American Rescue Plan Act Financial Assistance Application

I, the undersigned applicant, hereby certify under penalty of perjury, that all information in this Application is true and correct to the best of my knowledge, information and belief.

I understand that any funds I receive as a result of this application must be used to address negative economic impacts I have experienced since March 3, 2021 that were caused by the COVID-19 pandemic. I certify that the economic harm I have experienced due to the COVID-19 pandemic will not be covered by the American Rescue Plan Act (ARPA) funds from any other source, and that I will not apply for ARPA funds from any other source for costs, expenses, or other losses that are covered by funds received from this application. I understand that I may be required to reimburse the Tribe or the U.S. government for payments made to me for any misuse of funds or based upon any inaccurate statements or material omissions that I make in this application. The Tribe reserves all rights under law to recover funds paid by mistake of law or fact. I agree to assist the Tribe in verifying any of the information I submit in this application, upon reasonable request. I certify that I was not enrolled with another Tribe as of May 1, 2021 and have not received ARPA financial assistance from another Tribe. I understand that if my application is denied, I may request a copy of the Dispute Resolution procedure from the Tribe.