ISA MARICOPA AMENDMENT DC20-000016_FINAL-COPY.PDF
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DocuSign Envelope ID: F86035A9-F3D4-4851-A967-D524BE96E928
AMENDMENT TO Interagency Agreement (Agreement) Between Arizona Department of
Child Safety (DCS), the Arizona Supreme Court, Administrative Office of the Courts (AOC)
and
Maricopa County
This amends the above-described Agreement dated February 24, 2020 and subsequent Amendment
dated September 24, 2020 between the Arizona Department of Child Safety, the Arizona Supreme
Court, Administrative Office of the Courts, and Maricopa County. The introductory and purpose
statement of this agreement is amended to add the following:
Attachments A and Bare replaced by the "Certification of Expenditure" form(s) attached hereto.
Furthermore, the following exhibits are added as integral parts of the agreement:
Exhibit 1 - Federal 2 CFR § 200.332 requirements.
Exhibit 2 - Notification of sample award letter reflecting allocation amount received quarterly.
Any changes or requirements from the federal Children's Bureau to Title IV-E policy, claim forms, or
cost allocation documentation for legal representation for children or parents will be implemented
without amending the Agreement. AOC will assist in facilitating in communicating any changes to
County.
County must submit its claiming methodology to DCS for approval prior to any future County claims
being processed. A copy of the county's approved claiming methodology is attached to this
amendment. County must immediately provide any subsequent updates to its claiming methodology
to DCS for approval.
The following sections are replaced in their entirety from the original Agreement and the subsequent
Amendment:
1.0
TERM OF THE AGREEMENT
1.1
The term of this Agreement shall begin on the date of the last signature and shall
continue, with projected expenditures report submitted annually, until cancelled.
1.2
Allowable costs incurred must be invoiced, to the AOC, quarterly on the "Certification
of Expenditure" form.
1.3
"Certification of Expenditure" forms must be submitted to AOC by County within 15
calendar days following the end of each quarter.
1.4
A progress report must be submitted annually by County to AOC no later than
November 15th. AOC will forward all annual progress report to DCS.
1.5
Allowable costs maybe invoiced to cover expenditures beginning January 7, 2019. The
allowable expenditures from 2019 were required to be invoiced, in total, and submitted
to the AOC by March 31, 2020.
DocuSign Envelope ID: F86035A9-F3D4-4851-A967-D524BE96E928
1.6
The funding associated with this reimbursement is from Title IV-E Foster Care. CFDA.
#93-658.
1. 7
The terms of this Agreement will follow all federal requirements, changes, and
clarifications even without an amendment.
1.8
The terms of this Agreement outline requirements as required to be responsive to the
Federal Funding Accountability and Transparency Act (FFAT A).
1.9
The closeout process of the terms of this Agreement will begin 30 days following the
budget period end date.
2.0
PARTIES
2.1
This Interagency Agreement is between DCS, AOC, and County.
3.0
PURPOSE
3.1.
The purpose of this Agreement is to allow the County to receive partial reimbursement
for expenses incurred for the legal representation of children and parents in dependency
and termination cases, including appeals, pursuant to Title IV-E administration laws
and regulations and the federal Children's Bureau Child Welfare Policy Manual. These
expenditures shall include costs associated with the independent legal representation
by an attorney, including an attorney Guardian Ad Litem, for a child who is a candidate
for Title IV-E foster care or is in foster care, and his/her parent(s), to prepare for and
participate in all stages of Dependency and/or Termination related proceedings,
including appeals.
3.2.
DCS, AOC and County agree that DCS shall facilitate Title IV-E Federal Financial
Participation (FFP) to the County as partial reimbursement for allowable costs
associated with the independent legal representation by an attorney, for a child who is
a candidate for Title IV-E foster care or in foster care, and for his/her parent(s), to
prepare and participate in all stages of Dependency and/or Termination proceedings,
including appeals, contingent on the agreed upon responsibilities of all parties.
4.0
AUTHORITY
4.1
Authority for this Agreement is granted pursuant to the eligibility criteria of Title IV-
E of the Social Security Act 42 U.S.C. § 673(a)(6); 45 CFR §1356.60(c); Section
474(a)(3); the Children's Bureau Child Welfare Policy Manual; A.RS. § 35-148; and
the Arizona DCS Title IV-E State Plan.
5.0
ALLOWABLE COSTS
5.1
Expenditures shall include only costs for child welfare dependency cases that are
associated with the independent legal representation by an attorney, for a child who is
a candidate for Title IV-E foster care or in foster care and his/her parent(s ), to prepare
for and participate in all stages of Dependency and Termination, including appeals, and
related proceedings. Allowable costs are limited to attorney and paralegal
DocuSign Envelope ID: F86035A9-F3D4-4851-A967-D524BE96E928
compensation and the administrative costs allocated to directly support the attorney
representing the eligible parents or children allowable under Title IV-E.
