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TANF-ACF-PI-2009-05 (Form OFA-100, the Emergency Fund Request form)

Published: July 20, 2009
Audience:
Temporary Assistance for Needy Families (TANF)
Topics:
Contingency Fund
Types:
Program Instructions (PI), Reporting Forms
Tags:
Contingency Fund, TANF Contingency Fund, TANF Emergency Fund

TO: 

State, Territory, and Tribal agencies administering the Temporary Assistance for Needy Families (TANF) Program.

SUBJECT:

Form OFA-100, the Emergency Fund Request form.

REFERENCES:

Section 403(c) of the Social Security Act; TANF-ACF-PA-2009-01.

PURPOSE:

To transmit form OFA-100, a form and instructions for requesting grants from the Emergency Fund.

BACKGROUND:

On February 17, 2009, the President signed the American Recovery and Reinvestment Act of 2009 (Recovery Act), which established a new Emergency Contingency Fund for State TANF Programs (Emergency Fund) as section 403(c) of the Social Security Act (the Act). The Emergency Fund provides up to $5 billion to help States, Territories, and Tribes in fiscal year (FY) 2009 and FY 2010 that have an increase in assistance caseloads or in certain types of expenditures. It is intended to build upon and renew the principles of work and responsibility that underlie successful welfare reform initiatives. It provides resources to States, Territories, and Tribes (hereafter referred to as “jurisdictions”) to support work and families during this difficult economic period.

The Recovery Act calls on the Secretary of Health and Human Services (HHS) to implement the Emergency Fund “as quickly as possible pursuant to appropriate guidance.” In that spirit, we are issuing the attached form and instructions on which a jurisdiction may request emergency funds, form OFA-100. This form has been approved by OMB under the expedited clearance process.

ACTION:

Effective immediately, a jurisdiction applying for emergency funds must use form OFA-100. A jurisdiction should not resubmit any applications it made prior to the issuance of this guidance, but must use form OFA to update and revise data it has already submitted as part of an earlier application. The instructions explain the procedures for updating data.

ATTACHMENT:

Form OFA-100 , Instructions for completing the form.

EFFECTIVE:

Immediately.

INQUIRIES:

Please direct inquiries to the TANF Program Manager in your Region.

/s/
Ann Barbagallo,
Acting Director
Office of Family Assistance


Jurisdiction:                                                                                   Date of Completion:      

 

Request Year FY 2009

Which quarters have revised data?                Q1                         Q2                         Q3                       Q4

Category

Quarter 1
(Oct 2008-Dec 2008)

Quarter 2
(Jan 2009-Mar 2009)

Quarter 3
(Apr 2009-Jun 2009)

Quarter 4
(Jul 2009-Sep 2009)

Assistance Caseload

     

     

     

     

Expenditures

Basic Assistance

     

     

     

     

Non-Recurrent
Short-Term Benefits

     

     

     

     

Subsidized Employment

     

     

     

     

Request Year FY 2010

Which quarters have revised data?                Q1                         Q2                         Q3                       Q4

Category

Quarter 1
(Oct 2009-Dec 2009)

Quarter 2
(Jan 2010-Mar 2010)

Quarter 3
(Apr 2010-Jun 2010)

Quarter 4
(Jul 2010-Sep 2010)

Assistance Caseload

     

     

     

     

Expenditures

Basic Assistance

     

     

     

     

Non-Recurrent
Short-Term Benefits

     

     

     

     

Subsidized Employment

     

     

     

     

Jurisdiction:                                                                                         Date of Completion:_

For each category in which you are requesting emergency funds, briefly describe the programs within the expenditure category.  Then describe the reasons for the expenditure increase in the quarters for which you are requesting funding compared to the corresponding base quarters.  If you are using estimated data, include the basis for the estimate.

Basic assistance expenditures consist of:

     

Basic assistance expenditure increases are due to:

     

 

Non-recurrent short-term benefit expenditures consist of:

     

Non-recurrent short-term benefit expenditure increases are due to:

     

Subsidized employment expenditures consist of:

     

Subsidized employment expenditure increases are due to:

     

 

Jurisdiction:                                                                                               Date of Completion:       _

Section A – Program Configuration Changes

Answer each question in this section with each quarterly request for emergency funds

1.      Since October 1, 2006, has the jurisdiction made any changes in the groups of families receiving assistance in its TANF/SSP-MOE program that are the result of changes to a solely State-funded (SSF) program – either by starting or expanding a SSF, or by ending or scaling back a SSF?

       yes    no

      If yes, have you completed Section B on a prior submission to account fully for these changes?

       yes    no

2.      Since October 1, 2006, has the jurisdiction converted any part of a program that provides non-assistance benefits (including non-recurrent short-term benefits) to a basic assistance program or converted any part of a basic assistance program to one that provides non-assistance benefits? 

       yes    no

      If yes, have you completed Section B on a prior submission to account for these changes?

       yes    no

3.      Since October 1, 2006, has the jurisdiction converted either a subsidized employment or a non-recurrent short term benefit program that operated outside of TANF/SSP-MOE to one that is within TANF?

