696 Child Care and Development Fund (CCDF) ACF-696 Financial

Generic Clearance for Financial Reports used for ACF Non-Discretionary Grant Programs

Child Care 696 Form_clean (OGM & OCC) 4.4.24.xlsx

OMB: 0970-0510

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CHILD CARE AND DEVELOPMENT FUND ACF-696 FINANCIAL REPORT








State or Territory
Grant Year

Final Report
[ ] Yes
[ ] No


Current Quarter Ended




Grant Number:


Next Quarter Beginning



Cumulative Fiscal Year Totals









(COLUMN A)
MANDATORY FUNDS



Grant Document #s
CCDF (states)
CCDT (territories)
(COLUMN B)
MATCHING FUNDS
AT FMAP RATE OF ____%
(Federal and State Shares)

Grant Document #
CCDM
(COLUMN C)
DISCRETIONARY FUNDS



Grant Document #
CCDD
(COLUMN D)
MOE
(COLUMN E)
DISCRETIONARY
DISASTER RELIEF FUNDS


GrantDocument #
CCDX
(COLUMN G)
DISCRETIONARY
CARES ACT FUNDS


Grant Document #
CCC3
(COLUMN H)
DISCRETIONARY
CRRSA ACT FUNDS


Grant Document #
CCC5
(COLUMN I)
SUPPLEMENTAL DISCRETIONARY
ARP ACT FUNDS

Grant Document #
CDC6
(COLUMN J)
STABILZATION
ARP ACT FUNDS


Grant Document #
CSC6
1. Total Expenditures








  1(a). Child Care Administration








  1(b). Quality Activities Excluding Infant/Toddler Quality Activities Reported On Line 1(c)








  1(c). Infant/Toddler Quality Activities








  1(d). Direct Services








  1(e). Non - Direct Services








     1(e)(1). Systems








1(e)(2). Certificate Program Costs/Eligibility Determination








1(e)(3). All Other Non-Direct Services








  1(f). Construction and Major Renovation








2. State Share of Expenditures








  2(a). Regular








  2(b). Private Donated Funds








  2(c). Pre - K








3. ARP Act Stabilization Subgrants to Providers








4. ARP Act Stabilization Set Aside (Admin & TA)








4(a) Subgrant administration








4(b) Systems








4(c) TA - application








4(d) TA - implementation








4(e) Publicity








4(f) Activities to build supply








5. Federal Share of Expenditures








6. Federal Share of Obligations (Not Yet Liquidated)








7. Awarded








8. Transfer From TANF








9. Unobligated Balance








10. Federal Funds Requested : Estimates For Next Quarter (Refer to Next Quarter Beginning Date Above.)








Please refer to redistribution and reallotment of funds information information in the instructions. 








11. Redistributed Funds (September 30 Submittal): If available, does the State or Territory request redistributed funds? [Mandatory (territories, per ARP Act); Matching (states)] YES [ ] NO [ ] YES [ ] NO [ ]






11(a). If yes, does the State or Territory request a limit to
the redistributed funds received?
0.00 0.00






12. Reallotted Funds: If available, does the State request reallotted discretionary or stabilization funds?

YES [ ] NO [ ]





Signature Information








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 States share








of Estimates is or will be Available to meet the NON-FEDERAL Share of Expenditures as Required by Law. 








Signature: State Official
Typed Name, Title, Agency Name, Phone #:







Date Certified:
Submit Date:








FORM ACF-696
APPROVED OMB CONTROL NO. 0970-0510
EXPIRATION Date: XX/XX/XXXX
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13): Public reporting burden for this collection of information is estimated to average 6 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
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