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

CHILD CARE AND DEVELOPMENT FUND ACF-696 FINANCIAL REPORT
State or Territory	Grant Year				Final Report [ ] Yes [ ] No	Current Quarter Ended
	Grant Number:					Next Quarter 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) Grant Document # CCDX	(COLUMN F) DISCRETIONARY DISASTER RELIEF FUNDS CONST. & MAJOR RENOVATION (Federal Share Only) Grant Document # CCDY	(Column G) DISCRETIONARY CARES ACT FUNDS (Federal Share Only) Grant Document # CCC3	(Column H) DISCRETIONARY CRRSA ACT FUNDS (Federal Share Only) Grant Document # CCC5
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). Non - Direct Services
1(e)(1). Systems
1(e)(2). Certificate Program Costs/Eligibility Determination
1(e)(3). All Other Non-Direct 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 Quarter (Refer to Next Quarter Beginning Date Above.)
Redistributed and Reallotted Funds
Please refer to redistribution and reallotment of funds information 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:				0.00
3/31 Submittal -- If available, does the State request reallotted discretionary funds?					YES [ ] NO [ ]
REPORT MUST BE RECEIVED BY DUE DATE TO BE ELIGIBLE FOR REDISTRIBUTED MATCHING FUNDS OR REALLOTTED DISCRETIONARY FUNDS.
Signature Information
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 States share
of Estimates is or will be available to meet the NON-FEDERAL Share of Expenditures as required by law.
Signature: State/Territory Official	Typed Name, Title, Agency Name, Phone #:
Date Certified:
FORM ACF-696 APPROVED OMB CONTROL NO. 0970-0510 EXPIRATION Date: 05/31/2021	THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13): Public reporting burden for this collection of information is estimated to average 6 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Submit Date: