ARP Individual Assistance (Minor)

To be Filled Out by the Minor's Legal Guardian
On 09/29/2021, the Business Committee of the Ottawa Tribe of Oklahoma authorized an individual assistance program using American Rescue Plan Coronavirus State & Local Fiscal Recovery Program (CSLFRP) Funds in response to the COVID 19 public health emergency and its lasting negative economic impacts. The program offers direct monetary assistance to Ottawa tribal members living in households that have experienced direct negative economic impacts from COVID 19. Program funds will award up to $2,000 to each eligible tribal member.

The Department of Treasury's Interim Final Rule governing the use of CSLFRP funds sets forth that the Tribe "may presume that a household or population that experienced unemployment or increased food or housing insecurity or is low- or moderate-income experienced negative economic impacts resulting from the pandemic." This survey is designed to allow the Tribe to determine the applicant tribal member's eligibility on those terms. For this purpose, taking guidance from the federal government's own direct payment program under the American Rescue Plan, the Ottawa Tribe of Oklahoma is defining "moderate income" as being an annual income (Adjusted Gross Income or AGI on federal tax forms) of $75,000 or less for a single filer, $112,500 or less for a head of household filer or $150,000 or less for married filing jointly.

Tribal members who do not meet the eligibility requirements may still qualify for assistance based on demonstration of direct negative impact from the COVID 19 emergency.

This survey should be filled out separately for each eligible minor tribal member.  Some questions on this survey were created specifically to link minor tribal members to households for record keeping and to minimize production of individual checks.

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* 1. Are you, the Minor's Legal Guardian, a member of the Ottawa Tribe of Oklahoma and also applying for ARP Individual Assistance?

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* 2. Minor's Name

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* 3. Minor's Enrollment Number

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* 4. Minor's Date of Birth

Date

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* 5. Parent / Guardian's Name

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* 6. Parent / Guardian's Date of Birth

Date

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* 7. Parent / Guardian's Mailing Address

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* 8. Parent / Guardian's Telephone (Daytime Hours Central Time)

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* 9. Parent / Guardian's E-Mail

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