SECOND COUNTY DATA PACKET - University of Pittsburgh

Updated: 2020-1-8

SECOND COUNTY

DATAPACKET

The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, of 30

COUNTY NAME: SecondCERTIFIED

IN-HOME AND INTAKE 2,631,951 COMMUNITY BASED PLACEMENT 4,510,536

INSTITUTIONAL PLACEMENT 3,313,911 ADMINISTRATION 585,360

TOTAL EXPENDITURES 11,041,758

REVENUESState Act 148 4,582,060

State Share YDC 922,250 SUBTOTAL STATE FUNDS 5,504,310

Title XX 72,768 Title IV-E 2,051,939 Title IV-B 25,930

TANF Transition Funds/IV-A/TANF 388,062

Medical Assistance 19,471 SUBTOTAL FEDERAL FUNDS 2,558,170

PROGRAM INCOME 442,151

County Program (Reimbursable) 1,586,904 County Share YDC 614,834

County Program (NON-Reimb.) 335,389 SUBTOTAL COUNTY FUNDS 2,537,127

TOTAL REVENUES 11,041,758

CERTIFIED LETTER DATED 3/11/2016

Budget Summary


Tina L. Long TELEPHONE NUMBER

DIRECTOR (717) 705-2288

October 26, 2016RE: Second County

Dear Chief County Probation Officer:

REIMBURSMENT RATES State Share County Share

TOTAL

Secure/ResidentialState 60% and County 40% $72,695.40 $48,463.60 $121,159.00

TOTAL $72,695.40 $48,463.60 $121,159.00

Sincerely,

Tina L. Long, DirectorDivision of Financial Policy & OperationsBureau of Financial Operations

Attachments

cc: County Children and Youth Director File

Please be advised that state and county share participation should be reduced by any program income applicable to these services.

If you have any questions, concerning this invoice, please contact Wendy Naigle at (717) 789-5501.

The amounts listed below indicate a charge of $121,159 to your county for use of Commonwealth Youth Development Centers (YDC) and Youth Forestry Camps (YFC) during the months of July, August and September 2016. We have included a cost breakdown showing these charges at the various reimbursement rates. These YDC and YFC charges should be used in the calculation of cumulative YDC/YFC amounts and are to be reported on your Fiscal Year 2016-2017, First Quarter CY-348 Fiscal Summary.

COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF PUBLIC WELFARE

BUREAU OF FINANCIAL OPERATIONS

DIVISION OF FINANCIAL POLICY AND OPERATIONS

3rd Floor, Bertolino Building

Harrisburg, Pennsylvania 17105 - 2675


County Name Second

SECUREFacility Name Client ID Days Perdiem Total Cost State Share County ShareNCSTU Loysville B00922 73 268.00 19,564.00 11,738.40 7,825.60NCSTU Loysville B00872 63 268.00 16,884.00 10,130.40 6,753.60NCSTU Loysville B00891 91 268.00 24,388.00 14,632.80 9,755.20

Facility Total 227 60,836.00 36,501.60 24,334.40 60,836.00

Facility Name Client ID Days Perdiem Total Cost State Share County ShareNew Castle -High J04679 24 337.00 8,088.00 4,852.80 3,235.20New Castle -High J04461 63 337.00 21,231.00 12,738.60 8,492.40New Castle -High J04575 92 337.00 31,004.00 18,602.40 12,401.60

Facility Total 179 60,323.00 36,193.80 24,129.20 60,323.00

Totals 406 121,159.00 72,695.40 48,463.60 121,159.00


TYPES IV-E/IV-DSum of RD TOTAL DEP DELREMARK Total 1ST QUARTER 27926.95 3526.83HSDF 19694 2ND QUARTERINTEREST 50 3RD QUARTERIV-D 72355.5 4TH QUARTEROTHER 4500 TOTAL IV-E/IV-D 27926.95 3526.83SS 15208 31453.78SSI 17204Grand Total 129011.5

AGENCY/TYPESum of RD TOTALAGENCY REMARK TotalCYA IV-D 58481.25

SS 9876SSI 14789

CYA Total 83146.25JPP IV-D 13874.25

SS 5332SSI 2415

JPP Total 21621.25Grand Total 104767.5


RESULTING FACTORS

1 = 1 = 0.039%

2 = 4 = 0.156%

3 = 2 = 0.508%

4 = 11 = 5.278%

5 = 135 = 5.551%

6a = 9 = 27.873%

6b = 17 = 2.306%

6c = 7 = 0.039%

6d = 19 = 0.704%

6e = 13 = 1.681%

6f = 71 = 0.000%

6g = 6 = 31.196%

Total 6 = 142 = 24.668%

7a = 20 100%

7b = 103 = 73.65%

7c = 28

7d = 90

7e = 62

7f = 360

7g = 50

Total 7 = 713

8a = 1

8b = 8

8c = 2

8d = 5

8e = 17

8f = 25

8g = 1

Total 8 = 59

9a = 0

9b = 0

9c = 1

9d = 0

9e = 0

9f = 0

9g = 0

Total 9 = 1

10a = 1

10b = 2

10c = 3

10d = 3

10e = 8

10f = 1

10g = 0

Total 10 = 18

11 = 43

12 = 0

13a = 0

13b = 0

13c = 3

13d = 305

13e = 334

13f = 6

13g = 2

13h = 12

13i = 5

13j = 0

13k = 131

Total 13 = 798

14a = 107

14b = 148

14c = 376

Total 14 = 631

X Total = 2558

0.05%

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

54.55%

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

TOTAL

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

Information Technology Grant (ITG) for Invoice Computation

3.08%

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

K Treatment Counseling (12/X)