5.2
Additionally, administrative costs for paralegals, investigators, peer partners or social
workers may be claimed as Title IV-E foster care administrative costs to the extent that
they are necessary to support an attorney providing independent legal representation.
Allowable costs for foster care legal proceedings include:
5.2.1
Hearings related to judicial determinations that it is contrary to the welfare of
a child to remain in the home.
5.2.2
Hearings related to a child's removal from the home.
5.2.3
Hearings related to judicial determinations that the agency provided reasonable
efforts to prevent removal and finalize the permanency plan.
5.2.4
Permanency hearings.
5.2.5
Hearings related to progress on case plans; and
5.2.6
Appeal proceedings that relate to judicial determinations required under Title
IV-E.
5.3
Allowable costs for all stages of foster care legal proceedings include:
5.3.1
Independent investigation of the facts of the case, including interacting with
law enforcement.
5.3.2
Meeting with clients or making home or school visits.
5.3.3
Attending case planning meetings.
5.3.4
Providing legal interpretations.
5.3.5
Preparing briefs, memos, or pleadings.
5.3.6
Obtaining transcripts.
5.3.7
Interviewing and preparing their client and witnesses for hearings.
5.3.8
Maintaining files.
5.3.9
Supervising attorneys, paralegals, investigators, peer partners or social workers
that support an attorney in providing independent legal representation to
prepare for and participate in all stages of dependency proceedings.
5.3.10 Filing child abuse and neglect petitions for candidates for foster care.
DocuSign Envelope ID: F86035A9-F3D4-4851-A967-D524BE96E928
5.3.11 Court fees to file a petition for a judicial determination required under Title IV-
E; and
5.3.12 Appellate work related to dependency proceedings.
6.0
DISALLOWED COSTS
6.1.
Any costs related to delinquency cases, criminal cases, or other case types involving
matters not covered by this Agreement, such as housing, immigration, or traffic cases,
are not eligible under Title IV-E or this Agreement and will be disallowed. In any
disallowance or deferral action in which County is liable to DCS for the loss of funds,
County shall be responsible for all legal fees against Title IV -E federal financial
participation received by County and costs associated with the defense against the
disallowance action. DCS shall cooperate with County in defense of such action by
providing or making available all related records and documents and by permitting
DCS staff to provide technical assistance to County in preparing appropriate party
defense, but DCS assumes no other liability for the defense of the disallowance.
6.2.
DCS is entitled to recover all payments improperly made or made by error to County,
are not supported by appropriate documents or records, or are disallowed in a state or
federal audit. County is responsible for refunding the full amount of such payment upon
a written request from DCS.
7.0
RESPONSIBILITY
7.1
County shall:
7.1.1
Be considered a subrecipient of the federal award.
7.1.2
Provide DCS with contact information for a county point of contact and update
the contact information should there be a change.
7.1.3
Ensure participation of the appropriate representatives in the annual trainings,
and if needed, periodic refresher sessions provided by DCS for implementing
the provisions within this Agreement.
7.1.4
Assume all responsibility and liability for erroneous reporting of costs
allowable or disallowable.
7.1.5
Compile and identify allowable costs associated with allowable activities and
ensure that unallowable costs are excluded from County Certification of
Expenditure form.
7.1.6
Assume responsibility for implementing any federal policy changes.
7.1.7
Assume responsibility for programmatic decision making.
7 .1. 8
Establish agreements or contracts for legal services that com port with the
Arizona Rules of Procedure for Juvenile Court pertaining to the duties and
DocuSign Envelope ID: F86035A9-F3D4-4851-A967-D524BE96E928
responsibilities of attorneys appointed as counsel or Guardian ad Litem for the
child or their parent.
7 .1. 9
Send a completed and signed "Certification of Expenditure" form, within 15
calendar days following the end of each quarter, to the AOC that includes:
1. The number of represented children who are placed in foster care.
2. The number of represented children who have an open in-home
dependency or in-home intervention case.
7.1.10 Send a completed fiscal year annual progress report to AOC no later than
November 15th annually.
7.1.11 Be responsible for the non-federal share requirement.
7.1.12 Document the allocation methodology to identify child welfare allowable costs
and send to DCS for review and approval. Any changes to the allocation
methodology must be immediately submitted to DCS for approval.
