R2 Enrollment Collection Form instructions_FINAL

Tribal Enrollment Count

R2 Enrollment Collection Form instructions_FINAL

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UNITED STATES DEPARTMENT OF THE INTERIOR

BUREAU OF INDIAN AFFAIRS

FY 2021 Tribal Enrollment Collection Form





Welcome to the Indian Affairs FY 2021 Tribal Enrollment Data Collection Form


What This Form Is: This is a form to collect current enrollment information for federally recognized tribes. Enrollment data is an important source of information which allows the Indian Affairs and other Federal agencies to equitably distribute resources because it is a quantifiable representation of a Tribe’s overall population. 


The information to be collected is a count of the number of individuals enrolled with the Tribe. The collection does not ask for personal details of any member(s), nor does the collection ask for the data to be disaggregated in any way. 


Use of the Information: BIA requests this information immediately to ensure effective, accurate, and timely distribution of assistance to respond to the coronavirus pandemic in Indian Country, as provided in the American Rescue Plan which was recently signed into law.  Specifically, enrollment data will be a primary data source to inform Indian Affairs’ allocation of assistance to Tribal nations, as well as funding to be distributed by the Department of the Treasury. Therefore, once each Tribe receives the form, an authorized Tribal government official is requested to complete, endorse, and return the form within 7-10 days 


USER GUIDE


How to use this Form:


This Form is composed of a drop down box to select your tribal entity, a standard input field for you to enter your total tribal enrollment, a check box field for you to acknowledge the use of the information, and signature block for Tribal Leader sign off and certification of the number provided.

Note: You must download the form from email on to your computer before opening it in Adobe Acrobat in order for the drop down box to work properly.


If you are having trouble gaining access to complete the tool in Adobe, look for the "Enable All Features" button in your upper left corner. If you have this line, you must click on the yellow "Enable All Features" button to access the Tool.

Submitting the Form:


Please submit only one completed form with all the requested information from your Tribe. The final form should be certified by the Tribal Leader and sent via email to your designated Regional Office Data Collection email as outlined below. If you do not have access to send your file via email, you can submit by mailing or faxing your form as outlined below.


Email – Email a copy of your completed form to the email for your designated regional office.



Printing & Mailing – If you do not have access to email, you may submit a printed copy of the form. Complete the information, certify and sign the form and mail or fax it to the fax number listed below.


Please remember NOT to include any Privacy & Personally Identifiable Information (PII) in your responses. Some examples of PII include information which can be used to distinguish or trace an individual's identity, such as their social security number, date and place of birth, mother's maiden name, biometric records, etc.


Department of the Interior Privacy Notice:

The Department of the Interior (DOI), Bureau of Indian Affairs (BIA) is requesting this information for use in making equitable fund distributions. The information you have provided will only be used for this purpose. Please do not include any Personally Identifiable Information (PII) in your responses. The BIA will not share this information with third parties for promotional purposes.


Privacy Policy (https://www.doi.gov/privacy) Disclaimer (https://www.doi.gov/disclaimer) Notices (https://www.doi.gov/notices) Accessibility (https://www.doi.gov/accessibility) Copyright (https://www.doi.gov/accessibility)


For general assistance with this Collection, please contact the phone number for your region.


Region

Email

Address

Phone Number

Fax Number

Alaska

[email protected]

3601 C Street, Suite 1100
Anchorage, AK 99503

907-271-1734

907-271-1349

Eastern

[email protected]

545 Marriott Drive, Suite 700
Nashville, TN 37214

615-564-6500

615-564-6701

Eastern Oklahoma

[email protected]

3100 W. Peak Blvd.
Muskogee, OK 74401

918-781-4608

918-781-4604

Great Plains

[email protected]

115 4th Avenue, SE, Suite 400
Aberdeen, SD 57401

605-226-7343

605-226-7446

Midwest

[email protected]

5600 W. American Blvd.,

Suite #500,
Bloomington, MN 55437

612-725-4500

612-713-4401

Navajo

[email protected]

P.O. Box 1060
Gallup, NM 87305

505-863-8314

505-863-8324

Northwest

[email protected]

911 NE 11 Avenue
Portland, OR 97232

503-231-6702

503-231-2201

Pacific

[email protected]

2800 Cottage Way
Sacramento, CA 95825

916-978-6000

916-978-6099

Rocky Mountain

[email protected]

2021 Fourth Avenue North
Billings, MT 59101

406-247-7943

406-247-7976

Southern Plains

[email protected]

1 Mile North, Hwy 281, Riverside Drive
Anadarko, OK 73005

405-247-6673

405-247-5611

Southwest

[email protected]

1001 Indian School Road, NW
Albuquerque, NM 87104

505-563-3103

505-563-3101

Western

[email protected]

2600 N. Central Avenue
Phoenix, AZ 85004

602-379-6600

602-379-4139





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