Form Doi 477 Annual Financial Expenditure Report
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1
2U.S. Department of the Interior
Public Law 102-477
Annual Financial Expenditure Report
1. Tribe/Tribal Organization:
2. Other Identifying Number Assigned by DOI:
3. Mailing Address: (Provide complete mailing address)
4. Submission: (Mark One)
5. Final Report:
Yes
No
Original
Revised
6. Annual Report Period:
7. Plan Period Covered by this Report:
From:
/
/
To:
/
/
From:
/
/
To:
/
/
(Month/Day/Year) (Month/Day/Year)
(Month/Day/Year) (Month/Day/Year)
Column II:
Column I:
Column III:
8. Transactions:
This Annual Report
Previously Reported
Cumulative/Total
Period
a. Total Funds Available
$
-
$
-
$
-
b. Cash Assistance Expenditures
$
-
$
-
$
-
c. Child Care Services Expenditures
$
-
$
-
$
-
d. Education, Employment, Training and Supportive Services
$
-
$
-
$
-
Expenditures
i. TANF Purposes 3 and 4 (non-add)
$
-
$
-
$
-
ii. Other TANF Assistance (non-add)
$
-
$
-
$
-
e. Program Operations Expenditures
$
-
$
-
$
-
i. Child Care Quality Improvement (non-add)
$
-
$
-
$
-
f. Administration/Indirect Cost Expenditures
$
-
$
-
$
-
g. Total Federal Expenditures (Sum of lines b through f)
$
-
$
-
$
-
h. Total Unexpended Funds
$
$
$
9. Certification: 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 and that the tribe has complied with all directly applicable statutory requirements and with those directly applicable regulatory
requirements which have not been waived.
a. Signature of Tribal Official
b. Type Name and Title
c. Date Report Submitted
d. Questions regarding this report – Contact: (Type Name, Title, Phone #, and Email Address)
Form DOI-477
OMB Control No.
Expiration Date
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