Form ACF-196 Quarterly Financial Report

Department of Health and Human Services
Administration for Children and Families
Temporary Assistance for Needy Families (TANF) ACF - 196 Financial Report
State	Fiscal Year	Current Quarter Ended	Next Quarter Ending	Award Reconciliation [ ] YES [ ] NO
	Federal Funds	STATE FUNDS		CONTINGENCY FUND
				FEDERAL SHARE AT FMAP RATE OF:
	FEDERAL AWARDS			________%
	& TRANSFERS			FEDERAL AWARDS
	(A)	(B)	(C)	(D)
1. Awarded	$			$
2. Transferred to CCDF Discretionary	$
3. Transferred to SSBG	$
4. Adjusted SFAG	$
Expenditures Categories	FEDERAL TANF	STATE MOE EXPENDITURES IN TANF	MOE EXPENDITURES SEPARATE STATE PROGRAMS	FEDERAL EXPENDITURES
	EXPENDITURES
5. Expenditures On Assistance	$	$	$	$
a. Basic Assistance	$	$	$	$
b. Child Care	$	$	$	$
c. Transportation and Other Supportive Services	$	$	$	$
d. Assistance Authorized Solely under Prior Law	$	$	$	$
6. Expenditures on Non-Assistance	$	$	$	$
a. Work Related Activities / Expenses	$	$	$	$
1. Work Subsidies	$	$	$	$
2. Education and Training	$	$	$	$
3. Other Work Activities / Expenses	$	$	$	$
b. Child Care	$	$	$	$
c. Transportation	$	$	$	$
1. Job Access	$	$	$	$
2. Other	$	$	$	$
d. Individual Development Accounts	$	$	$	$
e. Refundable Earned Income Tax Credits	$	$	$	$
f. Other Refundable Tax Credits	$	$	$	$
g. Non-Recurrent Short Term Benefits	$	$	$	$
h. Prevention of Out-of-Wedlock Pregnancies	$	$	$	$
i. 2-Parent Family Formation and Maintenance	$	$	$	$
j. Administration	$	$	$	$
k. Systems	$	$	$	$
l. Non-Assistance Authorized Solely Under Prior Law	$	$	$	$
m. Other	$	$	$	$
7. Total Expenditures	$	$	$	$
8. Transitional Services for Employed
9. Federal Unliquidated Obligations	$			$
10. Unobligated Balance	$			$
11. State Replacement Funds		$
Quarterly Estimate	Estimate TANF Federal Funds
12. Estimate for Next QTR. Ended	$
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 STATE OFFICIAL			TYPED NAME, TITLE, AGENCY NAME
DATE SUBMITTED:	SUBMITTAL: [ ] NEW [ ] REVISED [ ] FINAL
PAGE 1 OF 1 APPROVED OMB No 0970-0247	FORM ACF-196