Attachment B
Certification of Tribal Population Under Age 21
INSTRUCTIONS:
The Tribe may certify a revised number of Tribal children who have
not reached their twenty-first birthday (by State if the
reservation is located in two or more States) to the ACF Regional
Administrator in its area. A statement that certifies the revised
numbers of children who have not reached their twenty-first
birthday and provides a justification for the revision must be
signed by the Tribal enrollment officer and the Tribal
president/chairperson. This statement must be received in the ACF
Regional Office by June 30, 2005. The deadline must be strictly
adhered to. Because grant amounts for both States and Tribes will
be affected by the revisions, the Regional Office may ask for
additional verification/documentation if the numbers vary
significantly from previous data. Regional Offices must forward the
approved certifications to ACF’s Division of Mandatory Grants
before September 15th. Numbers received after this deadline will
only be considered for subsequent year fund allotment purposes.
The _______________________________________________________ (Tribal Name and State) has read the ACF Program Instruction listing the Census Bureau year 2000 under age 21 population for Tribes and finds that the data do not accurately reflect the actual number of children in our Tribe.
The correct number of Tribal members under age 21 is ___________________ .
The reason that our population number is different from the Census Bureau is: (attach additional page(s) if necessary)
We understand that information given above will be reviewed by ACF and that we may be required to submit additional supporting documentation as requested by ACF to substantiate this notification of change in population data.
We are submitting this information and certify that it is accurate and true to the best of our knowledge and belief. This certification requires the signatures of both the Tribal enrollment coordinator and Tribal leader responsible for ACF programs.
_________________________ Tribal Enrollment Officer _____________________ Date __________________________ Tribal Chair __________________________ DateAttachments
| ACYF-CB-PI-05-05 | HTML or PDF (29 KB) |
| Attachment A 1 | - FY 2005 estimated
Title IV-B, subpart 1 allotments HTML or PDF (32 KB) |
| Attachment A 2 | - FY 2005 estimated Title IV-B,
subpart 2 allotments HTML or PDF (10 KB) |
| Attachment B | - Certification of Tribal
Population Under Age 21 HTML or PDF (8 KB) |
| Attachment C 1 | - CFS-101, Part I, Annual Budget
for Title IV-B, subparts 1 & 2 HTML or PDF (16 KB) |
| Attachment C 2 | - CFS-101, Part II, Annual Summary
of Child and Family Services HTML or PDF (15 KB) |
| Attachment C 3 | - CFS-101, Part II, Annual Summary
of Child and Family Services Instructions (new applicants
only) HTML or PDF (31 KB) |
| Attachment D | - ACF Regional
Administrators HTML or PDF (8 KB) |
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