CCDF Financial Reporting Form (ACF-696)Index: CCDF-ACF-PI-2007-05 | ACF-696 Form | ACF-696 Instructions | (Download in Word and PDF) Related Items: ACF Program Managers |
| 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: | |
| GRANT DOCUMENT # | ORIGINAL [ ] REVISED [ ] FINAL [ ] |
NEXT QTR. BEGINNING: | ||
| CUMULATIVE FISCAL YEAR TOTALS | ||||
| (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) |
|
| 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.) |
$ | $ | $ | |
| 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 | APPROVED OMB CONTROL NO. 0970-0163 | TYPED NAME, TITLE, AGENCY NAME, PHONE # | ||
| DATE SUBMITTED: | EXPIRATION DATE: 06-30-2010 |
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| FORM ACF-696 PAGE 1 OF 1 | ||||
| * FOR LINES 1(c), 1(d), 1(e) AND 1(f), 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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Index: CCDF-ACF-PI-2007-05 | ACF-696 Form | ACF-696 Instructions | (Download in Word and PDF) Related Items: ACF Program Managers |