Data Reporting for Indian Tribes; ACF-700 Form |
Index: ACYF-PI-CC-02-04 | ACF-700 Form | Tribal Annual Report: Guide for CCDF Tribal Lead Agencies (updated 11/2002) |
Related Items: ACF Regional Administrators | ACF-700 Help |
ACF-700 Form (also available in Excel) |
CHILD
CARE AND DEVELOPMENT FUND ANNUAL REPORT ON SERVICES PROVIDED FROM OCTOBER 1, 2001 THROUGH SEPTEMBER 30, 2002 |
OMB
Approval Number: 0980-0241
Expires:11/30/04 |
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COMPLETE NAME OF TRIBAL LEAD AGENCY: ADDRESS: CONTACT PERSON/PHONE/E-MAIL: |
(A) TOTAL |
CATEGORY/TYPE OF CHILD CARE | ||||||||||
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CARE PROVIDED BY A CCDF PROVIDER -- NO LICENSE CATEGORY AVAILABLE IN A | CARE PROVIDED BY A CCDF PROVIDER --LICENSED OR REGULATED IN A | |||||||||||
CHILD'S HOME BY A | FAMILY HOME BY A | GROUP HOME BY A | (H) Center |
(I) Child's Home |
(J) Family Home |
(K) Group Home |
(L) Center |
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(B) Relative |
(C) Non-Relative |
(D) Relative |
(E) Non-Relative |
(F) Relative |
(G) Non-Relative |
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1. Number of families receiving child care services | ||||||||||||
2 a. Average number of children served per month | ||||||||||||
2 b. Total number of children receiving child care services | ||||||||||||
3.
Age breakdown of children receiving child care services: a. 0 up to 1 year b. 1 year up to 2 years c. 2 years up to 3 years d. 3 years up to 4 years e. 4 years up to 5 years f. 5 years up to 6 years g. 6 years up to 13 years h. 0 up to 13 years(sum of rows 3a thru 3g) i. 13 - and older |
a. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
a. b. c. d. e. f. g. h. i. |
4.
Number of children receiving child care services because: a. Parent is (or parents are) working b. Parent is (or parents are) in training or education program c. Child is receiving or in need of protective services |
a. b. c. |
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5.
Average number of hours of child care service provided per week per child per month |
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6.
Average monthly amount paid for child care service per child a. Average monthly CCDF subsidy b. Average monthly parent copayment |
a. b. |
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7.
Number of children receiving child care services from families
with income: |
a. |
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Comments: Public reporting burden for this collection is estimated to average 35 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. |
Index: ACYF-PI-CC-02-04 | ACF-700 Form | Tribal Annual Report: Guide for CCDF Tribal Lead Agencies (updated 11/2002) |
Related Items: ACF Regional Administrators | ACF-700 Help |