CHILD COUNT DECLARATION
(P.L. 102-477 Tribe)
Federal Fiscal Year: YYYY
Name of Tribe/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: MM/DD/YYYY
Official Signature of Individual Authorized to Act for the Tribe
____________________________________________________
Date: MM/DD/YYYY
Type or Write Name and Title:
________________________________________________________________________________
REQUEST FOR REALLOTTED TRIBAL DISCRETIONARY FUNDS
The Tribe named above requests Discretionary Funds that may be available through the reallotment process.
____Yes ____ No