+---------------------+--------------------------+--------------------+
| ACF                 | **U.S. Department of     |                    |
|                     | Health and Human         |                    |
|                     | Services**               |                    |
|                     |                          |                    |
|                     | **Administration on      |                    |
|                     | Children, Youth and      |                    |
|                     | Families**               |                    |
+---------------------+--------------------------+--------------------+
| Administration      | **1. Log No:**           | **2. Issuance      |
|                     |                          | Date:**            |
|                     | **ACYF-PI-CC-04-02**     |                    |
|                     |                          | **April 7, 2004**  |
+---------------------+--------------------------+--------------------+
| for Children        | **3. Originating Office: |                    |
|                     | Child Care Bureau**      |                    |
+---------------------+--------------------------+--------------------+
| and Families        | **4. Key Words: Child    |                    |
|                     | Care Development Fund    |                    |
|                     | Financial Form ACF-696** |                    |
+---------------------+--------------------------+--------------------+

+----------------+-----------------------------------------------------+
| TO:            | State and Territorial Lead Agencies administering   |
|                | child care programs under the Child Care and        |
|                | Development Block Grant Act of 1990 as amended and  |
|                | other interested parties.                           |
+----------------+-----------------------------------------------------+
| SUBJECT:       | Approved Form ACF-696, the Financial Reporting Form |
|                | for the Child Care and Development Fund.            |
+----------------+-----------------------------------------------------+
| REFERENCES:    | The Child Care and Development Block Grant Act of   |
|                | 1990, as amended; section 418 of the Social         |
|                | Security Act; 45 CFR Parts 98 and 99.               |
+----------------+-----------------------------------------------------+
| EFFECTIVE      | Third Quarter of Federal FY 2004 (Quarter Ending    |
| DATE:          | June 30, 2004).                                     |
+----------------+-----------------------------------------------------+
| PURPOSE:       | To inform States and Territories of the renewal by  |
|                | the Office of Management and Budget (OMB) of the    |
| BACKGROUND:    | Child Care and Development Fund ACF-696 Financial   |
|                | Report, approved under OMB \# 0970-0163.            |
| ATTACHMENTS:   |                                                     |
|                | States are required to use Form ACF-696 to report   |
| ACTION         | estimates and expenditures for the three funding    |
|                | streams that comprise the Child Care and            |
| REQUIRED:      | Development Fund, the Mandatory Fund, the Matching  |
|                | Fund, and the Discretionary Fund. Territories are   |
| SUBMISSION:    | required to use the Form ACF-696 to report          |
|                | estimates and expenditures for the Discretionary    |
|                | Fund only.                                          |
|                |                                                     |
|                | OMB extended its approval of the Form ACF-696       |
|                | information collection through March 31, 2007. Form |
|                | ACF-696 remains unchanged from the format currently |
|                | in use by States and Territories. It is now         |
|                | available for electronic submission in accordance   |
|                | with the Government Paperwork Elimination Act of    |
|                | 1998.                                               |
|                |                                                     |
|                | Instructions for access to the electronic           |
|                | submission system can be obtained from the          |
|                | appropriate Regional Office.                        |
|                |                                                     |
|                | 1\. A copy of the Form                              |
|                | [ACF-696](http://www.acf.hhs.g                      |
|                | ov/programs/ccb/policy1/current/pi0402/696form.htm) |
|                |                                                     |
|                | 2\.                                                 |
|                | [Instructions](http://www.acf.hhs.gov/p             |
|                | rograms/ccb/policy1/current/pi0402/instruction.htm) |
|                | for completing Form ACF-696                         |
|                |                                                     |
|                | States and Territories are requested to make        |
|                | sufficient copies of the form and instructions      |
|                | attached to this Program Instruction to meet their  |
|                | reporting requirements.                             |
|                |                                                     |
|                | Form ACF-696 must be received by the last day of    |
|                | the month following the end of each fiscal quarter. |
|                |                                                     |
|                | \- One copy with an \"original signature\" should   |
|                | be submitted to:                                    |
|                |                                                     |
|                | The Administration for Children and Families        |
|                |                                                     |
|                | Office of Administration                            |
|                |                                                     |
|                | Division of Mandatory Grants                        |
|                |                                                     |
|                | 370 L\'Enfant Promenade, S.W.                       |
|                |                                                     |
|                | Washington, DC 20447                                |
|                |                                                     |
|                | \- A signed copy must also be submitted to the ACF  |
|                | Regional Administrator                              |
+----------------+-----------------------------------------------------+
| INQUIRIES:     | Inquiries should be directed to the appropriate     |
|                | Regional Office.                                    |
+----------------+-----------------------------------------------------+

