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0MB Control Number: oq?0-0234
Title of Information Collection: Social Services Block Grant Post-Expenditure Report
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RE • oRT1NG •ER100
_ _ _ _ _ _ _ _ _ _ __
Expend1tUfes Recipient•
Expiration Date: XX/XX/XXXX
DATE OF s UBM1ss10N
Vol+dotton
[--,�
SSBG
Expenditures
FY 20XX
Corry Ovef' from
Previoua FY
[===···�
Fund• Transferred
into SSBG•
Corry Over of
Fund• Tronaferred
into SSBG from
Previous FY
Expenditures of All
Other Fen
,_
_._
..,
Adults Age 5q
Yeors & Younger
Service Supported with SSBG EKpenditures
Adults Age 60
Years & Older
Adults of Unknown
Age
Total Adults
Actual, Estimated, or Sampled
Doto?
Actual
Estimated Sampled
Duplicated or
Undupticoted Counts?
Please enter the eligibility criteria
for this Service Category
State will submit
eligib�ity criteria to
OCS via email
Duplicated
1) Adoption S«viees
0
0
0
0
0
D
2) Cose Management
0
0
0
0
0
D
3) Congregate Meals
0
0
0
0
0
D
4) Counseling Services
0
0
0
0
0
D
5) Doy Core-·Adults
0
0
0
0
0
D
6) Doy Core--Ch�dren
0
0
0
0
0
D
7) Education&. Training Services
0
0
0
0
0
D
8) Employment Services
0
0
0
0
0
D
q) Family Planning Services
0
0
0
0
0
D
10) Foster Core Serviees--Adults
0
0
0
0
0
D
11) Foste< Core Se-rviees--Ch�dren
0
0
0
0
0
D
12) Heolth-Retoted Services
0
0
0
0
0
D
13) Home-Bosed Services
0
0
0
0
0
D
14) Home-Delivered Meals
0
0
0
0
0
D
15) Housing Services
0
0
0
0
0
D
16) lndependent/Tronsitiono1 Living Services
0
0
0
0
0
D
17) Information & Referral
0
0
0
0
0
D
18) leool Services
0
0
0
0
0
D
1q) Pregnancy & Parenting
0
0
0
0
0
D
20) Prevention & Intervention
0
0
0
0
0
D
21) Prote<:tive Services--Adults
0
0
0
0
0
D
22) Protective Services--Children
0
0
0
0
0
D
23) Recreot.00 Services
0
0
0
0
0
D
24) Residential Treatment
0
0
0
0
0
D
25) Speeiol Services--Oisobled
0
0
0
0
0
D
26) Special Services·· Youth at Risk
0
0
0
0
0
D
27) Substance Abuse Services
0
0
0
0
0
D
28) Tronsportotion
0
0
0
0
0
D
2q) Other Services""'
0
0
0
0
0
D
30) SUM OF RECIPIENTS OF SERVICES
A Web Page
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Title of Information Collection: Social Services Block Grant Post-Expenditure Report
Expenditures
Recipients
Validation
DEFINITIONS
0MB Control Number: oq?0-0234
'----------------------------------------------------�
Expiration Date: XX/XX/XXXX
Please provide the definition of o child for the services provided in your Stole.
Please provide the definition of on adult for the services provided in your State.
Please provide the definition of a family fOl" the serv.Ces provided in your State.
ASSURANCES
D
D
The grantee certifies that no carryover extends beyond the two year expenditure period outlined in the code Sec..2002(42 USC. 13q7o)(c)
The grantee certifies that funds transferred from TANF to SSBG compty with the statutory requirements described in Section 404(d) of the Social Security Act
· Transfer Limit No more than 10% of the TANF Block Grant was transferred to SSBG.
• Applicable Rules: Federal TANF funds that were transferred to SSBG were only used for programs and services to children or their fomaies whose income is less than 200 percent
of the income officiol poverty line opplicoble to a family of the size involved.
• Expenditure Period: Federal TANF funds thot were transferred to SSBG were expended within the two-yeor expenditure period. The transferred TANF funds and regulor SSBG
funds granted during a fiscol year are sub;&c:t to the two-yeor time1y filing provisions contained in 45 CFR Port qs.1.
By checking this box, the Stole SSBG officio! is prOYiding the certification set out above.
Was the octuol use of funds transferred from TANF to SSBG reflected in the pre-expenditurereport7
0 Yes
0 No
If no, please explain:'-------------------------'
Is the total amount of funds transferred from TANF to SSBG equal to the amount reported for the related period in the TANF financial report {ACF1%R)',
0 Yes
0 No
If no, pleose exploin: '-------------------------
-'
VALID,'.TION QUESTIONS
1. SSBG expenditures for a service were reported but no recipients were reported.
For the following service(s), you hove reported SSBG E,cpenditures but no recipients. Con you prO\lide this missing information? If so,
please enter the missing information in the recipients tab for the following services{s). If no recipients con be reported, please
provide o brief e,cplonotion.
2. Adult recipients were reported for o children's service.
You hove reported adult recipients for the foUowing services intended for children. Hove these doto been entered in error? If not,
con you e,cplain7
3. Ch�d recipients were reported f« on adult ser vice.
You hove reported child recipients for the following ser vices intended for adults. Hove these doto been entered in error? If not, con
you explain?
4. The number of children, total adults, or total recipients for o service is less than 10.
For the following service(s), you hove reported less than 10 recipients. Please provide additional detail on how these service
recipients ore counted.
5. The total e,cpenditures f0< o service ore less than $1,000.
F« the following service(s), you hove reported less than $1000 of total e,cpenditures. Please confirm that )'O'Jr State spent only this
amount for the following service(s).
6. The amount of total expenditures per recipient f« o service is $50 or less.
For the following service(s), the amount of total e,cpenditures per recipient is less than $50 (calculated by dividing total
e,cpenditures by total recipien18). Please prO\lide any information on how )'O'Jr State prO\lides services for this low per-person dollar
amount
7. The difference between the ollocotion ond expenditures is over $1 million.
Your reported SSBG ollocotion e,cpenditures ore $X more/less than your onnuol olocotion. Con )'O'J confirm that this difference is the
result of funds carried over from the previous year or carried forward to the following year?
8. The administrative costs ore m«e thon q%, of SSBG E,cpenditures.
You hove reported $X of SSBG e,cpenditures for administrative costs which is X% of your SSBG expenditures. Administration is on
ollowoble SSBG e,cpenditure category. Please prO\lide any e,comples of how SSBG funds ore used for odminis1rotive costs or the
definihon of odministrotive costs that is used for SSBG reporting purposes.
q. T,'.NF Transfer Funds were reported for o service but no child recipients were reported
You hove reported T,'.NF transfer funds for one or more ser vices, ond reported no child recipients for the some service(s). The
intended use of TANF funds is to provide services to children ond families. Please report any children benefitting from services paid
for by T,'.NF funds. If no known children benefitted from the service(s) indicated, please pr011ide on explanation of how the T,'.NF
funds were employed for their intended purposes withoYt collecting doto on ch�d recipients.
| File Type | application/pdf |
| File Modified | 2020-11-16 |
| File Created | 2017-06-28 |