196R ACF-196R Form

TANF Expenditure Report – ACF 196R

acf_196r_form - TANF ARPA - Expedited Approval.xlsx

OMB: 0970-0446

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Overview

ACF-196R Part 1
ACF-196R Part 2


Sheet 1: ACF-196R Part 1

Department of Health and Human Services
Administration for Children and Families
Temporary Assistance for Needy Families (TANF) ACF - 196R Financial Report
Part 1: Expenditure Data

State Grant Year Fiscal Year Report Quarter Ending Next Quarter Ending Report is Submitted as:

[ ] New [ ] Revised
--------------------------------
[ ] Final
(Zero Grant Funds Remaining)









Federal Funds State Funds Federal Funds Federal Funds

State Family Assistance Grant

Contingency Funds

Award Reconciliation

Federal Share at FMAP Rate of:
______%
Pandemic Emergency Funds
(Authorized by ARPA)


(A) (B) (C) (D) (E)
1. Awarded

$

2. Transferred to CCDF Discretionary $



3. Transferred to SSBG $



4. Adjusted Award





5. Carryover





Expenditures Categories FEDERAL EXPENDITURES STATE MOE EXPENDITURES IN TANF MOE EXPENDITURES SEPARATE STATE PROGRAMS EXPENDITURES WITH CONTINGENCY FUNDS EXPENDITURES WITH PANDEMIC EMERGENCY FUNDS

6 Basic Assistance





6.a. Basic Assistance (excluding Relative Foster Care Maintenance Payments and Adoption and Guardianship Subsidies) $ $ $ $ $
6.b. Relative Foster Care Maintenance Payments and Adoption and Guardianship Subsidies
$ $ $ $ $
7. Assistance Authorized Solely Under Prior Law





7.a. Foster Care Payments $

$ $
7.b. Juvenile Justice Payments $

$ $
7.c. EmergencyAssistance Authorized Solely Under Prior Law $

$ $
8. Non-Assistance Authorized Solely Under Prior Law





8.a. Child Welfare or Foster Care Services $

$ $
8.b. Juvenile Justice Services $

$ $
8.c. Emergency Services Authorized Solely Under Prior Law $

$ $
9. Work, Education, and Training Activities





9.a. Subsidized Employment $ $ $ $ $
9.b. Education and Training $ $ $ $ $
9.c. Additional Work Activities $ $ $ $ $
10. Work Supports





11. Early Care and Education





11.a. Child Care (Assistance and Non-Assistance) $ $ $ $ $
11.b. Pre-Kindergarten/Head Start $ $ $ $ $
12. Financial Education and Asset Development $ $ $ $ $
13. Refundable Earned Income Tax Credits $ $ $ $ $
14. Non-EITC Refundable State Tax Credits $ $ $ $ $
15. Non-Recurrent Short Term Benefits $ $ $ $ $
16. Supportive Services $ $ $ $ $
17. Services for Children and Youth $ $ $ $ $
18. Prevention of Out-of-Wedlock Pregnancies $ $ $ $ $
19. Fatherhood and Two-Parent Family Formation and Maintenance Programs $ $ $ $ $
20. Child Welfare Services





20.a. Family Support/ Family Preservation /Reunification Services $ $ $ $ $
20.b. Adoption Services $ $ $ $ $
20.c. Additional Child Welfare Services $ $ $ $ $
21. Home Visiting Programs $ $ $ $ $
22. Program Management





22.a. Administrative Costs $ $ $ $ $
22.b. Assessment/Service Provision $ $ $ $ $
22.c. Systems $ $ $ $ $
23.Other $ $ $ $ $
24.Total Expenditures







25 Transitional Services for Employed $ $ $ $ $
26 Job Access $ $ $




27. Federal Unliquidated Obligations $

$ $
28. Unobligated Balance $

$ $
29. State Replacement Funds
$










Quarterly Estimate Estimate TANF Federal Funds






30. Estimate of TANF Funds Requested for the Following Quarter $




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:






PAGE 1 OF 2 of APPROVED OMB No: 0970-0446, Expiration Date 02/29/2024








Sheet 2: ACF-196R Part 2

Department of Health and Human Services
Administration for Children and Families
Temporary Assistance for Needy Families (TANF) ACF - 196R Financial Report
Part 2: Narrative Section


State Fiscal Year


Expenditure Categories Descriptions of Expenditures Methodology Used to Estimate Federal Funding and State MOE Expenditures
6 Basic Assistance

6.a. Basic Assistance (excluding Relative Foster Care Maintenance Payments and Adoption and Guardianship Subsidies)

6.b. Relative Foster Care Maintenance Payments and Adoption and Guardianship Subsidies


7. Assistance Authorized Solely Under Prior Law


7.a. Foster Care Payments

7.b. Juvenile Justice Payments

7.c. EmergencyAssistance Authorized Solely Under Prior Law

8. Non-Assistance Authorized Solely Under Prior Law

8.a. Child Welfare or Foster Care Services

8.b. Juvenile Justice Services

8.c. Emergency Services Authorized Solely Under Prior Law

9. Work, Education, and Training Activities

9.a. Subsidized Employment

9.b. Education and Training

9.c. Additional Work Activities

10. Work Supports

11. Early Care and Education

11.a. Child Care (Assistance and Non-Assistance)

11.b. Pre-Kindergarten/Head Start

12. Financial Education and Asset Development

13. Refundable Earned Income Tax Credits

14. Non-EITC Refundable State Tax Credits

15. Non-Recurrent Short Term Benefits

16. Supportive Services

17. Services for Children and Youth

18. Prevention of Out-of-Wedlock Pregnancies

19. Fatherhood and Two-Parent Family Formation and Maintenance Programs

20. Child Welfare Services

20.a. Family Support/ Family Preservation /Reunification Services

20.b. Adoption Services

20.c. Additional Child Welfare Services

21. Home Visiting Programs

22. Program Management

22.a. Administrative Costs

22.b. Assessment/Service Provision

22.c. Systems

23.Other






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:

PAGE 2 OF 2 of APPROVED OMB No: 0970-0446, Expiration Date 02/29/2024






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