L Other Services (13/X)

M General Administration (14/X)

H Permanent Legal Custodianship (9/X)

I Independent Living (10/X)

J Training (11/X)

E Prevention (Pre-Placing Activities) (6/X)

F Case Planning and Management (7/X)

G IV-E Adoption Ass't. Case Mgmt. (8/X)

B IV-E Eligibility (2/X)

C XIX Medicaid (3+4/X)

D Non-Client Specific Administration (5/X)

A Support Enforcement (1/X)

COMMONWEALTH OF PENNSYLVANIA

Department of Human Services

Office of Children, Youth and Families

RMTS Final Results April-May 2015

STATEWIDE CODE COUNTS


Days in Qtr 92

July DaysAug DaysSep Days Average

Adoption AssistanceUnder Age 18

Total Children Rec Adopt As 3,294 3,325 3,278 108Total IV-E Children Rec AA (CY 63) 8,857 96

Over Age 18Total Children Rec Adopt As 0 0 0 0Total IV-E Children Rec AA ( 0 0 0 0

0 0 0 0

Subsidized Permanent Legal Custodian (SPLC)Under Age 18

Total Children Rec SPLC 124 124 124 4Total IV-E Children Rec SPLC (CY 63) 568 4

Over Age 18Total Children Rec SPLC 0 0 0 0Total IV-E Children Rec SPL 0 0 0 0

0 0 0 0

TITLE IV-E ADMINISTRATION QUARTER 1 - FY 2016/17

Service Type


Days in Qtr 92

July DaysAug DaysSep Days AverageTotal Children in Placement

Under Age 18Foster Monthly Billings 2,087 2,085 2,039 68CYA Purchased 6,262 68JPP -CY63 (Jul-Sep 11) IVE 923 10

TOTAL QTR 1 PLACEMENTS 11,050 146

Over Age 18Foster Monthly Billings 0 0 0 0CYA Purchased 0 0 0 0JPP -CY63 (Jul-Sep 11) IV-E 0 0 0 0

TOTAL QTR 1 PLACEMENTS 0

Total IV-E PlacementsUnder Age 18

Foster Monthly Billings - IV-E 4,453CYA Purchased - IV-E 3,872CYA SSI Children 368

Total CYA IV-E 8,693JPP / IV-E 877JPP SSI Youth 46

Total JPP / IV-E 923TOTAL IV-E PLAC MAIN UNDER 18 9,616 105

Over Age 18Foster Monthly Billings - IV-E 0 0 0CYA Purchased - IV-E 0 0 0CYA SSI Children 0 0 0

Total CYA IV-E 0 0 0JPP / IV-E 0 0 0JPP SSI Youth 0 0 0

Total JPP / IV-E 0 0 0TOTAL IV-E PLAC MAIN OVER 18 0

TITLE IV-E ADMINISTRATION QUARTER 1 - FY 2016/17

Service Type


ACF COUNTS BY MONTH FOR QUARTERLY ACT 148 INVOICING

Additional data for ACF: July August September October November December January February March Aprlil May June

107 110 109110 112 111150 150 152120 127 134

95 97 98109 108 107

1 0 0

4 4 44 4 40 0 0

Adoption Assistance-Children receiving Title IV-E Non-Recurring Administrative Cost Payments (line 47 on CB 496)

SPLC-Children receiving Title IV-E Subsidy Payments (line 48 on CB 496)

SPLC-Children receiving ANY type of SPLC Subsidy Payments (line 49 on CB 496)

SPLC-Children receiving Title IV-E Non-Recurring Administrative Cost Payments (line 50 on CB 496)

Foster Care-Children In Placement receiving Title IV-E Maintenance Payments (line 41 on CB 496)

Foster Care-Children In Placement receiving Title IV-E Maintenance administrative funding (line 42 on CB 496)

Foster Care-Children in Foster Care receiving ANY type of funding for maintenance or administrative costs (line 43 on CB 496)

Foster Care-Children receiving Title IV-E Candidate administrative funding (line 44 on CB 496)

Adoption Assistance-Children receiving Title IV-E Subsidy Payments (line 45 on CB 496)

Adoption Assistance-Children receiving ANY type of Adoption Assistance Payments (line 46 on CB 496)


IH370.WK

SECOND COUNTY

ADOPTION SERVICES - 10002

STATE COST CENTER 1-A

CC CD TOTAL

10002 110 1674110002 120 669610002 310 398 Operating Total10002 320 163 1237710002 350 72010002 370 11096

