Form ACF-800 CCDF Annual Aggregate Report

OMB Approval Number: 0970-0150

FOR SERVICES PROVIDED FROM __________________ THROUGH __________________

Expires: XX/XX/XXXX

Complete Name of Grantee:

CATEGORY/TYPE OF CHILD CARE

CARE PROVIDED BY A LICENSED OR

CARE PROVIDED BY A LEGALLY OPERATING PROVIDER (LICENSE CATEGORY

Address:

REGULATED PROVIDER IN A

UNAVAILABLE IN A STATE OR LOCALITY) IN A

CHILD'S HOME BY A

FAMILY HOME BY A

GROUP HOME BY A

Contact Person (First, Middle, Last Name)

( A )

( B )

( C )

( D )

( E )

( F )

( G )

( H )

( I )

( J )

( K )

( L )

Contact Person Phone: Phone Type: (select one) Work, Mobile

TOTAL

Child's

Family

Group

Center

Relative

Non-Relative

Relative

Non-Relative

Relative

Non-Relative

Center

Contact Person Email:

Home

Home

Home

Number Served:

1. Number of families receiving

child care services

2. Number of children receiving

child care services

2a. Number of child fatalities

3a. Does the State claim public pre-

kindergarten expenditures on

Y N

CCDF-eligible children as State

CCDF Match?

3b. Does the State claim public pre-

kindergarten expenditures on

Y N

CCDF-eligible children as State

CCDF MOE?

4. If yes to 3a or 3b, indicate the

estimated number of CCDF eligible

children receiving public pre-

kindergarten services for which

CCDF Match or MOE is claimed.

Payment Methods:

5. Number of children served

through grants or contracts

6. Number of children receiving

child care services through

certificates and/or cash

7. Of children served through

certificates, number of children

served through cash payments

directly to parents (only)

Provider Information:

8. Number of child care providers

receiving CCDF funding by type of

care

Consumer Education:

9a. Estimated number of families receiving

consumer education

9b. How are estimates of the number of

families receiving consumer

education determined?

10. No longer collected effective FFY2016 (OCC is not changing the numbering of the questions, so that users of the data are not confused when they analyze data across fiscal years.)

11. Indicate the Methods Used on

a Regular Basis:

11a. Written materials including

brochures, booklets, checklists,

Y N

newspaper articles, or billboards

about child care topics

11b. Counseling from Resource

Y N

and Referral Agencies, eligibility workers,

and other entities

11c. Mass media broadcasts

including TV announcements or

Y N

radio announcements about child

care topics

11d. Electronic media publications

or broadcasts including Internet

Y N

sites and webcasts about child care

topics

11e. Referral to other programs for

which parents might be eligible

Y N

Pooling Factor:

12. Is this report based on pooled CCDF and non-CCDF funds?

Y N

13. If this report is based on pooled CCDF and non-CCDF funds, what is the

%

percent of funds which are CCDF?

13a. If this year's pooling factor has changed more than +/- 5% since last year, please

explain what led to the change

14. If this report is based on pooled CCDF and non-CCDF funds, please indicate

which non-CCDF funds are included in the pool.

14a. Title XX (Social Services Block Grant, SSBG)

Y N

14b. State-only child care funds (in excess of State funds used

Y N

to meet CCDF Match and MOE requirements)

14c. TANF direct funds for child care not transferred into CCDF

Y N

14d. Title IV-B or IV-E funds

Y N

14e. No longer collected effective FFY2016

14f. Other: (Please specify other non-CCDF funds included in the pool)

Y N