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Joan E. Ohl

Commissioner

Administration on Children,

Youth and Families

cc: ACF Regional Offices

Office of Management and Budget

+------------------+------------+------------+-----------+------------+
| **U. S.          |            |            |           |            |
| DEPARTMENT OF    |            |            |           |            |
| HEALTH AND HUMAN |            |            |           |            |
| SERVICES \--     |            |            |           |            |
| ADMINISTRATION   |            |            |           |            |
| FOR CHILDREN AND |            |            |           |            |
| FAMILIES**       |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| **CHILD CARE AND |            |            |           |            |
| DEVELOPMENT FUND |            |            |           |            |
| ACF-696          |            |            |           |            |
| FINANCIAL        |            |            |           |            |
| REPORT**         |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| STATE            | FISCAL     |            | S         | CURRENT    |
|                  | YEAR       |            | UBMISSION | QTR.       |
|                  |            |            | (MARK ONE | ENDED:     |
|                  |            |            | BOX)      |            |
+------------------+------------+------------+-----------+------------+
|                  | GRANT      |            | ORIGINAL  | NEXT QTR.  |
|                  | DOCUMENT   |            | \[ \]     | BEGINNING: |
|                  | \#         |            | REVISED   |            |
|                  |            |            | \[ \]     |            |
|                  |            |            |           |            |
|                  |            |            | FINAL \[  |            |
|                  |            |            | \]        |            |
+------------------+------------+------------+-----------+------------+
|                  | **         |            |           |            |
|                  | CUMULATIVE |            |           |            |
|                  | FISCAL     |            |           |            |
|                  | YEAR       |            |           |            |
|                  | TOTALS**   |            |           |            |
+------------------+------------+------------+-----------+------------+
|                  | (COLUMN A) | (COLUMN B) | (COLUMN   | (COLUMN D) |
|                  |            |            | C)        |            |
|                  | MANDATORY  | MATCHING   |           | MOE        |
|                  | FUNDS      | FUNDS      | DISC      |            |
|                  |            |            | RETIONARY | (State     |
|                  | (Federal   | AT FMAP    | FUNDS     | Share      |
|                  | Share      | RATE       |           | Only)      |
|                  | Only)      | OF\        | (Federal  |            |
|                  |            | _\_\_\_\_\ | Share     |            |
|                  |            | _\_\_\_\_% | Only)     |            |
|                  |            | (Federal   |           |            |
|                  |            | and State  |           |            |
|                  |            | Share)     |           |            |
+------------------+------------+------------+-----------+------------+
|                  |            |            |           |            |
+------------------+------------+------------+-----------+------------+
|                  |            |            |           |            |
+------------------+------------+------------+-----------+------------+
|                  |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1\. TOTAL        | \$         | \$         | \$        | \$         |
+------------------+------------+------------+-----------+------------+
| 1(a). CHILD CARE | \$         | \$         | \$        | \$         |
| ADMINISTRATION   |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(b). QUALITY    | \$         | \$         | \$        | \$         |
| ACTIVITIES NOT   |            |            |           |            |
| INCLUDED IN      |            |            |           |            |
| EARMARKS         |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(c). EARMARK TO |            |            | \$        |            |
| INFANT AND       |            |            |           |            |
| TODDLER          |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(d). EARMARK TO |            |            | \$        |            |
| QUALITY          |            |            |           |            |
| EXPANSION        |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(e). EARMARK TO |            |            | \$        |            |
| SCH              |            |            |           |            |
| OOL-AGE/RESOURCE |            |            |           |            |
| AND REFERRAL     |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(f). OTHER      |            |            | \$        |            |
| EARMARKED FUNDS  |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(g). DIRECT     | \$         | \$         | \$        | \$         |
| SERVICES         |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(h). NONDIRECT  | \$         | \$         | \$        | \$         |
| SERVICES         |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(h)(1). SYSTEMS | \$         | \$         | \$        | \$         |
+------------------+------------+------------+-----------+------------+
| 1(h)(2).         | \$         | \$         | \$        | \$         |
| CERTIFICATE      |            |            |           |            |
| PROGRAM          |            |            |           |            |
| COSTS/ELIG.      |            |            |           |            |
|                  |            |            |           |            |
| DETERMINATION    |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 1(h)(3). ALL     | \$         | \$         | \$        | \$         |
| OTHER NONDIRECT  |            |            |           |            |
| SERVICES         |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 2\. STATE SHARE  |            | \$         |           | \$         |
| OF EXPENDITURES  |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 2(a). REGULAR    |            | \$         |           | \$         |
+------------------+------------+------------+-----------+------------+
| 2(b). PRIVATE    |            | \$         |           | \$         |
| DONATED FUNDS    |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 2(c). PRE-K      |            | \$         |           | \$         |
+------------------+------------+------------+-----------+------------+
| 3\. FEDERAL      | \$         | \$         | \$        |            |
