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ACF-801 Online Help

Published: March 28, 2016
Categories:
Child Care Development Fund (CCDF) Reporting
Topics:
ACF-801, States/Territories

ACF - 801 Child Care Quarterly Case Record Form

OMB #: 0970-0167 Expires: 12/31/2018

Head of Family Receiving Assistance

Element

More Information

1. Reporting Period

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2. Unique State Identifier

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3. Filler (Leave Blank)

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4. Family FIPS Code

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5. Single Parent

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6. Reason for Receiving Subsidized Child Care

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7. Total Monthly Child Care Co-payment by Family

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8. Month/Year Child Care Assistance to the Family Started

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9. Total Monthly Family Income for Determining Eligibility

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Family Income Sources

Field Name

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10. Employment Including Self-Employment

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11. Cash or Other Assistance Under Title IV of the Social Security Act (TANF)

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12. State Program for Which State Spending Is Counted Towards TANF MOE

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13. Housing Voucher or Cash Assistance

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14. Supplemental Nutrition Assistance Program  (SNAP, formerly Food Stamps)

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15. Other Federal Cash Income Programs (such as SSI)

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16. Family Size Used for Determining Eligibility

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16a. Family Homeless Status

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16b. Family ZIP Code

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16c. Military Status

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16d. Primary Language Spoken at Home

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Child Data Sources

Field Name

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17. Filler (Leave Blank)

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18. Hispanic or Latino

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19. American Indian or Alaskan Native

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20. Asian

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21. Black or African American

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22. Native Hawaiian or Other Pacific Islander          

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23. White

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24. Gender

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25. Month/Year of Birth

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25a. Child Disability

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26. Type of Child Care

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27. Total Monthly Amount Paid to Provider

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28. Total Hours of Care Provided in Month

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29. Provider FEIN

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30. Provider Unique State ID

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Provider Data Sources

 
Element

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31. Provider FEIN (same as #29)

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32. Provider State ID (same as #30)

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33. QRIS Participation

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34. QRIS Rating

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35. Accreditation Status

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36. Provider is Subject to Pre-K Standards

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37. Other State-Defined Quality Measure

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38. Provider is Subject to Head Start or Early Head Start Standards

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39. Provider ZIP Code

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40. Inspection Date

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Last Reviewed: April 11, 2016