Form ACF-696T CCDF ACF-696T Financial Report for Tribal Grantees

U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
ADMINISTRATION FOR CHILDREN AND FAMILIES
CHILD CARE AND DEVELOPMENT FUND ACF-696T FINANCIAL REPORT
TRIBE:	FISCAL YEAR GRANT WAS AWARDED: GRANT DOC. #(S):				SUBMISSION (MARK ONE BOX)
	EXPENDITURE PERIOD: 10/1/_______________________ TO 9/30/_______________________ FINAL REPORT: YES [ ] NO [ ]				ORIGINAL [ ] REVISED [ ]
	CUMULATIVE FISCAL YEAR TOTALS
	COLUMN (A) TRIBAL MANDATORY FUNDS GRANT DOC # CCDF	COLUMN (B) DISCRETIONARY FUNDS (NOT INCLUDING BASE) GRANT DOC # CCDD	COLUMN (C) DISCRETIONARY FUNDS BASE AMOUNT GRANT DOC # CCCD	COLUMN (D) CONSTRUCTION & MAJOR RENOVATION TRIBAL MANDATORY GRANT DOC # CONT	COLUMN (E) CONSTRUCTION & MAJOR RENOVATION DISCRETIONARY GRANT DOC # CONT	COLUMN (F) DISCRETIONARY DISASTER RELIEF FUNDS	COLUMN (G) DISCRETIONARY DISASTER RELIEF FUNDS--CONST. & MAJOR RENOVATION
#NAME?
1. FEDERAL FUNDS AWARDED	$	$	$			$
2. TRANSFER TO CONSTRUCTION / MAJOR RENOVATION	$	$	$			$
3. TOTAL FUNDS AVAILABLE	$	$	$	$	$	$	$
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 INFANT/TODDLER QUALITY ACTIVITIES	$	$	$	$	$	$	$
9. EXPENDITURES FOR CONSTRUCTION / MAJOR RENOVATION				$	$	$	$
10. TOTAL FEDERAL EXPENDITURES	$	$	$	$	$	$	$
11. TOTAL FEDERAL UNLIQUIDATED OBLIGATIONS	$	$	$	$	$	$	$
12. TOTAL FEDERAL UNOBLIGATED BALANCE	$	$	$	$	$	$	$
REALLOTTED FUNDS
PLEASE REFER TO REALLOTTED FUNDS INFORMATION IN 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.
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: TRIBAL OFFICIAL		TYPED NAME, TITLE, LEAD AGENCY NAME, PHONE #, FAX #
DATE SUBMITTED:	OMB CONTROL NO. 0970-0510
FORM ACF-696T PAGE 1 OF 1	EXPIRATION DATE: 05/31/2021	HAS ANY CONTACT INFORMATION CHANGED SINCE LAST YEAR? [ ] YES [ ] NO
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13): Public reporting burden for this collection of information is estimated to average 7 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.