| SHARE OF         |            |            |           |            |
| EXPENDITURES     |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 4\. FEDERAL      | \$         | \$         | \$        |            |
| SHARE OF         |            |            |           |            |
| UNLIQUIDATED     |            |            |           |            |
| OBLIGATIONS      |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 5\. AWARDED      | \$         | \$         | \$        |            |
+------------------+------------+------------+-----------+------------+
| 6\. TRANSFER     |            |            | \$        |            |
| FROM TANF        |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 7\. UNOBLIGATED  | \$         | \$         | \$        |            |
| BALANCE          |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 8\. FEDERAL      | \$         | \$         | \$        |            |
| FUNDS REQUESTED\ |            |            |           |            |
| ESTIMATES FOR    |            |            |           |            |
| NEXT QTR. (Refer |            |            |           |            |
| to Next Qtr.     |            |            |           |            |
| Beginning Date   |            |            |           |            |
| Above.)          |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| PLEASE REFER TO  |            |            |           |            |
| REALLOTTED FUNDS |            |            |           |            |
| INFORMATION ON   |            |            |           |            |
| PAGES 5 OF THE   |            |            |           |            |
| INSTRUCTIONS.    |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 9/30 SUBMITTAL   |            |            |           |            |
| \-- IF           |            |            |           |            |
| AVAILABLE, DOES  |            |            |           |            |
| THE STATE        |            |            |           |            |
| REQUEST          |            |            |           |            |
| REALLOTTED       |            |            |           |            |
| MATCHING FUNDS?  |            |            |           |            |
| YES \[ \] NO \[  |            |            |           |            |
| \]. IF YES AND   |            |            |           |            |
| THE STATE        |            |            |           |            |
| REQUESTS A       |            |            |           |            |
| [LI              |            |            |           |            |
| MIT]{.underline} |            |            |           |            |
| TO THE MATCHING  |            |            |           |            |
| AMOUNT, PLEASE   |            |            |           |            |
| ENTER AMOUNT \$  |            |            |           |            |
| \_\_\_\_\_\_\_   |            |            |           |            |
| \_\_\_\_\_\_\_\_ |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 3/31 SUBMITTAL   |            |            |           |            |
| \-- IF           |            |            |           |            |
| AVAILABLE, DOES  |            |            |           |            |
| THE STATE        |            |            |           |            |
| REQUEST          |            |            |           |            |
| REALLOTTED       |            |            |           |            |
| DISCRETIONARY    |            |            |           |            |
| FUNDS? YES \[ \] |            |            |           |            |
| NO \[ \].        |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| 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 STATE\'S     |            |            |           |            |
| SHARE OF         |            |            |           |            |
| ESTIMATES IS OR  |            |            |           |            |
| WILL BE          |            |            |           |            |
| AVAILABLE TO     |            |            |           |            |
| MEET THE         |            |            |           |            |
| NONFEDERAL SHARE |            |            |           |            |
| OF EXPENDITURES  |            |            |           |            |
| AS REQUIRED BY   |            |            |           |            |
| LAW.             |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| SIGNATURE: STATE | APPROVED   | TYPED      |           |            |
| OFFICIAL         | OMB        | NAME,      |           |            |
|                  | CONTROL    | TITLE,     |           |            |
|                  | NO.        | AGENCY     |           |            |
|                  | 0970-0163  | NAME,      |           |            |
|                  |            | PHONE \#   |           |            |
+------------------+------------+------------+-----------+------------+
|                  |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| DATE SUBMITTED:  | EXPIRATION |            |           |            |
|                  | DATE:      |            |           |            |
|                  | 03/31/2007 |            |           |            |
+------------------+------------+------------+-----------+------------+
| FORM ACF-696     |            |            |           |            |
| PAGE 1 OF 1      |            |            |           |            |
+------------------+------------+------------+-----------+------------+
| \* FOR LINES     |            |            |           |            |
| 1(c), 1(d), 1(e) |            |            |           |            |
| AND 1(f), ATTACH |            |            |           |            |
| A SEPARATE PAGE  |            |            |           |            |
| THAT INCLUDES A  |            |            |           |            |
| BRIEF            |            |            |           |            |
| DESCRIPTION OF   |            |            |           |            |
| THE ACTIVITIES   |            |            |           |            |
| ON WHICH         |            |            |           |            |
| EARMARKED\       |            |            |           |            |
| FUNDS, FROM THE  |            |            |           |            |
| FISCAL YEAR\'S   |            |            |           |            |
| GRANT, WERE      |            |            |           |            |
| EXPENDED. THIS   |            |            |           |            |
| NEED ONLY BE     |            |            |           |            |
| COMPLETED WITH   |            |            |           |            |
| EACH 4TH         |            |            |           |            |
| QUARTER\'S       |            |            |           |            |
| REPORT.          |            |            |           |            |
+------------------+------------+------------+-----------+------------+