ADOPTION ASSISTANCE - 10003

STATE COST CENTER 1-B

10003 210 152823.75

SPLC - 10000

STATE COST CENTER 1-C

10000 210 4840

GRAND TOTAL 1-A, 1-B AND 1-C 193478

COUNSELING INTERVENTION 10004, 40004

STATE COST CENTER 1-D

CC CD TOTAL

10004 320 2310004 350 196 Operating Total10004 360C 22525 999210004 370 9773JPP - 1-E

40004 360J 45455

GRAND TOTAL 1-D AND 1-E 77972

DAY CARE -10005

STATE COST CENTER 1-F

CC CD TOTAL

10005 360C 946

GRAND TOTAL 1-F 946


DAY TREATMENT - 40006

STATE COST CENTER 1-H

CC CD TOTAL

40006 360J 1870

GRAND TOTAL 1-H 1870

INTAKE AND REFERRAL -10006

STATE COST CENTER 1-J

CC CD TOTAL

10011 110 3348310011 120 1339310011 130 797 Operating Total10011 320 122 106310011 330 12610011 350 18

GRAND TOTAL 1-J 47939

LIFESKILLS 10007

STATE COST CENTER 1-K

CC CD TOTAL

10007 310 1410007 320 3210007 330 5 Operating Total10007 340 287 162810007 350 129010007 360C 26775HUMAN SV DEV FUNDS

10008 360C 19694

GRAND TOTAL 1-K 48097

GRAND TOTAL HSDF 19694


PROTECTIVE CHILD ABUSE - 10009

STATE COST CENTER 1-M

CC CD TOTAL

10009 110 6696610009 120 2678610009 130 1594 Operating Total10009 320 146 1050310009 330 16210009 350 106710009 370 7534

GRAND TOTAL 1-M 104255

CHILD PROTECTIVE GENERAL 10010

STATE COST CENTER 1-N

CC CD TOTAL

10010 110 6696610010 120 2678610010 130 1594 Operating Total10010 310 1576 1684910010 320 161710010 330 28910010 340 314010010 350 676310010 360C 5197510010 370 182710010 390 43

GRAND TOTAL 1-N 162576

SERVICE PLANNING -10011

STATE COST CENTER 1-O

CC CD TOTAL

10011 110 3348310011 120 1339310011 130 797 Operating Total10011 320 122 106310011 330 12610011 350 18

GRAND TOTAL 1-O 47939


JUVENILE ACT -10003

STATE COST CENTER 1-P

CC CD TOTAL

10003 360C 10500

GRAND TOTAL 1-P 10500

COMMUNITY BASED 10012,40012,GIG YDC'S

STATE COST CENTERS 2-C AND 2-D

CC CD TOTAL

10012 110 3348310012 120 1339310012 130 797 Operating Total10012 320 172 220410012 330 29310012 340 16910012 350 76210012 360C 19803510012 370 11JPP 2-D

40012 340 174 Operating Total40012 360J 69477 174

GRAND TOTAL 2-C AND 2-D 316766

GRAND TOTAL CYA 247115GRAND TOTAL JPP 69651


EMERGENCY SHELTER -10013,40013

STATE COST CENTER 2-E AND 2-F

CC CD TOTAL

10013 360C 29068JPP 2-F

40013 360JY 37876

GRAND TOTAL 2-E AND 2-F 66944


FOSTER FAMILIES 10014, 40014

STATE COST CENTERS 2-G AND 2-H

CC CD TOTAL

10014 110 5022410014 120 2009010014 130 1195 Operating Total10014 310 867 3203710014 320 84310014 330 138510014 340 404610014 350 1005510014 370 1364610014 360C 396809JPP 2-H


GRAND TOTAL 2-G AND 2-H 503729


JUVENILE DETENTION C1411

STATE COST CENTER 3-A

CC CD TOTAL


GRAND TOTAL 3-A 152583


RESIDENTIAL - 10017,40017

STATE COST CENTERS 3-B, 3-C

CC CD TOTAL

10017 340 276 Operating Total10017 360C 45157 276JPP 3-C


GRAND TOTAL 3-B AND 3-C 163233

SECURE - 40018 - YDC SECURE

STATE COST CENTERS 3-E

CC CD TOTAL

40018 360J 121159

GRAND TOTAL 3-E 121159

ADMINISTRATION - 10001

STATE COST CENTER 4

CC CD TOTAL

10001 110 6696610001 120 2678610001 130 1593 Operating Total10001 310 5098 3782310001 320 166310001 330 134610001 340 010001 350 7810001 370 119210001 390 92810001 394 25925

GRAND TOTAL ADMIN 4 131575

TOTAL EXPENDITURES 2,151,561


FEE FOR SERVICE SCHEDULE -CY 383

SECOND COUNTY07/01/2016 - 09/30/2016

J & A Sept. Oct.

P.O. P.O. P.O.