7.1.13 Maintain and have readily available an accurate record and supporting
documents of the actual costs incurred and invoiced under this Agreement for
providing independent legal representation to parents and children in
dependency proceedings and claimed on the Certification of Expenditures
form. These financial and performance records and documents must establish
that such funds have been expended in accordance with this Agreement and the
federal regulations of allowable costs.
These financial and performance
records and documents shall be retained for a period of no less than five years
and made available to DCS upon request.
7.1.14 Provide and oversee the delivery of high quality, standards-based, independent
legal representation to parents and children in child welfare proceedings.
7.1.15 Encourage counsel for the child, or their office social worker, to participate in
all FCRB reviews for their client. If attendance is not possible, counsel should
make every effort to provide to the FCRB in advance of the review, an update
or a statement on the child's status and counsel's recommendations on next
steps for moving towards permanency.
7.1.16 Make available to DCS, upon written request, all documents supporting the
expenditures and claims identified in the "Certification of Expenditures" form,
excluding attorney work product and confidential information.
7.1.17 Utilize at least 75% of the monies acquired through Title IV-E reimbursement
to supplement and not supplant existing funding for parent or child
representation through expanding, enhancing, or developing initiatives such as,
but not limited to:
1. Preventing dependency filings without jeopardizing child safety.
DocuSign Envelope ID: F86035A9-F3D4-4851-A967-D524BE96E928
2. Implementing a Parent Mentoring Program.
3. Meeting timeframes mandated by the Arizona Revised Statutes, Title 8,
Chapter 4, Articles 4, 5, 8, 9, 10 and 11, as well as all applicable Court
Rules.
4. Enhancing representation through training and education.
5. Improving the ability of attorneys to manage their dependency case load.
6. Improving attorney/client ratios.
7. Establishing models that bring together attorneys, social workers, and parent
advocates to form interdisciplinary representation teams.
7.1.18 Partner with the Juvenile Court to implement initiatives to enhance child and
parent representation both before and after the filing of a dependency petition
and as identified through the partnership.
7.1.19 Provide DCS an anticipated projection of allowable costs by September 1st, to
be claimed the following federal fiscal year. The actual transfer amount will
depend on County expenditures that qualify for FFP under Title IV-E.
7.1.20 Participate in subrecipient monitoring activities as deemed necessary by DCS
1. Take timely and appropriate action to address detected deficiencies through
audits, on-site reviews and written confirmation as performed by DCS.
2. Complete required repo1ting documents to DCS in pursuant with the Federal
Funding Accountability and Transparency Act (FF AT A)
7.2
AOC Shall:
7.2.1 Be responsible for selecting and inviting the appropriate trainees to participate
in the annual trainings, and if needed, periodic refresher sessions provided by
DCS for implementing the provisions within this Agreement.
7.2.2 Be considered the cash receipt and disbursement entity on the behalf of the
counties for the purpose of this Agreement.
7.2.3
As the cash receipt and disbursement entity, AOC shall send a copy of
completed and signed County Certification of Expenditure form to DCS, within
25 days after the end of each quarter which will be used as a funding draw down
request.
7.2.4 Complete and submit to DCS the Certification of Expenditure by County
(aggregate) form, within 30 calendar days after the end of each quarter.
7.2.5 Provide to DCS an annual progress report with information from each county.
DocuSign Envelope ID: F86035A9-F3D4-4851-A967-D524BE96E928
7.2.6 As the cash receipt and disbursement entity, shall disburse funds to County
upon receiving the Title IV-E reimbursement funds from DCS.
7.3
DCS Shall:
7.3.1
Be considered a pass-through entity of the federal award.
7.3.2
Be responsible for providing annual trainings and, if needed, periodic refresher
sessions to the County, AOC, and others who participate in the Title IV-E legal
representation funding process. Annual training may include a Title IV-E
overview, allowable and non-allowable claiming activities, changes to
expenditure claiming, policies, documents, and informational updates.
7.3.3
Approve the County's claiming methodology.
7.3.4
Apply the Arizona DCS Title IV-E penetration rate/population factor(% Title
IV-E eligible children) to the total county expenditures and claim 50% FFP
administrative
reimbursement,
upon
receipt of a "Certification of
Expenditures" form.
7.3.5
Disburse, to AOC the County's share of the Federal Title IV-E reimbursement
via an AFIS transfer, upon receiving the Federal Title IV-E reimbursement
funds.
7.3.6
Track, report and ensure timely transfer of IV-E Federal Reimbursement to
AOC.
7.3.7
Provide technical support and direction on Federal Title IV-E policy.
7.3.8
Retain no more than $95,000 annually for the administrative expenses
associated with processing claims.
