Form Acf-196t - Administration For Children And Families - U. S. Department Of Health And Human Services

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U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
ADMINISTRATION FOR CHILDREN AND FAMILIES
TRIBAL TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) ACF - 196T FINANCIAL REPORT
TRIBE Name:
GRANT AWARD YEAR:
SUBMISSION:
EMPLOYER ID NUMBER (EIN):
REPORT PERIOD:
ORIGINAL [
] or REVISED [
]
From:
QUARTERLY [
] or FINAL [
]
COLUMN (A)
COLUMN (B)
COLUMN (C)
REPORTING ITEMS
FEDERAL TFAG
STATE CONTRIBUTED
TRIBAL FUNDS
FUNDS
MOE FUNDS
1. TOTAL FEDERAL FUNDS AWARDED
$
$
EXPENDITURES ON ASSISTANCE
2a. Cash Assistance Payments
$
$
2b. Other Assistance Expenditures
$
$
2c. TOTAL ASSISTANCE EXPENDITURES
$
$
EXPENDITURES ON NON-ASSISTANCE
3a. Administration
$
$
3b. Systems
$
$
3c. Other Non-Assistance Expenditures
$
$
3d. TOTAL NON-ASSISTANCE EXPENDITURES
$
$
TOTALS
4. Total Expenditures
$
$
5. Unliquidated Balance
$
6. Unobligated Balance
$
7. Tribal Replacement Funds
$
$
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
PHONE NUMBER:
DATE SUBMITTED:
CONTROL NO. 0970-0345
FORM ACF-196T PAGE 1 OF 1
EXPIRATION DATE: 02/29/2020
EMAIL ADDRESS:

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