Form ACF-404 State Improper Payments Report - 2026 Version

OMB Control Number: 0970-0323
Expiration Date: xx/xx/20xx

STATE IMPROPER PAYMENTS REPORT (ACF-404)
Part I. Program Assurances and Certifications
The Lead Agency, named below, assures and certifies the following:
1.

2.

3.
4.

5.
6.

The data collection process, including sample selection and case record reviews, adhered to
all requirements of the instructions and regulations for Error Rate Reporting at 45 CFR 98
Subpart K.
The reviews were not conducted by persons who: (1) make or approve eligibility
determinations, or who (2) are under the supervision of persons responsible for eligibility
determinations, or (3) ever made or approved eligibility determinations for a case in which
they were assigned to review.
All reviewers have been trained to ensure that the review process is consistent with state
policies and that there is consistency within the state in interpretation of what is an error.done
The state agrees to retain Record Review Worksheets, the State Improper Payments Report
and any revisions, and any other records pertinent to the case reviews and submission of error
rate reports for five years from the date of submission of the State Improper Payments Report
or final revision submitted, whichever date is later.
The state understands that this information, including the sampled case records and
calculations are subject to federal review.
Documents submitted to the Office of Child Care as part of the error rate review must not
contain any personally identifiable information (PII) as defined in Section I of the Child Care
Improper Payments Data Collection Instructions.
Submission Date:
Name:
Signature:
Title:
State:
State Agency:
Phone Number:
E-mail:
Fiscal Year:

Part II. Error Measures Reporting
Item #

N/A

N/A

1.

Number of cases reviewed

N/A

2.

Total number of cases with an error

N/A

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Item #

N/A

N/A

3.

Percentage of cases with an error

N/A

4.

Total number of cases with an improper payment

N/A

5.

Percentage of cases with an improper payment

N/A

6.

Total number of cases with an improper payment error due to missing or insufficient documentation (MID) N/A

7A.

Total number of MID errors with identified potential improper payments

N/A

7B.

Total dollar amount of potential improper payments resulting from the MID errors. Apply the state’s
pooling factor if pooled funds were used.

N/A

8A.

Total number of MID potential improper payment errors that was mitigated using an additional inquiry
(AI)

N/A

8B.

Total dollar amount of MID potential improper payments that was mitigated using an AI. Apply the state’s N/A
pooling factor if pooled funds were used.

9A.

Total number of MID improper payment errors that, after an AI was considered and possibly used, still
resulted in an improper payment

9B.

Total dollar amount of MID improper payments that resulted even after an AI was considered and possibly N/A
used.

9C.

Total dollar amount of MID underpayments that resulted even after an AI was considered and possibly
used. Apply the state’s pooling factor if pooled funds were used.

9D.

Total dollar amount of MID overpayments that resulted even after an AI was considered and possibly used.
Apply the state’s pooling factor if pooled funds were used.

10.

Total amount of payments for the sampled cases. Apply the state’s pooling factor if pooled funds were
used.

11.

Total amount of improper payments for review period (gross amount of underpayments and overpayments) N/A

11A.

Total amount of underpayments for review period. Apply the state’s pooling factor if pooled funds were
used.

N/A

11B.

Total amount of overpayments for review period. Apply the state’s pooling factor if pooled funds were
used.

N/A

12.

Percentage of the total amount of payments for the sampled cases that are improper payments

N/A

13.

Average amount of improper payments

N/A

14A.

Total annual amount of CCDF subsidy payments

N/A

14B.

Estimated annual amount of improper payments

N/A

N/A

N/A

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Item #
15.

N/A

N/A

Check the appropriate response based on whether the state combines or pools funds, and conducted its
reviews based on a sample drawn from a universe of cases served by these pooled funds. Check one of the
following:
a. the review was not based on a sample drawn from pooled funds.
b. the review was based on a sample drawn from pooled funds, and the state applied pooling factor from
the relevant ACF-800 reporting form.
b-i. indicate the number of sampled cases that used pooled funds.
b-ii. indicate the percentage of sampled cases that used pooled funds.
b-iii If the Lead Agency did not apply the pooling factor to all sample cases, please describe which
cases the pooling factor was applied to and why. Otherwise, enter N/A.
c. the review was based on a sample drawn from pooled funds, but the state did not apply the pooling
factor found on the relevant ACF-800 reporting form.
c-i. provide the pooling factor.
c-ii. explain the derivation of this pooling factor.
c-iii. indicate the number of sampled cases that used pooled funds.
c-iv. indicate the percentage of sampled cases that used pooled funds.
c-v. If the Lead Agency did not apply the pooling factor to all sample cases, please describe which
cases the pooling factor was applied to and why. Otherwise, enter N/A.

16.

Number of replacement cases used each month of the 12-month review period and reason for each
replacement

N/A

(if one or more replacement cases were used): Describe how the Lead Agency will review and adjust (if
necessary) the sampling methodology to reduce the need for replacement cases in the next review cycle.