       yes    no

      If yes, have you completed Section B on a prior submission to account for these changes?

       yes    no

4.      Since October 1, 2006, are expenditures in any of your Emergency Fund categories subject to uneven claiming across quarters?  For example, do you pay a contractor in a quarter to provide a service or benefit throughout the year but do not pay that contractor in the same quarter each year?

       yes    no

      If yes, have you completed Section B on a prior submission to account for these changes?

       yes    no

5.      Since October 1, 2006, has the jurisdiction made any other changes that resulted in a change of funding between a TANF/SSP-MOE program and a SSF program or resulted in a funding change across any of the three categories?

       yes    no

      If yes, have you completed Section B on a prior submission to account for these changes?

       yes    no

Section B – Adjustments for Program Configuration Changes

Change # 1

Description of program change: 

     

 

Date program change took effect:

     

 

Explanation of the methodology:

Describe why the program change requires an adjustment and how you estimated the adjustment.  Be sure to provide documentation to support the adjustments you are proposing to the assistance caseload and expenditure data.

     

Section B – Adjustments for Program Configuration Changes

Change # 2

Description of program change: 

     

 

Date program change took effect:

     

 

Explanation of the methodology:

Describe why the program change requires an adjustment and how you estimated the adjustment.  Be sure to provide documentation to support the adjustments you are proposing to the assistance caseload and expenditure data.

     

Section B – Adjustments for Program Configuration Changes

Change # 3

Description of program change: 

     

 

Date program change took effect:

     

 

Explanation of the methodology:

Describe why the program change requires an adjustment and how you estimated the adjustment.  Be sure to provide documentation to support the adjustments you are proposing to the assistance caseload and expenditure data.

     

 

 

 

Jurisdiction:                                                                                      Date of Completion:       _

 

FY 2007 Base-Year Data

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Average Monthly Assistance Caseload

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Caseload

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Caseload

0

0

0

0

0

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Basic Assistance Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

 

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Non-Recurrent Short-Term Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

$0

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Subsidized Employment Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

$0


 

Jurisdiction:                                                                                     Date of Completion:       _

 

FY 2008 Base-Year Data

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Average Monthly Assistance Caseload

Quarter 1
(Oct 2007-Dec 2007)

Quarter 2
(Jan 2008-Mar 2008)

Quarter 3
(Apr 2008-Jun 2008)

Quarter 4
(Jul 2008-Sep 2008)

FY 2008

Unadjusted Caseload

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Caseload

0

0

0

0

0

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Basic Assistance Expenditures

Quarter 1
(Oct 2007-Dec 2007)

Quarter 2
(Jan 2008-Mar 2008)

Quarter 3
(Apr 2008-Jun 2008)

Quarter 4
(Jul 2008-Sep 2008)

FY 2008

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

 

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Non-Recurrent Short-Term Expenditures

Quarter 1
(Oct 2007-Dec 2007)

Quarter 2
(Jan 2008-Mar 2008)

Quarter 3
(Apr 2008-Jun 2008)

Quarter 4
(Jul 2008-Sep 2008)

FY 2008

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

$0

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Subsidized Employment Expenditures

Quarter 1
(Oct 2007-Dec 2007)

Quarter 2
(Jan 2008-Mar 2008)

Quarter 3
(Apr 2008-Jun 2008)

Quarter 4
(Jul 2008-Sep 2008)

FY 2008

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

$0

 

 

Jurisdiction:                                                                                        Date of Completion      _

 

You must complete a certification with each request for emergency funds.

Certification

I certify that:

(1) this request includes all expenditure and caseload data for the fiscal quarters for which we are requesting emergency funds and (if applicable) for the base years of FY 2007 and FY 2008;

(2) the data in this request are accurate;

(3) if the request includes estimated data, the estimates are reasonable; and

(4) the request includes adjustments for all program configuration changes that would affect quarterly comparisons of the base-year and request-quarter data.

 

 

___________________________________________________________

     (signature)

(name)

(title)

 


 

Contact in the Jurisdiction

 

In the event that we have questions about any of the information in this request for emergency funds, please provide a contact with whom we can discuss them.

 

Name:                

Telephone:          

Email:                 

 


 

Purpose

Public Law 111-5 established the Emergency Contingency Fund for State TANF Programs (Emergency Fund) as section 403(c) of the Social Security Act (the Act).  The Emergency Fund provides up to $5 billion to help States, Territories, and Tribes (hereafter referred to as “jurisdictions”) in fiscal year (FY) 2009 and FY 2010 that have an increase in assistance caseloads and basic assistance expenditures, or in expenditures related to non-recurrent short-term benefits or subsidized employment, compared to the lower of FY 2007 or FY 2008.

A jurisdiction administering the Temporary Assistance for Needy Families (TANF) program wishing to apply for emergency funds for FY 2009 or FY 2010 must complete and submit form OFA-100 in accordance with these instructions.  Please refer to Policy Announcement TANF-ACF-PA-2009-01 for further information about the Emergency Fund.