**INSTRUCTIONS FOR COMPLETION OF FORM ACF-696**

**Financial Reporting Form for the Child Care and Development Fund**

All States are required to complete and submit this report in accordance
with these instructions on behalf of the State agency administering the
Child Care and Development Fund.

Due Dates: This form must be submitted quarterly by January 31, April
30, July 31 and October 31.

**States must submit quarterly reports for each fiscal year until all
funds are expended.**

Distribution: The original copy (with original signatures) must be
submitted to: Administration for Children and Families, Office of Grants
Management, Division of Mandatory Grants, OA/OGM/DMG, 370 L\'Enfant
Promenade, S.W., Washington, D.C. 20447. An additional copy must be
submitted to the ACF Regional Administrator.

**General Instructions.**

-   Round all entries to the nearest dollar. Omit cents. If .50 cents or
    more round up to the nearest dollar. If .49 cents or less round down
    to the nearest dollar.

-   Enter State Name

-   Enter the Fiscal Year (the award year) for which this report is
    being submitted. **Fiscal years will run simultaneously so it is
    important to indicate the year for which information is being
    reported.**

-   Enter the Grant Document Number.

-   Indicate whether this is a new report, a revision of a report
    previously submitted for the same period or a final report.

-   Enter the ending date for the current quarter (the quarter just
    ended which constitutes the report of actual obligations or
    expenditures) and the ending date of next quarter (180 days or 2^nd^
    quarter after the reporting quarter, which estimates are being
    provided for on line 8).

-   Enter at the top of column (B) the Federal Medical Assistance
    Percentage Rate used by the State.

**Columns:** All amounts reported in columns (A), (B), (C), and (D) must
be actual obligations or expenditures made under the State\'s plan and
in accordance with all applicable statutes and regulations. All amounts
reported in the Estimates section are estimates of obligations or
expenditures to be made during the quarter indicated based on the best
information available to the State.

-   Column (A): Mandatory Funds. - States must administer these funds in
    accordance with their State plan. These funds are 100% Federal funds
    and are available until expended.

-   Column (B): Matching Funds. - States must administer these funds in
    accordance with their State plan. Matching funds are available
    provided the State: (1) obligates all of its Mandatory Funds by the
    end of the Federal fiscal year; and, (2) expends State funds in an
    amount that equals the State Maintenance of Effort (MOE) threshold
    for allowable child care activities. Matching funds must be matched
    by State expenditures that are in excess of the amount required to
    satisfy the MOE requirement. The applicable matching rate is the
    Federal Medical Assistance Percentage (FMAP) rate for the year in
    which the funds were awarded, regardless of when funds are expended.
    Federal and State Matching funds must be obligated by September 30th
    of the year in which funds are received. Obligations must be
    liquidated by September 30th of the following fiscal year.

