Child Care Bureau: Laws, Policies, Program Instructions, and Allocations

ACF-801 Child Care Quarterly Case-Level Reporting Form

Instructions and Definitions

NOTE: These instructions are for the manual preparation of the ACF-801 Form. Instructions will also be made available for the electronic submission of the ACF-801 at a later time.

SECTION I. HEAD OF FAMILY:

The following group of elements (items 1-9) refer to the head of the family receiving child care assistance which is being reported on this form.

Reporting Period: Enter the numbers that identify the month and year being reported.
Unique State Identifier (Optional): Enter the unique identifying number, up to fifteen digits, assigned by the State to the child care family receiving assistance. States may use alphanumeric characters. If identifier is less than fifteen digits, use leading zeros. Example: 19056, code 000000000019056. THIS ITEM IS OPTIONAL AND IS NOT REQUIRED TO BE REPORTED.
Social Security Number: Enter the Social Security Number of the head of the family. THIS ITEM IS NOT OPTIONAL.
Federal Information Processing Standards (Fips) Code: Enter the FIPS Code geographic identifier issued by the National Bureau of Standards to designate where the head of the family unit receiving assistance is residing. If the address of the head of the family is unknown, leave FIPS code blank. (A list of all FIPS codes will be provided to states.)
Single Parent? (Yes/No): Enter the one digit code if head of family receiving assistance is single or not.
Reason For Receiving Subsidized Child Care: Enter the one digit code indicating the reason for receiving subsidized child care.
Total Monthly Child Care Copayment By The Family Receiving Assistance: Enter the total monthly dollar amount that the family receiving assistance is expected to pay for child care services for the month being reported, using leading zeros as necessary.
Month/Year Child Care Assistance to the Family Started: Enter the numbers for the month and year child care assistance started for the family receiving assistance. If there was a short interruption of up to three months in child care assistance (like vacation, illness) enter the original month/year the assistance started, rather than when the assistance resumed.
Total Monthly Income for Determining Eligibility: Enter the total monthly dollar amount upon which eligibility is determined, totaled to the nearest dollar amount using leading zeros as necessary.

SECTION II. FAMILY INCOME BY SOURCE:

Enter the code for yes or no for all sources of income that apply to the family receiving assistance for the month being reported. Income information is not required for protective services cases, if income is not used to determine eligibility.

Employment income, including self-employment.
Cash or other other monetary assistance under Title IV of the Social Security Act (Temporary Assistance to Needy Families). 99
State Program for Which State Spending is Counted Towards Temporary Assistance to Needy Families MOE.
Housing voucher or cash assistance.
Assistance under the Food Stamps Act of 1977.
Other Federal Cash Income Programs (such as SSI).

SECTION III. DEPENDENT CHILDREN RECEIVING CHILD CARE ASSISTANCE:

This group of elements refers to dependent children in the family receiving child care assistance, and specifies demographic and child care service elements of children receiving care. Child care data in this section must be coded for dependent children receiving care.

Child's Social Security Number (Optional): Enter the Social Security Number of the child receiving assistance. THIS INFORMATION IS OPTIONAL.
Child's Race (Ethnicity): Enter the one digit code for the race of each child.
Child's Gender: Enter the one digit code for the gender of the child receiving care.
Month/Year Of Birth: Enter the numbers for the month and year of birth of the child receiving care.
ITEMS 5-7 apply to the child care provided to each child. Enter the child care data for the greatest number of hours of care provided on the first line for each child (following Month/Year of Birth), and the next highest number of child care hours on the Caregiver 2 line, and the next highest number of child care hours on the Caregiver 3 line.
Type Of Child Care: Definitions: Provider types are divided into two broad categories of licensed/regulated and legally operating (no license category available in state or locality). Under each of these categories are four types of providers: in-home, family home, group home, and centers. A relative provider is defined as being at least 18 years of age and who is a grandparent, great-grandparent, aunt or uncle, or sibling living outside the child's home.
Instructions: Enter the type of care, two digit code, for each child. The following codes specify who cared for the child and where such care took place during the sample month.

Codes:
Total Monthly Amount Paid to the Provider: For each child receiving care, enter the total monthly dollar amount (round to the nearest dollar and use leading zeros as necessary) expected to be paid to the provider for the care of the child. The total monthly amount should include Federal, State, and locally funded amounts. Use leading zeros as necessary.
Total Hours of Care Provided in the Month: Enter the number for the total number of hours provided for the reporting period (round to the nearest whole number and use leading zeros as necessary).