TANF Data Reporting System - SSP-MOE - Section 1

SSP MOE DATA REPORT - SECTION 1
DISAGGREGATED DATA COLLECTION FOR FAMILIES RECEIVING ASSISTANCE UNDER THE
STATE SEPARATE PROGRAMS

GENERAL INFORMATION

1.	State FIPS Code				2.	County FIPS Code							3.	Reporting Month									4.	Stratum
														Year					Month

														Y	Y	Y	Y		M	M

FAMILY LEVEL DATA

			5.	Case Number - Separate State MOE											6.	ZIP Code					7.	Disposition			8.	Number of Family Members			9.	Type of Family for Work Participation


ASSISTANCE RECEIVED BY THE FAMILY

			10.	Has the Family Received Assistance Under a State (Tribal) TANF Program Within the Past Six Months							11.	Has the Family Received Assistance Under a State (Tribal) TANF Program Within the Past Six Months						12.	Receives Medical Assistance				13.	Receives Food Stamps				14.	Amount of Food Stamps Assistance


			15.	Receives Subsidized Child Care						16.	Amount of Subsidized Child Care							17.	Amount of Child Support						18.	Amount of the Family's Cash Resources


ASSISTANCE PROVIDED UNDER STATE SEPARATE PROGRAMS, BY TYPE

		19.	Cash and Cash Equivalent
		A.	Amount							B.	Number of Months


		20.	Child Care																	21.	Transportation
		A.	Amount					B.	Number of Children Covered				C.	Number of Months							A.	Amount						B.	Number of Months


		22.	Transitional Services																	23.	Other Assistance
		A.	Amount							B.	Number of Months										A.	Amount						B.	Number of Months


REASON FOR AND AMOUNT OF REDUCTION IN ASSISTANCE

24.	Reason for and Amount of Reduction In Assistance:
	A.:	Sanctions:
	i.	Total Dollar Amount of Reduction Due to Sanctions					ii.	Work Requirements Sanction			iii.	Family Sanction for an Adult with No High School Diploma or Equivalent				iv.	Sanction for Teen Parent Not Attending School			v.	Non-cooperation in Child Support			vi.	Failure to Comply with Individual Responsibility Plan					vii.	Other Sanction


	B.	Recoupment of Prior Overpayment						C.	Other:
								i.	Total Dollar Amount of Reductions Due to Other Reasons (excludes Sanctions and Recoupment)									ii.	Family Cap			iii.	.Reduction Based on Length of Receipt of Assistance						iv.	Other, Non-sanction


25.	Waiver Evaluation Research Group


PERSON LEVEL DATA

ADULT AND MINOR CHILD HEAD-OF-HOUSEHOLD CHARACTERISTICS

Adult			26.	Family Affiliation			27.	Non-Custodial Parent Indicator						28.	Date of Birth (Age)								29.	Social Security Number
														Y	Y	Y	Y	M	M	D	D
	1																									-			-
	2																									-			-
	3																									-			-
	4																									-			-
	5																									-			-
	6																									-			-

			30.	Race/Ethnicity
			Ethnicity						Race
Adult			30.	Race/Ethnicity					B.	American Indian of Alaska Native				C.	Asian			D.	Black or African American				E.	Native Hawaiian or Pacific Islander				F.	White
	1
	2
	3
	4
	5
	6

						32.	Receives Disability Benefits
Adult			31.	Gender		A.	Receives Federal Disability Insurance Benefits			B.	Receives Benefits Based on Federal Disability Status			C.	Receives Aid Under Title XIV-APDT			D.	Receives Aid Under Title XVI-AABD			E.	Receives Aid Under Title XVI-SSI				33.	Marital Status
	1
	2
	3
	4
	5
	6

Adult		34.	Parent with Minor Child in Family				35.	Parent with Minor Child in Family				36.	Needs of a Pregnant Woman					37.	Educational Level					38.	Citizen-ship / Alienage			39.	Cooperation in Child Support
	1
	2
	3
	4
	5
	6

Adult					40.	Employment Status				41.	Work-Eligible Individual Indicator						42.	Work Participation Status
	1
	2
	3
	4
	5
	6

ADULT WORK PARTICIPATION ACTIVITIES

Adult			43.	Unsubsidized Employment					44.	Subsidized Private Sector					45.	Subsidized Public Sector					46.	Work Experience					47.	On-the-Job Training
	1
	2
	3
	4
	5
	6

Adult			48.	Job Search and Job Readiness Assistance					49.	Community Service Programs					50.	Vocational Educational Training					51.	Job Skills Training Directly Related to Employment					52.	Education Directly Related to Employment for Individuals with No High School Diploma or Certificate of High School Equivalency
	1
	2
	3
	4
	5
	6

Adult			53.	Satisfactory School Attendance for Individuals with No High School Diploma or Certificate of High School Equivalency							54.	Providing Child Care Services to an Individual Who is Participating in a Community Service Program					55.	Additional Work Activities Permitted Under Waiver Demonstration					56.	Other Work Activities				57.	Required Hours of Work Under Waiver Demonstration
	1
	2
	3
	4
	5
	6

AMOUNT OF INCOME, BY TYPE

			58.	Amount of Earned Income				59.	Amount of Unearned Income
Adult			58.	Amount of Earned Income				A.	Earned Income Tax Credit-EITC				B.	Social Security				C.	SSI				D.	Worker's Compensation				E.	Other Unearned Income
	1
	2
	3
	4
	5
	6

CHILD CHARACTERISTICS

Child			60.	Family Affiliation						61.	Date of Birth (Age)								62.	Social Security Number
										Y	Y	Y	Y	M	M	D	D
	1																					-			-
	2																					-			-
	3																					-			-
	4																					-			-
	5																					-			-
	6																					-			-
	7																					-			-
	8																					-			-
	9																					-			-
	10																					-			-

			63.	Race/Ethnicity
			Ethnicity						Race
Child			A.	.Hispanic or Latino					B.	.American Indian of Alaska Native				C.	.Asian			D.	.Black or African American				E.	.Native Hawaiian or Pacific Islander				F.	White
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10

			64.	Gender			65.	Receives Disability Benefits:												66.	Relationship to Head of Household					67.	Parent with Minor Child in the Family			68.	Educational Level
Child			64.	Gender			A.	Receives Benefits Based on Federal Disability Status						B.	Receives Aid Under Title XVI-SSI					66.	Relationship to Head of Household					67.	Parent with Minor Child in the Family			68.	Educational Level
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10

			69.	Citizenship / Alienage					70.	Amount of Unearned Income
Child									A.	SSI					B.	Other Unearned Income
	1
	2
	3
	4
	5
	6
	7
	8
	9
	10