Cost Center ACCT CD PROVIDERCERT

# UNIT ID Target Population DescriptionContracted

RateRateDef JULY AUG SEPT Units

TotalCost

Days of Care

4 6583 C Stepping Stones A Dep Youth/FamiliesGeneral Counseling 80.00 hr 480 240 320 13.0 1,040.00 7

4 6583 C Stepping Stones B Dep Youth/FamiliesGeneral Counseling 45.00 1/2 hr 3285 2700 2700 193.0 8,685.00 6

4 6583 C Stepping Stones C Dep Youth/FamiliesGeneral Counseling 100.00 grp sessio 2000 1800 1600 54.0 5,400.00 20

4 6583 C Manno, Inc. IN Dep Youth/FamiliesGeneral Counseling 150.00 Ind 1350 1500 1800 31.0 4,650.00 10

4 6583 C Manno, Inc. GR Dep Youth/FamiliesGeneral Counseling 125.00 Group 875 1000 875 22.0 2,750.00 8

4 6583 C 22,525.00 51

4 6584 J Stepping Stones A Del YouthGeneral Counseling 80.00 hr 1360 960 800 39.0 3,120.00 15

4 6584 J Stepping Stones B Del YouthGeneral Counseling 45.00 1/2 hr 3375 2880 2880 203.0 9,135.00 9

4 6584 J Stepping Stones C Del YouthGeneral Counseling 100.00 grp sessio 2100 2000 1800 59.0 5,900.00 10

4 6584 J Manno, Inc. IN Del YouthGeneral Counseling 150.00 Ind 3600 4500 3750 79.0 11,850.00 11

4 6584 J Manno, Inc. FA Del YouthGeneral Counseling 200.00 Family 3200 3600 3400 51.0 10,200.00 9

4 6584 J Manno, Inc. GR Del YouthGeneral Counseling 125.00 Group 1750 1875 1625 42.0 5,250.00 11

4 6584 J 45,455.00 65

5 6681 C YMCA Dep YouthDay Care ages 0-6 86.00 week 344.00 344.00 258.00 11.00 946.00 1

5 6681 C 946.00 1

6 6735 J Mid-Point Services A Del YouthLicensed DT 5 day/wk 66.80 day 668.00 935.20 267.20 28.00 1,870.40 4

6 6735 J 1,870.40 4

9 6954 C PPL Electric Service reasonable quarter 1.00 19,694.00

9 6954 C Family Services HSD Dep Youth/Famliles LS Educ Services 175.00 session 9,100.00 11,375.00 6,300.00 153.00 26,775.00 479 6954 C 46,469.00 47

GPS

11 7189 C Family Services INV Dep FamiliesIn Home Support Serv 225.00 visit 16,875.00 18,900.00 16,200.00 231.00 51,975.00 74

11 7189 C 51,975.00 74

13 7333 C Gerg & Associates Dep YouthLegal Representation 3,500.00 month 1.00 1.00 1.00 3.00 10,500.00 154

13 7333 C 10,500.00 154Community-Based Residential

15 7442 C Children's Home of Reading 111111 CC Dep Fem, Age 14-18Moderate Beh Issues 207.50 Day 31 31.0 6,432.50

15 7442 C Children's Home of York 111112 DD Dep Males, Age 14-18Level 2 Beh Issues 214.17 Day 5 22 12 39.0 8,352.63

15 7442 C Children's Home of York 111112 CC Dep Males, Age 14-18Level 1 Beh Issues 191.16 Day 62 80 74 216.0 41,290.56

Day Treatment Delinquent

Life Skills

Juvenile Act Proceedings

Children Served

Counseling

Day Care


J & A Sept. Oct.

P.O. P.O. P.O.




TotalCost

Days of Care

Children Served

15 7442 C Children's Home of York 111112 BB Dep Fem, Age 13-15Level 1 Beh Issues 148.89 Day 93 93 68 254.0 37,818.06

15 7442 C Children's Home of York 111112 AA Infant With MotherInfant Placed with Mom 36.16 Day 62 73 135.0 4,881.60

15 7442 C Clear Vision 111113 AA Dep Fem, Age 14-18Moderate Beh Issues 175.86 Day 12 8 20.0 3,517.20

15 7442 C COBYS 111114 BB Dep Fem, Age 15-18Level 1 Beh Issues 123.00 Day 54 37 20 111.0 13,653.00

15 7442 C COBYS 111114 AA Infant with MotherInfant Placed with Mom 57.00 Day 74 67 40 181.0 10,317.00

15 7442 C Families United Network 111115 AA Dep Fem, Age 13-18Level 1 Beh Issues 184.35 Day 16 14 30.0 5,530.50

15 7442 C Kidspeace 111116 BB Dep Males, Age 13-16Level 2 Beh Issues 253.00 Day 44 21 2 67.0 16,951.00

15 7442 C Kidspeace 111116 AA Dep Males, Age 14-18 Lev 1 Beh Issues 234.00 Day 31 31 30 92.0 21,528.00 15 7442 C There's Room in the Inn 111117 AA Dep Fem, Age 15-18 Lev 1 Beh Issues 125.00 Day 31 31 30 92.0 11,500.00 15 7442 C UMHC-Residential/Mechanicsburg 111118 AB Dep Malles, Age 13-18 Lev 1 Beh Issues 176.77 Day 31 31 30 92.0 16,262.84 15 7442 C 1360 198,034.89 1,360 18

