Form ACF-696 CCDF ACF-696 Financial Report for States and Territories

CHILD CARE AND DEVELOPMENT FUND ACF-696 FINANCIAL REPORT
STATE	FISCAL YEAR		SUBMISSION (MARK ONE BOX)		REPORT QTR. ENDED:
	GRANT DOCUMENT # (s)		ORIGINAL [ ] REVISED [ ] FINAL [ ]		NEXT QTR. BEGINNING:
	CUMULATIVE FISCAL YEAR TOTALS
	(COLUMN A) MANDATORY FUNDS (Federal Share Only) Grant Document # CCDF	(COLUMN B) MATCHING FUNDS AT FMAP RATE OF _% (Federal and State Share) Grant Document # CCDM	(COLUMN C) DISCRETIONARY FUNDS (Federal Share Only) Grant Document # CCDD	(COLUMN D) MOE (State Share Only)	(COLUMN E) DISCRETIONARY DISASTER RELIEF FUNDS (Federal Share Only)	(COLUMN F) DISCRETIONARY DISASTER RELIEF FUNDS- CONSTRUCTION AND MAJOR RENOVATION (Federal Share Only)
1. TOTAL EXPENDITURES	$	$	$	$	$	$
1(a). CHILD CARE ADMINISTRATION	$	$	$	$	$	$
1(b). QUALITY ACTIVITIES EXCLUDING INFANT/TODDLER QUALITY ACTIVITIES REPORTED ON LINE 1(c)	$	$	$	$	$	$
1(c). INFANT/TODDLER QUALITY ACTIVITIES	$	$	$	$	$	$
1(d). DIRECT SERVICES	$	$	$	$	$	$
1(e). NONDIRECT SERVICES	$	$	$	$	$	$
1(e)(1). SYSTEMS	$	$	$	$	$	$
1(e)(2). CERTIFICATE PROGRAM COSTS/ELIG. DETERMINATION	$	$	$	$	$	$
1(e)(3). ALL OTHER NONDIRECT SERVICES	$	$	$	$	$	$
1(f) CONSTRUCTION AND MAJOR RENOVATION					$	$
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.)	$	$	$	$
PLEASE REFER TO REDISTRIBUTION AND REALLOTMENT OF FUNDS INFORMATION IN THE INSTRUCTIONS.
September 30 SUBMITTAL -- IF AVAILABLE, DOES THE STATE REQUEST REDISTRIBUTED MATCHING FUNDS? YES [ ] NO [ ]. IF YES AND THE STATE REQUESTS A LIMIT TO THE MATCHING AMOUNT, PLEASE ENTER AMOUNT $________________________
	March 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	APPROVED OMB CONTROL NO. 0970-0510	TYPED NAME, TITLE, AGENCY NAME, PHONE #
DATE SUBMITTED:	EXPIRATION DATE: 05/31/2021
FORM ACF-696 PAGE 1 OF 1

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