INSTRUCTIONS FOR FORM ACF-4125
ANNUAL STATISTICAL REPORT ON CHILDREN IN FOSTER HOMES
AND CHILDREN IN FAMILIES RECEIVING PAYMENTS IN EXCESS
OF THE POVERTY INCOME LEVEL FROM A STATE PROGRAM FUNDED
UNDER PART A OF TITLE IV OF THE SOCIAL SECURITY ACT
The formulas for computing Title I, Part A grants to local education agencies, a program whose purpose is to
improve the academic achievement of low-achieving students served by the program and that is authorized by
the Elementary and Secondary Education Act of 1965, as amended by Public Law 114-95, includes October
caseload data for children in foster homes supported with public funds, and children in families receiving
annual payments in excess of the current poverty income level from a State program funded under part A of
Title IV of the Social Security Act (Block Grants to States for Temporary Assistance for Needy Families
(TANF)). The purpose of this annual survey is to provide these data for each local educational agency (LEA)
or county so that funds may be allocated on an equitable basis. An electronic (MS Excel) version of this report
is available on the Office of Family Assistance’s Home Page TANF Programs Data & Reports ACF-4125:
This report is required annually of all State agencies administering or supervising administration of
TANF and child welfare programs, including the District of Columbia and Puerto Rico. Guam, the
Virgin Islands, and American Samoa are not required to report. No sampling or estimating is to be
used in preparing this report. Since the data reported will generate Federal funds, they are subject to
audit and must be supportable based on State TANF and foster care records.
Complete both Parts I and II. Provide data for each LEA or county listed in the excel file provided with this
report form. If data are provided by LEA, it is not necessary to provide them by county.
For purposes of both parts of this form, a child who reaches the age of five years during October should be
included in the count. A child who attains 18 during October should not be counted.
Report, by LEA, the number of children aged 5-17 (inclusive) living in foster homes supported by public funds
during the month of October 2016. If the data are not available by LEA, report by county. Include foster homes
of all types and under all programs, i.e., public agency foster homes; group homes and foster homes where care
is purchased by public agencies. "Public funds" is defined as monies (Federal, State and/or local) which are
used by public assistance agencies to support foster children.
Children receiving foster care in institutions operated primarily for the care of neglected or delinquent children
must not be included in this report because a separate survey [U.S. Department of Education ED FORM 4376]
is conducted annually to collect the data on children in neglected or delinquent institutions.