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pdfSSP-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
Page 2
| File Type | application/pdf |
| File Title | SSP-MOE DATA REPORT - SECTION 3 |
| Author | ACF |
| File Modified | 2006-06-13 |
| File Created | 2006-06-13 |