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Federal forms, ICRs, and supporting documents

Information Collection Request

Instructions for Annual Report on State Maintenance-of-Effort Programs: Form ACF-204

ICR 201510-0970-002 · OMB 0970-0248 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Form 204 Annual Report on State MOE Programs Form and Instruction Modified Available
SUPSTAT_OFA ACF-204 - edit 10.5.15.doc Supporting Statement A Uploaded 2015-10-06 Available
PI-ACF-2041.pdf Supplementary Document Uploaded 2014-12-22 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
10099 Annual Report on State MOE Programs Form and Instruction Modified
ICR Details
0970-0248 201510-0970-002
Historical Inactive 201412-0970-010
HHS/ACF
Instructions for Annual Report on State Maintenance-of-Effort Programs: Form ACF-204
Revision of a currently approved collection   No
Regular
Preapproved 10/08/2015
Retrieve Notice of Action (NOA) 10/01/2015
  Inventory as of this Action Requested Previously Approved
10/31/2016 36 Months From Approved 10/31/2016
54 0 54
7,452 0 6,372
0 0 0
In accordance with P.L. 112-96, each state is required to report to the Secretary by February 22, 2014, and annually thereafter, on its implementation and maintenance of policies and practices that prevent TANF funded assistance from being used in any electronic benefit transfer transaction in any liquor store; any casino, gambling casino, or gaming establishment; or any retail establishment which provides adult-oriented entertainment in which performers disrobe or perform in an unclothed state for entertainment. The Administration for Children and Families is required to reduce a state's block grant if the state fails to comply with this reporting requirement or if, based on the information that the state reports in their Annual TANF Report, ACF finds that the state has not implemented and maintained the required policies and practices.
US Code: 42 USC 611 Name of Law: Social Security Act
  
PL: Pub.L. 112 - 96 4004 Name of Law: Middle Class Tax Relief and Job Creation Act of 2012
0970-AC56 Proposed rulemaking 79 FR 7127 02/06/2014
  79 FR 44444 02/14/2014
80 FR 44444 10/01/2015
No
1
IC Title Form No. Form Name
Annual Report on State MOE Programs 204 ACF-204
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 54 54 0 0 0 0
Annual Time Burden (Hours) 7,452 6,372 0 1,080 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Burden increase because of EBT requirement.
$35,100
No
No
No
No
No
Uncollected
Robert Sargis 2026907275
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/01/2015