Form ACF-196P TANF Pandemic Emergency Assistance Fund (PEAF) Financial

U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR CHILDREN AND FAMILIES

.

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)

PANDEMIC EMERGENCY ASSISTANCE FUNDS AWARDED TO GRANTEES

GRANTEE NAME:

GRANTEE ENTITY TYPE (State, Territory, Tribe):

EMPLOYER ID NUMBER (EIN):

SUBMISSION:

GRANT AWARD YEAR:

2021

ANNUAL

FINAL

REPORT PERIOD: From: April 1, 2021 To:

REPORTING ITEMS

PANDEMIC EMERGENCY FUND (Authorized by ARPA)

1. Total Federal Funds Awarded

$0.00

2. Administration

$0.00

3. Non-Recurrent, Short Term Benefits

$0.00

4. Total Expenditures (if using Excel, this will automatically calculate)

$0.00

5. Unliquidated Obligations

$0.00

6. Unobligated Balance (if using Excel, this will automatically calculate)

$0.00

In concert with the QE 9/30/22 reporting cycle, the grantee should select their preference for receiving any available reallotted Pandemic Emergency Assistance Funds. The “yes” option must be selected in order for a reallotted award to be issued. If neither a “yes” or “no” is selected, OFA will interpret that to mean that the grantee does not want to receive additional funds.

If available, does the grantee opt to receive reallotted Pandemic Emergency Assistance Funds?

YES

NO

No Reallotted PEAF Requested

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: AUTHORIZED ORGANIZATIONAL REPRESENTATIVE

TYPED NAME, TITLE

DATE SUBMITTED:

PHONE NUMBER:

EMAIL ADDRESS:

FORM ACF-196P

CONTROL NO. 0970-0510 EXPIRATION DATE: xx/xx/xxxx

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering information to ensure that federal TANF Pandemic Emergency Assistance Funds are used for activities that are reasonably calculated to meet one of the purposes of PEAF. Public reporting burden for this collection of information is estimated to average 6 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 403 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 # is 0970-0510 and the expiration date is 6/30/2024. If you have any comments on this collection of information, please contact [email protected].