OMB Control Number: 0970-0617; Expiration date: 09/30/2026

Registration

(* = Required)

Please select your role at this event.

Role*

--------- Tribal CCDF administrator Tribal CCDF co-administrator Tribal fiscal staff member Grant writer OCC federal staff member Non-OCC federal staff member (Please list your agency) OCC National Center TA staff member Other

Sub Role

--------- Child Care Automated Reporting System (CARS) Child Care Meeting Management Center (CMC) Child Care State Capacity Building Center (SCBC) Data and Information Systems Consultation Center (DISCC) National Center on Afterschool and Summer Enrichment (NCASE) National Center on Early Childhood Quality Assurance (NCECQA) National Center on Subsidy Innovation and Accountability (NCSIA) Tribal Child Care Capacity Building Center (TCBC) Tribal Child Care Program Support Center (TPSC)

Other Sub Role

List your agency

Contact Information

First Name*

Last Name*

Prefix

--------- Dr. Mr. Mrs. Ms.

Title/Position*

Tribal Nation/Tribal Organization or Other Organization*

City*

State*

--------- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

ZIP*

Phone number*

Email*

Emergency contact name

Emergency contact phone number

Emergency contact email

OCC Region*

--------- Region 1 (CT, ME, MA, NH, RI, VT) Region 2 (NJ, NY, PR, VI) Region 3 (DE, DC, MD, PA, VA, WV) Region 4 (AL, FL, GA, KY, MS, NC, SC, TN) Region 5 (IL, IN, MI, MN, OH, WI) Region 6 (AR, LA, NM, OK, TX) Region 7 (IA, KS, MO, NE) Region 8 (CO, MT, ND, SD, UT, WY) Region 9 (AS, AZ, CA, GU, HI, MP, NV) Region 10 (AK, ID, OR, WA) NA

Additional Information

Select how long you have been in your role*

---- N/A Less than 6 months 6 – 18 months 18 months – 3 years 3 years or longer

Select Your Tribal CCDF Allocation Size*

---- Small Medium Large Unsure N/A

Are you a Public Law 102-477 Grantee and receive your CCDF funds through the BIA?*

---- Yes No Unsure N/A

Do you require any special accommodations? If so, please describe.

---- Yes No

Please specify

0

Will you require over night accommodations? Note, you need to reserve your own hotel room using the information provided on the Travel page.

---- Yes No

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to obtain feedback from participants in OCC’s Tribal CCDF Plan Training. Public reporting burden for this collection of information is estimated to average 5 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB number is 0970-0617 and the expiration date is 09/30/2026. If you have any comments on this collection of information, please contact Stacy Cassell, Stacy.Cassell@acf.hhs.gov.