-   Column (C): Discretionary Funds. - States must administer these
    funds in accordance with their State plan. States must obligate
    these Federal funds by September 30 of the fiscal year immediately
    following the fiscal year in which they were awarded. States must
    liquidate obligations within one year after the end of the
    obligation period.

```{=html}
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```
-   Column (D): MOE - States must administer these funds in accordance
    with their State plan. Section 418(a)(2)(C) of the Social Security
    Act requires States to spend a specified amount of non-Federal funds
    on child care in order to claim Federal match from the Matching
    Fund. This State maintenance of effort (MOE) must be expended on
    allowable services or activities as described in the approved State
    Plan as appropriate, that meet the goals and purposes of the Act.

**[Cumulative Fiscal Year Totals]{.underline}**

**[Line 1.]{.underline} Total.** Enter in columns (A) and (C) the
cumulative expenditures of Mandatory and Discretionary funds made from
October 1 of the fiscal year for which the report is being submitted
through the current quarter being reported. Enter in column (B) the
cumulative total of both Federal and State expenditures made from
October 1 of the fiscal year for which the report is being submitted
through the current quarter being reported. Enter in column (D) the
State Maintenance of Effort (MOE) expenditures from October 1 of the
fiscal year for which the report is being submitted through the quarter
being reported. Additionally, in column (D) the 20% pre-K limitation
will be strictly observed, and for purposes of determining if the CCDF
MOE level is met, pre-K expenditures, as represented in the State's
approved CCDF plan, will be counted only up to the allowable percentages
provided in the regulations. Similarly, donated funds reported in column
(D) must meet the requirements of the regulations. Additionally, States
may choose to use Column (D) to report additional State expenditures on
child care that are not required to meet MOE or matching thresholds but
that meet the requirements for MOE. Finally, quality expenditures
reported in the MOE in column (D) WILL NOT be counted towards the
minimum expenditure amount required to be spent on quality activities
from the Mandatory, Matching, and Discretionary funds.

Line 1 is equal to 1(a)+1(b)+1(c)+1(d)+1(e)+1(f)+1(g)+1(h).

**[Line 1(a).]{.underline}** **Child Care Administration.** Enter in
columns (A) and (C) the cumulative expenditures of Mandatory and
Discretionary funds, respectively, for child care administration from
October 1 of the fiscal year for which the report is being submitted
through the current quarter being reported. Enter in column (B) the
cumulative total of both Federal and State expenditures made from
October 1 of the fiscal year for which the report is being submitted
through the current quarter being reported. Enter in column (D) the
cumulative total of State MOE expenditures made from October 1 of the
fiscal year for which the report is being submitted through the current
quarter being reported. At the end of the liquidation period, no more
than 5% of Line 1 (the sum of columns (A), (B), and (C)) can be claimed
for this activity. Expenditures reported in column (D) are not subject
to the 5% limitation.

**[Line 1(b).]{.underline} Quality Activities Not Included in
Earmarks.** Enter in columns (A) and (C) the cumulative expenditures of
Mandatory and Discretionary funds, respectively, for child care quality
activities from October 1 of the fiscal year for which the report is
being submitted through the current quarter being reported. Enter in
column (B) the cumulative total of both Federal and State expenditures
made from October 1 of the fiscal year for which the report is being
submitted through the current quarter being reported. Enter in column
(D) the cumulative total of State MOE expenditures made from October 1
of the fiscal year for which the report is being submitted through the
current quarter being reported. At the end of the liquidation period, no
less than 4% of Line 1 (the sums of column (A), (B), and (C)) can be
claimed for this activity.

**[Line 1(c).]{.underline}** **Earmark to Infant and Toddler.** Enter in
column (C) the cumulative Discretionary Fund expenditures for the Infant
and Toddler child care Earmark from October 1 of the fiscal year for
which the report is being submitted through the current quarter being
reported.

**[Line 1(d]{.underline}). [Earmark to Quality Expansion.]{.underline}**
Enter in column (C) the cumulative Discretionary Fund expenditures for
the Quality Expansion Earmark from October 1 of the fiscal year for
which the report is being submitted through the current quarter being
reported.

**[Line 1(e]{.underline}). [Earmark to School-Age/Resource and
Referral.]{.underline}** Enter in column (C) the cumulative
