Child Care and Development Fund Quarterly Financial Report

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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
STATE

SUBMISSION (MARK ONE BOX)

FISCAL YEAR 2009

ORIGINAL [ ] REVISED [

GRANT DOCUMENT #

CURRENT QTR. ENDED:

NEXT QTR. BEGINNING:

(COLUMN D)
MOE
(State Share Only)

(COLUMN E)
ARRA (American Recovery
and Reinvestment Act Funds
(Federal Share Only)

]

FINAL [ ]

CUMULATIVE FISCAL YEAR TOTALS
(COLUMN B)
MATCHING FUNDS
AT FMAP RATE OF _____%
(Federal and State Share)

(COLUMN A)
MANDATORY FUNDS
(Federal 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(h)(1). SYSTEMS
1(h)(2). CERTIFICATE PROGRAM COSTS/ELIG. DETERMINATION
1(h)(3). ALL OTHER NONDIRECT SERVICES

$

$

$

$

1(f). OTHER TARGETED FUNDS

1(h). NONDIRECT SERVICES

$

$

1(e). SCHOOL-AGE/RESOURCE AND REFERRAL TARGETED FUNDS*

1(g). DIRECT SERVICES

(COLUMN C)
DISCRETIONARY FUNDS
(excluding ARRA)
(Federal Share Only)

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

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.)

$

$

$

$

$

$

$

$

9. ESTIMATED CHILD SERVICE MONTHS FUNDED BY ARRA:
(See page 8 of instructions)

#

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: 6/30/2010

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.