Indirect/Administrative Costs – This cost pool includes



XYZ Community-Based Care, Inc.

Child Welfare Cost Allocation Plan Amendment

(Name), CEO

(Street Address)

(City, Florida zip)

Effective 1/1/2019

Section I – Certification

XYZ Community-Based Care, Inc.

Certification by Responsible Individual

I hereby certify, as the responsible official of XYZ Community-Based Care, Inc., that the following is correct to the best of my knowledge and belief:

• This Cost Allocation Plan has been developed in accordance with the requirements of Uniformed Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (also known as the Super Circular), Code of Federal Regulations Title 2, Part 200 and is referenced hereafter as (2 CFR, Part 200).

• The allocation methodologies contained in this Cost Allocation Plan have been developed on the basis of a beneficial or causal relationship between the expenses incurred and the receiving organizational units or programs.

• Costs related to each activity are based on the current reporting month. All costs have been screened for allowable costs in accordance with 2 CFR, Part 200.

• An adequate accounting and statistical system exists to support claims that will be made under the Cost Allocation Plan.

• The same costs that have been treated as indirect costs have not been claimed as direct costs. Similar types of cost have been accounted for on a consistent basis.

• The information provided in support of the proposed Cost Allocation Plan is accurate.

__________________________

Signature

Printed Name

Title

Date

In Section IX – Community-Based Care Managed Costs

Cost Allocation Plan revision

The following cost pools approved in the initial plan for State Fiscal Year 2018-2019 are discontinued as of services through 12/31/2018 and replaced by the additions below.

EFCFH – Extended Foster Care – Foster Home – Room and Board

EFCGH – Extended Foster Care – Group Home – Room and Board

EFCSL – Extended Foster Care – Other Supervised Living Arrangement – Room and Board

KRA00 – Extended Foster Care – Allowance Payment

KRCME – Case Management Extended Foster Care

Cost Allocation Plan Amendment - Additions

Adoption Subsidies

WR002 – Title IV-E Extended Adoption Subsidies – Effective 1/1/2019, this cost pool captures cost of adoption subsidy payments as recorded in the Florida Safe Families Network (FSFN) system for those adopted clients ages 18, 19 and 20, who meet the Title IV-E eligibility requirements AND who were at least 16 years of age when adopted from foster care after spending at least six months in the Department's custody within the twelve months immediately preceding such adoption AND are either: completing secondary education or a program leading to an equivalent credential; enrolled in an institution that provides postsecondary or vocational education; participating in a program or activity designed to promote or eliminate barriers to employment; employed at least 80 hours per month; or unable to participate in programs or activities listed above on a full-time basis due to a physical, intellectual, emotional, or psychiatric condition that limits participation. Any such barrier to participation must be supported by documentation in the child's case file, education file, or medical records within FSFN. Costs are charged in accordance with the funding matrix included as Attachment I.

CBC Cost Allocation Plan Requirement – The CBC will provide a description of the types of costs that will be charged to this cost pool and the chart of accounts values in their accounting system to capture and report these costs.

WO007 – Child Welfare Extended Adoption Subsidies – Effective 1/1/2019, this cost pool captures cost of adoption subsidy payments as recorded in the Florida Safe Families Network (FSFN) system for those adopted clients ages 18, 19 and 20, who do not meet the Title IV-E eligibility requirements AND who were at least 16 years of age when adopted from foster care after spending at least six months in the Department's custody within the twelve months immediately preceding such adoption AND are either: completing secondary education or a program leading to an equivalent credential; enrolled in an institution that provides postsecondary or vocational education; participating in a program or activity designed to promote or eliminate barriers to employment; employed at least 80 hours per month; or unable to participate in programs or activities listed above on a full-time basis due to a physical, intellectual, emotional, or psychiatric condition that limits participation. Any such barrier to participation must be supported by documentation in the child's case file, education file, or medical records within FSFN. Costs are charged in accordance with the funding matrix included as Attachment I.

CBC Cost Allocation Plan Requirement – The CBC will provide a description of the types of costs that will be charged to this cost pool and the chart of accounts values in their accounting system to capture and report these costs.

Extended Foster Care, Road-to-Independence Program, and Independent Living Program

EFCCM –Extended Foster Care Case Management – Effective 1/1/2019, this cost pool captures the cost of the certified child welfare professional positions in the community-based care (CBC) lead agencies providing case management to Title IV-E eligible Extended Foster Care youth. A Certified Child Welfare Professional Case Manager is an individual who has demonstrated the knowledge, skills, abilities and priorities necessary to competently discharge their duties, as evidenced by their successful completion of all applicable classroom instruction, field training, testing and job performance requirements for their position classification. The federal Fostering Connections to Success and Increasing Adoptions Act of 2008 gives states the option of allowing youth to remain in foster care after reaching age 18 up to age 20, or 21 with a documented disability and meet certain eligibility requirements.

Allocation methodology – Costs are charged in accordance with the funding matrix included as Attachment I.

CBC Cost Allocation Plan Requirement – In this section, the CBC should provide a description as to how these services are provided including an indication as to whether they are provided by CBC staff or sub-contracted agencies (or both), an organizational chart, anticipated number of case managers carrying a caseload, anticipated average caseload per manager, anticipated staff to supervisor ratios, and other types of costs that are charged to the cost pool, such as the types of expenses specific to the Extended Foster Care certified case managers. In addition, the CBC should provide a description as to how the CBC ensures that only eligible costs are charged to this cost pool, such as the staff within the CBC responsible for assigning the account code/OCA/Cost Pool and how their accounting system captures these costs. The CBC should provide the general ledger account and sub-account codes as listed in the Chart of Accounts that are used to capture the costs included in this cost pool.  If the account/sub-account codes are not unique for this cost pool, explain how the costs are identified for this cost pool.  Attachments may be used to simplify the explanation of allocated costs.

