CCDF Financial Reporting Form ACF-696 for FY 2009 Grant Award, ARRA of 2009
ACF-696 Form
Publication Date:
October 7, 2013
Current as of:
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U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES—ADMINISTRATION FOR CHILDREN AND FAMILIES CHILD CARE AND DEVELOPMENT FUND ACF—696 FINANCIAL REPORT |
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| STATE | FISCAL YEAR: | SUBMISSION (MARK ONE BOX) | CURRENT QTR. ENDED: | NEXT QTR. BEGINNING: | |
| GRANT DOCUMENT # |
ORIGINAL [ ] REVISED [ ] FINAL [ ] |
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| CUMULATIVE FISCAL YEAR TOTALS | |||||
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(COLUMN A) MANDATORY FUNDS (Federal Share Only) |
(COLUMN B) MATCHING FUNDS AT FMAP RATE OF__________% (Federal and State Share) |
(COLUMN C) DISCRETIONARY FUNDS (Federal Share Only) |
(COLUMN D) MOE (State Share Only) |
(COLUMN E) ARRA (American Recovery and Reinvestment Act Funds) (Federal Share Only) |
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| 1. TOTAL | $ | $ | $ | $ | |
| 1(a). CHILD CARE ADMINISTRATION | $ | $ | $ | $ | |
| 1(b). QUALITY ACTIVITIES EXCLUDING TARGETED FUNDS | $ | $ | $ | $ | |
| 1(c). INFANT AND TODDLER TARGETED FUNDS* | $ | ||||
| 1(d). QUALITY EXPANSION TARGETED FUNDS* | $ | ||||
| 1(e). SCHOOL-AGE/RESOURCE AND REFERRAL TARGETED FUNDS* | $ | ||||
| 1(f). OTHER TARGETED FUNDS | $ | ||||
| 1(g). DIRECT SERVICES | $ | $ | $ | $ | |
| 1(h). NONDIRECT SERVICES | $ | $ | $ | $ | |
| 1(h)(1). SYSTEMS | $ | $ | $ | $ | |
|
1(h)(2). CERTIFICATE PROGRAM COSTS/ELIG. DETERMINATION |
$ | $ | $ | $ | |
| 1(h)(3). ALL OTHER NONDIRECT SERVICES | $ | $ | $ | $ | |
| 2. STATE SHARE OF EXPENDITURES | $ | $ | |||
| 2(a). REGULAR | $ | $ | |||
| 2(b). PRIVATE DONATED FUNDS | $ | $ | |||
| 2(c). PRE-K | $ | $ | |||
| 3. FEDERAL SHARE OF EXPENDITURES | $ | $ | $ | ||
| 4. FEDERAL SHARE OF UNLIQUIDATED OBLIGATIONS | $ | $ | $ | ||
| 5. AWARDED | $ | $ | $ | ||
| 6. TRANSFER FROM TANF | $ | ||||
| 7. UNOBLIGATED BALANCE | $ | $ | $ | $ | |
|
8. FEDERAL FUNDS REQUESTED ESTIMATES FOR NEXT QTR. (Refer to Next Qtr. Beginning Date Above.) |
$ | $ | $ | ||
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9. Estimated Child Service Months Funded by ARRA: (See instruction (PDF)) |
$ | ||||
| PLEASE REFER TO REALLOTTED FUNDS INFORMATION ON PAGES 5 OF THE INSTRUCTIONS. | |||||
| 9/30 SUBMITTAL -- IF AVAILABLE, DOES THE STATE REQUEST REALLOTTED MATCHING FUNDS? YES [ ] NO [ ]. IF YES AND THE STATE REQUESTS A LIMIT TO THE MATCHING AMOUNT, PLEASE ENTER AMOUNT $ _______________ | |||||
| 3/31 SUBMITTAL -- IF AVAILABLE, DOES THE STATE REQUEST REALLOTTED DISCRETIONARY FUNDS? YES [ ] NO [ ]. | |||||
| 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 STATE'S SHARE OF ESTIMATES IS OR WILL BE AVAILABLE TO MEET THE NONFEDERAL SHARE OF EXPENDITURES AS REQUIRED BY LAW. | |||||
| SIGNATURE: STATE OFFICIAL | DATE SUBMITTED: | TYPED NAME, TITLE, AGENCY NAME, PHONE # |
APPROVED OMB CONTROL NO. 0970-0163 EXPIRATION DATE: 3-31-2013 |
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FORM ACF-696 PAGE 1 OF 1 * TARGETED FUNDS NARRATIVE REPORT ATTACHMENT: FOR LINES 1(c), 1(d), 1(e) IN COLUMN C AND COLUMN E, ATTACH A SEPARATE PAGE THAT INCLUDES A BRIEF DESCRIPTION OF THE ACTIVITIES ON WHICH TARGETED FUNDS, FROM THE FISCAL YEAR'S GRANT, WERE EXPENDED. THIS NEED ONLY BE COMPLETED WITH EACH 4TH QUARTER'S REPORT. |
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