• Social Services Program

    Serving the Oklahoma Counties of Beckham, Blaine, Canadian, Custer, Dewey, Ellis, Kingfisher, Major, Roger Mills, Washita, and the city of Woodward.
  • General Assistance Application

  • Program Description: 

    The Cheyenne and Arapaho Tribes provide assistance to federally recognized American Indian and Alaskan Native Tribal members in the following ways: 

    General Assistance: 

    Cash assistance to meet essential needs of food,clothing, shelter, and utilities. Additionally, each General Assistance recipient must work with a social services worker to develop a signed and agreed upon Individual Self-Sufficiency Plan (ISP) to meet the goal of employment. The plan must outline specific steps individuals will take to increase their independence. Eligibility will be reviewed on either a three-month or six-month basis, or whenever there is change in status affecting eligibility. Recipients must immediately inform their Social Services Caseworker of such changes. If a client refuses employment or quits a job under the agreement of their ISP, he/she will be sanctioned and made ineligible for services for a minimum of 60 days, not to exceed a period of 90 days.

    General Program Requirements:

    Individuals must meet all of the following eligibility criteria:

    1.    Be enrolled member of a federally-recognized American Indian/Alaskan Native tribe,

    2.    Prove their inability to meet the essential need of food, clothing, shelter, and utilities,

    3.    Reside in an 11 county approved service area (Blaine, Beckham, Canadian, Custer, Dewey, Kingfisher, Roger Mills, Washita, Major, Woodward , or Ellis)

    4.    Apply concurrently for all the other federal, state, tribal, county,and local programs for which he/ she may be eligible, and

    5.    Shall not be receiving any comparable assistance.

    Items to Copy & Upload (Required)

    1.      Verification of residence (Rent receipt, and utility bill OR written statement from homeowner)

    2.      Verification of tribal enrollment (CDIB Tribal membership card)

    3.      Statement verifying whether or not employment benefits are being received

    4 .  Verification of any and all income

    5.     Verification of a submitted/pending application or denial letter to TANF or SSI if eligible

    6.     Physicians statement verifying inability to work and anticipated amount of time (if claiming temporary disability)

     

  • Privacy Act Statement & Paperwork Reduction Act Statement

  • Privacy Act Statement

    25 CFR Part 20 and 25 U.S.C. 13 authorize the collection of this information. The information is confidential and is never disclosed without written clearance and consent of the applicant. The primary use of this information is to determine eligibility for financial assistance and services from the Bureau of Indian Affairs (BIA) Child Welfare, Burial, and Disaster programs. Additional disclosures of the information may be to other BIA or tribal officials in the conduct of their official duties pertaining to  the application for financial assistance or services, or in the conduct of program review and to the Office of the Inspector General or the General Accounting Office when conducting an audit of BIA programs, or local law enforcement agency when the agency aware of violation or possible violation of civil or criminal law, and to the General Services Administration in connection with it responsibility for records management. This information will be entered into the BIA, Social Services system of records which can be obtained upon request from Chief, Division of Social Services, 1849 C Street, NW, MS-4513-MIB, Washington, DC 20240. No record contained therein may be disclosed by any means of communication to any person, or to another agency, except pursuant to a request by, or with prior written consent of the individual to whom the record pertains. Executive Order 9397 authorizes the collection of your Social Security number. Furnishing the information is voluntary but failure to do so may result in disapproval of your application. If the BIA uses the information furnished on this form for purposes other than those indicated above, it may provide you with an additional statement reflecting those purposes.

    Paperwork Reduction Act Statement

    The information is being collected to determine applicant eligibility for financial assistance and services to provide Bureau of Indian Affairs (BIA) managers with information for program planning, reporting and utilization. Response to this collection is required to obtain a benefit(s) required in 25 CRF 20. A Federal Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Public reporting for this form is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining data, and completing the form. Direct comments regarding the burden estimate or any other aspect of this form to: Office of Regulatory Affairs & Collaborative Action – Indian Affairs, Information Collection Clearance Officer, 1849 C Street, NW, MS-4141, Washington, DC 20240.

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  • Federal Law Governing Fraud

  • “Whoever, in any matter with jurisdiction of any Department or Agency of the United States, knowingly and willingly falsifies, conceals, or covers up by trick, scheme, or devises a material fact, or makes any false, fictitious, or fraudulent statement or representations or makes or uses any false writing or document, knowing the same to contain false, fictitious, or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five (5) years or both. “

    I (We), have read, or heard or have had interpreted to me (us) the preceding provisions of law and understand them. I (We), agree to supply all necessary information about my (our) household, employment and to notify the Agency when my (our) situation changes. I (We), also authorize the Bureau of Indian Affairs to obtain information necessary to establish my (our) eligibility for General Assistance.

    “ALL APPLICANTS SHALL BE NOTIFIED IN WRITING, BY MAIL, OR GIVEN IN HAND, REGARDING THE DECISION AND ACTIONS ON THEIR APPLICATION, INCLUDING THE AMOUNT OF THE GRANT, IF APPROVED”

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  • Social Services of the Cheyenne and Arapaho Tribes APPLICATION for General Assistance

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  • Section 1: FAMILY PROFILE OF HEAD OF HOUSEHOLD MEMBERS APPLYING (25 CFR §20.308) Family Profile

  • Fill in all required blanks for everyone who lives with you, either permanently or temporarily. You must list yourself first, then your spouse and other adults and children. Be sure to check the requested box for each individual not included in the payment.

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  • Client Background Summary


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  • Section III. EARNED INCOME & UNEARNED INCOME (25 CFR §20.308-§20.310)

  • Identify Household Member(s) who are working and their earnings:

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  • Section IV. STATEMENT OF COOPERATION

  • I (We) apply for financial assistance/services for the listed members of my (our) household who are in need. I/We have received a copy of and have had explained to us, and understand the provisions of Federal Law governing fraud. Under 18 U.S.C. §1001, the Federal Law concerning fraud states: “Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or devise a material fact, or makes or uses any false writing or document and knowing to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both. I (We) agree to supply information regarding resources and income and to notify the agency of any changes in my (our ) situation. Release of information for services is authorized to obtain/exchange information necessary to establish eligibility for assistance. I (We) have read, or had explained to me (us), this for our protection under the Paperwork Reduction Act and the Privacy Act.

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  • AUTHORIZATION FOR RELEASE OF INFORMATION

  • I hereby authorize you to release any information from any medical facility, institutions, the Social Security Administration, any local, State, or Federal Law Enforcement Agency, or any other agency. The information will be used to prove my identity and moral standing in my respective community for the purposes of placement AND/OR adoption of foster children. I understand that his information is to be held confidential by all parties.

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  • The information is to be released from:

  • The information is to be released to:

  • This authorization will terminate one year from the date of my signature.  It is further understood that I may revoke this authorization any time by written request except to the extent that action has been taken in reliance theron.

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  • GENERAL ASSISTANCE ADDITIONAL SECONDARY FORMS

  • These additional forms are required to be completed.  Complete these forms and attach them below.  They will be attached to your application for processing.  

    https://cheyenneandarapaho-nsn.gov/wp-content/uploads/2020/05/GENERAL-ASSISTANCE-JOTFORM-SECONDARY-FORMS-05-04-20-1.pdf

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  • REQUIRED DOCUMENTS

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  • *Applicants Name must match the name on the utility bill

    *Check stubs, SSI/SSA/VA award letters, TANF award letters, unemployment benefit statements, child support award letters, & an annual IIM account summary must be included in the proof of income. 

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