Pawnee Tribe of Oklahoma
Community Service Block Grant (CSBG) Program
Other Members of Household
Source of Income For All Adult Members of Household 18 Years of Age or Older
Community Service Block Grant (CSBG)
Pawnee Nation of Oklahoma
Applicant must be Native American as verified by a Certified Degree of Indian Blood (CDIB) or Tribal Membership card. Please provide CDIB or Tribal Membership card for all members residing at the residence. If CDIB or Tribal Membership card is not applicable, provide Driver License or Social Security card.
Applicant must reside in Pawnee County as verified by a Proof of Residence-current utility billt.
Proof of Income - prior (30) days income verification (i.e. check stub, social security, bank statement, unemployment, TANF, etc.). Applicant must meet poverty guidelines set forth by Department of Health & Human Services (DHHS).
*One time assistance will be available per household per fiscal year.
Client Rights & Responsibilities
I declare that the information I have given on my application is true and correct and that I will cooperate with Tribal and Federal officals should my application become part of a quality control audit review. I understand that the Pawnee Nation CSBG Program is federally funded and that there is a penalty for providing false information.
I hereby authorize Tribal Representatives to make any necessary investigation of my financial condition or other information regarding my elgibility. I understand that I have a right to a fiar hearing if I am not satisfied with the decision, action, or any unreasonable delay in a decision on my application. A request for a hearing must be submitted in a written form to the Pawnee Nation CSBG Office within (10) working days of decision notification. If no request for a hearing is filed within the (10) working day period, the hearing offer is deemed to have been refused and no hearing will be held.
If a hearing is requested, the Pawnee Nation CSBG Office will designate a presiding officer, and the hearing will take place on a date, time, and location agreed upon among the hearing requestor, Pawnee Nation CSBG Office, and the presiding officer. If an agreement cannot be reached, the presiding officer will designate a date, time, and location for the hearing.