15 7442 J Children's Home of York 111112 DD Del Males, Age 14-18Level 2 Beh Issues 214.17 Day 36 54 6 96.0 20,560.32

15 7442 J Children's Home of York 111112 EE Dep Fem, Age 13-15 Lev 1 Beh Issues 168.10 Day 106 93 92 291.0 48,917.10 15 7442 J 387 69,477.42 387 6

Emergency Shelter

16 7442 C Boys Club & Girls Club 111119 AA Dep Youth Age 12-18Emer Shelter 30 day 133.69 Day 10 10.0 1,336.90

16 7442 C Children's Home of York 111112 FF Dep Youth Age 12-18Emer Shelter 30 day 146.03 Day 10 12 15 37.0 5,403.11

16 7442 C Cornell Abraxas 111120 AA Dep Youth Age 12-18Emer Shelter 30 day 208.74 Day 18 12 30.0 6,262.20

16 7442 C Families United Network 111115 BB Dep Youth Age 12-18Emer Shelter 30 day 164.68 Day 6 20 15 41.0 6,751.88

16 7442 C Foster Families 111110 AA Dep Youth Age 12-18Emer Shelter 30 day 25.00 Day 45 45 37 127.0 3,175.00

16 7442 C UMHC-Emergency Shelter/Daron 111121 AA Dep Youth Age 12-18Emer Shelter 30 day 161.55 Day 25 13 38.0 6,138.90

16 7442 C 283 29,067.99 283 7


J & A Sept. Oct.

P.O. P.O. P.O.




TotalCost

Days of Care

Children Served

16 7442 J Adelphoi 111122 AA Del Youth Age 12-18Emer Shelter 30 day 180.31 Day 42 25 32 99.0 17,850.69

16 7442 J Bethany 111123 AA Del Youth Age 12-18Emer Shelter 30 day 152.00 Day 22.0 15.0 22.0 59.0 8,968.00

16 7442 J Boys Club & Girls Club 111119 BB Del Youth Age 12-18Emer Shelter 30 day 131.07 Day 5.0 5.0 25.0 35.0 4,587.45

16 7442 J Children's Home of York 111112 GG Del Youth Age 12-18Emer Shelter 30 day 137.66 Day 10 22 15 47.0 6,470.02

16 7442 J 1,790.79 240 37,876.16 240 5Foster Family

17 7399 C Foster Families 111110 AA Foster Home Age 0-12Level 1 Traditional 25.00 Day 2,148 3,338 3,156 8,642 216,050.00

17 7442 C Children's Home of York 111112 HH Foster Home Age 13-18Level 1 Traditional 63.48 Day 715 702 748 2165.0 137,434.20

17 7442 C Families United Network 111115 CC Foster Home Age 13-18Level 1 Traditional 65.00 Day 45 30 75.0 4,875.00

17 7442 C Hope for Kids 111124 AA Foster Home Age 0-12Special Needs, Lev 1 74.00 Day 155 153 120 428.0 31,672.00

17 7442 C Northwestern Human Svcs. 111125 AA Foster Home Age 0-18R&B, CRR Host Home 28.72 Day 236 236.0 6,777.92

17 7442 C 11546 396,809.12 11,546 149

17 7442 J Bair Foundation 111126 AA Del Home Age 13-18Level 1 Traditional 61.59 Day 12 31.0 17.0 60.0 3,695.40

17 7442 J 60 3,695.40 60 1Juvenile Detention

19 J CCYC 111127 JD Del Youth Age 12-18Temporary Secure Det 274.58 Day 74.00 98.00 66.00 238.00 65,350.04

19 J YIC 111128 AB Del Youth Age 12-18Temporary Secure Det 324.62 Day 104.00 64.00 98.00 266.00 86,348.92

19 7318 J Day 504 151,698.96 504 17Residential Services

20 7442 C Bradley Center 111129 AA Dep Youth Age 13-18Level 2 Beh Issues 279.52 Day 5 31.0 30 66.0 18,448.32

20 7442 C Kidspeace 111116 CC Dep Youth Age 14-18Level 3 Beh Issues 316.00 Day 31 31 30 30.0 9,480.00

20 7442 C Laurel Youth Services 111130 AA Dep Youth Age 14-18Level 1 Beh Issues 223.75 Day 31 31 15 77.0 17,228.75

20 7442 C 173 45,157.07 173 4

20 7442 J Clear Brook 111131 AA Del Youth Age 14-18 Institutional Lev 1 159.00 Day 31 31 28 90.0 14,310.00

20 7442 J Cornell Abraxas 111132 AA Del Youth Age 14-18 Institutional Lev 2 287.17 Day 92 92 90 274.0 78,684.58 20 7442 J Drug and Alcohol Rehab 111133 AA Del Youth Age 14-18 D&A R&B 89.00 Day 131 140 4 275.0 24,475.00 20 7442 J 639 117,469.58 639 25

YDC

21 Y YS Loysville NCSTU Del Youth Age 14-18Repeat/violent offenders 268.00 Day 73 63 91 227 60,836.00

21 Y YS New Castle High Sec Del Youth Age 14-18Repeat/violent offenders 337.00 Day 24 63 92 179 60,323.00

406.00 121,159.00 406 6Grand Total "360"Purchased Services 1,350,185.99


Children Served In-Home Services PURCHAS AGENCY PROVIDED

1-A ADOPTION SERVICE 15 1-B ADOPTION ASSISTANCE 111 1-C SUBSIDIZED PLC 4 1-D COUNSELING - DEPENDE 51 1-E COUNSELING - DELINQUE 65 1-F DAY CARE 1 1-G DAY TREATMENT - DEPENDENT 1-H DAY TREATMENT - DELIN 4 1-I HOMEMAKER SERVICE 1-J INTAKE & REFERRAL 245 1-K LIFE SKILLS - DEPENDEN 47 1-L LIFE SKILLS - DELINQUENT 1-M PROTECTIVE SERVICE - CHILD ABU 130 1-N PROTECTIVE SERVICE - G 74 162 1-O SERVICE PLANNING 261 1-P JUVENILE ACT PROCEED 154 1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT

TOTAL 511 813

Unduplicated number of children served with ONLY Non-Purchased Services 396

Unduplicated number of children documented at imminent risk 354


Non-Reimbursable Expenses 1st Quarter 2016-2017

$93.00 meal in excess of State Rateallocated according to Agency time study as follows

% amount1-A ADOPTION SERVICE 0.0753% 7.001-B ADOPTION ASSISTANCE

1-C SPLC

1-D COUNSELING - DEPENDENT 0.0215% 2.001-E COUNSELING - DELINQUENT

1-F DAY CARE

1-G DAY TREATMENT - DEPENDENT

1-H DAY TREATMENT - DELINQUENT

1-I HOMEMAKER SERVICE

1-J INTAKE & REFERRAL

1-K LIFE SKILLS - DEPENDENT 0.1398% 13.001-L LIFE SKILLS - DELINQUENT

1-M PROTECTIVE SERVICE - CHILD ABUS 0.1183% 11.001-N PROTECTIVE SERVICE - GENERAL 0.6344% 59.001-O SERVICE PLANNING

1-P JUVENILE ACT PROCEEDINGS - DEPENDENT

1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT

4 ADMINISTRATION 0.0108% 1.00

Non-Reimbursable Placement Expenses- Facility unlicensed2-A ALTERNATIVE TREATMENT - DEPENDENT 2-B ALTERNATIVE TREATMENT - DELINQUENT 2-C COMMUNITY RESIDENTIAL - DEPENDENT 365.50 2-D COMMUNITY RESIDENTIAL - DELINQUENT 61.25 2-E EMERGENCY SHELTER - DEPENDENT 223.00 2-F EMERGENCY SHELTER - DELINQUENT 447.75 2-G FOSTER FAMILY - DEPENDENT 170.75 2-H FOSTER FAMILY - DELINQUENT 2-I SUPERVISED INDEPENDENT LIVING - DEPENDENT 2-J SUPERVISED INDEPENDENT LIVING - DELINQUENT 3-A JUVENILE DETENTION SERVICE 2033.00 3-B RESIDENTIAL SERVICE - DEPENDENT 3-C RESIDENTIAL SERVICE - DELINQUENT (EXCEPT YDC) 3-D SECURE RESIDENTIAL SERVICE (EXCEPT YDC) 3-E YDC/YFC (NON-SECURE)-Institutional 3-F YDC SECURE

Total Non-Reimbursable Expenses 3394.25 411: Act 148 Invoicing Handout #15, of 0

The PA Child Welfare Resource Center Act 148: Invoicing Trainer Resource #03, Page 20 of 30

PROGRAM INCOME FOR FISCAL YEAR 2016-2017

REVENUE BREAKDOWN BY CC AGENCY/TYPESum of RD TOTAL Sum of RD TOTALAGENCY NAME Total TYPES AGENCY REMARK TotalCYA ADMIN 0 Sum of RD TOTAL CYA IV-D 58481.25

CR-DEP-GH 14178 REMARK Total SS 9876ES-DEP 3308 HSDF 19694 SSI 14789FF-DEP 66110 INTEREST 50 CYA Total 83146.25LIFESKILLS 19694 IV-D 72355.5 JPP IV-D 13874.25RS-DEP 4050.25 OTHER 4500 SS 5332GPS 50 SS 15208 SSI 2415

CYA Total 107390.25 SSI 17204 JPP Total 21621.25JPP CR-DEL-GH 10145.75 Grand Total 129011.5 Grand Total 104767.5

