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Program Instruction: CCDF-ACF-PI-2014-01 Attachment A - Child Count Declaration

Published: May 29, 2014
Topics:
Tribes
Types:
Form

CHILD COUNT DECLARATION

 

Name of Tribal Lead Agency: _____________________________________________________________________

This certifies that the number of Indian children under age 13 who reside on or near the reservation or service area 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) ____________________________________

 

____________________________________________
Signature of Individual Authorized to Act for Tribe/Title

 

____________________________________________
Type or Write Name/Title
____________________________________________
Date

 

____________________________________________
Federal Fiscal Year 2015