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Program Instruction: CCDF-ACF-PI-2014-02 Attachment A - Child Count Declaration (P.L. 102-477 Tribe)

Published: June 2, 2014
Topics:
Tribes
Types:
Form

CHILD COUNT DECLARATION

(P.L. 102-477 Tribe)

Federal Fiscal Year: 2015

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)

The Tribe/Tribal Lead Agency may not count any children who are included in the Child Count of another CCDF Tribe/Tribal Lead Agency. To ensure unduplicated child counts, a Tribe/Tribal Lead Agency is required to confer with all other CCDF Tribe/Tribal Lead Agencies that have overlapping or neighboring service areas.

This count shows the number of Indian children under age 13 as of (date) _____/_____/_____

 

____________________________________________
Official Signature of Individual Authorized to
Act for the Tribe/Title

 

____________________________________________
Type or Write Name/Title
____________________________________________
Date