Extended Foster Care (EFC) – {Effective January 1, 2019}

As used in the EFC section, the term “child” means an individual who has not attained 21 years of age, and the term “young adult” means an individual who has attained 18 years of age, but who has not attained 21 years of age.

EFRBE – Title IV-E Eligible Extended Foster Care Payments –

Effective 1/1/2019, this cost pool captures the cost of the Title IV-E eligible Extended Foster Care (EFC) payments recorded in the Florida Safe Families Network (FSFN) System for young adults in Extended Foster Care, ages 18, 19 and 20, or 21 with a documented disability. These payments are for "room and board" expenses which include but are not limited to: deposits for housing and utilities, safe housing, utilities, including electricity, gas, water and garbage collection. Other payments may include child care payments to a licensed child care facility, for a young adult with a child, to meet their education, training and/or work requirement, expense related to a qualifying activity, and transportation to and from the young adult's qualifying activities.

Young adults, ages 18, 19 and 20, or 21 with a documented disability who are in Extended Foster Care, in a supervised living arrangement and are: completing secondary education or a program leading to an equivalent credential, enrolled

in an institution that provides postsecondary or vocational education, participating in a program or activity designed to promote or eliminate barriers to employment, employed for at least 80 hours per month, or unable to participate in programs or activities listed above. full time due to a physical, intellectual, emotional, or psychiatric condition that limits participation. Any such barrier to participation must be supported documentation in the child's case file or school or medical records.

CBC Cost Allocation Plan Requirement – The CBC will provide a description of the types of costs that will be charged to this cost pool and the chart of accounts values in their accounting system to capture and report these costs.

EFRBI – Title IV-E Ineligible Extended Foster Care Payments –

Effective 1/1/2019, this cost pool captures the cost of the Title IV-E ineligible Extended Foster Care (EFC) payments recorded in the Florida Safe Families Network (FSFN) System for young adults in Extended Foster Care, ages 18, 19 and 20, or 21 with a documented disability. These payments are for "room and board" expenses which include but are not limited to: deposits for housing and utilities, safe housing, utilities, including electricity, gas, water and garbage collection. Other payments may include child care payments to a licensed child care facility, for a young adult with a child, to meet their education, training and/or work requirement, expense related to a qualifying activity, and transportation to and from the young adult's qualifying activities.

Young adults, ages 18, 19 and 20, or 21 with a documented disability who are in Extended Foster Care, in a supervised living arrangement and are: completing secondary education or a program leading to an equivalent credential, enrolled

in an institution that provides postsecondary or vocational education, participating in a program or activity designed to promote or eliminate barriers to employment, employed for at least 80 hours per month, or unable to participate in programs or activities listed above. full time due to a physical, intellectual, emotional, or psychiatric condition that limits participation. Any such barrier to participation must be supported documentation in the child's case file or school or medical records.

CBC Cost Allocation Plan Requirement – The CBC will provide a description of the types of costs that will be charged to this cost pool and the chart of accounts values in their accounting system to capture and report these costs.

|Attachment I – Funding Sources |

| |

| |

| |

|OCA |CFDA/CSFA |Fund Description |

|Adoption Subsidies  |

|39MAS |93.558 |BG - TEMPORARY ASSISTANCE FOR NEEDY FAMILIES(TANF) |

|  |93.558 |BG - TEMPORARY ASSIST FOR NEEDY FAMILIES (TANF MOE |

|SFMSA |93.658 |FG - STATE TITLE IV-E FOSTER CARE |

|WO006 |93.603 |FG - TITLE IV-E ADOPTION INCENTIVE PAYMENTS |

|  |93.658 |FG - STATE TITLE IV-E FOSTER CARE |

|WO007 |93.603 |FG - TITLE IV-E ADOPTION INCENTIVE PAYMENTS |

|  |93.658 |FG - STATE TITLE IV-E FOSTER CARE |

|WR001 |93.659 |FG - TITLE IV-E ADOPTION ASSISTANCE PMTS |

|  |93.659 |FG - TITLE IV-E ADOPTION ASSIST PMTS/ADMIN - MATCH |

|WR002 |93.659 |FG - TITLE IV-E ADOPTION ASSISTANCE PMTS |

|  |93.659 |FG - TITLE IV-E ADOPTION ASSIST PMTS/ADMIN - MATCH |

|Extended Foster Care (EFC) Admin/Direct Services and Dually Enrolled EFC and Road-to-Independence Program / Postsecondary Education & |

|Support Services |

|EFCFH |60.141 |ST CSFA - EXTENDED FOSTER CARE |

|EFCGH |60.141 |ST CSFA - EXTENDED FOSTER CARE |

|EFCOE |60.141 |ST CSFA - EXTENDED FOSTER CARE |

|EFCSL |60.141 |ST CSFA - EXTENDED FOSTER CARE |

|EFRBE |93.658 |FG - TITLE IV-E FOSTER CARE |

|  |93.658 |FG - TITLE IV-E FOSTER CARE - MATCH |

|EFRBI |93.658 |FG - TITLE IV-E FOSTER CARE - MATCH |

|KRA00 |93.674 |FG - INDEPENDENT LIVING PROGRAM |

|  |93.674 |FG - INDEPENDENT LIVING PROGRAM - MATCH |

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