Application Dates

A jurisdiction applies for emergency funds by fiscal quarter.  Each time a jurisdiction applies for emergency funds for a quarter or updates data, it must submit form OFA-100.  A jurisdiction should submit this form once in a reporting period.  A reporting period begins one month before the start of a fiscal quarter to allow a jurisdiction to apply in advance of a quarter using estimated data.  The reporting periods are:  June to August; September to November; December to February; and March to May.

Once a jurisdiction has requested emergency funds, it must submit form OFA-100 in each subsequent reporting period to update data.  For instructions about revising data submitted in prior quarterly submissions, please refer to the section labeled “Revisions” below.

After September 1, 2010, we will not accept an initial request for funding for any quarter to allow sufficient time to obligate all emergency funds before September 30, 2010, when the program expires.  We will accept revisions to prior data after that date.

All jurisdictions must submit final Emergency Fund data by March 31, 2011.  After that date, a jurisdiction may correct data in error, but such a correction will not result in the awarding of additional emergency funds.  We will only use corrections after that date to reduce overpayments. 

Submission

We have designed form OFA-100 so that a jurisdiction can complete it electronically.  We do not have a mechanism for on-line completion of the report and need to receive a completed, signed certification page.  We prefer to receive electronic copies of the report in the original Microsoft Word format, as well as a certification page in hard copy (or a scanned image of the hard copy), but you may opt to submit the entire report in hard copy.  Submit the original to: 

Office of Family Assistance, Attention:  Emergency Fund

Administration for Children and Families, 5th Floor East

370 L'Enfant Promenade, S.W., Washington, DC  20447

 

Or by email to:  TANFEmergencyFund@acf.hhs.gov

Also, submit a copy to the TANF Program Manager in your Region.

The Paperwork Reduction Act of 1995

Public reporting burden for this collection of information is estimated to average 24 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

General Instructions

Form OFA-100 consists of five parts in a single Microsoft Word file.  In Part 1, a jurisdiction submits initial and revised data on the quarters for which it is requesting or has requested funds.  In Part 2, a jurisdiction briefly describes its program and the reasons for expenditure increases.  In Part 3, a jurisdiction lists changes to the structure of its TANF program in the three funding categories and describes the methodology it used for any adjustments to the data.  In Part 4, a jurisdiction provides quarterly data for the two possible base years, FY 2007 and FY 2008.  In Part 5, a jurisdiction must certify that it has included all relevant caseload and expenditure data and that the data are accurate.

Using This Form

Form OFA-100 allows you to enter information only in specific fields.  These may be check boxes or larger fields where you can enter text or numbers.  When you enter data, use the “Tab” key to exit and move to the next field; do not use the “Enter” key, which will add hard returns and prevent the form from functioning correctly.

These instructions provide both general information and specific directions for completing each part of this form.  For your convenience, we have numbered items where you need to take specific action to complete the form.

Financial and Caseload Data

Financial data reported on this form must consist of combined Federal TANF expenditures and qualified State maintenance-of-effort (MOE) expenditures.  Expenditures for a quarter should reflect the amount actually expended for that particular quarter, irrespective of when the jurisdiction reports them on a TANF financial report.  This is true whether the expenditures are for a quarter in the base year or for a request quarter.  Expenditures you submit to apply for emergency funds must be consistent with those you report on your TANF financial report (e.g., the ACF-196 for States), but they may not be the same as the amounts reported on any given quarter’s report.  This is because TANF financial reports often reflect adjustments to prior data and because the timing of claims on those reports does not necessarily have to correspond to the period of actual expenditure.

In addition, it is possible for a jurisdiction to report expenditures that relate to one Emergency Fund category in more than one place on its TANF Financial Report.  For example, it may report some subsidized employment expenditures under the category “work subsidies” on the TANF Financial Report and additional ones under the “other” category.  When applying for emergency funds, you should be sure to include all expenditures for a category, regardless of how you report them on your TANF Financial Report.  This is true base-year quarters and request quarters.

Caseload data reported on this form must consist of combined TANF and separate State program (SSP-MOE) assistance cases.  These data should be the same as those you report on your respective TANF/SSP-MOE data reports (e.g., the ACF-199 for States and Territories).

Revisions

A jurisdiction should submit form OFA-100 once in a reporting period.  When you apply for emergency funds, you will submit an initial request with expenditure data and, if applicable, caseload data.  In each subsequent reporting period, you must update the data that you submitted before.  If you are applying for emergency funds for the next quarter, you would submit that initial request for the next quarter with the updates to prior data.

Definitions

 For the purposes of the Emergency Fund, we are using several definitions that already exist in regulations or in various reporting instruments as well as some additional technical terms we have adopted to help this process work smoothly.  Those definitions appear in Appendix 1 to these instructions for reference.

Instructions for Completing Part 1, Request Quarter Data

Part 1 consists of two tables for entering request-quarter data, one for FY 2009 and one for FY 2010.  When you use this part, you will be applying for funds for the first time for one or more quarters, updating data for quarters for which you previously requested emergency funds, or both.

