Final Tribal TANF Data Report

TRIBAL TANF DATA REPORT - SECTION 3

TANF AGGREGATED DATA COLLECTION FOR FAMILIES RECEIVING ASSISTANCE UNDER

THE TANF PROGRAM

GENERAL INFORMATION

1. State FIPS Code								2. Tribal Code (For Tribal Use Only)									3. Calendar Quarter
																		Year					Quarter
																		Y	Y	Y	Y		Q

TANF APPLICATIONS
FIRST MONTH										SECOND MONTH										THIRD MONTH
4. Total Number of Applications
5. Total Number of Approved Applications
6. Total Number of Denied Applications

FAMILIES RECEIVING ASSISTANCE
FIRST MONTH										SECOND MONTH										THIRD MONTH
7. Total Amount of Assistance
$										$										$
8. Total Number of Families

9. Total Number of Two-Parent Families

10. Total Number of One-Parent Families

11. Total Number of No-Parent Families

12. Total Number of Recipients

13. Total Number of Adult Recipients

14. Total Number of Child Recipients

15. Total Number of Non-Custodial Parents Participating in Work Activities

16. Total Number of Births

17. Total Number of Out-of-Wedlock Births

FAMILIES NO LONGER RECEIVING ASSISTANCE

FIRST MONTH										SECOND MONTH										THIRD MONTH
18. Total Number of Closed Cases

OMB Number 0970-0215- Expiration Date: xx/xx/xxxx TRIBAL TANF DATA REPORT - SECTION 3 Page 2