Financial Reporting for Indian Tribes |
Index: ACYF-PI-CC-02-03 | Form ACF-696T | Instructions for Completion of Form ACF-696T | (Collection also available in Word and PDF) |
Related Items: ACF Regional Administrators | Help for ACF-696T |
Form ACF-696T (also available in Excel) |
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
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TRIBE:
|
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SUBMISSION (MARK ONE
BOX) ORIGINAL [ ] REVISED [ ] |
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DOC. #(s): | |||||||
CUMULATIVE FISCAL YEAR TOTALS
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COLUMN(A)
TRIBAL MANDATORY FUNDS |
COLUMN
(B)
TRIBAL DISC.FUNDS (NOT INCLUDING BASE) |
COLUMN(C)
DISCRETIONARY FUNDSBASE AMOUNT |
COLUMN
(D)
CONST. & RENOVATION TRIBAL MANDATORY |
COLUMN
(E)
CONST. & RENOVATION DISCRETIONARY |
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1. FEDERAL FUNDS AWARDED | $ | $ | $ | ||||
2. TRANSFER TO CONSTRUCTION / 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 CONSTRUCTION / RENOVATION | $ | $ | |||||
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 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 IN ACCORDANCE WITH THE EARMARK FOR CHILD CARE RESOURCE AND REFERRAL AND SCHOOL-AGE CARE ACTIVITIES. |
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SIGNATURE: TRIBAL OFFICIAL |
TYPED NAME, TITLE, LEAD AGENCY NAME, PHONE #, FAX # HAS ANY CONTACT INFORMATION CHANGED SINCE LAST YEAR? [ ] YES [ ] NO |
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DATE SUBMITTED: | CONTROL NO. 0970-0195 | ||||||
FORM ACF-696T PAGE 1 OF 1 | EXPIRATION DATE: 3/31/2005 |
Index: ACYF-PI-CC-02-03 | Form ACF-696T | Instructions for Completion of Form ACF-696T | (Collection also available in Word and PDF) |
Related Items: ACF Regional Administrators | Help for ACF-696T |