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 Page 1 of 62
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
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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
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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
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CY 969 Dep/Del. Summary…………………………………………………………………….…………….……52
Completed Revenue Report…………………………………………………………………………….….….….53
Invoice Completion Check Sheet……………………………………………………………....…………...…....54
References…………………………………………………………………………………………….………….…60
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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.
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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
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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
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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.
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Slide 1
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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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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Slide 4
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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Slide 7
Revenue Breakdown
Total Revenues
Total Expenses = PI Federal State Local
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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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Slide 10
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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Slide 13
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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Slide 16
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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Slide 19
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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Slide 20
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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Slide 22
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
Reimbursement Rate by Cost Center Demo 2
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
Reimbursement Rate by Cost Center Demo 3
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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Slide 25
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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RMTS Counts vs ACF Data Counts
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Slide 28
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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Slide 31
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
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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
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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
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• 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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• 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.
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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
EMPLOYEE BENEFITS SUBSIDIES OPERATING PURCHASED
SERVICESFIXED
ASSETSTOTAL
EXPENDITURES DAYS OF CARE
Children Served (Purchased)
Non-Reimbursables NON PS/SUB
Non-Reimbursables Purchased Serv./
Subsidies
Program Income related to all Non-
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
EMPLOYEE BENEFITS SUBSIDIES OPERATING PURCHASED
SERVICESFIXED
ASSETSTOTAL
EXPENDITURES DAYS OF CARE
Children Served (Purchased)
Non-Reimbursables NON PS/SUB
Non-Reimbursables Purchased Serv./
Subsidies
Program Income related to all Non-
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 = $
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 26 of 62
ORIGINAL SUBMISSION DATE: November 15, 2016 COUNTY NAME: First CountyREVISED SUBMISSION DATE:
REVISION # REPORT PERIOD: 7/1/2016-9/30/2016
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 27 of 62
COMMUNITY BASED PLACEMENTTOTAL
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
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-J KINSHIP CARE - DELINQUENT
2-K SUPERVISED IND. LIVING - DEPENDENT 2,3072-L SUPERVISED IND. LIVING - DELINQUENT 02-M SUBTOTAL CBP 50,481
INSTITUTIONAL PLACEMENTTOTAL
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
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
MAJOR SERVICE CATEGORIES & COST CENTERS REVENUE SOURCES
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 28 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 29 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 30 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 31 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 32 of 62
(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)
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 33 of 62
(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)
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 34 of 62
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
Page 35 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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 36 of 62
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
Page 37 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 38 of 62
County Code: 68
1860.00
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
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.
Grand Total: Title IV-E Allowable Administration
Grand Total: Group Home/Institution Maximum
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:
First County 111 Front St
PROGRAM (Check One)Foster Care (FC)Adoption Assistance (AA) / Non-Recurring (NR)Subsidized Permanent Legal Custodianship (SPLC)
Submission Date: 11/15/2016 Quarter Ending Date: 9/30/2016
TITLE IV-E INVOICE
OCYF Approval for Payment: Reviewer:
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 39 of 62
County Code: 68
$22,906.00
Program Child's MCI Number Child's Last Name Child's First Name MIJudicial Docs
Status 1-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
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
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 Care
Grand Total: Title IV-E Allowable Maintenance
Cancel Print
Grand Total: Title IV-E Allowable Administration
Grand Total: Group Home/Institution Maximum
Allowable
Total Title IV-E Claim: $22,116.00
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 40 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 41 of 62
SAP VENDOR#: DOCUMENT#:PAYMENT DOCUMENT#:
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:
For Comptroller's Office Use Only:
TRAINING COST
Non-Recurring SPLC Incident Costs (separate CY-63 attached)
GRAND TOTAL FEDERAL SHARE
ADMINISTRATIVE COST
SECTION B: COMPUTATION OF PAYMENT
SPLC(from Grand Total Column 6
Page 1 of CY-63)
NET ALLOWABLE COST
FMAP or FFP RATE
SUBTOTAL FEDERAL SHARE
COMPTROLLER'S USE ONLY:
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 42 of 62
SAP VENDOR#: DOCUMENT#:PAYMENT DOCUMENT#:
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 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 :
COMPTROLLER'S USE ONLY:
TITLE IV-E FOSTER CARE - SUMMARY INVOICEName and Address of the County Executive Officers
Indicate with "X" if SUPPLEMENTAL
SECTION B: COMPUTATION OF PAYMENT
1NET
ALLOWABLE COST
FMAP or FFP RATE
SUBTOTAL FEDERAL SHARE
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 43 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 44 of 62
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)
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 45 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 46 of 62
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-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) 5363-D SECURE RESIDENTIAL SERVICE (EXCEPT YDC)
3-E YDC SECURE
4 ADMINISTRATIONTotal
Title XX and IV-B by CC Worksheet
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 47 of 62
ORIGINAL SUBMISSION DATE: November 15, 2016 COUNTY NAME: First
REVISED SUBMISSION DATE:
REVISION # REPORT PERIOD: 7/1/16-9/30/16
(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-J KINSHIP CARE - DELINQUENT
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 48 of 62
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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 49 of 62
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:
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 50 of 62
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
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ORIGINAL SUBMISSION DATE: November 15, 2016 COUNTY NAME: First
REVISED SUBMISSION DATE:
REVISION # REPORT PERIOD: 7/1/2016-9/30/2016
Section I
IN-HOME WAGES and SALARIES
EMPLOYEE BENEFITS SUBSIDIES OPERATING PURCHASED
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
REIMBURSABLE EXPENDITURES
PROGRAM INCOME
TITLE IV-E Maintenance
TITLE IV-E ADMIN. TANF TITLE XX TITLE IV-B OTHER
FUNDINGMEDICAL
ASSISTANCE
NET REIMBURSABLE EXPENDITURES
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
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ORIGINAL SUBMISSION DATE: November 15, 2016 COUNTY NAME: First CountyREVISED SUBMISSION DATE:
REVISION # REPORT PERIOD: 7/1/2016-9/30/2016
IN-HOME TOTAL
REIMBURSABLE EXPENDITURES
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
REIMBURSABLE EXPENDITURES
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
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-J KINSHIP CARE - DELINQUENT
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
REIMBURSABLE EXPENDITURES
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
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
MAJOR SERVICE CATEGORIES & COST CENTERS REVENUE SOURCES
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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
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 54 of 62
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.
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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.
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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
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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.
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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.
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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.
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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]
The PA Child Welfare Resource Center Act 148: Invoicing - Participant Guide Page 61 of 62
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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