Document
Revised ACF-800 Form, 2003
ICR 201205-0970-007 · OMB 0970-0150 · Object 32530701.
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Document Metadata
| File Type | application/msword |
|---|---|
| File Title | Revised ACF-800 Form, 2003 |
| Subject | CCDF Annual Aggregate Report |
| Author | Child Care Bureau, Administration for Children and Families, Dep |
| Last Modified By | Writer |
| File Modified | 2009-08-28 |
| File Created | 2026-10-02 |
| Conversion State | complete |
Extracted Text
DRAFT
CHILD CARE AND DEVELOPMENT FUND ANNUAL AGGREGATE REPORT (ACF-800)
(Effective for FFY 2010 and Subsequent Reports) OMB Approval Number: XXXX-XXXX
FOR SERVICES PROVIDED FROM __________________ THROUGH __________________
Expires: XX/XX/XXXX
Complete Name of Grantee:
CATEGORY/TYPE OF CHILD CARE
Address:
CARE PROVIDED BY A LICENSED OR REGULATED PROVIDER IN A
CARE PROVIDED BY A LEGALLY OPERATING PROVIDER (LICENSE CATEGORY UNAVAILABLE IN A STATE OR LOCALITY) IN A
CHILD’S HOME BY A
FAMILY HOME BY A
GROUP HOME BY A
Contact Person, Phone & Email:
( A )
TOTAL
( B )
Child’s Home
( C )
Family Home
( D )
Group Home
( E )
Center
( F )
Relative
(G )
Non-Relative
( H )
Relative
(I )
Non-Relative
(J )
Relative
(K )
Non-Relative
(L )
Center
Number Served:
1. Number of families receiving child care services
2. Number of children receiving child care services
3a. Does the State claim public pre-kindergarten expenditures on CCDF-eligible children as State CCDF Match?
Y N
3b. Does the State claim public pre-kindergarten expenditures on CCDF-eligible children as State CCDF MOE?
Y N
4. If yes to 3a or 3b, indicate the estimated number of CCDF eligible children receiving public pre-kindergarten services for which CCDF Match or MOE is claimed.
Payment Methods:
5. Number of children served through grants or contracts
6. Number of children receiving child care services through certificates and/or cash
7. Of children served through certificates, number of children served through cash payments directly to parents (only)
Provider Information:
8. Number of child care providers receiving CCDF funding by type of care
Consumer Education:
9a. Estimated number of families receiving consumer education
9b. How is the estimated number of families receiving consumer education determined?
10. Indicate the Content Used on a Regular Basis:
10a. Information about use of certificates, grants or contracts
Y N
10b. Information for locating legally operating child care providers, and/or lists of legally operating child care providers
Y N
DRAFT
Page 2 - CHILD CARE AND DEVELOPMENT FUND ANNUAL REPORT (ACF-800)
(Effective for FFY 2010 and Subsequent Reports) OMB Approval Number: XXXX-XXXX
FOR SERVICES PROVIDED FROM __________________ THROUGH __________________
Expires: XX/XX/XXXX
Expires: XX/XX/XXXX
Grantee:
Contact Person & Phone:
Consumer Education, continued:
10c. Information about types and quality of child care
Y N
10d. Information about health and safety requirements
Y N
10e. Information about child care laws and regulations
Y N
10f. Information about provider complaint policies
Y N
11. Indicate the Methods Used on a Regular Basis:
11a. Written materials including brochures, booklets, checklists, newspaper articles, or billboards about child care topics
Y N
11b. Counseling from Resource and Referral Agencies
Y N
11c. Mass media broadcasts including TV announcements or radio announcements about child care topics
Y N
11d. Electronic media publications or broadcasts including Internet sites and webcasts about child care topics.
Y N
Pooling Factor:
12. Is this report based on pooled CCDF and non-CCDF funds?
Y N
13. If this report is based on pooled CCDF and non-CCDF funds, what is the percent of funds which are CCDF?
_________%
14. If this report is based on pooled CCDF and non-CCDF funds, please indicate which non-CCDF funds are included in the pool.
14a. Title XX (Social Services Block Grant, SSBG)
14b. State-only child care funds (in excess of State funds used
to meet CCDF Match and MOE requirements.)
14c. TANF direct funds for child care not transferred into CCDF
14d. Title IV-B or IV-E funds
14e. Supplemental Nutrition Assistance Program (formerly Food Stamps)
14f. Other: (Please specify other non-CCDF funds included in the pool).
Y N
Y N
Y N
Y N
Y N
Y N
_______________________________________________
_______________________________________________
_______________________________________________
DRAFT
Page 3 - CHILD CARE AND DEVELOPMENT FUND ANNUAL REPORT (ACF-800)
(Effective for FFY 2010 and Subsequent Reports) OMB Approval Number: XXXX-XXXX
FOR SERVICES PROVIDED FROM __________________ THROUGH __________________
Expires: XX/XX/XXXX
Expires: XX/XX/XXXX
Grantee:
Contact Person & Phone:
Other: (Optional)
15. Please enter explanatory comments regarding any of the data elements as appropriate.
16. Please attach any reports, materials, information developed as a result of the use of CCDF quality funds.