Under Title IV-E of the Social Security Act, states, territories, and tribes are entitled to claim partial federal reimbursement for the cost of providing foster care, adoption assistance, and kinship guardianship assistance to children who meet federal eligibility criteria. The Title IV-E program, as it is commonly called, provides support for monthly payments on behalf of eligible children, as well as funds for related case management activities, training, data collection, and other costs of program administration. For FY2013, states spent $12.3 billion under the Title IV-E program and expected to receive federal reimbursement of $6.7 billion, or 54% of that spending. To be eligible to claim federal support under the Title IV-E program, a state, territory, or tribe must have a Title IV-E plan that is approved by the U.S. Department of Health and Human Services (HHS), Administration for Children and Families (ACF). The plan must provide that the state, tribal, or territorial agency that operates the Title IV-E program will adhere to all federal requirements related to providing direct financial assistance to all eligible children, including those related to ensuring the safety, permanence, and well-being of children receiving Title IV-E assistance. All 50 states, the District of Columbia, Puerto Rico, and 5 tribal entities have an approved Title IV-E plan. This report focuses on the Title IV-E plan requirements that largely address the child welfare goals of safety, permanence, and well-being of children. Safety refers to ensuring that children served are protected from further abuse or neglect. Permanence refers to the goal of ensuring that children do not spend too many of their formative years in foster care. Accordingly, if a child enters foster care the state must work to quickly and safely reunite a child with his or her parents, or, if that is not possible or appropriate, to quickly find another safe and permanent home for the child. Well-being is inextricably linked to children's safety and permanency. The term generally refers to efforts by the child welfare agency to promote positive developmental outcomes for the children they serve—including education and physical and mental health outcomes—as well as to enhance the capacity of children's families to help drive those positive outcomes. The Title IV-E plan is a single document that applies to all three Title IV-E program components (foster care, adoption, and kinship guardianship). No state may receive funding under any one of the Title IV-E components without meeting each of the plan requirements (whether that requirement is directed toward children in foster care, or those receiving adoption assistance, or kinship guardianship assistance). Although Title IV-E plan requirements primarily address meeting the needs of children while they are in foster care, those requirements are meaningful to other children receiving assistance under Title IV-E because nearly all children who receive Title IV-E adoption assistance, and all of those who receive Title IV-E kinship guardianship assistance, were previously in foster care. Additionally, the Preventing Sex Trafficking and Strengthening Families Act ( P.L. 113-183 ) mandates that states, under the Title IV-E plan, develop and implement protocols to identify, document, and determine necessary services for certain child welfare-involved children and youth who are victims of sex trafficking or at risk of being such victims. These protocols are to apply to children for whom the child welfare agency has an open case file (whether or not the child is, or was previously, in foster care), as well as to children who are in foster care, including those who have run away from their foster care placement, and youth formerly in foster care who are receiving services under the Title IV-E Chafee Foster Care Independence (CFCIP) program. P.L. 113-183 requires states to implement these protocols no later than September 29, 2016. A Title IV-E plan must be submitted to HHS, ACF using a "pre-print" (rather than as a narrative description). The "pre-print" is a form that lists each requirement of the plan and provides a space for the Title IV-E agency to fill in the relevant law, regulation, or policy indicating that it is in compliance with the given requirement. A state's Title IV-E plan must be amended and/or updated as necessary to reflect policy compliance with any new requirements included in the law. Funding spent under the Title IV-E program—both federal and state dollars—must be spent on "eligible activities" and on behalf of "eligible children." Eligible activities are, for the most part, described in the Title IV-E plan. In FY2013, state child welfare agencies spent $12.3 billion in federal and state Title IV-E dollars with the second -largest category of Title IV-E spending (25%, $3.1 billion) used to support the kind of Title IV-E "administrative" activities that are the primary focus of the plan requirements described in this report. These include requirements related to case planning and management for eligible children in foster care, pre-placement activities for eligible children at imminent risk of entering foster care; and licensing, recruitment, or background checks for foster care providers of eligible children. The single largest amount of FY2013 Title IV-E spending (28%, $3.5 billion) provided payments to support eligible children in new permanent families (including for adoption assistance and kinship guardianship assistance). Spending for foster care maintenance payments on behalf of eligible children in foster care (20%, $2.5 billion) represented the third-largest Title IV-E program spending category. (See Figure 1 for all Title IV-E spending.) As of October 2014, 29 states, the District of Columbia, and 1 tribe had approval for, or were already implementing, a Title IV-E waiver project. (Authority for HHS to issue these waivers expired on September 30, 2014.) Under a waiver, formally called a "child welfare demonstration project," states may be permitted to spend Title IV-E funds for activities other than those described in the Title IV-E plan—and for a broader set of individuals—so long as the project meets the overall child welfare goals of Title IV-E and is cost neutral to the federal government. At the same time, the statute prohibits HHS from waiving any requirement that would "impair the entitlement" of any child or family to benefits or services under Title IV-E. Additionally, it prohibits HHS from waiving any of the child protections included in the case planning and case review system. These case planning and review requirements are numerous. They are discussed throughout the report and are shown together in Figure 2 , at the end of the report. Spending related to meeting these requirements is included as part of the foster care case planning and pre-placement activities; licensing, recruitment, and background check category shown in Figure 1 . Compliance with specific Title IV-E plan requirements is subject to periodic federal conformity reviews, the largest of which is the Child and Family Services Review (CFSR). That review assesses outcomes achieved by the state for the children it serves through detailed onsite review of a specified number of case records in a given state and by measuring statewide performance against certain national data indicators. Additionally, stakeholders are interviewed as a part of assessing whether the state has specific "systems" in place that are required by the federal child welfare law and are intended to facilitate the achievement of safety, permanency and well-being for children. States that are found to be out of "substantial conformity" with federal policy must develop and successfully implement a Program Improvement Plan (PIP) to avoid fiscal penalties. The reviews are conducted in each of the 50 states, the District of Columbia and Puerto Rico. A third round of the CFSR is scheduled to begin in FY2015 and will continue through FY2018. In the first two rounds of the CFSR (conducted in 2001-2004 and 2007-2010) no jurisdiction was found in full compliance with federal child welfare policies. Apart from providing assistance to eligible children, the state, territorial, or tribal agency operating a Title IV-E program must have an approved Title IV-E plan that provides for policies and procedures to accomplish the following nine purposes: Enable children to be reunited with their families or prevent their entry to foster care (e.g., by making "reasonable efforts"—in nearly all cases—to prevent children's entry into foster care or to reunite children with their families, including by developing a plan for each child that describes services and activities necessary to permit reunification). Promote children's placement with relatives and maintain sibling connections (e.g., by considering placement of a child with a relative rather than a non-relative foster caregiver, making diligent efforts to identify adult relatives of children who enter care and notifying those relatives of their options to be involved in the child's care and placement; and by always placing sibling groups in the same foster, adoptive or kinship home, unless this is contrary to the welfare of one of those siblings). Ensure children's living arrangements are safe and appropriate and permit "normalcy" (e.g., by establishing licensing standards for foster family homes and other group or residential settings where foster children live and requiring them [effective September 29, 2015] to ensure foster caregivers may apply a "reasonable and prudent parenting standard" when determining age and developmentally appropriate activities in which foster children may participate; and by conducting background checks of prospective foster and adoptive parents, and of prospective relative guardians).