Discretionary Fund expenditures for the School-Age/Resource and Referral
Earmark from October 1 of the fiscal year for which the report is being
submitted through the current quarter being reported.

**[Line 1(f).]{.underline}** **Other Earmarked Funds.** Enter in column
(C) the cumulative Discretionary Fund expenditures for the other
Earmarked funds from October 1 of the fiscal year for which the report
is being submitted through the current quarter being reported.

> **NOTE (applies to Lines 1 (c), 1 (d), 1 (e), and 1 (f)**: Attach to
> the 4^th^ quarter submission of the current year's financial report
> (ACF-696) a narrative description of the activities funded with the
> earmarked funds. The narrative should outline the activities funded
> with CCDF earmarked funds for all appropriation years that were spent
> in the current Fiscal Year by the State.

**[Line 1(g).]{.underline} Direct Services.** Enter in columns (A), and
(C) the cumulative expenditures from the Mandatory and Discretionary
funds, respectively, from October 1 of the fiscal year for which the
report is being submitted through the current quarter being reported.
Enter in column (B) the cumulative total of both Federal and State
expenditures from October 1 of the fiscal year for which the report is
being submitted through the current quarter being reported. Enter in
column (D) the cumulative total of State MOE expenditures made from
October 1 of the fiscal year for which the report is being submitted
through the current quarter being reported.

**[Line 1(h).]{.underline} Nondirect Services.** Enter in columns (A)
and (C) the cumulative expenditures from Mandatory and Discretionary
funds, respectively, made from October 1 of the fiscal year for which
the report is being submitted through the current quarter reported.
Enter in column (B) the cumulative total of both Federal and State
expenditures made from October 1 of the fiscal year for which the report
is being submitted through the current quarter being reported. Enter in
column (D) the cumulative total of State MOE expenditures made from
October 1 of the fiscal year for which the report is being submitted
through the current quarter being reported.

Line 1(h) is equal to 1(h)(1)+1(h)(2)+1(h)(3).

**[Line 1(h)(1).]{.underline} Systems[.]{.underline}** Enter in columns
(A) and (C) the cumulative expenditures from Mandatory and Discretionary
funds, respectively, made from October 1 of the fiscal year for which
the report is being submitted through the current quarter reported.
Enter in column (B) the cumulative total of both Federal and State
expenditures made from October 1 of the fiscal year for which the report
is being submitted through the current quarter being reported. Enter in
column (D) the cumulative total of State MOE expenditures made from
October 1 of the fiscal year for which the report is being submitted
through the current quarter being reported.

**[Line 1(h)(2).]{.underline} Certificate Program Cost / Eligibility
Determination.** Enter in columns (A) and (C) the cumulative
expenditures from the Mandatory and Discretionary funds, respectively,
made from October 1 of the fiscal year for which the report is being
submitted through the current quarter reported. Enter in column (B) the
cumulative total of both Federal and State expenditures made from
October 1 of the fiscal year for which the report is being submitted
through the current quarter being reported. Enter in column (D) the
cumulative total of State MOE expenditures made from October 1 of the
fiscal year for which the report is being submitted through the current
quarter being reported.

**[Line 1(h)(3).]{.underline} All Other Nondirect Services.** Enter in
columns (A) and (C) the cumulative expenditures from Mandatory and
Discretionary funds, respectively, made from October 1 of the fiscal
year for which the report is being submitted through the current quarter
reported. Enter in column (B) the cumulative total of both Federal and
State expenditures made from October 1 of the fiscal year for which the
report is being submitted through the current quarter being reported.
Enter in column (D) the cumulative total of State MOE expenditures made
from October 1 of the fiscal year for which the report is being
submitted through the current quarter being reported.

**[Line 2.]{.underline} State Share of Expenditures.** Enter in column
(B) cumulative State expenditures for the fiscal year for which the
report is being submitted at the specified FMAP rate. Enter the column
(D) cumulative State MOE expenditures for the fiscal year for which the
report is being submitted. Only columns (B) and (D) are completed. No
entry is required in columns (A) and (C). Line 2(D) will be the same
number as entered in line 1(D).

Line 2 is equal to 2(a)+2(b)+2(c).

**[Line 2(a).]{.underline} Regular.** Enter in column (B) cumulative
State expenditures for the fiscal year for which the report is being
