CCTH Community ARPA Application

Central Council Tlingit & Haida Indian Tribes of Alaska

Welcome to the Burial Assistance Program Application

A Tlingit & Haida Community Directed ARPA Program

Please use a Chrome browser to complete this application.

Tlingit & Haida is pleased to offer supplemental relief under the Tribe's Community Directed American Rescue Plan Act (ARPA) program to tribal citizens who are registered to specific communities and have been impacted by the COVID-19 pandemic.

The application will take approximately 10-15 minutes to complete and will require you to enter your Tlingit & Haida enrollment number, date of birth and social security number.

If the information you enter does not allow you to continue in the application, please contact our Program Compliance (Tribal Enrollment) department at 1.800.344.1432 ext. 7146 to confirm your tribal enrollment information.

We are honored to serve you during these unprecedented times.

Gunalchéesh, Háw'aa!

Please click the New Intake button to start the application process.

The online application must be completed and submitted.

* - Required field

* Tribal Citizen is:

* Enrollment ID:

* Date of Birth:

Applicant/Deceased Info

Applicant Information

* Applicant Name:

Applicant Tribal Enrollment Number:

* Social Security Number:

* Date of Birth:

Mailing Address:

City:

State:

Zip:

Physical Address:

City:

State:

Zip:

* Cell Phone:

Email Address:

Deceased Information

* Deceased Name:

* Deceased Enrollment Number:

* Relationship to Applicant:

* Deceased Last Physical Address:

* Deceased Last City:

* Deceased Last State:

* Deceased Zip:

* Date of Birth:

* Date of Death:

* Place of Death:

* Deceased Marital Status:

Community Verification

Here is the community we currently have you listed under:

If this is correct, press "Next".

If this is not correct, you will need to contact Program Compliance to have it updated before you can continue. Phone: 1-800-344-1432 ext. 7146 Email: enrollment@ccthita-nsn.gov Fax: 907-885-0052

Program Selection

Preferred Payment Method

* Payee Name

* Payee Address:

* City:

* State:

* Zip:

* Tax ID Number/SSN:

* Payment Type:

* Direct Deposit?

Yes No

A bank verifier must be uploaded to the final page of this application for it to be considered complete. Accepted bank verifiers include voided check, direct deposit form, and an official bank statement.

Please select a previously used payment method, or you may select to enter new information.:

Document Upload

Application Certifications

* I certify that I have been economically impacted by the COVID-19 pandemic.

* I certify I (applicant) OR the named deceased are enrolled with Tlingit & Haida Central Council and registered to vote with the voting community.

* I Certify any misinformation may potentially delay or deny my application.

* I Certify that I have not previously received any reimbursement of these specifically claimed expenses from any other federal funds whether from a Tribe, City, State, or Native Corporation.

Financial Certifications

Under penalties of perjury, I certify that:

* The number shown on this form is my correct taxpayer identification number/SSN: .

* I am not subject to backup withholding because: (a) I am exempt from backup withholding; or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.

* I Certify that I am a US Citizen.

Signature Certification

By entering my name in the box below I certify that all information is correct and accurate to the best of my knowledge.

* Signature: