**CHILD CARE AND DEVELOPMENT FUND**

**ACF-801 CASE-LEVEL REPORTING FORM**

**Definitions**

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  **Head of Family Receiving Assistance**

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The following elements (items 1-16) refer to the head of the family
receiving child care assistance. The \"Head of Family Receiving
Assistance,\" is the person for whom eligibility is determined. If the
child is considered a family of one (i.e., a protective service case),
then all items refer to the child.

1\. Reporting Period: The month and year being reported. The report
should include information about the families and children who actually
received child care services during the reporting month, irrespective of
when payment is made for those services.

2\. Unique State Identifier: A unique identifying number, up to fifteen
characters, assigned by the State to the family receiving child care
assistance. States may use alphanumeric characters. The Social Security
Number may not be required of families as a condition of eligibility.
However, in the absence of the Social Security Number, the Child Care
Bureau requires that States use a Unique State Identifier to ensure that
cases are unduplicated for reporting purposes in accordance with the
Statute governing the Child Care and Development Fund. If a case has
neither a Social Security Number nor a Unique State Identifier, the data
related to the case cannot be processed.

3.  Social Security Number: The Social Security Number of the head of
    the family. Again, States are reminded that CCDF eligibility may not
    be denied because a parent chooses not to provide their Social
    Security Number. (See ACYF-PI-CC-00-04 issued October 27, 2000). In
    cases in which care is being provided to a child as a family of one,
    the child's Social Security Number is used for this element.

4\. Federal Information Processing Standards (FIPS) Code: The FIPS Code
geographic identifier issued by the National Bureau of Standards to
designate where the head of the family receiving assistance is residing.
A list of all FIPS codes can be found at the Child Care Bureau\'s
Technical Assistance Web site
(http://www.acf.dhhs.gov/programs/ccb/systems/index.htm) or by
contacting the Child Care Automation Technical Assistance Center
(1-877-249-9117). This includes a two digit State code and three digit
county code.

5\. Single Parent: A single parent/adult who is legally/financially
responsible for and living with a child where there is no other adult
legally/financially responsible for the child in that eligible family.
If there is someone else in the household who does not have
legal/financial responsibility for the child, the legally/financially
responsible applicant is still considered a single parent. A one-digit
code indicates if the head of the family receiving assistance is single
or not.

0 \-- No

1 \-- Yes

9 \-- Not applicable; child is reported as head of household. (If "9" is
selected, indicate the Child's Social Security Number in Item 3).

6\. Reason for Receiving Subsidized Child Care: The one-digit code
indicating the reason for receiving subsidized child care. If more than
one category applies, report the primary reason. "Other" should only be
used when no other category applies and should not be used to report
missing data.

1 \-- Employment

2 \-- Training/Education

3 \-- Both Employment and Training/Education

4 \-- Protective Services

5 -- Other

6 - Federal Declared Emergency and Employment, including on-the-job
training;

7 - Federal Declared Emergency and Training/Education;

8 - Federal Declared Emergency and Both Employment and
Training/Education;

9 - Federal Declared Emergency and Protective Services;

0 - Federal Declared Emergency and Other.

7\. Total Monthly Child Care Co-payment by the Family Receiving
Assistance: The monthly dollar amount the family receiving assistance
must pay for child care services for the month being reported (the
co-payment assigned by the Lead Agency or its designee).

8\. Date Child Care Assistance to the Family Started: The numbers for
the month and year child care assistance started for the family
receiving assistance. If there was a short interruption of up to three
months in child care assistance (for reasons such as a vacation or
illness) indicate the original month/year the assistance started, rather
than when the assistance resumed.

9\. Total Gross Monthly Income: The total monthly dollar amount received
by the family prior to any deductions that may be allowed for
determining eligibility and/or co-payments. This includes cash
assistance received under TANF or other program but not income
disregarded in TANF eligibility determinations. The amount should be
rounded to the nearest dollar.

FAMILY INCOME BY SOURCE: Items 10 through 15, sources of income, require
a "yes" (1) or "no" (0) answer as they relate to the family receiving
assistance for the month being reported. Even if a source of income is
disregarded for eligibility determination purposes, the correct answer
is "yes" for a family that received income from that source in the
reporting month. If, on a case-by-case basis, income is not used to
determine eligibility for protective service cases, items 10-15 do not
have to be reported for such cases. Item 13, "State program in which
State spending is counted toward TANF MOE," refers to State-funded
initiatives that provide assistance to needy families. Lead Agencies
will need to consult with their TANF administrative offices to determine
which programs are used for TANF MOE since these programs differ from
State to State.

10. Employment income, including self-employment.

11. Cash or other monetary assistance under Title IV of the Social
    Security Act (TANF)

12. State program for which State spending is counted towards TANF MOE

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13. Housing voucher or cash assistance

14. Assistance under the Food Stamps Act of 1977

15. Other Federal Cash Income Programs (such as SSI)

16. NUMBER IN ELIGIBLE FAMILY (New Data Element): Number of family
    members upon which eligibility is based. The field size is two (2)
    with a required value within the range of 1 to 99. The change must
    be implemented for the reporting period beginning with the month of
    January 2002.

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  Dependent Children Receiving Child Care Assistance (One record per
  child)

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These items, 17 through 25, refer to dependent children in the family
receiving child care assistance and indicate the demographic
characteristics of children receiving care. States and Territories are
required to request information about ethnicity and race. However, if a
parent refuses to report ethnicity and/or race for their child, the
field should be left blank.

17\. Child's Social Security Number *(Optional)*: Indicate the Social
Security Number of the child receiving assistance.

18\. Hispanic or Latino Ethnicity: Indicate the one digit code for the
ethnicity of each child. (Ethnicity should be determined for every child
in the family).

0 -- No

1 --Yes

[RACE OF CHILD]{.underline} (ITEMS 19-23) applies to each child
receiving care. Indicate the code for \"yes\" (1) or \"no\" (0) for each
race listed below. Select yes for as many races as reported by the
family. (Each child should have at least one race coded yes.)

19\. American Indian or Alaskan Native

20\. Asian

21\. Black or African American

22\. Native Hawaiian or Other Pacific Islander

23\. White

24\. Child's Gender: Indicate the one digit code for the gender of the
child receiving care.

1 - Male

2 -- Female

25\. Month/Year of Birth: Enter the numbers for the month and year of
birth of the child receiving care.

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  Child Care Provider (One record for each provider for each child)

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This group of questions applies to the child care provided to each
child. Include all providers receiving subsidies for each child in the
family receiving care.

26\. Type Of Child Care:

Definitions: Provider types are divided into two broad categories:
"licensed/regulated" and "legally operating without regulation." For
reporting purposes, a legally operating, unregulated provider is a
provider that, if not participating in the CCDF program, would not be
subject to any State or local child care regulations. The
"licensed/regulated" and "legally operating without regulation"
categories each include four types of providers (each State\'s
definition of these terms apply): in-home, family home, group home, and
centers. A relative provider is defined as being at least 18 years of
age and the grandparent, great-grandparent, aunt or uncle, or sibling
(living outside of the child's home) of the child in care. The following
codes specify the type of care provided by each provider for each child
during the report month.

Codes:

01 \-- Licensed/regulated in-home child care

02 \-- Licensed/regulated family child care

03 \-- Licensed/regulated group home child care

04 \-- Licensed/regulated center-based care

05 \-- In-home care provided by a non-relative in a setting legally
operating without regulation

06 \-- In-home care provided by a relative in a setting legally
operating without regulation

07 \-- Family home child care provided by a non-relative in a setting
legally operating without regulation

08 \-- Family home child care provided by a relative in a setting
legally operating without regulation

09 \-- Group home child care provided by a non-relative in a setting
legally operating without regulation

10 \-- Group home child care provided by a relative in a setting legally
operating without regulation

11 \-- Child care center legally operating without regulation

27\. Total Monthly Amount Paid to the Provider: For each child receiving
care, indicate the total monthly dollar amount (rounded to the nearest
dollar) paid or to be paid to the provider for the care of the child.
The total monthly amount should include Federal, State, and locally
funded amounts as well as the amount the parent is responsible for
contributing as the assigned co-pay. (This should not include any other
amount the provider may charge the parent in addition to the co-pay
determined by the Lead Agency or its designee.)\
28. Total Hours of Care Provided in the Month: Indicate the total number
of hours of care provided for the reporting period (rounded to the
nearest whole number).