7.3.9
Complete and submit required reporting documents to federal cognizant
agency in pursuant with the Federal Funding Accountability and Transparency
Act (FF AT A).
7.3.10 Evaluate risk of County non-compliance with federal statutes, regulations, and
the terms and conditions of the subaward for purposes of determining the
appropriate subrecipient monitoring.
7.3.11 Perform subrecipient monitoring, including but not limited to, review of
County financial records and performance reports for the purpose of
monitoring activities as necessary to ensure funds are used for authorized
purposes; verify that the County is audited as expected by federal requirements.
1. Issue management decisions for applicable audit findings pertaining to the
County.
Dave Byers
Digitally signed by Dave Byers
Date: 2022.12.02 09:16:40
-07'00'
DocuSign Envelope ID: F86035A9-F3O4-4851-A967-D524BE96E928
2. Confirm action is taken by County to address deficiencies detected audits, on-
site reviews and written confirmation.
16.0
RECORDS & AUDIT
16.1
Pursuant to A.R.S § 35-214 and § 35-215, AOC and County shall retain and shall
contractually require each subcontractor to retain all data, books and other records
("Records") relating to this Agreement for a period of five (5) years after the end of the
current federal fiscal year. All records shall be subject to inspection and audit upon
request by DCS. AOC and County shall produce the original of any or all such Records
at no cost. Such records shall exclude attorney work product and confidential
information.
16.2
Pursuant to 2 CFR § 200.332, the County permits DCS access to the County records
and financial statements as necessary for the pass-through entity requirements. DCS
will monitor activities as necessary to ensure funds are used for authorized purposes,
in compliance with Federal statutes, regulations, and the terms and conditions; and that
performance goals are achieved.
David K. Byers, Director
Rob~rt8~~~fr~o, Deputy Director
Arizona Department of Chi Id Safety
Arizona Administrative Office of the Courts
Date: --------------
Date: 11/22/2022 I 3: o s PM MST
Chairman, Board of Supervisors
Date: --------------
Clerk of the Board
Date: --------------
Deputy County Attorney
Date: --------------
SIGN
SIGN
SIGN
DEPARTMENT OF CHILD SAFETY
Legal Representation for Children/Parents
Cost Allocation Methodology
COUNTY:
___ Maricopa County ________ _
Print County Name
Title IV-E of the Social Security Act requires that only IV-E allowable expenditures are included in each
request for federal reimbursement. Non-allowable IV-E expenditures must not be included in the request
for federal reimbursement.
The State must ensure that only allowable IV-E Legal Cost are allocated and Charged to the State
County Name: _Lauren Cochran Williams __ is providing DCS with the following cost allocation
methodology used by the county for claiming only IV-E allowable expenditures and documenting the
processes in place for the counties claiming.
How is your county tracking the allowable IV-E legal representation activities and expenditures from
the unallowable IV-E legal representation activities and expenditures before submitting your invoice to
AOC/DCS for federal reimbursement? As part of your response please, include how your county will
specifically address delinquency vs Dependency representation. Please be specific.
County Response (Response can be an attachment to this template.)
Maricopa County uses activity based budgets in determining applicable IV-E expenses. The categories for
these expenses are assigned to Parental Dependencies, Child Dependency Representation and Juvenile
Guardian ad litem. The county uses transaction reports that identify expenses charged to these
particular categories. For staffed offices, a payroll detail report is used. Only attorneys that spend 100%
of their time on dependency cases are submitted for reimbursement. If an attorney is charged to
dependency and any other case type we do not request reimbursement. For contract counsel, attorney
and paralegal invoices are submitted by case number. Each invoice is audited and charged to the
appropriate activity, ensuring only dependency cases are paid for in the activities listed above.
AMENDMENT TO Interagency Agreement (Agreement) Between Arizona Department of
Child Safety (DCS), the Arizona Supreme Court, Administrative Office of the Courts (AOC)
and
Maricopa County
Exhibit 1
2 CFR § 200.332 REQUIREMENTS
Federal A ward
Title IV-E Faster Care
Federal A ward Date
09/30/2020
Federal Award Number/CFDA#
2101AZFOST
93.658
Subrecipient Name
Maricopa County
Subrecipient's Unique Entity Identifier
YC11KWJKWM97
Subaward Period of Performance
10/1/2022-9/30/2023
Subaward Budget Period
10/1/2022-3/31/2024
Subaward Projected Award Amount*
$3,159,189
*This subaward projected award amount is for the annual year and will be disbursed in quarter
increments.
