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U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES -- ADMINISTRATION FOR CHILDREN AND FAMILIES |
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CHILD CARE AND DEVELOPMENT FUND ACF-696 FINANCIAL REPORT |
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FISCAL YEAR 2009 |
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SUBMISSION (MARK ONE BOX) |
CURRENT QTR. ENDED: |
NEXT QTR. BEGINNING: |
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ORIGINAL [ ] REVISED [ ] |
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GRANT DOCUMENT # |
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FINAL [ ] |
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CUMULATIVE FISCAL YEAR TOTALS |
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(COLUMN A) |
(COLUMN B) |
(COLUMN C) |
(COLUMN D) |
(COLUMN E) |
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MANDATORY FUNDS |
MATCHING FUNDS |
DISCRETIONARY FUNDS |
MOE |
ARRA (American Recovery |
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(Federal Share Only) |
AT FMAP RATE OF _____% |
(excluding ARRA) |
(State Share Only) |
and Reinvestment Act Funds |
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(Federal and State Share) |
(Federal Share Only) |
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(Federal Share Only) |
| 1. TOTAL |
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$ |
$ |
$ |
$ |
$ |
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1(a). CHILD CARE ADMINISTRATION |
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$ |
$ |
$ |
$ |
$ |
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1(b). QUALITY ACTIVITIES EXCLUDING TARGETED FUNDS |
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$ |
$ |
$ |
$ |
$ |
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1(c). INFANT AND TODDLER TARGETED FUNDS* |
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$ |
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$ |
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1(d). QUALITY EXPANSION TARGETED FUNDS* |
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$ |
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$ |
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1(e). SCHOOL-AGE/RESOURCE AND REFERRAL TARGETED FUNDS* |
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$ |
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1(f). OTHER TARGETED FUNDS |
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$ |
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1(g). DIRECT SERVICES |
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$ |
$ |
$ |
$ |
$ |
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1(h). NONDIRECT SERVICES |
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$ |
$ |
$ |
$ |
$ |
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1(h)(1). SYSTEMS |
$ |
$ |
$ |
$ |
$ |
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1(h)(2). CERTIFICATE PROGRAM COSTS/ELIG. DETERMINATION |
$ |
$ |
$ |
$ |
$ |
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1(h)(3). ALL OTHER NONDIRECT SERVICES |
$ |
$ |
$ |
$ |
$ |
| 2. STATE SHARE OF EXPENDITURES |
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$ |
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2(a). REGULAR |
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$ |
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2(b). PRIVATE DONATED FUNDS |
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$ |
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2(c). PRE-K |
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$ |
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| 3. FEDERAL SHARE OF EXPENDITURES |
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$ |
$ |
$ |
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$ |
| 4. FEDERAL SHARE OF UNLIQUIDATED OBLIGATIONS |
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$ |
$ |
$ |
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$ |
| 5. AWARDED |
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$ |
$ |
$ |
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$ |
| 6. TRANSFER FROM TANF |
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$ |
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| 7. UNOBLIGATED BALANCE |
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$ |
$ |
$ |
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$ |
| 8. FEDERAL FUNDS REQUESTED |
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$ |
$ |
$ |
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$ |
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ESTIMATES FOR NEXT QTR. (Refer to Next Qtr. Beginning Date Above.) |
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9. ESTIMATED CHILD SERVICE MONTHS FUNDED BY ARRA:
(See page 8 of instructions) |
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# |
| PLEASE REFER TO REALLOTTED FUNDS INFORMATION ON PAGES 5 OF THE INSTRUCTIONS. |
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9/30 SUBMITTAL -- IF AVAILABLE, DOES THE STATE REQUEST REALLOTTED MATCHING FUNDS? YES [ ] NO [ ]. IF YES AND THE STATE REQUESTS A LIMIT TO THE MATCHING |
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AMOUNT, PLEASE ENTER AMOUNT $ _______________ |
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3/31 SUBMITTAL -- IF AVAILABLE, DOES THE STATE REQUEST REALLOTTED DISCRETIONARY FUNDS? YES [ ] NO [ ]. |
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| THIS IS TO CERTIFY THAT THE INFORMATION REPORTED ON ALL PARTS OF THIS FORM IS ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. |
| THIS ALSO CERTIFIES THAT THE STATE'S SHARE OF ESTIMATES IS OR WILL BE AVAILABLE TO MEET THE NONFEDERAL SHARE OF EXPENDITURES AS REQUIRED BY LAW. |
| SIGNATURE: STATE OFFICIAL |
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DATE SUBMITTED: |
TYPED NAME, TITLE, AGENCY NAME, PHONE # |
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APPROVED OMB CONTROL NO. 0970-0163 |
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EXPIRATION DATE: 6/30/2010 |
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| FORM ACF-696 PAGE 1 OF 1 |
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| * TARGETED FUNDS NARRATIVE REPORT ATTACHMENT: FOR LINES 1(c), 1(d), 1(e) IN COLUMN C AND COLUMN E, ATTACH A SEPARATE PAGE THAT INCLUDES A BRIEF DESCRIPTION OF THE ACTIVITIES ON WHICH TARGETED FUNDS, FROM THE FISCAL YEAR'S GRANT, WERE EXPENDED. THIS NEED ONLY BE COMPLETED WITH EACH 4TH QUARTER'S REPORT. |