Form ACF 696T ACF 696T ACF 696T

CHILD CARE AND DEVELOPMENT FUND ACF-696T FINANCIAL REPORT

Tribal Lead Agency:

Grant Year (FFY grant was awarded):

GDN:

Submission: [ ] Original [ ] Revised

Final Report: [ ] Yes [ ] No

Expenditure Period: 10/1/______

TO 9/30/_______

Cumulative Fiscal Year Totals

COLUMN (A) MANDATORY Grant Document # CCDF

COLUMN (B) DISCRETIONARY Not including Base Grant Document # CCDD

COLUMN (C) DISCRETIONARY Base Amount Grant Document # CCDD

COLUMN (D) CONST. & MAJOR RENOVATION MANDATORY Grant Document # CONT

COLUMN (E) CONST. & MAJOR RENOVATION DISCRETIONARY Grant Document # CONT

COLUMN (F) DISCRETIONARY DISASTER RELIEF FUNDS Grant Document # CCDX

COLUMN (G) DISCRETIONARY DISASTER RELIEF FUNDS CONST. & MAJOR RENOVATION Grant Document # CCDY

Column (H) DISCRETIONARY CARES ACT FUNDS Grant Document # CCC3

Column (I) DISCRETIONARY CARES ACT FUNDS CONST. & MAJOR RENOVATION Grant Document # CYC3

Column (J) DISCRETIONARY CRRSA ACT FUNDS Grant Document # CCC5

Column (K) DISCRETIONARY CRRSA ACT FUNDS CONST. & MAJOR RENOVATION Grant Document # CYC5

COLUMN (L) SUPPLEMENTAL DISCRETIONARY ARP ACT FUNDS Grant Document # CDC6

COLUMN (M) SUPPLEMENTAL DISCRETIONARY ARP ACT FUNDS CONST. & MAJOR RENOVATION Grant Document # CONTCDC6

COLUMN (N) STABILIZATION ARP ACT FUNDS BASE AMOUNT Grant Document # CSC6

COLUMN (O) STABILIZATION ARP ACT FUNDS NOT INCLUDING BASE Grant Document # CSC6

COLUMN (P) STABILIZATION ARP ACT FUNDS CONST. & MAJOR RENOVATION Grant Document # CONTCSC6

1. Federal Funds Awarded

2. Transfer to Constructions / Renovation

3. Total Funds Available

4. Expenditures for Direct Child Care Services

5. Expenditures for Child Care Administration

6. Expenditures for Non-Direct Services

7. Expenditures for Quality Activites (excluding infant and toddler quality activites reported on line 8)

8. Expenditures for Infant/Toddler Quality Activities

9. Expenditures for Construction / Major Renovation

10. ARP Act Stabilization Sub-Grants to Providers

11. ARP Act Stabilization Set Aside (Admin & TA)

11(a) Subgrant administration

11(b) Systems

11(c) TA - application

11(d) TA - implementation

11(e) Publicity

11(f) Activities to Build Supply

12. Total Federal Expenditures

13. Total Federal Unliquidated obligations

14. Total Federal Unobligated balance

14(a). Was the Tribal Lead Agency unable to obligate at least 50% of the CCDF stabilization grants by December 11, 2021?

YES [ ] NO [ ]

YES [ ] NO [ ]

15. Reallotted Funds: If available, does the Tribe request reallotted discretionary funds? Please refer to reallotted funds information in the instructions. If this report is not received within 90 days after the end of the fiscal year in which the grant was awarded (12/29), the tribe will not be eligible for reallotment.

YES [ ] NO [ ]

YES [ ] NO [ ]

YES [ ] NO [ ]

YES [ ] NO [ ]

YES [ ] NO [ ]

YES [ ] NO [ ]

Signatures

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 tribal lead agency has expended required funds in accordance with CCDF regulation.

Signature: Tribal Official

Typed Name: Title: Agency Name:

Date Submitted:

Phone #:

Form: ACF - 696T

APPROVED OMB CONTROL NO. 0970-0510

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13): Public reporting burden for this collection of information is estimated to average 7 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.

EXPIRATION DATE: 06/30/2024