ARIZONA
DEPARTMENT
of CHILD SAFETY
Mike Faust, Director
Douglas A. Ducey, Governor
Date
Re:
Notice of Award-FY
Dear
Name of Award
Grantee Name
Congratulations! The Department of Child Safety is pleased to inform you that your request for funding has been awarded.
This grant award represents obligation for fiscal year
These funds are subject to the requirements of the
Award Number
Award Performance Period
Award Budget Period
Award Amount
Allocation Amount
FAIN No.
CFDA No.
EIN:
UEI/DUNS:
Fiscal Year
Program
for the ~------------ program.
Program
With the acceptance of this award, you agree to administer this grant in
compliance with conditions set forth in the Interagency Agreement 1bis award is
also subject to the requirements of2 CFR § 200.332 REQUIREMENTS as it aligns
with subrecipient funding.
Your Point of
Contact for
this grant is:
We look forward to working with you on our shared commitment to meeting the needs of Arizona's families as we prepare for the
implementation of the
program.
---------------------------
Sincerely,
Arizona Department of Child Safety
Equal Opportunity Employer/Program. The Department of Child Safety (DCS) prohibits discrimination in admissions, programs, services, activities, or
employment based on race, color, religion, sex, national origin, age, disability, genetics, or retaliation or any other status protected by federal law, state law, or
regulation. Reasonable accommodations to allow a person with a disability to take part in a program, service, or activity are available upon request. To request
this document in alternative format or for further information about this policy contact your local office. TTY/TDD Services: 7-1-1. Free language assistance
for DCS services is available upon request. Ayuda gratuita con traducciones relacionadas con los servicios de! DCS esta disponible a solicitud de] cliente.
CS0-3284
(09/22)
Instructions for completing the Legal Representation request for reimbursement
Arizona can claim federal reimbursement under the Title IV-E program for administrative costs of independent legal representation provided by an
attorney under section74(a)(3) of the Act and 45 CFR 1356.60(c). This includes costs for attorneys who provide independent legal representation for the
child welfare agency, a child/youth who is a at imminent risk of being removed from their home and placed into foster care or is currently in foster care,
and the child/youth's parents to prepare for and participate in all stages of foster care related legal proceedings.
*This form must be completed and submitted to DCS quarterly, within 30 days following the end of each quarter. The completed form must be emailed
to: Bruce.Halliday@azdcs.gov and Sherry.Fang-Mounier@azdcs.gov
County Breakdown - COMPLETED BY AOC
Allowable Expenditures and Number Fill in the grey cells based on each of the individual county reports, potentially copy/pasted depending on how
of Children
they are sent .
Certification of Expenditures Form-Summary - COMPLETED BY DCS
Section
Instructions
Name and Address of Provider
Complete the header information in cells: provider name, contact person, telephone number of contact person,
invoice number and invoice period.
Number will be pulled over automatically from the Certification of Expenditures tab, counties do not have to
complete any information on this tab. AZ population factor will be entered by DCS and will need updated each
Summary of Reimbursement
quarter.
Summary of Federal Reporting
To be completed by DCS to align with CB-496 reporting requirements.
Definition of Terms
Only costs related to child welfare should be reported. Allowable costs related to foster care proceedings include: Hearings related to
judicial determinations that it is contrary to the welfare of a child to remain in the home; Hearings related to a child's removal from the
home; Hearings related to judicial determinations that the agency provided reasonable efforts to prevent removal and finalize the
permanency plan; Permanency hearings; Hearings related to progress on case plans; and Appeal proceedings that relate to judicial
determinations required under Title IV-E.
Allowable costs related to all stages of dependency proceedings include: Independent investigation of the facts of the case, including
Allowable Costs
interacting with law enforcement; Meeting with clients or making home or school visits; Attending case planning meetings; Providing legal
interpretations; Preparing briefs, memos or pleadings; Obtaining transcripts; Interviewing and preparing their client and witnesses for
hearings; Hearing presentation; Maintaining files; Supervising attorneys, paralegals, investigators, peer partners or social workers that
support an attorney in providing independent legal representation to prepare for and participate in all stages of dependency proceedings;
Filing child abuse and neglect petitions for candidates for foster care; Court fees to file a petition for a judicial determination required
under Title IV-E; and Appellate work in reference to dependency proceedings.
Title IV-E reimbursement is on a cash basis, therefore the costs must be based on when expenditures were made not when the service was
rendered.
Backup Documentation
Each legal provider must maintain administrative fiscal records that substantiate the costs invoiced on this form and produce them upon
request for any internal or external review or audit.
Federal Financial
The portion of costs the federal government will reimburse for allowable costs- this is 50 percent. The total costs with the population factor
Participation (FFP)
applied is entered on the CB-496. The CB-496 applies the 50 percent to this amount.