Once you apply for emergency funds, you must update the data in each subsequent reporting period until the data are final.  If the data for a quarter changed in any of the categories, you should enter the revised data and check the box marked “revised” at the top of the column.  If the prior data did not change, you should re-enter the quarterly data.  In either case, you should enter the most current data.

As you revise prior data, we will revise the amount of your Emergency Fund award.  For example, if your revised data show that you qualify for additional emergency funds, we will increase your award.  If your revised data show that you qualify for a smaller award than you received, we will adjust your award accordingly or ask you to remit the difference if you already expended the funds.

1.      Enter the name of your jurisdiction.  Use the “Tab” key to exit the field and move to the next one, rather than the “Enter” key.

2.      Enter the date you are completing this form.  You will only need to enter the jurisdiction name and the completion date once for each submission.  These fields will appear on each page in the form.  If you need to change the completion date, you must do so in Part 1.  You must use the “Tab” key to exit the field before it will update the remaining pages of the form.

3.      Enter the most current data available for all the categories and quarters for which you are applying.  Be sure to enter total expenditures (Federal plus MOE) when entering expenditure data.  Use the “Tab” key to exit a field and move to the next one, rather than the “Enter” key.  Remember that you are permitted to apply for a given quarter no earlier than one month before that quarter begins.  Please refer to the “Application Dates” section above for a list of the reporting periods.

4.      If you have updated any data that you previously submitted for a quarter, check the box at the top of the column for that quarter.  If the data for a prior quarter have not changed, enter the same data you entered before without checking the box for the quarter.

Instructions for Completing Part 2, Expenditure Increases

In this part, you must describe briefly the programs within each expenditure category for which the jurisdiction is requesting emergency funds and describe the causes of the expenditure increase in the request quarter compared to either possible base quarter.  We do not expect a jurisdiction to provide detailed data here, but rather to include general information about the programs funded in each category and the source of expenditure increases.

1.      Briefly describe the benefits and services that you fund in each category for which you are requesting funds.

2.      Briefly describe the types of expenditures that increased and the factors that contributed to the increase.  If you are applying for emergency funds based on an estimate, explain the basis for the estimate.  For example, for the basic assistance category, the increase might be due to growth in the caseload (due to the economy or programmatic changes) or an increase in the family benefit levels.  If there are multiple factors, you should list them all.

If you already provided these descriptions on an earlier submission and nothing has changed, you do not need to provide them again.  Instead, indicate in the field for the category that you have described it before, preferably telling us the date of the submission on which you described it.

Instructions for Completing Part 3, Program Configuration

This part provides information on the configuration of a jurisdiction’s TANF program.  A change to the way that you structure your program after the beginning of FY 2007 may make caseload or expenditure growth between base-year quarters and request quarters appear either smaller or larger than it should for Emergency Fund purposes.  This part is designed to ensure that data for each request quarter and corresponding base-year quarter are comparable.

Program Configuration Changes

Part 3 begins with Section A, a set of questions about your program configuration to help us determine whether we need to make any adjustments.  While we expect that few jurisdictions will have configuration changes that require adjustment, if you answer “yes” to one of the primary questions in Section A, you must complete Section B so we can adjust for that program configuration change.

Each primary question is followed by the secondary question:  “If yes, have you completed Section B on a prior submission to account fully for these changes?”  If this is the first time you are submitting form OFA-100, obviously you will answer “no” to that secondary question.  If you have submitted the form before with a “yes” to a primary question, you should have completed Section B at that time; however, your original Section B may or may not account fully for the changes now that you are submitting the form again.  For example, you may have accounted for one solely State-funded program that you ended at the beginning of FY 2009, but if you then create a new one part way through the fiscal year, you would need to submit a new Section B so we could make another adjustment.  Or, if you were phasing out a diversion program, you may not have projected the rate of the phase-out correctly and thus need to revise the data with updated figures.  The key to this section is to ensure that you account fully for the program configuration changes.

Types of Adjustments

We will adjust data to the extent that they represent changes in funding categories, rather than actual increases or decreases in caseloads or expenditures in the Emergency Fund categories.  For example, in recent years, some jurisdictions began to serve families in solely State-funded (SSF) programs.  These are programs that provide benefits to TANF-eligible families, but are funded with State dollars that are not claimed as MOE.  Without adjustment, a jurisdiction with a SSF program might not get full credit for any increases it experienced in its TANF/MOE caseload and spending.

We may also need to adjust for program configuration changes across Emergency Fund categories.  For example, some jurisdictions served newly-approved families in initial months by providing non-recurrent short-term benefits that were not considered to be “assistance” but were “assistance-like” programs.  Some of these jurisdictions have since discontinued these front-end programs in response to a recent TANF Program Instruction on this issue and enrolled families directly in a basic assistance program.  Without adjustment, a jurisdiction that made this change might appear to have caseload growth even though the overall number of families served did not change.

When we make an adjustment, generally we will do it by adjusting base-year data.  This will represent what the caseload or expenditures would have been in a base-year quarter if the program configuration for the corresponding request quarter had been in place during the base year.

