SSP-MOE Data Report

SSP-MOE DATA REPORT - SECTION 3
AGGREGATED DATA COLLECTION FOR FAMILIES RECEIVING ASSISTANCE UNDER THE
STATE SEPARATE PROGRAM

GENERAL INFORMATION
1.

State FIPS Code

2.

Calendar Year and Quarter
Year

Y

Quarter

Y

Y

Y

Q

ACTIVE SSP CASES
FIRST MONTH
3.

Total Number of SSP-MOE Families

4.

Total Number of Two-Parent Families

5.

Total Number of One-Parent Families

6.

Total Number of No-Parent Families

7.

Total Number of Recipients

OMB Number 0970-0199 - Expiration Date: 06/30/2002
ACF - 209

SECOND MONTH

SSP-MOE DATA REPORT - SECTION 3

THIRD MONTH

Page 1

FIRST MONTH

SECOND MONTH

8.

Total Number of Adult Recipients

9.

Total Number of Child Recipients

10.

Total Number of Non-Custodial Parents Participating in Work Activities

11.

Total Amount of Assistance

$

$

THIRD MONTH

$

CLOSED SSP CASES
FIRST MONTH
12.

SECOND MONTH

THIRD MONTH

Total Number of Closed Cases

OMB Number 0970-0199 - Expiration Date: 06/30/2002
ACF - 209

SSP-MOE DATA REPORT - SECTION 3

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