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0970-0163 EXPIRATION DATE 3/31/2013 FORM ACF-696 PAGE 1 OF 1 TARGETED FUNDS NARRATIVE REPORT ATTACHMENT FOR LINES 1 c 1 d 1 e IN COLUMN C AND COLUMN E ATTACH A SEPARATE PAGE THAT INCLUDES A BRIEF DESCRIPTION OF THE ACTIVITIES ON WHICH TARGETED FUNDS FROM THE FISCAL YEAR S GRANT WERE EXPENDED. U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES -- ADMINISTRATION FOR CHILDREN AND FAMILIES CHILD CARE AND DEVELOPMENT FUND ACF-696 FINANCIAL REPORT STATE FISCAL YEAR SUBMISSION MARK ONE BOX ORIGINAL GRANT DOCUMENT REVISED FINAL CURRENT QTR. ENDED NEXT QTR. BEGINNING COLUMN D MOE State Share Only ARRA American Recovery and Reinvestment Act Funds Federal Share Only CUMULATIVE FISCAL YEAR TOTALS MANDATORY FUNDS 1 b. QUALITY ACTIVITIES EXCLUDING TARGETED FUNDS 1 a. CHILD CARE ADMINISTRATION 1. TOTAL MATCHING FUNDS AT FMAP RATE OF Federal and State Share DISCRETIONARY FUNDS excluding ARRA 1 d. QUALITY EXPANSION TARGETED FUNDS 1 c. INFANT AND TODDLER TARGETED FUNDS 1 e. SCHOOL-AGE/RESOURCE AND REFERRAL TARGETED FUNDS 1 f. OTHER TARGETED FUNDS 1 h 2. CERTIFICATE PROGRAM COSTS/ELIG* DETERMINATION 1 h 3. ALL OTHER NONDIRECT SERVICES 1 h 1. SYSTEMS 1 h. NONDIRECT SERVICES 1 g. DIRECT SERVICES 2. STATE SHARE OF EXPENDITURES 2 a. REGULAR 2 b. PRIVATE DONATED FUNDS 2 c. PRE-K 5. AWARDED 4. FEDERAL SHARE OF UNLIQUIDATED OBLIGATIONS 6. TRANSFER FROM TANF 7. UNOBLIGATED BALANCE 8. FEDERAL FUNDS REQUESTED ESTIMATES FOR NEXT QTR* Refer to Next Qtr* Beginning Date Above. 9. ESTIMATED CHILD SERVICE MONTHS FUNDED BY ARRA See page 7 of instructions 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 AIMIT TO THE MATCHING L. 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* AMOUNT PLEASE ENTER AMOUNT SIGNATURE STATE OFFICIAL DATE SUBMITTED TYPED NAME TITLE AGENCY NAME PHONE APPROVED OMB CONTROL NO. QUALITY ACTIVITIES EXCLUDING TARGETED FUNDS 1 a. CHILD CARE ADMINISTRATION 1. TOTAL MATCHING FUNDS AT FMAP RATE OF Federal and State Share DISCRETIONARY FUNDS excluding ARRA 1 d. QUALITY EXPANSION TARGETED FUNDS 1 c. INFANT AND TODDLER TARGETED FUNDS 1 e. SCHOOL-AGE/RESOURCE AND REFERRAL TARGETED FUNDS 1 f. QUALITY EXPANSION TARGETED FUNDS 1 c. INFANT AND TODDLER TARGETED FUNDS 1 e. SCHOOL-AGE/RESOURCE AND REFERRAL TARGETED FUNDS 1 f. OTHER TARGETED FUNDS 1 h 2. CERTIFICATE PROGRAM COSTS/ELIG* DETERMINATION 1 h 3. ALL OTHER NONDIRECT SERVICES 1 h 1. OTHER TARGETED FUNDS 1 h 2. CERTIFICATE PROGRAM COSTS/ELIG* DETERMINATION 1 h 3. ALL OTHER NONDIRECT SERVICES 1 h 1. SYSTEMS 1 h. NONDIRECT SERVICES 1 g. DIRECT SERVICES 2. STATE SHARE OF EXPENDITURES 2 a. REGULAR 2 b. SYSTEMS 1 h. NONDIRECT SERVICES 1 g. DIRECT SERVICES 2. STATE SHARE OF EXPENDITURES 2 a. REGULAR 2 b. PRIVATE DONATED FUNDS 2 c. PRE-K 5. AWARDED 4. FEDERAL SHARE OF UNLIQUIDATED OBLIGATIONS 6. TRANSFER FROM TANF 7.

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