Also, we may need to make adjustments to account for uneven claiming of expenditures across quarters.  For example, a jurisdiction may pay subsidized employment contractors every six months but the timing of such payments in the base year and request year may not match.  If this appears to be the case, we may smooth out certain expenditures over the course of both the base year and the request year, once we have data for the full year.

Step-by-Step Instructions for Completing Part 3

1.      Answer each question in Section A.  If you answer “yes” to a question, we also ask whether you have completed section B on a prior submission to account for these changes.  If you completed Section B before, but you have made additional program configuration changes, you should check “no” to indicate that you have not fully described them in a prior submission.

2.      Complete Section B if you answered “yes” to any question in Section A about program configuration changes and have not completed Section B on a prior submission that fully accounts for those changes.  We have included three copies of the Section B page in this form.  If you need additional pages, include them in an attachment to your submission.

You must provide documentation to support the adjustments you are proposing to the assistance caseload and expenditure data.  We have provided some examples of a completed form for Part 3, Section B in Appendix 2.

In describing an adjustment, be sure to indicate whether the adjustment is positive or negative.  In other words, you should indicate whether you are adding to or subtracting from base-year cases or expenditures.

Please note that you may need to provide data to adjust to both possible base years (i.e., FY 2007 and FY 2008), depending on the timing of the change to your program’s configuration.  Be sure that you explain in Section B how you have addressed this issue.

If you answered “yes” to a question in Section A but the program configuration change relates to a category for which you are not requesting emergency funds, you do not have to show an adjustment for it in Section B; however, if, at a later time, you opt to apply for funding in that category, you will have to complete Section B to adjust for the program configuration change.

Instructions for Completing Part 4, Base Years

 You should provide data for both possible base years, FY 2007 and FY 2008, for each category for which you are requesting emergency funds so that we can determine the correct base year for each category.  Even if you only expect to request funds for some of the quarters in a fiscal year, you must provide data for each of the base-year quarters.  We strongly encourage jurisdictions to provide base-year data for all categories in case you decide to apply for emergency funds in additional categories at a later date.

Each base-year data page includes four tables, one for the assistance caseload data and one for each of the three expenditure categories.  For each quarter, you will enter the unadjusted caseload and expenditures by category and any adjustments to these data from Part 3 of this form.  We use the term “unadjusted” caseload or expenditures to distinguish your caseload or expenditures as they occurred for a quarter from the “adjusted” caseload or expenditures that accounts for changes in the structure of your program.  Please refer to the definitions in Appendix 1 for more detail.

1.   The first time you request emergency funds, enter the unadjusted data for each quarter in each category table for both base years.  if you made no adjustments in Part 3 of this form, you do not need to enter any more information in this part.  Microsoft Word will fill in the adjusted caseload and expenditures, which will be identical to the unadjusted ones.

2.      If you did provide data for adjustments in Part 3, then enter the total adjustments (i.e., the sum of all adjustments) for each respective category from your calculation in Part 3, Section B.  Be sure to use a minus sign or parentheses if the adjustment is a subtraction from the base-year data.  You may need to make adjustments to both base years (i.e., FY 2007 and FY 2008), depending on the timing of the change to your program’s configuration.  Microsoft Word will add the adjustments to arrive at the adjusted caseload and expenditures.

3.      If this is not your first request for emergency funds and you have revised adjustments – or the unadjusted base-year data change after your first request for emergency funds – update the data accordingly.  Check the box at the top of the column for each base-year quarter that you update.  Be sure to provide supporting documentation for your explaining why you have updated the unadjusted base-year data.

Instructions for Completing Part 5, Certification and Contact

 

You must complete a certification with each request for emergency funds.

1.      Enter the name and title of the official certifying the request for emergency funds.

When the form is complete, the certifying official should sign it.  Send us an original certification page in hard copy or a scanned image of the hard copy.  For further information about submitting this form, please refer to the “Submission” section of these instructions.

2.      Enter the name, telephone number, and email address for a contact with whom we can discuss the content of the emergency fund request should we have questions.  This does not need to be the same as the official signing the form.

 

Appendix 1 – Definitions

We are using several definitions that already exist in regulations or in various reporting instruments (i.e., the TANF Financial Report (ACF-196), the TANF Data Report (ACF-199), the SSP-MOE Data Report (ACF-209), the Tribal TANF Data Report (ACF-343), the Territorial Financial Report (ACF-196TR), and the Tribal Financial Reports (SF-269A, ACF-196T, or ACF-102-477 Financial Report 12g)).  There are also some technical terms we have adopted to help this process work smoothly.  This attachment serves as a reference for all of these definitions.

Assistance caseload:  The average monthly number of TANF and SSP-MOE cases receiving “assistance.”  Consistent with 45 CFR 260.31(a) and 45 CFR 286.10(a), “assistance” includes cash, payments, vouchers, and other forms of benefits designed to meet a family’s ongoing basic needs (i.e., for food, clothing, shelter, utilities, household goods, personal care items, and general incidental expenses).  It includes such benefits even when they are provided in the form of payments by a TANF agency, or other agency on its behalf, to individual recipients and are conditioned on their participation in work experience or community service (or any other work activity (i.e., under §261.30)).  It also includes supportive services such as transportation and child care provided to families who are not employed.

