Form ACF-696 CCDF Financial Report

Child Care and Development Fund (CCDF) Quarterly Financial Report (ACF-696)

CCDF 696 Form Revised for CRRSA Clean Version.xlsx

Child Care and Development Fund ACF-696 Financial Report

OMB: 0970-0163

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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.
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