Number of Children in
The number of children served through these legal representation activities who are placed in out of home dependency (foster care) in that
Foster Care
month and whose legal representation expenditure was paid for in that month.
Number of In Home
The number of children who have an open in-home dependency or in-home intervention case, are at imminent risk of removal, the
Children
planned placement is foster care and whose legal representation expenditure was paid for in that month. All other in-home cases should be
excluded from this count.
Quarter Ending
The form needs to be completed each quarter. The quarters are October 1 - December 31, January 1 - March 31, April 1 - June 30, July 1-
September 30.
Reasonable Candidates
A candidate for foster care is a child who is at serious risk of removal from home as evidenced by DCS either pursuing his/her removal from
the home or making reasonable efforts to prevent such removal.
The federal Title IV-E Foster Care program helps to provide safe and stable out-of-home care for children and youth until they can be safely
returned home, placed permanently with adoptive families or placed in other planned arrangements for permanency. The program is
authorized by Title IV-E of the Social Security Act (the Act) and implemented under the Code of Federal Regulations (CFR) at 45 CFR parts
Title IV•E
1355, 1356, and 1357. The program has specific eligibility requirements and fixed allowable uses of funds. Funds are available for monthly
maintenance payments for the daily care and supervision of eligible children; administrative costs necessary for the proper and efficient
administration of the program; training of staff and foster care providers; recruitment of foster parents and costs related to the design,
implementation and operation of a state-wide data collection system. Recognizing the importance federal funding has to improve practice,
CB issued revised and new policies to allow child welfare agencies to claim Federal Financial Participation (FFP) for administrative costs of
independent legal representation provided by an attorney under section 474(a)(3) of the Act and 45 CFR 1356.G0(c).
Any non-child welfare related costs such as costs related to delinquency or criminal cases or any other non related legal case-child welfare
Unallowable Costs
such as housing, immigration, or traffic related activities are not eligible under Title IV-E Costs that are not directly attributable to the cost
of attorneys for parents or children in dependency or termination cases, or they were not supported by appropriate records.
Unduplicated Count
The unique number of children or parents for whom legal representation services that correspond to the expenditures in that month.
Arizona Title IV-E Legal Pass-Through - Certification of Expenditure by County
The Arizona Administrative Office of the Courts {AOC) is providing the Arizona Department of Child Safety {DCS) with the following expenditures and
corresponding case counts for submittal to the federal ACF Children's Bureau for Title IV-E reimbursement.
Within 30 days following the end of each quarter, this form must be emailed to: Bruce.Halliday@azdcs.gov and Sherry.Fang-Mounier@azdcs.gov
REQUEST FOR REIMBURSEMENT
Reporting (Invoice) Period
County
Apache
Cochise
Coconino
GIia
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
,~OTAL EXPENDITURES DURING THE QUARTER
AVERAGE UNDUPLICATED MONTHLY CASE COUNT
PERCENTAGE OF AVERAGE MONTHLY CASES
Month
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
April
May
June
Quarter
Year
'----'Q"-E--''.6"-/30c..c... __ ...._ __
-'-2020"--___
_.·I (Period in which expenditures were paid)
QE= Quarter Ending
Paid Allowable
Number of Children in
Number of In-home
Expenditures1
Foster Care2
Children '
"
"'
·.
'
"'"
.,
"-'
Ii
-
'
t:"~
-
-
,.
Ill
,.
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....
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.
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..
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$0.00
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/DI
1 Paid Allowable Expenditures includes expenditures far legal representation far parents or children paid in that month.
2 Number of Children in Foster Care: the unduplicated number of children who are placed in out-of-home dependency (i.e., foster care} whose legal representation was paid for in that
month.
3 Number of Children living in their own home (not placed in faster care}: the undup/icated number of children who have an open in-home dependency or in-home intervention case
that are imminent risk of removal and placement into foster care whose legal representation was paid far in that month.
Attestation:
The information above is true and accurate to the best of my knowledge. The expentltures submitted for Title IV-E federal reimbursement exclude costs that are not allowable under the Title IV-E
program. In accordance with the agreement between the County, the Department of Child Safety, and the Administrative Office of the Courts, each County will maintain their administrative fiscal
records that substantiate costs invoiced and produce them upon request for any Internal or external review or audit.
Signature:
Arizona Title IV-E Legal Pass-Through - Certification of Expenditure Form - Summary
REQUEST FOR REIMBURSEMENT/REPORTING SUMMARY
Quarter
Calendar Year
Reporting (Invoice) Period I
QE 6/30
I
2020
I
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Total Allowable Expenses
In-Placement (Foster Care) Percentage of Children
Fgster Care Expenditures
$0.00
#DIV/0I
#DIV/0!