Basic assistance: Consistent with 45 CFR 260.31(a)(1) and (2), and with 45 CFR 286.10(a)(1), basic assistance means cash, payments, vouchers, and other forms of benefits designed to meet a family's ongoing basic needs (i.e., for food, clothing, shelter, utilities, household goods, personal care items, and general incidental expenses).  It includes such benefits even when they are provided in the form of payments by a TANF agency, or other agency on its behalf, to individual recipients, and when they are conditioned on participation in work experience or community service (or any other work activity).

This is the same definition that the ACF-196 (line 5a) uses; it is not assistance that would be reported on line 5b, 5c, or 5d of the ACF-196 (child care, transportation or other supportive services, or assistance authorized solely under prior law, if it is not basic assistance.)  It can include benefits regardless of whether the parent is working or the benefit is provided in what the jurisdiction considers its basic TANF program or in another program that serves a particular subgroup of families or a particular purpose (e.g., an earnings supplement program).

Non-recurrent short-term benefits:  Consistent with the definition at 45 CFR 260.31(b)(1) and 45 CFR 286.10(b)(1), non-recurrent short-term benefits means benefits designed to deal with a specific crisis situation or episode of need, that are not intended to meet recurrent or ongoing needs, and that will not extend beyond four months.  This is the same definition that the ACF-196 (line 6g) uses.

Note that these benefits include those provided directly to a family and those paid to others on behalf of the family, such as a payment to a landlord.  Both families receiving other forms of “assistance” and families that do not otherwise receive ongoing assistance may receive non-recurrent short-term benefits.

Subsidized employment expenditures:  There is no expenditure category called “subsidized employment” but subsidized employment activities are typically reported under the category “Work Subsidies” on TANF financial reports.  Consistent with the definition at 45 CFR 260.31(b)(2) and at 45 CFR 286.10(b)(2), work subsidies means payments to employers or third parties to help cover the costs of employee wages, benefits, supervision, and training.  This is the same definition that the ACF-196 (line 6a1) uses.  We will use this definition for the definition of subsidized employment expenditures.

Note that some jurisdictions may in the past have reported some subsidized employment expenditures in categories other than “work subsidies” on their respective financial reports.  Such a jurisdiction should nevertheless include all expenditures related to operating a subsidized employment program, including the cost of overseeing the program, developing work sites, and providing training to participants, when applying for funding.

Emergency Fund base year:  Either FY 2007 or FY 2008, whichever has the lower assistance caseload (for the basic assistance category) or lower expenditures (for the non-recurrent short-term benefits and subsidized employment categories).  The base year for a jurisdiction could be different for different expenditure categories.  Since HHS may adjust the caseload and expenditure data, the base year for each category is the one that is the lesser after making any adjustments.

Unadjusted caseload:  The average monthly number of TANF and SSP-MOE cases receiving “assistance” as reported on jurisdiction’s TANF data report for a quarter.

Unadjusted expenditures:  The total Federal and MOE expenditures a jurisdiction made in TANF and SSP-MOE programs in an Emergency Fund category, where expenditures reflect the amount actually expended for a quarter, irrespective of when the jurisdiction claimed the expenditures on the applicable financial report.

Adjustment:  The number of cases or amount of expenditures that should be added or subtracted from a quarter in the base year due to a change in program configuration between the base year and the request year.

Solely State-funded (SSF) program:  A program that provide benefits to TANF-eligible families, but is funded with State dollars that are not claimed as MOE.

Adjusted caseload:  The average monthly number of TANF and SSP-MOE cases receiving “assistance” derived by adding or subtracting adjustments from the unadjusted caseload.

 Adjusted expenditures:  The total Federal and MOE expenditures a jurisdiction made in TANF and SSP-MOE programs in an Emergency Fund category after adding or subtracting adjustments from the unadjusted expenditure amounts.

 

 

Appendix 2 – Examples: Adjustment Descriptions and Methodologies

 

This appendix includes two examples of adjustments.  Each example is separate, submitted by two different, hypothetical jurisdictions, thus the caseload and expenditure data are different.  Each includes an example of Part 3, Section B, and of Part 4 to illustrate how to use the adjustment data in the base-year table.

Example 1, adjustment for creation of two-parent solely State-funded (SSF) program.

Section B – Adjustments for Program Configuration Changes

Change # 1

Description of program change: 

We created a solely State-funded program for two-parent families.

Date program change took effect:

October 1, 2007

Explanation of the methodology:

Describe why the program change requires an adjustment and how you estimated the adjustment.  Be sure to provide documentation to support the adjustments you are proposing to the assistance caseload and expenditure data.

Reason for Adjustment:  The creation of our SSF at the beginning of FY 2008 requires an adjustment because our actual FY 2007 caseload and basic assistance expenditures would have been lower if we had had the SSF in place in that year.  Therefore the data are not comparable without adjustment.

