT
1
NET ALLOWABLE
COSTFFP RATE
SUBTOTAL FEDERAL SHARE
ALLOWABLE SERVICE
COSTS (from Grand Total
Column 6 Page 1 of CY-63)
COMPTROLLER'S USE ONLY: SAP VENDOR#: DOCUMENT#:
TITLE IV-E FOSTER CARE - SUMMARY INVOICE
Name and Address of the County Executive Officers Indicate with "X" if SUPPLEMENTAL
ADMINISTRATIVE COSTS
Eligible Expenditure
487
9/30/16
11/15/2016
352781.2
4500.00 348281.28
72355.50
.5564 $193783.70
.5564 (40258.60)
18445.40 167348.97 .50 92897.19
33328.97 .50 16664.49
1305.44 .50 652.72
32012.35 .50 16006.18
4278.37 .50 2139.19
$ 281,884.87
Submit Save Delete
Accept Reject
Reset
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 25 of 30
TANF by CC
CC % CENTER TYPE 1ST GROSS 1ST FEDERAL TOTAL10005 DC DIRECT10004 CS DIRECT 7008.54 7008.54 700910010 GPS DIRECT10013 ES DIRECT10007 LS DIRECT40006 DT-DEL DIRECT40013 ES-DEL DIRECT40004 80% CS-DEL DIRECT
TOTAL 7008.54 7008.54 7009
Sum of TOTALCENTER TotalCS 7009CS-DELDCDT-DELESES-DELGPSLSGrand Total 7009
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 26 of 30
OCYF BULLETIN3140-00-03ATTACHMENT A
NAME AND ADDRESS OF THE COUNTY EXECUTIVE OFFICERS
FROM: 7/1/2016TO: 9/30/2016
FEDERAL ID #:
TANF CFDA #: 93.558
ME#:
Signature and Title of the Designated County Official Date
FUND DEPT APP YEAR LDG. ORGCOST
FUNCTIONOBJ SUB-OBJ AMOUNT
001 021 986 7 1600 631
001 021 986 7 1600 631
001 021 986 7 1600 631
001 021 986 7 1600 631
CY-69
ACCOUNT CODE FOR COMPROLLER'S OFFICE USE ONLY
TOTAL TOTAL TANF CLAIM 7,008.54
JUVENILE DETENTION SERVICES
7,008.54
EMERGENCY SERVICES
IN HOME SERVICES15 7,008.54
Child Welfare TANF Service
Number of Children Served
Allowable TANF Service Costs
Program Income (related to claimed expenditures)
Net Allowable Cost
TANF SUMMARY INVOICE Temporary Assistance for Needy Families
INVOICE PERIOD
Second County Commissioners
SECTION A - COUNTY CERTIFICATION
(4)
I certify that the children listed on the attached CY-68 are eligible under the child welfare
TANF program for the periods indicated and that this is an accurate statement of the costs of
of services and of related administrative costs incurred for the children
SECTION B - COMPUTATION OF PAYMENT
(5)(1) (2) (3)
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 27 of 30
APPLICATION OF TITLE XX AND TITLE IV-B REVENUE1ST QTR 2011-12
IN-HOME XX 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
2-D COMMUNITY RESIDENTIAL - DELINQUENT
2-E EMERGENCY SHELTER - DEPENDENT
2-F EMERGENCY SHELTER - DELINQUENT
2-G FOSTER FAMILY - DEPENDENT 72767.002-H FOSTER FAMILY - DELINQUENT
2-I KINSHIP CARE - DEPENDENT
2-J KINSHIP CARE - DELINQUENT
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) 255293-D SECURE RESIDENTIAL SERVICE (EXCEPT YDC)
3-E YDC/YFC (NON-SECURE)-Institutional
3-F YDC SECURE
4 ADMINISTRATION
72767.00 25529.00
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 28 of 30
Direct Charges to the Cost Pool
2016-2017COST POOL ADJUSTMENTS
COL 3 COL 5 COL 6 COL 7
1ST QTR MAINTPROG
INCTANF IV-
B XX DIR CHG TOTAL
GH-DEP Maintenance Expenditures 340 696 696 696GH-DEL Maintenance Expenditures 340 106 106 106FF-DEP Maintenance Expenditures 340 16182 16182 16182FF-DEL Maintenance Expenditures 340 0 0 0RS-DEP Maintenance Expenditures 340 121 121 121RS-DEL Maintenance Expenditures 340 205 205 205
TOTAL MAINTENANCE 17310 17310 17310
GPS Program Income 50 50 5050 50 50
TOTALS 17360 17310 50 0 0 17360
FF - Dep Admin related to FF Homes 18075.9 x.50 9038FF - Del Admin related to FF Homes 369.5 x .50 185
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 29 of 30
County:
7/1/2016 - 09/30/2016
Federal I.D. Number:Routing #:
Vendor Code:
DATE
DATE
DATE
CY 886
OCYF APPROVAL
2. Percentage 50%
3. Invoice / Claim Total 2,121.35
SIGNATURES/APPROVAL
COUNTY C&Y ADMINISTRATOR/DESIGNEE
COUNTY C&Y FISCAL OFFICER/DESIGNEE
INVOICE/CLAIM CALCULATIONS1. Total Amount Claimable
$4,242.69 (From RMTS Worksheet, CALCULATION: 35)
Bank Account #:
Name and Address of the County Executive Officers
Office of Children, Youth and Family
MEDICAID ADMINISTRATIVE INVOICE/CLAIM
Date of Claim: Second
Report Period:
The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 30 of 30
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