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