Caseload Reduction Documentation Process, AC-202

DRA TANF Final Rule

CRC form new 2007

Caseload Reduction Documentation Process, AC-202

OMB: 0970-0338

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Form ACF-202 – TANF Caseload Reduction Report


State: ____________________________

Fiscal Year to which credit applies: ______

Overall Report ___

Two-parent Report ___

(check one)

Apply the overall credit to the two-parent participation rate?

____ yes

____ no

PART 1 –Eligibility Changes Made Since FY 2005
(Complete this section for EACH change)

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:


  1. Description of the methodology used to calculate the estimated impact of this eligibility change
    (attach supporting materials to this form):


  1. Estimated average monthly impact of this eligibility change on caseload in comparison year: _______

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:

  1. Name of eligibility change:

  1. Implementation date of eligibility change:

  1. Description of policy, including the change from prior policy:

  1. Description of the methodology used to calculate the estimated impact of this eligibility change:
    (attach supporting materials to this form)

  1. Estimated average monthly impact of this eligibility change on caseload in comparison year:


State: ____________________________

Fiscal Year to which credit applies: ______


PART 2 – Estimate of Caseload Reduction Credit



(Complete Part 2 using Excel Workbook provided.)







State: ____________________________

Fiscal Year to which credit applies: ______



PART 3 -- Certification


I certify that we have provided the public an appropriate opportunity to comment on the estimates and methodology used to complete this report and considered those comments in completing it. Further, I certify that this report incorporates all reductions in the caseload resulting from State eligibility changes and changes in Federal requirements since Fiscal Year 2005.






___________________________________________________________

(signature)





___________________________________________________________

(name)





___________________________________________________________

(title)


OMB Approval No.: Expiration Date:

Page 12 of 12

File Typeapplication/msword
File TitleState ______________________
AuthorACF
Last Modified ByJLSiegel
File Modified2008-01-22
File Created2008-01-22

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