ES-DEL 268.25FF-DEL 125.75MONITORING 2037.5RS-DEL 7546.25YDC-SEC 426.75

JPP Total 21621.25JDC JD 1071Grand Total 129011.5


Title IV-E by Cost Center

REVENUE BREAKDOWN BY CC Sum of 1ST FEDERAL TYPECENTER DIRECTAA 74,827.45CR-DEL-GH 13,817.26CR-DEP-GH 41,451.78ES - DEL 7,676.26ES-DEP 6,141.00FF-DEL 1,535.25FF-DEP 82,903.55GPSRS-DELRS-DEPSILSIL-DELSPLC 2,692.76Grand Total 231,045.31


Federal ID#:

ADOPTION ASSISTANCE

ACH Bank Code Invoice Period

Bank Account # Child Service Months

Submission Date

7334.00 2 3

4 5 6

7 8 9

10 11 12

Title IV-E Eligible Children # $ State Only Eligible Children # $

13

Service Costs:

Increased Federal Share Related to American Recovery Reinvestment:

Maintenance without Enhanced FFP:

For Comptroller's Office Use Only:

ADMINISTRATIVE COST

TRAINING COST

Non-Recurring Special Needs Adoption Incident Costs (separate CY-

63 attached)

COMPTROLLER'S USE ONLY: SAP VENDOR#: DOCUMENT#:

TITLE IV-E ADOPTION ASSISTANCE - SUMMARY INVOICE

SECTION B: COMPUTATION OF PAYMENT

ADOPTION ASSISTANCE Adoption Assistance

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

GRAND TOTAL FEDERAL SHARE

NET ALLOWABLE

COST FFP RATE SUBTOTAL FEDERAL

SHARE

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

343

9/30/16

11/15/2016

.5564 $74827.45

17115.78 .50 8557.89

3911.65 .50 1955.83

$ 85,341.17

134485.00


Federal ID#:

SPLC



Submission Date

1 2 3

4 5 6

7 8 9

10 11 12

Title IV-E Eligible Children # $

13

Service Costs:

Increased Federal Share Related to American Recovery Reinvestment:

Maintenance without Enhanced FFP:


TITLE IV-E SUBSIDIZED PERMANENT LEGAL CUSTODIANSHIP SUMMARY INVOICE




SPLC (from Grand Total Column 6

Page 1 of CY-63)

NET ALLOWABLE

COSTFFP RATE

SUBTOTAL FEDERAL SHARE

ADMINISTRATIVE COST

TRAINING COST

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

GRAND TOTAL FEDERAL SHARE

12

9/30/16

11/15/2016

4840.00 .5564 $ 2692.76

326.36 .50 $ 163.18

162.99 .50 $ 81.50

$ 2937.44


Federal ID#:

FOSTER CARE



Submission Date

FOSTER CARE

OTHER INCOME (Non-Title IV-D) 2 3 4 5

TITLE IV-D COLLECTION 6 7 8

From CY-63 From RMTSCASE PLANNING AND MANAGEMENT 9 10 11 12

PRE PLACEMENT ACTIVITIES

From Direct Claim

Worksheet13 14 15

ELIGIBILITY DETERMINATIONS 16 17 18 19

OTHER ADMINISTRATION 20 21 22 23

TRAINING COSTS 24 25 26 27

Preventing Sex Trafficking 28 29 30 31

GRAND TOTAL FEDERAL SHARE 32

Allowable Service Costs

Net Allowable Costs

Maintenance without Enhanced FFP

Increased Federal Share Related to ARRA Title IV-D Collections

TotalFoster Family and Incidentals

GH/Institutional - Maximum Allowable PaymentGH/Institutional - Deferred Payment



1

NET ALLOWABLE

COSTFFP RATE

SUBTOTAL FEDERAL SHARE

ALLOWABLE SERVICE

COSTS (from Grand Total

Column 6 Page 1 of CY-63)


TITLE IV-E FOSTER CARE - SUMMARY INVOICE


ADMINISTRATIVE COSTS

Eligible Expenditure

487

9/30/16

11/15/2016

352781.2

4500.00 348281.28

72355.50

.5564 $193783.70

.5564 (40258.60)

18445.40 167348.97 .50 92897.19

33328.97 .50 16664.49

1305.44 .50 652.72

32012.35 .50 16006.18

4278.37 .50 2139.19

$ 281,884.87

Submit Save Delete

Accept Reject

Reset


TANF by CC

CC % CENTER TYPE 1ST GROSS 1ST FEDERAL TOTAL10005 DC DIRECT10004 CS DIRECT 7008.54 7008.54 700910010 GPS DIRECT10013 ES DIRECT10007 LS DIRECT40006 DT-DEL DIRECT40013 ES-DEL DIRECT40004 80% CS-DEL DIRECT

TOTAL 7008.54 7008.54 7009

Sum of TOTALCENTER TotalCS 7009CS-DELDCDT-DELESES-DELGPSLSGrand Total 7009


OCYF BULLETIN3140-00-03ATTACHMENT A

NAME AND ADDRESS OF THE COUNTY EXECUTIVE OFFICERS

FROM: 7/1/2016TO: 9/30/2016

FEDERAL ID #:

TANF CFDA #: 93.558

ME#:

