Form 196 TANF Financial Report

ACF-196: TANF ARRA Financial Report

Department of Health and Human Services
Administration for Children and Families

Temporary Assistance for Needy Families (TANF) ACF - 196 Financial Report
Grantee

Fiscal Year

Current Quarter Ended

Next Quarter Ending

Award Reconciliation
YES
NO

Report is Submitted as:
New
Revised
Final

Federal Awards Transfers
SECTION A - Federal Awards and Transfers

A: Federal Awards
Transfers

B: State Funds

C: State Funds

D: Contingency Fund
Federal Share at FMAP
RATE of
.6854

E: ARRA Funds

F: Supplemental

Federal Expenditures

Federal Expenditures
(ARRA)

Federal Expenditures
(ARRA)
Supplemental

1. Awarded
2. Transferred to CCDF Discretionary
3. Transfered to SSBG
4. Adjusted SFAG

Expenditures
SECTION B - Expenditure Categories

Federal TANF
Expenditures

State MOE Expenditures in
TANF

MOE Expenditures
Separate State Programs

5. Expenditures On Assistance
a. Basic Assistance
b. Child Care on Assistance
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 on Non-Assistance
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 Information and
Maintenance
j. Administration

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ACF-196: TANF ARRA Financial Report
k. Systems
l. Non-Assistance Authorized Solely under
Prior Law
m. Other
7. Total Expenditures-If 4th Quarter add
attachment explaining information

Obligations Replacement Fund
Section B2 - Expenditure Categories (Contd.)

Federal TANF
Expenditures

State MOE Expenditures in
TANF

MOE Expenditures
Separate State Programs

Federal Expenditures

Federal
Expenditures(ARRA)

Federal Expenditures
(ARRA)
Supplemental

8. Transitional Services for Employed
9. Federal Unliquidated Obligations
10. Unobligated Balance
11. State Replacement Funds

Quarterly Estimate
SECTION C - Quarterly Estimate

Estimate TANF Federal
Funds

12. Estimate for Next QTR. Ended

Grantee Certification
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, Approving State Official
Signature Date:

State Official Name

State Official Title

State Official Agency

Date Submitted:

OMB #0970-0247, Expiration Date: XX/XX/XXXX
NOTE: PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to obtain revised expenditure data used by states with open grant awards for
fiscal years (FYs) prior to FY 2015. Public reporting burden for this collection of information is estimated to average 5 hours per grantee, including the time for reviewing instructions, gathering and maintaining the data needed, and
reviewing the collection of information. This is a mandatory collection of information which is authorized under Section 411 (a)(3) of the Social Security Act. An agency may not conduct or sponsor, and a person is not required to respond
to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # and expiration date for this collection of information is 0970-0247
and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact ACF at email address: [email protected].