Program Instruction CCDF-ACF-PI-2008-02; FY 2009 Tribal Application Plan Procedures for CCDF Grantees

(Printable versions of the Child Count Declaration Form are available in Word (12 KB) and PDF (18 KB) format.

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Attachment C

 

APPENDIX 3 - CHILD COUNT DECLARATION

Name of Tribal Lead Agency:

 

This certifies that the number of Indian children under age 13 (as defined in Appendix 2, #2) who reside on or near the reservation or service area (as defined in Appendix 2, #3) is:                  (number)

This count shows the number of Indian children under age 13 as of ______________ (date).

                                                                                                                                           

         Signature of Individual Authorized to Act for the Tribe

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