submitted. Enter the column (D) cumulative State MOE expenditures for
the fiscal year for which the report is being submitted. Only columns
(B) and (D) are completed. No entry is required in columns (A) and (C).
All other public funds used by the State as the State share are to be
included in this category. These could include, for example,
certified/transferred funds from public schools (non pre-K), city and
county governments, and Community Development Block grant funds.

**[Line 2(b).]{.underline} Private Donated Funds.** Enter in column (B)
cumulative State expenditures for the fiscal year for which the report
is being submitted. Enter the column (D) cumulative State MOE
expenditures for the fiscal year for which the report is being
submitted. Only columns (B) and (D) are completed. No entry is required
in columns (A) and (C).

**[Line 2(c).]{.underline} Pre-K.** Enter in column (B) cumulative State
expenditures for the fiscal year for which the report is being
submitted. Enter the column (D) cumulative State MOE expenditures for
the fiscal year for which the report is being submitted. Only columns
(B) and (D) are completed. No entry is required in columns (A) and (C).
A State may use public Pre-K funds for up to 20% of the funds for State
match and for up to 20% of the funds for MOE expenditures. The 20%
assessment will take place at the end of the applicable expenditure
period, and not by quarter.

**[Line 3.]{.underline} Federal Share of Expenditures.** Enter the
cumulative Federal share of funds expended for the FY for which the
report is being submitted. In columns (A) and (C) this number will be
the same as that on line 1.

**[Line 4.]{.underline} Federal Share of Unliquidated Obligations.**
Enter the cumulative amount of obligated Federal funds that have not
been liquidated for the FY.

**[Line 5.]{.underline} Awarded.** Enter the cumulative amount of
Federal funds awarded for the FY for which the report is being
submitted.

**[Line 6.]{.underline} Transfer from TANF.** Enter the cumulative
amount transferred from TANF for the FY for which the report is being
submitted. The rules and regulations of the Child Care and Development
Block Grant (Discretionary Funds) program will govern any amounts
transferred from TANF. **Only column (C) is completed.** No entry is
required in columns (A), (B), and (D). Funds reported on this line must
also be incorporated into the amounts entered on the other lines of
**column (C).**

**[Line 7.]{.underline} Unobligated Balance.** Enter the amount of
unobligated Federal funds for the FY for which the report is being
submitted. Amounts reported in column (B) and remaining unobligated
after the one-year obligation period will be returned to the Federal
government and re-distributed. Amounts reported in column (C), and
remaining unobligated, after the two-year obligation period, will be
returned to the Federal Government.

**[Estimates]{.underline}**

**[Line 8.]{.underline} Federal Funds Requested.** Enter the State
estimate of funds needed for the quarter ending 180 days after this
reporting quarter. (This date is entered as the Next Quarter Ending date
in upper right hand corner of report.)

**[Reallotted Funds]{.underline}**

For the quarter ending 3/31, check whether or not the State would like
to receive its proportional share of reallotted Discretionary funds that
may become available. For the quarter ending 9/30, check whether or not
the State would like to receive its proportional share of reallotted
Matching funds that may become available. If the State wishes to limit
the amount received to a specific amount, due to State share funding
limitations, it should indicate in the space available the maximum
amount it would like to receive. **Please Note:** If reports are not
received within 30 days after the end of the quarter (10/31 and 4/30
respectively), the State **will not** be eligible for reallotted funds.

**Signatures.** This report must be signed and dated in the space
provided, including the title, agency and phone number of the individual
whose signature is shown. **Note:** The individual who signs this report
is certifying that: (a) the information provided on all parts of this
form and all accompanying documents is accurate and correct; and (b)
that any amount shown as the State share of obligations is or will be
available to meet the non-Federal share as prescribed by law.

**NOTE:**

\"THE PAPERWORK REDUCTION ACT OF 1995\"

Public reporting for this collection of information is estimated to
average 8 hours per response, including the time for reviewing
instructions, gathering and maintaining the data needed, and reviewing
the collection of information.

An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently
valid OMB control number.

**[SUPPLEMENTAL INFORMATION]{.underline}**

Below are explanations of terms that may be of use in completing the
form.

1)  Child Care and Development Fund (CCDF):

> Means the child care programs conducted under the provisions of the