Foster Care Candidate (In-home dependency/intervention) Percentage of Children
Foster Care Candidate (In-home dependency/intervention) Expenditures
1irnJM1!U ~s~.rtt~~I/R.fil!ORTIN~ §JJi fviAit'f1t p ~ecomfll"it£~by DG§/J9r £fS-1f.Se ip{eg?,ra/ r~porilng)
To be completed by DCS
AZ Foster Care Population Factor
1..
1~.QQ¾
.1
For submission on the federal form CB-496
CB-496 Line 8. In-Placement Administrative Costs -
#DIV/0!
CB-496 Line 10b. Title IV-E Foster Care Candidate Administrative Costs - Legal
CB-496 Line 49b. Number of Children: In-Placement -
#DIV/0!
CB-496 Line Slb. Number of Children: Title IV-E Foster Care Candidate -Title IV-E Funded
#DIV/0I
#DIV/0!
#DIV/0!
#DIV/0I
'Adrnn1l.<can.¢1cJifn·fedeti:!1,Jeimbursement,,i,:1nder the Title·1v-~,,prowam fQr.cJqh)Jhistratlve••Costs of:ti:iq~penderitleg~hrepresentiil.Jion prgvidf;l(f'.byan
attomey,undersection74fa)(3)ofthe,Actand·4SCtl:t 1356f60(d). Tblslritludes oostsfor attorneyswhoc:provide :inclependenttlegal representation for a
child;fyollthwho::is a atimrnineotrisk ofbeJngaremo11edJromtheir home 1l.nd;:place1:Wnto foster care or·is t;\.ltrent!ye:in'foster•c::!'!te; cl!ld the child/youth's
parentsto:prepar:e,for ijhdilpar,tic\pate"in ,.arnstages:o'fifoster care .. reflateddegal>:ptote'l:!dings,
*1h~ .reqµ~~! NI reJmJ:Jµrsemeotlbrm · mtf~t bet9Ji7ple_ted amlsubrnit(ed,qllgr-terly, withih i'5 day~afpllowipgthe ehd ,qf each.,q1J13rter.
Section
Request for Reimbursement
Name and Address of Provider
Summary of Expenses for
Reimbursement
Attestation
Cert(ftcation a/ Expenditures Form
·
~~
lnstr:uctions
Select the Quarter and Year for the requested reimbursement.
Complete the header information in cells: provider name and address, county invoice number, contact person,
telephone number, email address, and county.
a. For each corresponding quarter/month add_t_~_federal fiscal year that aligns with the reporting period.
b. Add monthly allowable Title IV-E expenditures to each line - see definitions tab for examples of allowable costs
and paid allowable expenditures.
c. Add the monthly number of children who are placed in foster care whose legal representation expenditure was
paid for in that month under the Number of Children in Foster Care column.
d. Add the monthly number of children, who have not entered foster care whose legal representation
expenditure was paid for in that month and meet the definitions of a "reasonable candidate" (see definitions tab)
under the Number of Children in Foster Care column.
Signatory of person authorized to attest and certify costs reported on invoice.
Definition of Terms
Only costs related to child welfare should be reported. Allowable costs related to foster care proceedings include: Hearings related to
judicial determinations that it is contrary to the welfare of a child to remain in the home; Hearings related to a child's removal from the
home; Hearings related to judicial determinations that the agency provided reasonable efforts to prevent removal and finalize the
permanency plan; Permanency hearings; Hearings related to progress on case plans; and Appeal proceedings that relate to judicial
determinations required under Title IV-E.
Allowable costs related to all stages of dependency proceedings include: Independent investigation of the facts of the case, including
Allowable Costs
interacting with law enforcement; Meeting with clients or making home or school visits; Attending case planning meetings; Providing legal
interpretations; Preparing briefs, memos or pleadings; Obtaining transcripts; Interviewing and preparing their client and witnesses for
hearings; Hearing presentation; Maintaining files; Supervising attorneys, paralegals, investigators, peer partners or social workers that
support an attorney in providing independent legal representation to prepare for and participate in all stages of dependency proceedings;
Filing child abuse and neglect petitions for candidates for foster care; Court fees to file a petition for a judicial determination required
under Title IV-E; and Appellate work in reference to dependency proceedings.
Title IV-E reimbursement costs are based on when expenditures were paid not when the service was rendered.
Backup Documentation Each legal provider/county must maintain administrative fiscal records that substantiate the costs invoiced on this form and produce them
upon request for any internal or external review or audit.