Methodology:  To make the FY 2007 quarterly base-year caseload and basic assistance expenditures comparable with the request quarter, we SUBTRACTED our actual two-parent average monthly caseload (TANF/SSP-MOE) each quarter in FY 2007 from the unadjusted average monthly caseload each quarter in FY 2007.  Then we SUBTRACTED our quarterly two-parent basic assistance expenditures in FY 2007 from the unadjusted basic assistance expenditures each quarter in that year.  The resulting adjusted caseload and expenditures for FY 2007 reflect the program configuration in the corresponding request quarters, i.e., show the caseload and expenditures we would have had if the SSF had been operating in FY 2007.

Table X-1 shows our two-parent caseload by month and quarter in FY 2007.  Table X-2 shows our total quarterly basic assistance expenditures for two-parent families in FY 2007.  The caseload data in Table X-1 came from our actual caseload reported on the TANF Data Reporting System.  The financial data come from our financial database.  These data reflect actual expenditures during FY 2007 and are consistent with data reported on the TANF Financial Report (ACF-196).

Part 3 reflects these adjustments from our unadjusted base-year data in Part 3.

Supporting documentation:  All tables are attached to this submission.

We did not adjust the FY 2008 quarterly base-year data because the SSF program began and was fully in effect at the start of FY 2008 and thus the program configuration in FY 2008 is identical to FY 2009 and FY 2010.

 


Example 1, jurisdiction’s attached tables X-1 and X-2.

 

Change # 1, Two-Parent Solely State-Funded Program

 

Table X-1: FY 2007 Two-Parent Caseload

Month

Monthly Two-Parent Caseload

Fiscal Quarter

Average Monthly Caseload by Quarter

October

100

 

Quarter 1

 

110

November

110

December

120

January

120

 

Quarter 2

 

120

February

120

March

120

April

130

 

Quarter 3

 

130

May

130

June

130

July

140

 

Quarter 4

 

150

August

150

September

160

 

Table X-2: FY 2007 Two-Parent Expenditures

Fiscal Quarter

Average Quarterly Basic Assistance Expenditures

Quarter 1

$110,000

Quarter 2

$120,000

Quarter 3

$130,000

Quarter 4

$150,000

 

Example 1, Part 4 – FY 2007 base year with adjustments.

 

FY 2007 Base-Year Data

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Average Monthly Assistance Caseload

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Caseload

1,000

1,100

1,200

1,350

 

           Total Adjustments

(110)

(120)

(130)

(150)

 

Adjusted Caseload

890

980

1,070

1,200

1,035

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Basic Assistance Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

$1,000,000

$1,100,000

$1,200,000

$1,350,000

 

           Total Adjustments

($110,000)

($120,000)

($130,000)

($150,000)

 

Adjusted Expenditures

$890,000

$980,000

$1,070,000

$1,200,000

 

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Non-Recurrent Short-Term Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

$0

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Subsidized Employment Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

$0


Example 2, ending an assistance-like diversion program.

Section B – Adjustments for Program Configuration Changes

Change # 1

Description of program change: 

We ended a diversion program providing non-recurrent short-term benefits that provided what ACF considered to be assistance to all TANF applicants for up to four months.  The benefits were identical to those received by families on assistance, but were intended to help families deal with a crisis and avoid welfare.

Date program change took effect:

October 1, 2008. The diversion program was created October 1, 2006, and ended two years later.

Explanation of the methodology:

Describe why the program change requires an adjustment and how you estimated the adjustment.  Be sure to provide documentation to support the adjustments you are proposing to the assistance caseload and expenditure data.

Reason for Adjustment:  The termination of the diversion program requires an adjustment because our assistance caseload and basic assistance expenditures are now higher than they would have been if we had continued the diversion program.  This means we need to ADD assistance cases and basic assistance expenditures to each quarter in the base years in this category to make the base years comparable to our present program configuration.  Similarly, our non-recurrent short-term benefit expenditures need to be adjusted DOWNWARD in both base years to make them comparable to expenditures of our current non-recurrent short-term benefits program.

Methodology:  We adjusted for the termination of the diversion program on the assistance side by ADDING the actual average monthly diversion caseload in FY 2007 (Table Y-1) to the average monthly unadjusted assistance caseload for each quarter in FY 2007.  We also ADDED the quarterly diversion expenditures in FY 2007 (Table Y-2) to the total unadjusted basic assistance expenditures each quarter in FY 2007.

For the non-recurrent short-term benefits expenditures, we SUBTRACTED the quarterly FY 2007 diversion expenditures (Table Y-2) from total unadjusted nonrecurrent short-term benefit expenditures each quarter. 

We adjusted the FY 2008 data in the same way (see Tables Y-3 and Y-4).

To make these adjustments, we identified the diversion cases equivalent to the ones we re-classsified as regular TANF cases beginning in FY 2009 using case codes associated with our up-front diversion program.  Next we identified the expenditures on those cases.  We had other non-recurrent short-term expenditures in FY 2007 and FY 2008 not related to this program, so we did not use the total expenditures in this category.  These changes made both the basic assistance and the non-recurrent short-term benefit categories in FY 2007 comparable to the request-quarter data.