Month

# Times Reason
Used

Reason(s) for Replacement Cases (please list)

October
November
December

.

January
February
March
April
May
June
July
August
September

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Part III. State Response to Error Measures Findings
Item #

N/A

17.

Describe lessons learned or improvements made in implementation of the review process during the current
review cycle.

Item #

N/A

18.

For each potential improper payment error due to missing or insufficient documentation, enter the following:
a. the Element number of the RRW where the error was identified;
b. a description of what documentation was missing or insufficient;
c. the dollar amount of the potential improper payment;
d. a description of the AI that was done or an explanation of why there was no appropriate AI;
e. (if an AI was used) the dollar amount (if any) that was able to be mitigated;
f. (if an AI was used) how the state determined whether or not the potential improper payment could be mitigated.

a)
Element #

b) What was the
MID?

N/A
N/A
N/A
N/A
N/A

d) AI used?
Describe why or
why not

c) Dollar amount
of potential IP

N/A
N/A
N/A
N/A
N/A

N/A
N/A
N/A
N/A
N/A

N/A
N/A
N/A
N/A
N/A

Item #
19.

e) How much
mitigated?
N/A
N/A
N/A
N/A
N/A

N/A
Identify all root causes of improper payments.. List each cause, the number of cases with an error due to this
cause, an example of an error, and whether this cause involved missing or insufficient documentation. Note: If any
of the errors identified were caused by IT systems issues, please include a description of how the Lead Agency will
address these issues in Items 20 and 22.

MID? (Y/N)

Root Cause

# Cases

Example

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Item #
20.

Error
1.

f) Explain how state
determined whether or
not the potential IP
could be mitigated
N/A
N/A
N/A
N/A
N/A

N/A
List the root causes of improper payment errors identified in Item 19. For each cause, describe the action steps
planned in between review cycles in order to reach the targeted reductions identified in Item 23, the timeline for
implementing the action steps, and method(s) that will be used to measure progress and the impact of the action
steps.
Root Cause of Error
N/A

Action Steps
N/A

Timeline
N/A

Progress Measurement
N/A

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Error

Root Cause of Error

Action Steps

Timeline

Progress Measurement

2.

N/A

N/A

N/A

N/A

3.

N/A

N/A

N/A

N/A

4.

N/A

N/A

N/A

N/A

Item #
21A.

N/A
State the amount of improper payments the state expects to recover as a result of the review. If the amount is less
than the total amount of overpayments (see Item 11B above), provide a summary of the reasons limiting the
collections.

Item #
21B.

N/A
State the amount of improper payments the state recovered as a result of the previous review. If the amount is less
than the total amount expected to have been recovered according to the previous report, describe the reasons.

Item #
22.

N/A
Describe the information systems and other infrastructure that assist the state in identifying and reducing improper
payments. If the Lead Agency does not have these tools, describe actions to be taken to acquire the necessary
information systems and other infrastructure.

Item #
23.

N/A
Provide the findings for the current cycle, data and targets for the prior and current cycles, and targets for the next
cycle for percentage of cases with an error, percentage of cases with an improper payment, percentage of improper
payments, average amount of improper payments, and estimated annual amount of improper payments.

Error Measures

Prior Cycle Data

Prior Cycle
Target

Current Cycle
Data

Current
Cycle Target

Target for
Next Cycle

Percentage of cases with an error

N/A

N/A

N/A

N/A

N/A

Percentage of cases with an
improper payment

N/A

N/A

N/A

N/A

N/A

Percentage of total amount of
payments for the sample that are
improper payments

N/A

N/A

N/A

N/A

N/A

Average amount of improper
payments

N/A

N/A

N/A

N/A

N/A

Estimated annual amount of
improper payments

N/A

N/A

N/A

N/A

N/A

Item #
24.

Item #
25.

N/A
If any targets were not met, provide an explanation of why the state did not meet these targets and describe how
the actions outlined in Item 20 will address these areas.
N/A
List the causes of improper payment errors identified in the previous cycle (item 20 in the 2021 ACF-404) and for
each cause, describe the action steps that were taken, (including dates), to correct the cause, whether the action
steps reduced the identified errors, and how any progress was measured. Discuss any barriers to the effectiveness
of the action steps to reduce improper payments.

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Improper Payment
Error

Action steps and dates
when taken

Did the action steps
reduce the identified
errors?

How did you measure
your progress in
reducing the identified
errors?

Barriers to reducing
error

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC
BURDEN: The purpose of this information collection is to gather data from states once every
three years about the errors occurring in the administration of CCDF grant funds. Public
reporting burden for this collection of information is estimated to average 66 hours per response,
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 (45 CFR
Part 98, Subpart K). 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 0970-0323
and the expiration date is xx/xx/20xx. If you have any comments on this collection of
information, please contact ACF Office of Child Care.

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