Number of Children in The number of children served through these legal representation activities who are placed in out of home dependency (foster care) in that
Foster care
month and whose legal representation expenditure was paid for in that month.
Number of In Home
The number of children who have an open in-home dependency or in-home intervention case, are at imminent risk of removal, the planned
Children
placement is foster care and whose legal representation expenditure was paid for in that month. All other in-home cases should be
excluded from this count.
Paid Allowable
Expenditures are considered made on the date the payment occurs, regardless of the date of receipt of the good or performance of the
Expenditures
service.
'
Quarter/Quarter Ending The form needs to be completed each quarter. The quarters are October 1 - December 31, January 1 - March 31, April 1 -June 30, July 1-
September 30.
Reasonable Candidate A candidate for foster care is a child who is at serious risk of removal from home as evidenced by DCS either pursuing his/her removal from
the home or making reasonable efforts to prevent such removal.
The federal Title IV-E Foster Care program helps to provide safe and stable out-of-home care for children and youth until they can be safely
returned home, placed permanently with adoptive families or placed in other planned arrangements for permanency. The program is
authorized by Title IV-E of the Social Security Act (the Act) and implemented under the Code of Federal Regulations (CFR) at 45 CFR parts
1355, 1356, and 1357. The program has specific eligibility requirements and fixed allowable uses of funds. Funds are available for monthly
Title IV-E
maintenance payments for the daily care and supervision of eligible children; administrative costs necessary for the proper and efficient
administration of the program; training of staff and foster care providers; recruitment of foster parents and costs related to the design,
implementation and operation of a state-wide data collection system. Recognizing the importance federal funding has to improve practice,
CB issued revised and new policies to allow child welfare agencies to claim Federal Financial Participation (FFP) for administrative costs of
independent legal representation provided by an attorney under section 474(a)(3) of the Act and 45 CFR 1356.60(c).
Any non-child welfare related costs such as costs related to delinquency or criminal cases or any other non related legal case-child welfare
Unallowable Costs
such as housing, immigration, or traffic related activities are not eligible under Title IV-E. This also includes costs that are not directly
attributable to the cost of attorneys for parents or children in dependency or termination cases, or they were not supported by
appropriate records.
Unduplicated Count
The unique number of children or parents for whom legal representation services that correspond to the expenditures in that month.
Arizona Title IV-E Legal Pass-Through - Certification of Expenditure Form
Quarter
Year
REQUEST FOR REIMBURSEMENT
Reporting (Invoice) Period
___
Q_
· E_:6~/_;3_0 __ ~
___
2~92~.0 __ ~I {Period in which expenditures were paid)
QE= Qtr. Ending
NAME AND ADDRESS OF PROVIDER {All gray fields required}
Provider's Legal Name:
Address:
Email To
'PrGvitler A
Address,!
Apgre,~ ~
Rob Shelley
rshelley@courts.az.gov
SUMMARY OF EXPENSES FOR REIMBURSEMENT
Show only expenditures made during the months of this quarter.
Refer to Definitions tob to review guidance about allowable paid expenditures.
Contact Person: -
Telephone Number:
Email
Paid Allowable
Number of Children Number of In-home
Quarter
Federal Fiscal Year
Month
Expenditures
1
2
3
in Foster Care
Children
April
QE 6/30
2020
May
.
,,
June
Ill
II
.. --
TOTAL EXPENDITURES DURING THE QUARTER
$0.00
AVERAGE UNDUPLICATED MONTHLY CASE COUNT
#DIV/0!
#DIV/0!
PERCENTAGE OF AVERAGE MONTHLY CASES
#DIV/0!
#DIV/0!
1 Paid Allowable Expenditures includes expenditure for legal representation for parents or children paid in that month.
2 Number of Children in Foster Care: the unduplicated number of children who are placed in foster care whose legal representation was paid for
in that month.
3 Number of Children reside in-home (not placed in foster care): the unduplicated number of children who have an open in-home dependency or
in-home intervention case that are imminent risk of removal and placement into foster care whose legal representation was paid for in that
month.
Attestation:
The information above is true and accurate to the best of my knowledge. This excludes costs that are not allowable under the Title IV-E
program (for example delinquency or criminal cases) or are currently being reimbursed by any other federal funding source. In accordance
with my County's agreement with the Department of Child Safety (DCS) and the Administrative Office of the Court (AOC) we will maintain
administrative fiscal records that substantiate costs invoiced and produce them upon request for any internal or external review or audit to
DCS.
Signature and Title of Authorized Representative
Date
Submit this form within fifteen (15} days fa/lawing the end of each quarter
DRAFT January 2021