TANF-ACF-PI-2008-04 (Federal TANF Contingency Funds)

REQUEST FOR FEDERAL TANF CONTINGENCY FUNDS

State:

Trigger Satisfied:                 Food Stamp                    Unemployment

Contingency Funds requested for fiscal year                               

Indicate Below Request Method Option 1 or Option 2:

-      Option 1               

I hereby request payment for the full fiscal year. 

-      Option 2               

I hereby request payment only for the months indicated below.

October:              November:                  December:              

January:              February:                  March:                 

April:                May:                       June:                   

July:                 August:                    September:             

CERTIFICATION:

In requesting the above-indicated contingency payments, I certify the following:

1.      The State will meet our 100 percent Contingency Fund Maintenance-of-Effort (MOE) spending requirement.

2.      State matching funds are available to spend in excess of our required Contingency Fund MOE spending level.

3.      State funds and Contingency Funds will be used only for allowable expenditures under the TANF program.

4.      I understand that the Contingency Funds are provisional payments.  Accordingly, upon completion of the annual reconciliation process, the State will remit the amount (if any) determined as a result of this process, no later than within one year after the State has failed to be a needy State for three consecutive months.

Date:                                                                                                                                        

                                                                        Signature of Governor or Official Designee