TANF DATA REPORT - SECTION 2
TANF DISAGGREGATED DATA COLLECTION FOR FAMILIES NO LONGER RECEIVING
ASSISTANCE UNDER THE TANF PROGRAM
GENERAL INFORMATION
1.	State FIPS Code						2	County FIPS Code						3.	Tribal Code (For Tribal Use Only)					4.	Reporting Month										5	Stratum
																					Year						Month
																					Y	Y	Y	Y			M	M
FAMILY LEVEL DATA
			6.	Case Number - TANF											7.	ZIP Code						8.	Disposition				9.	Reason for Closure
ASSISTANCE RECEIVED BY THE FAMILY
			10.	Received Subsidized Housing						11.	Received Medical Assistance						12.	Received Food Stamps						13.	Received Subsidized Child Care
PERSON LEVEL DATA
Person		14.	Family Affiliation				15.	Date of Birth (Age)									16.	Social Security Number
							Y	Y	Y	Y	M	M	D	D
	1																			-			-
	2																			-			-
	3																			-			-
	4																			-			-
	5																			-			-
	6																			-			-
	7																			-			-
	8																			-			-
Person		14.	Family Affiliation				15.	Date of Birth (Age)									16.	Social Security Number
							Y	Y	Y	Y	M	M	D	D
	9																			-			-
	10																			-			-
	11																			-			-
	12																			-			-
	13																			-			-
	14																			-			-
	15																			-			-
	16																			-			-
			17.	Race/Ethnicity
			Ethnicity						Race
Person			A.	Hispanic or Latino					B.	American Indian of Alaska Native				C.	Asian			D.	Black or African American				E.	Native Hawaiian or Pacific Islander				F.	White
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16
							19.	Received Disability Benefits
Person			18.	Gender			A.	Received Federal Disability Insurance Benefits - OASDI					B.	Received Benefits Based on Federal Disability Status					C.	Received Aid Under Title XIV-APDT				D.	Received Aid Under Title XVI-AABD				E.	Received Aid Under Title XVI-SSI
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16
Person			20.	Marital Status			21.	Relationship to Head of Household					22.	Parent with Minor Child in Family				23.	Needs of a Pregnant Woman				24.	Educational Level				25.	Citizenship / Alienage
	9
	10
	11
	12
	13
	14
	15
	16
Person			26.	Number of Months Countable Toward Federal Time Limit						27.	Number of Countable Months Remaining Under State's (Tribe's) Time Limit								28.	Employment Status
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16
AMOUNT OF INCOME, BY TYPE
Person				29.	Amount Earned Income									30.	Amount of Unearned Income
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10
	11
	12
	13
	14
	15
	16

ACF Home | Questions? | Site Index | Contact Us | Accessibility | Privacy Policy | Freedom of Information Act | Disclaimers
Department of Health and Human Services | The White House | USA.gov: The U.S. government's official web portal

Administration for Children and Families • 370 L'Enfant Promenade, S.W. • Washington, D.C. 20447