Form 1 Expenditure Report 196T

	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:	DOCUMENT CONTROL NUMBER:		GRANT AWARD YEAR:	SUBMISSION:
	EMPLOYER ID NUMBER (EIN):	REPORT PERIOD:			ORIGINAL [ ] REVISED [ ]
		From:	To:		QUARTERLY [ ] FINAL [ ]
		COLUMN (A)	COLUMN (B)	COLUMN (C)	COLUMN (D)
	REPORTING ITEMS	FEDERAL TFAG	STATE CONTRIBUTED	TRIBAL FUNDS	American Recovery & Reinvestment Act
		FUNDS	MOE FUNDS		ARRA FUNDS
	1. TOTAL FEDERAL FUNDS AWARDED	$	$		$
	EXPENDITURES ON ASSISTANCE
	2a. Cash Assistance Payments (Basic 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. 0970-0345	PHONE NUMBER:
	FORM ACF-196T PAGE 1 OF 1	EXPIRATION DATE: 07/31/2011	EMAIL ADDRESS: