Form ACF-196 TANF Financial Report

Temporary Assistance for Needy Families Quarterly Financial Report

ACF 196 Final with ARRA 8Mar13.xls

Temporary Assistance for Needy Families Quarterly Financial Report

OMB: 0970-0247

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Department of Health and Human Services






Administration for Children and Families
Temporary Assistance for Needy Families (TANF) ACF - 196 Financial Report






State FY Funds were Awarded Current Quarter Ended Next Quarter Ending Report is Submitted as: [ ] New [ ] Revised [ ] Final







State Family Assistance Contingency Funds Emergency Contingency Fund

Award Reconciliation [ ] YES [ ] NO

Federal Funds State Funds




Federal Share at FMAP Rate of: _______%






(A) (B) (C) (D) (E)
1. Awarded $
$ $
2. Transferred to CCDF Discretionary $

3. Transferred to SSBG $

4. Adjusted SFAG $



Expenditures Categories FEDERAL TANF STATE MOE EXPENDITURES IN TANF MOE EXPENDITURES SEPARATE STATE PROGRAMS FEDERAL EXPENDITURES FEDERAL EXPENDITURES
EXPENDITURES
5. Expenditures On Assistance




a. Basic Assistance $ $ $ $ $
b. Child Care $ $ $ $ $
c. Transportation and Other Supportive Services $ $ $ $ $
d. Assistance Authorized Solely under Prior Law $

$ $
6. Expenditures on Non-Assistance




a. Work Related Activities / Expenses $ $ $ $ $
1. Work Subsidies $ $ $ $ $
2. Education and Training $ $ $ $ $
3. Other Work Activities / Expenses $ $ $ $ $
b. Child Care $ $ $ $ $
c. Transportation $ $ $ $ $
1. Job Access $ $ $ $ $
2. Other $ $ $ $ $
d. Individual Development Accounts $ $ $ $ $
e. Refundable Earned Income Tax Credits $ $ $ $ $
f. Other Refundable Tax Credits $ $ $ $ $
g. Non-Recurrent Short Term Benefits $ $ $ $ $
h. Prevention of Out-of-Wedlock Pregnancies $ $ $ $ $
i. 2-Parent Family Formation and Maintenance $ $ $ $ $
j. Administration $ $ $ $ $
k. Systems $ $ $ $ $
l. Non-Assistance Authorized Solely Under Prior Law $ $ $ $ $
m. Other $ $ $ $ $
7. Total Expenditures $ $ $ $ $

8. Transitional Services for Employed










9. Federal Unliquidated Obligations $ $ $ $ $
10. Unobligated Balance $ $ $ $ $






11. State Replacement Funds
$



Quarterly Estimate TANF Federal Funds



12. Estimate for Next QTR. Ended $



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: AUTHORIZED STATE OFFICIAL

TYPED NAME, TITLE, AGENCY NAME
DATE SUBMITTED:




PAGE 1 OF 1 FORM ACF-196 APPROVED OMB No 0970-0247 Expires 04/30/2012





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