TANF-ACF-PI-2010-09 (Q & A on the TANF Contingency Fund for Fiscal Years (FY) 2011 and 2012)

REQUEST FOR FEDERAL TANF CONTINGENCY FUNDS

State:

Months eligible as a Needy State:

Trigger Satisfied:             _____________      Food Stamp Unemployment    ___________________

Funds requested for fiscal year  _____________

Indicate Below Request Method Option 1 or Option 2:

• Option 1   _____________

I hereby request payment for all months of the fiscal year that my State meets the Unemployment or Food Stamp Trigger.

• Option 2   _____________

I hereby request payment just for the months indicated below.

October:     _____________     November:     _____________      December:     _____________

January:     _____________     February:       _____________      March:            _____________

April:          _____________      May:              _____________      June:               _____________

July:           _____________      August:         _____________      September:     _____________
 

CERTIFICATION:

In requesting the above-indicated Federal TANF 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 Federal Contingency funds will be used only for allowable expenditures under the TANF program.
4. I understand that the Federal TANF 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, within one year after the State has failed to meet either the Food Stamp trigger or the Unemployment Trigger for three consecutive months.

Date:    ________________________               Signature of Governor or legal Designee     ________________________