This letter transmits revisions to the JFS 02911 “Title IV-E Single Cost Report” and JFS 02911-I “Instructions for Completing JFS 02911, Title IV-E Single Cost Report” which are used pursuant to Ohio Administrative Code (OAC) rule 5101:2-47-26.1 “Title IV-E Agencies, Private Child Placing Agencies (PCPA), Private Noncustodial Agencies (PNA), Residential Care Facilities, Substance Use Disorder (SUD) Facilities and a Qualified Residential Treatment Program (QRTP): Title IV-E Cost Report Filing Requirements, Record Retention Requirements and Related Party Disclosure Requirements.”

The revised form and instructions are to be used for the state fiscal year reporting period of July 1, 2020, through June 30, 2021 (SFY 2021).

An explanation of the revisions to the cost report form and instructions appears below:

Form

• All worksheet footers updated to reflect "JFS 02911 (Rev. 8/2021)."
• Based upon Consumer Price Index data for SFY 2021, an inflation factor of 9.6% has been added to the calculated amounts on the Title IV-E Reimbursement Ceiling Per Diem Amount and Cost Per Diem Amount Calculations worksheet.

Instructions

• Date references were revised to reflect proper reporting and effective periods.
• Facility Expense, Rental of Privately-Owned Building, updated in accordance with Title 2 U.S. Code of Federal Regulations Part 200, Section 465, to address proper reported amount for less-than-arm’s length transactions (i.e., related party rental/lease agreements).

An agency which seeks to establish Title IV-E reimbursement ceilings for the effective period April 1, 2022, through March 31, 2023, must complete the filing requirements outlined in OAC rule 5101:2-47-26.1 (cost report) and OAC rule 5101:2-47-26.2 (agreed-upon procedures) for SFY 2021.