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Attachment A (Also available in Word and PDF)

CHILD COUNT DECLARATION

Name of Tribal Lead Agency:________________________________________________

This certifies that the number of Indian children under age 13 (as defined in the CCDF section of the 102-477 plan) who reside on or near the reservation or service area (as defined in the CCDF section of the 102-477 plan) 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

Index: Cover Letter | ACYF-PI-CC-04-03 | Child Count Declaration | FY 2005 Tribal Allocation Estimates | ACF Regional Administrators | Assurances and Certifications | Statutory and Regulatory Requirements That Will Not be Waived (Collection available in Word and PDF)

Related Items: FY 2005 Tribal Application Plan Procedures for CCDF Grantees | CCDF Construction and Renovation Procedures for Tribal Lead Agencies