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| SSBG Post-Expenditure Report |
| Year: Group: |
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| Contacts |
| Contact Type Name |
First Name |
Last Name |
Title |
Agency |
Street1 |
Street2 |
City |
State Name |
Zip |
Phone Number |
Fax Number |
| State CFO Contact Info |
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| State SSBG Contact Info |
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| State Official Contact Info |
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| Definitions |
| Child |
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| Adult |
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| Family |
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| Assurances |
| Assurance Name |
Yes |
No |
Comment |
| Is the total amount of funds transferred from TANF to SSBG equal to the amount reported for the related period in the TANF financial report (ACF196R)? |
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| The grantee certifies that funds transferred from TANF to SSBG comply with the statutory requirements described in Section 404(d) of the Social Security Act. |
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| The grantee certifies that no carryover extends beyond the two year expenditure period outlined in the code Sec.2002 42 U.S.C. 1397a (c) |
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| Was the actual use of funds transferred from TANF to SSBG reflected in the pre-expenditurereport? |
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| Expenditures and Recipients |
| Service Supported with SSBG Expenditures |
Current Year SSBG Allocation Expenditures |
Carried Over SSBG Allocation Expenditures |
Carried Over TANF Transfer Fund Expenditures |
Current Year TANF Transfer Fund Expenditures |
Expenditures of All Other Federal, State, and Local Funds |
Total Expenditures |
Actual |
Estimated |
Public |
Private |
Include All |
Children |
Adults Age 59 Years & Younger |
Adults Age 60 years & Older |
Adults of Unknown Age |
Total Adults |
Total Recipients |
Actual |
Estimated |
Sampled |
Duplicated |
Unduplicated |
Eligibility Comment |
Email |
| 1) Adoption Services |
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| 2) Case Management |
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| 3) Congregate Meals |
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| 4) Counseling Services |
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| 5) Day Care--Adults |
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| 6) Day Care--Children |
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| 7) Education and Training Services |
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| 8) Employment Services |
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| 9) Family Planning Services |
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| 10) Foster Care Services--Adults |
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| 11) Foster Care Services--Children |
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| 12) Health-Related Services |
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| 13) Home-Based Services |
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| 14) Home-Delivered Meals |
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| 15) Housing Services |
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| 16) Independent/Transitional Living Services |
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| 17) Information & Referral |
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| 18) Legal Services |
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| 19) Pregnancy & Parenting |
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| 20) Prevention & Intervention |
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| 21) Protective Services--Adults |
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| 22) Protective Services--Children |
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| 23) Recreation Services |
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| 24) Residential Treatment |
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| 25) Special Services--Disabled |
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| 26) Special Services--Youth at Risk |
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| 27) Substance Abuse Services |
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| 28) Transportation |
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| 29) Other Services*** |
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| 30) SUM OF EXPENDITURES FOR SERVICES |
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| 31) Administrative Costs |
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| 32) SUM OF EXPENDITURES FOR SERVICES AND ADMINISTRATIVE COSTS |
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| 33) Total SSBG Expenditures |
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| 34) Remaining funds to be carried over into the next fiscal year |
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| Comments |
| From which block grant(s) were these funds transferred: |
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| **Please list the sources of these funds: |
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| ***Please list other services: |
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| Additional Comments |
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