Supporting documentation:  Tables Y-1 through Y-4.

 


Example 2, jurisdiction’s attached tables Y-1through Y-4.

 

Change # 1, Ending Diversion Program

Table Y-1: FY 2007 Diversion Cases for Adjustment Calculation

Month

Monthly Diversion Caseload

Fiscal Quarter

Average Monthly Diversion Caseload by Quarter

October

20

 

Quarter 1

 

22

November

22

December

24

January

24

 

Quarter 2

 

24

February

24

March

24

April

26

 

Quarter 3

 

26

May

26

June

26

July

28

 

Quarter 4

 

30

August

30

September

32

 

Table Y-2: FY 2007 Diversion Expenditures for

Adjustment Calculation

 

Fiscal Quarter

Average Quarterly Basic Assistance Expenditures

 
 
 

Quarter 1

$22,000

 

Quarter 2

$24,000

 

Quarter 3

$26,000

 

Quarter 4

$30,000

 


Table Y-3: FY 2008 Diversion Cases for Adjustment Calculation

Month

Monthly Diversion Caseload

Fiscal Quarter

Average Monthly Diversion Caseload by Quarter

October

30

Quarter 1

32

November

32

December

34

January

34

Quarter 2

34

February

34

March

34

April

36

Quarter 3

36

May

36

June

36

July

38

Quarter 4

40

August

40

September

42

 

Table Y-4: FY 2008 Diversion Expenditures for

Adjustment Calculation

 

Fiscal Quarter

Expenditures

 
 
 

Quarter 1

$32,000

 

Quarter 2

$34,000

 

Quarter 3

$36,000

 

Quarter 4

$40,000

 


Example 2, Part 4 – FY 2007 and FY 2008 base years with adjustments

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Average Monthly Assistance Caseload

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Caseload

900

950

1,000

1,000

 

           Total Adjustments

22

24

26

30

 

Adjusted Caseload

922

974

1,026

1,030

988

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Basic Assistance Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

$900,000

$950,000

$1,000,000

$1,000,000

 

           Total Adjustments

$22,000

$24,000

$26,000

$30,000

 

Adjusted Expenditures

$922,000

$974,000

$1,026,000

$1,030,000

 

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Non-Recurrent Short-Term Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

$50,000

$50,000

$50,000

$50,000

 

           Total Adjustments

($22,000)

($24,000)

($26,000)

($30,000)

 

Adjusted Expenditures

$28,000

$26,000

$24,000

$20,000

$98,000

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Subsidized Employment Expenditures

Quarter 1
(Oct 2006-Dec 2006)

Quarter 2
(Jan 2007-Mar 2007)

Quarter 3
(Apr 2007-Jun 2007)

Quarter 4
(Jul 2007-Sep 2007)

FY 2007

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

$0


FY 2008 Base-Year Data

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Average Monthly Assistance Caseload

Quarter 1
(Oct 2007-Dec 2007)

Quarter 2
(Jan 2008-Mar 2008)

Quarter 3
(Apr 2008-Jun 2008)

Quarter 4
(Jul 2008-Sep 2008)

FY 2008

Unadjusted Caseload

1,100

1,150

1,200

1,200

 

           Total Adjustments

32

34

35

40

 

Adjusted Caseload

1,132

1,184

1,235

1,240

1,197

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Basic Assistance Expenditures

Quarter 1
(Oct 2007-Dec 2007)

Quarter 2
(Jan 2008-Mar 2008)

Quarter 3
(Apr 2008-Jun 2008)

Quarter 4
(Jul 2008-Sep 2008)

FY 2008

Unadjusted Expenditures

$1,100,000

$1,150,000

$1,200,000

$1,200,000

 

           Total Adjustments

$32,000

$34,000

$36,000

$40,000

 

Adjusted Expenditures

$1,132,000

$1,184,000

$1,236,000

$1,240,000

 

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Non-Recurrent Short-Term Expenditures

Quarter 1
(Oct 2007-Dec 2007)

Quarter 2
(Jan 2008-Mar 2008)

Quarter 3
(Apr 2008-Jun 2008)

Quarter 4
(Jul 2008-Sep 2008)

FY 2008

Unadjusted Expenditures

$55,000

$55,000

$55,000

$55,000

 

           Total Adjustments

($32,000)

($34,000)

($36,000)

($40,000)

 

Adjusted Expenditures

$23,000

$21,000

$19,000

$15,000

$78,000

 

Which quarters have revised data?       Q1                    Q2                   Q3                   Q4

Subsidized Employment Expenditures

Quarter 1
(Oct 2007-Dec 2007)

Quarter 2
(Jan 2008-Mar 2008)

Quarter 3
(Apr 2008-Jun 2008)

Quarter 4
(Jul 2008-Sep 2008)

FY 2008

Unadjusted Expenditures

     

     

     

     

 

           Total Adjustments

     

     

     

     

 

Adjusted Expenditures

$0

$0

$0

$0

$0