| U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES |
| ADMINISTRATION FOR CHILDREN AND FAMILIES |
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| CHILD CARE AND DEVELOPMENT FUND ACF-696T FINANCIAL REPORT |
| TRIBE: |
FISCAL YEAR GRANT WAS AWARDED: GRANT DOC. #(S): |
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SUBMISSION (MARK ONE BOX) |
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EXPENDITURE PERIOD: 10/1/_______________________ TO 9/30/_______________________ FINAL REPORT: YES [ ] NO [ ] |
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ORIGINAL [ ] REVISED [ ] |
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CUMULATIVE FISCAL YEAR TOTALS |
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COLUMN (A) |
COLUMN (B) |
COLUMN (C) |
COLUMN (D) |
COLUMN (E) |
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TRIBAL MANDATORY |
DISCRETIONARY FUNDS |
DISCRETIONARY FUNDS |
CONST. & RENOVATION |
CONST. & RENOVATION |
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FUNDS |
(NOT INCLUDING BASE) |
BASE AMOUNT |
TRIBAL MANDATORY |
DISCRETIONARY |
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| 1. FEDERAL FUNDS AWARDED |
$ |
$ |
$ |
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| 2. TRANSFER TO CONSTRUCTION / RENOVATION |
$ |
$ |
$ |
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| 3. TOTAL FUNDS AVAILABLE |
$ |
$ |
$ |
$ |
$ |
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| 4. EXPENDITURES FOR CHILD CARE SERVICES |
$ |
$ |
$ |
$ |
$ |
| 5. EXPENDITURES FOR CHILD CARE ADMINISTRATION |
$ |
$ |
$ |
$ |
$ |
| 6. EXPENDITURES FOR NON-DIRECT SERVICES (INCLUDING SYSTEMS, CERTIFICATE PROGRAM, AND ELIGIBILITY DETERMINATION COSTS) |
$ |
$ |
$ |
$ |
$ |
| 7. EXPENDITURES FOR QUALITY ACTIVITIES |
$ |
$ |
$ |
$ |
$ |
| 8. EXPENDITURES FOR CONSTRUCTION / RENOVATION |
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$ |
$ |
| 9. TOTAL FEDERAL EXPENDITURES |
$ |
$ |
$ |
$ |
$ |
| 10. TOTAL FEDERAL UNLIQUIDATED OBLIGATIONS |
$ |
$ |
$ |
$ |
$ |
| 11. TOTAL FEDERAL UNOBLIGATED BALANCE |
$ |
$ |
$ |
$ |
$ |
| REALLOTTED FUNDS |
| PLEASE REFER TO REALLOTTED FUNDS INFORMATION ON PAGE FIVE (5) OF THE INSTRUCTIONS. |
| IF AVAILABLE, DOES THE TRIBE REQUEST REALLOTTED DISCRETIONARY FUNDS ? YES [ ] NO [ ]. |
| IF THIS REPORT IS NOT RECEIVED WITHIN 90 DAYS AFTER THE END OF THE FISCAL YEAR (12/29), THE TRIBE WILL NOT BE ELIGIBLE FOR REALLOTMENT. |
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| 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. |
| THIS ALSO CERTIFIES THAT THE TRIBAL LEAD AGENCY HAS EXPENDED REQUIRED FUNDS THAT ARE TARGETED FOR CHILD CARE RESOURCE AND REFERRAL AND SCHOOL-AGE CARE ACTIVITIES. |
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| SIGNATURE: TRIBAL OFFICIAL |
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TYPED NAME, TITLE, LEAD AGENCY NAME, PHONE #, FAX # |
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| DATE SUBMITTED: |
OMB CONTROL NO. 0970-0195 |
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| FORM ACF-696T PAGE 1 OF 1 |
EXPIRATION DATE: XX/XX/XXXX |
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HAS ANY CONTACT INFORMATION CHANGED SINCE LAST YEAR? [ ] YES [ ] NO |
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