> Child Care and Development Block Grant Act, as amended. The fund
> consists of Discretionary funds authorized under section 658B of the
> amended Act, and Mandatory and Matching funds appropriated under
> section 418 of the Social Security Act.

2)  Mandatory Funds:

> Means the general entitlement child care funds described at section
> 418(a)(1) of the Social Security Act.

3)  Matching Funds:

> Means the remainder of the general entitlement child care funds that
> are described at section 418(a)(2) of the Social Security Act.
>
> 4\) Discretionary Funds:
>
> Means the funds authorized under section 658B of the Child Care and
> Development Block Grant Act. The discretionary funds were formerly
> referred to as the Child Care and Development Block Grant.
>
> 5\) Quality Services:
>
> Activities designed to provide consumer education to parents and to
> the public; activities that increase parental choice; and activities
> designed to improve the overall quality and availability of child
> care. Section 658(G) of the CCDBG Act was amended to direct that a
> State that receives CCDF funds shall use not less than 4 percent of
> the amount of such funds for activities to improve the quality of
> child care and availability of child care. Section 98.51(a) provides
> that the not less than 4 percent for quality applies to the aggregate
> amount of expenditures (Discretionary, Mandatory, and both the Federal
> and State share of Matching funds). Section 98.51(a) also provides
> that the 4 percent requirement applies to funds expended, rather than
> the total of funds available. It should also be noted that 98.51(c)
> provide that the quality expenditure requirement does not apply to the
> maintenance-of-effort expenditures required by 98.53(c) in order to
> claim from the Matching fund. The minimum percentages apply at the end
> of the liquidation period.
>
> 6\) Direct Services:
>
> Section 418(b)(2) of the Social Security Act requires the State to
> ensure that not less than 70% of funds (Mandatory and Matching)
> received by the State are used to provide child care assistance under
> a State program under Part A of title IV of the Social Security Act,
> families who are attempting through work activities to transition off
> such assistance program and families that are at risk of becoming
> dependent on such assistance program. Section 658E(c)(3)(D) of the
> Child Care and Development Block Grant Act stipulates that a State
> shall ensure that a substantial portion of the amounts available
> (after the State has complied with the requirement of Section
> 418(b)(2) of the Social Security Act) to the State to carry out
> activities is used to provide assistance to low-income working
> families other than the families described in Section 418(b)(2). See
> 98.50(a) and (e) for specific description.
>
> 7\) Nondirect Services:
>
> Child Care services provided that do not meet the definition of Direct
> Services outlined above, including systems costs, certificate program
> costs, and eligibility determination costs.
>
> 8\) Systems:
>
> Expenditures related to the establishment and maintenance of
> computerized child care information systems
>
> 9\) Certificate Costs:
>
> Expenditures related to developing and operating a certificate
> program.
>
> 10\) Eligibility Determination:
>
> Expenditures related to the process of determining the eligibility of
> a particular person for child care services.
>
> 11\) Other Nondirect Services:

Other nondirect service costs associated with the goods and services
required for the administration of the CCDF program not covered under
8,9, and 10 above.

> 12\) Private Donated Funds for State Share:
>
> State match can include donated funds from private sources when the
> donated funds are made without any restriction that would require
> their use for a specific individual, organization, facility or
> institution; do not revert to the donor\'s facility or use; and are
> not used to match other federal funds. The donated funds shall be
> certified both by the donor and lead agency as available and
> representing expenditures eligible for Federal match and shall be
> subject to audit requirements. See 98.53(e)(2) and related preamble.
>
> 13\) Pre-K Funds used for State share:
>
> Public Pre-K expenditures may be eligible for match if the State
> includes in its plan, as provided in 98.16(q), a description of the
> efforts it will undertake to ensure that Pre-K programs meet the needs
> of working parents. In any fiscal year, a State may use public Pre-K
> funds for up to 20% of the funds for State match.
>
> 14\) Pre-K funds used for MOE:
>
> Public Pre-K expenditures may be used to meet the
> maintenance-of-effort requirement only if the State has not reduced
> its expenditures for full-day/full year child care services. In any
> fiscal year, a State may use public Pre-K funds for up to 20% of the
> funds for State maintenance-of-effort.