|
|
|
|
|
|
|
|
|
|
|
|
U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES |
|
|
|
|
|
|
|
|
|
ADMINISTRATION FOR CHILDREN AND FAMILIES |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TRIBAL TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) ACF - 196T FINANCIAL REPORT |
|
|
|
|
|
|
|
|
TRIBE Name: |
GRANT AWARD YEAR: |
|
SUBMISSION: |
|
|
|
|
|
|
EMPLOYER ID NUMBER (EIN): |
REPORT PERIOD: |
|
ORIGINAL [ ] or REVISED [ ] |
|
|
|
|
|
|
|
From: |
To: |
QUARTERLY [ ] or FINAL [ ] |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
COLUMN (A) |
COLUMN (B) |
COLUMN (C) |
|
|
|
|
|
|
REPORTING ITEMS |
FEDERAL TFAG |
STATE CONTRIBUTED |
TRIBAL FUNDS |
|
|
|
|
|
|
|
FUNDS |
MOE FUNDS |
|
|
|
|
|
|
|
1. TOTAL FEDERAL FUNDS AWARDED |
$ |
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EXPENDITURES ON ASSISTANCE |
|
|
|
|
|
|
|
|
|
2a. Cash Assistance |
$ |
$ |
|
|
|
|
|
|
|
2b. Other Assistance Expenditures |
$ |
$ |
|
|
|
|
|
|
|
2c. TOTAL ASSISTANCE EXPENDITURES |
$ |
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
EXPENDITURES ON NON-ASSISTANCE |
|
|
|
|
|
|
|
|
|
3a. Administration |
$ |
$ |
|
|
|
|
|
|
|
3b. Systems |
$ |
$ |
|
|
|
|
|
|
|
3c. Other Non-Assistance Expenditures |
$ |
$ |
|
|
|
|
|
|
|
3d. TOTAL NON-ASSISTANCE EXPENDITURES |
$ |
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
TOTALS |
|
|
|
|
|
|
|
|
|
4. Total Expenditures |
$ |
$ |
|
|
|
|
|
|
|
5. Unliquidated Balance |
$ |
|
|
|
|
|
|
|
|
6. Unobligated Balance |
$ |
|
|
|
|
|
|
|
|
7. Tribal Replacement Funds |
$ |
|
$ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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 |
|
|
|
|
|
|
SIGNATURE: TRIBAL OFFICIAL |
|
TYPED NAME, TITLE |
|
|
|
|
|
|
|
DATE SUBMITTED: |
CONTROL NO. XXXX-XXX |
PHONE NUMBER: |
|
|
|
|
|
|
|
FORM ACF-196T PAGE 1 OF 1 |
EXPIRATION DATE: XX/XX/XXXX |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|