Financial Reporting for Indian Tribes: ACF-696T Form (2013)

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Publication Date: November 20, 2013
Current as of:

All Tribal Child Care and Development Fund (CCDF) grantees are required to complete and submit the 696-T report on an annual basis in accordance with these instructions on behalf of the Tribal Lead Agency administering the CCDF. Tribal Lead Agencies have the option of submitting the form ACF-696T either electronically through Online Data Collection (OLDC) or manually by mailing hard copies. ACF encourages grantees to use OLDC since it reduces paperwork, allows for quicker processing, automatically completes required calculations, and checks for potential errors.

 

U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
ADMINISTRATION FOR CHILDREN AND FAMILIES
CHILD CARE AND DEVELOPMENT FUND ACF-696T FINANCIAL REPORT
TRIBE: FISCAL YEAR GRANT WAS AWARDED:  GRANT DOC. #(s): SUBMISSION (MARK ONE BOX)
EXPENDITURE PERIOD: 10/1 ____TO 9/30_______  FINAL REPORT   YES [   ]   NO [   ] ORIGINAL [  ]  REVISED [  ]
CUMULATIVE FISCAL YEAR TOTALS
  COLUMN (A)
TRIBAL MANDATORY FUNDS		 COLUMN (B)
DISCRETIONARY FUNDS
(NOT INCLUDING BASE)		 COLUMN (C)
DISCRETIONARY
FUNDS (Base Amount)
 		 COLUMN (D)
CONST. & RENOVATION
TRIBAL MANDATORY		 COLUMN (E)
CONST. & RENOVATION
DISCRETIONARY
1. FEDERAL FUNDS AWARDED $ $ $    
2. TRANSFER TO CONSTRUCTION / RENOVATION $ $ $    
3. TOTAL FUNDS AVAILABLE $ $ $ $ $
      
4. EXPENDITURES FOR CHILD CARE SERVICES $ $ $ $ $
5. EXPENDITURES FOR CHILD CARE ADMINISTRATION $ $ $ $ $
6. EXPENDITURES FOR NON-DIRECT SERVICES (INCLUDING SYSTEMS, CERTIFICATE PROGRAM, AND ELIGIBILITY DETERMINATION COSTS) $ $ $ $ $
7. EXPENDITURES FOR QUALITY ACTIVITIES $ $ $ $ $
8. EXPENDITURES FOR CONSTRUCTION/ RENOVATION       $ $
9. TOTAL FEDERAL EXPENDITURES $ $ $ $ $
10. TOTAL FEDERAL UNLIQUIDATED OBLIGATIONS $ $ $ $ $
11. TOTAL FEDERAL UNOBLIGATED BALANCE $ $ $ $ $

REALOTTED FUNDS

PLEASE REFER TO REALLOTTED FUNDS INFORMATION ON PAGE FIVE (5) OF THE INSTRUCTIONS.

IF AVAILABLE, DOES THE TRIBE REQUEST REALLOTTED DISCRETIONARY FUNDS? YES [ ]  NO [ ].

 

IF THIS REPORT IS NOT RECEIVED WITHIN 90 DAYS AFTER THE END OF THE FISCAL YEAR (12/29), THE TRIBE WILL NOT BE ELIGIBLE FOR REALLOTMENT

.THIS IS TO CERTIFY THAT THE INFORMATION REPORTED ON ALL PARTS OF THIS FORM IS ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

THIS ALSO CERTIFIES THAT THE TRIBAL LEAD AGENCY HAS EXPENDED REQUIRED FUNDS IN ACCORDANCE WITH THE EARMARK FOR CHILD CARE RESOURCE AND REFERRAL AND SCHOOL-AGE CARE ACTIVITIES.
SIGNATURE: TRIBAL OFFICIAL TYPED NAME, TITLE, LEAD AGENCY NAME, PHONE #, FAX #

 

 

 

 

 

 
DATE SUBMITTED: OMB CONTROL NO. 0970-0195   HAS ANY CONTACT INFORMATION CHANGED SINCE LAST YEAR?
[ ] YES [ ] NO
FORM ACF-696T PAGE 1 OF 1 EXPIRATION DATE: 5/31/2016  

 

Program Office:
Office of Child Care
Types:
Form
Topics:
Reporting