SSP-MOE DATA REPORT - SECTION 3

AGGREGATED DATA COLLECTION FOR FAMILIES RECEIVING ASSISTANCE UNDER THE

STATE SEPARATE PROGRAM

GENERAL INFORMATION

1.

State FIPS Code

2.

Calendar Year and Quarter

Year

Quarter

Y

Y

Y

Y

Q

ACTIVE SSP CASES

FIRST MONTH

SECOND MONTH

THIRD MONTH

3.

Total Number of SSP-MOE Families

4.

Total Number of Two-Parent Families

'5.

Total Number of One-Parent Families

6.

Total Number of No-Parent Families

7.

Total Number of Recipients

8.

Total Number of Adult Recipients

9.

Total Number of Child Recipients

10.

Total Number of Non-Custodial Parents Participating in Work Activities

11.

Total Amount of Assistance

$

$

$

CLOSED SSP CASES

FIRST MONTH

SECOND MONTH

THIRD MONTH

12.

Total Number of Closed Cases

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