Signature and Title of the Designated County Official Date

FUND DEPT APP YEAR LDG. ORGCOST

FUNCTIONOBJ SUB-OBJ AMOUNT

001 021 986 7 1600 631

001 021 986 7 1600 631

001 021 986 7 1600 631

001 021 986 7 1600 631

CY-69

ACCOUNT CODE FOR COMPROLLER'S OFFICE USE ONLY

TOTAL TOTAL TANF CLAIM 7,008.54

JUVENILE DETENTION SERVICES

7,008.54

EMERGENCY SERVICES

IN HOME SERVICES15 7,008.54

Child Welfare TANF Service

Number of Children Served

Allowable TANF Service Costs

Program Income (related to claimed expenditures)

Net Allowable Cost

TANF SUMMARY INVOICE Temporary Assistance for Needy Families

INVOICE PERIOD

Second County Commissioners

SECTION A - COUNTY CERTIFICATION

(4)

I certify that the children listed on the attached CY-68 are eligible under the child welfare

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

of services and of related administrative costs incurred for the children

SECTION B - COMPUTATION OF PAYMENT

(5)(1) (2) (3)


APPLICATION OF TITLE XX AND TITLE IV-B REVENUE1ST QTR 2011-12

IN-HOME XX IV-B1-A ADOPTION SERVICE

1-B ADOPTION ASSISTANCE

1-C SUBSIDIZED PLC

1-D COUNSELING - DEPENDENT

1-E COUNSELING - DELINQUENT

1-F DAY CARE

1-G DAY TREATMENT - DEPENDENT

1-H DAY TREATMENT - DELINQUENT

1-I HOMEMAKER SERVICE

1-J INTAKE & REFERRAL

1-K LIFE SKILLS - DEPENDENT

1-L LIFE SKILLS - DELINQUENT

1-M PROTECTIVE SERVICE - CHILD ABUSE

1-N PROTECTIVE SERVICE - GENERAL

1-O SERVICE PLANNING

1-P JUVENILE ACT PROCEEDINGS - DEPENDENT

1-Q JUVENILE ACT PROCEEDINGS - DELINQUENT

COMMUNITY BASED PLACEMENT2-A ALTERNATIVE TREATMENT - DEPENDENT

2-B ALTERNATIVE TREATMENT - DELINQUENT

2-C COMMUNITY RESIDENTIAL - DEPENDENT

2-D COMMUNITY RESIDENTIAL - DELINQUENT

2-E EMERGENCY SHELTER - DEPENDENT

2-F EMERGENCY SHELTER - DELINQUENT

2-G FOSTER FAMILY - DEPENDENT 72767.002-H FOSTER FAMILY - DELINQUENT

2-I KINSHIP CARE - DEPENDENT

2-J KINSHIP CARE - DELINQUENT

2-K SUPERVISED INDEPENDENT LIVING - DEPENDENT

2-L SUPERVISED INDEPENDENT LIVING - DELINQUENT

INSTITUTIONAL PLACEMENT3-A JUVENILE DETENTION SERVICE

3-B RESIDENTIAL SERVICE - DEPENDENT

3-C RESIDENTIAL SERVICE - DELINQUENT (EXCEPT YDC) 255293-D SECURE RESIDENTIAL SERVICE (EXCEPT YDC)

3-E YDC/YFC (NON-SECURE)-Institutional

3-F YDC SECURE

4 ADMINISTRATION

72767.00 25529.00


Direct Charges to the Cost Pool

2016-2017COST POOL ADJUSTMENTS

COL 3 COL 5 COL 6 COL 7

1ST QTR MAINTPROG

INCTANF IV-

B XX DIR CHG TOTAL

GH-DEP Maintenance Expenditures 340 696 696 696GH-DEL Maintenance Expenditures 340 106 106 106FF-DEP Maintenance Expenditures 340 16182 16182 16182FF-DEL Maintenance Expenditures 340 0 0 0RS-DEP Maintenance Expenditures 340 121 121 121RS-DEL Maintenance Expenditures 340 205 205 205

TOTAL MAINTENANCE 17310 17310 17310

GPS Program Income 50 50 5050 50 50

TOTALS 17360 17310 50 0 0 17360

FF - Dep Admin related to FF Homes 18075.9 x.50 9038FF - Del Admin related to FF Homes 369.5 x .50 185


County:

7/1/2016 - 09/30/2016

Federal I.D. Number:Routing #:

Vendor Code:

DATE

DATE

DATE

CY 886

OCYF APPROVAL

2. Percentage 50%

3. Invoice / Claim Total 2,121.35

SIGNATURES/APPROVAL

COUNTY C&Y ADMINISTRATOR/DESIGNEE

COUNTY C&Y FISCAL OFFICER/DESIGNEE

INVOICE/CLAIM CALCULATIONS1. Total Amount Claimable

$4,242.69 (From RMTS Worksheet, CALCULATION: 35)

Bank Account #:

Name and Address of the County Executive Officers

Office of Children, Youth and Family

MEDICAID ADMINISTRATIVE INVOICE/CLAIM

Date of Claim: Second

Report Period:


SECOND COUNTY DATA PACKET - University of Pittsburgh

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