Confederated Tribes of Siletz Indians PO Box 549 (541) 444-2532 1-800-922-1399

Siletz Oregon 97380 FAX (541) 444-2307

Thursday December 15th 2016

Vincent Romero

BIA - Office of Indian Services

Division of Workforce Development

911 NE 11th Ave

Portland OR 97232

RE Siletz PL 102-477 2016 Year End Report

Dear Mr Romero

The Confederated Tribes of Siletz Indians 477-Self Sufficiency Program is submitting the following

reports and documents for your review

bull Statistical Report for the period of October 1st 2015 - Sept ember 30th 2016

bull Narrative Report (Including TANF)

bull Financial Expenditures Report

bull Financial Certifications

Should you have any questions please contact Kurtis Barker 477-Self Sufficiency Program Director at

(800) 922-1399 ext 1247 or (541) 444-8247

Respectfully

~ttY~ Brenda Bremner

General Manager

Confederated Tribes of Siletz Indians

0MB Control No I 076-01 35 (Vers ion 2) Expiration Date 02282018

Public Law 102-477 Statistical Report Tribal Nation

Confederated Tribes of Siletz Indians Report Period

From 10 12015 To 9302016 I Participants Served Adults Youth Cash Assistance Recipients

A Total Participants 11 9 33 260 B Total Terminees 86 26 173 C Total Current Participants 33 7 87

II Terminee Outcomes Adult Youth Cash Assistance Recipients A Total with Employment Objective 52 16 11 5

I Entered Unsubsidized Employment 23 0 45 2 Other Employment Outcomes 46 16 100 3 Employment Ob jective Not Achieved I 0

-II

4 Average Adult Earnings Gain $ 1361 B Total with EducationalTraining Objective 67 24 85

I DegreeCertificate a Attempted 41 13 31 b Attained 9 2 8

2 Other Education Outcomes 64 24 71 3 Education Objective Not Achieved

) 0 14 C Misc Objective Achieved 86 26 173 D Other (Non-Positive) 0 0 0

Ill Terminee Characteristics Adult Youth Cash Assistance Recipients A Female 52 19 85 B Male 34 7 88

-C Education Level I Dropout 10 I 38 2 Student 2 10 2 3 High SchoolDiplomaGED 54 15 125 4 Post High School 20 0 8

D Veteran 4 0 I

IV Participant Activities Adult Youth Cash Assistance Recipients A Employment 75 20 150 B EducationTraining 92 31 150 C Misc ObjectiveSupportive Services 11 9 33 260 D OtherService Referral 11 9

)) 260

V Child Care and Development Activities Families Children Cash Assistance Recipients A Families Receiving Child Care B Chi ldren Receiving Child Care - - - - - -

I Ages Othrough 3 years 2 Ages 4 through 5 years -3 Ages 6 through 12 - - -- - -4 Ages 13 and older --- - - -

C Care Received - Type of Provider I Center Based - -2 Family Child Care Home -~- middot--- - -- - - -3 Group Home -- -4 Child s Home

Vl Jobs CreationEconomic Development Jobs Created AlAN Employed Businesses Assisted A Number 14 42 83

Report Prepared By (Print Name amp Sien) Phone Number 541-444-8247 Date I 192016 Kurtis Barker k~-

Siletz Tribal 477 Self-Sufficiency Program Narrative Report for PL 102-477

October 1 2015 to September 30 2016

The Siletz Tribal 477-Self Sufficiency Program (SSP) has provided services to both Siletz Tribal members as well as other Natives as outlined in the 477-Plan The program is operating with (6) Tribal Service Specialists (TSS) (3) Intake SpecialistsJob Coaches (1) Administrative amp Monitoring Specialist (AMS) and a Program Director The AMS position is being reevaluated and the staff in that position has been temporarily transferred into a vacant TSS position The 477 Self-Sufficiency Program is operated out of (3) area offices (Portland Salem Eugene) and our central office located in Siletz Oregon

The Intake SpecialistJob Coach is responsible for all new intakes client workshopstrainings and carries the caseload for all Department of Labor Programs (Work Experience On-the-Job Training Classroom Training Core Services) and they service our Emergency Assistance cases This position is also responsible for providing services for youth on Temporary Assistance for Needy FamiliesNon-Needy Caretaker Relative (TANF) through TANF Purpose 3 and 4 The Tribal Services Specialists are primarily responsible for the day to day case management of TANF and General Assistance (GA) cases recertification of those cases and providing comprehensive services to our hardest to serve clients Many of those are considered unemployable

During the reporting year the Program served 412 participants a slight decrease from the previous year of 457 participants Of the total clients participating in programs there were 245 with an employment objective of the terminees 68 (24) entered into unsubsidized employment with an average earnings of $1361 for adult participants The economic situation in Oregon has improved and it reflects that in our overall figures The average earnings gains were higher than the previous year of $1248 but our overall employment numbers were down from 80 gaining unsubsidized employment The majority of our programs experienced fewer client numbers compared to previous years The major decline in client numbers took place in our cash assistance programs We continue to experience low case load numbers for the TANF program We didnt experience an increase in caseload figures in any of the three reporting categories This is due to several families reaching the 60-month time limit and there are more jobs available in rural areas of the service area Weve noticed that the improved economy has resulted in employable clients remaining on services for a shorter period oftime More of our long term clients who are unemployable are receiving more targeted case management and several have been approved for socia l security benefits

As of October 2016 Oregon was ranked 14th highest unemployment rate compared nationally Oregon has a 48 percent unemployment rate and the national average is 47 percent Here is a breakdown of each county and major city that is served with in our 11 county service area

bull Cit y of Eugene 52 City of Portland 47 City of Salem 49

bull Benton County 38 Clackamas County 45 Lane County 52

bull Lincoln County 57 Linn County 56 Mari on County 49

bull Multnomah County 43 Polk County 50 Tillamook County 50

bull Washington County 42 Yamhill County 45

Page 1 of 10

The countiescities highlighted reflect higher unemployment rates than the State average Out of the eleven counties served six are still above or at the national average in unemployment and six counties remain above the state of Oregons unemployment average

The 477-Participants are working towards self sufficiency in various ways The case management strategy varies by office location due to the different population types they serve The Portland Salem and Eugene offices serve mostly urban populations while the Siletz central office serves mostly rural areas The amount of resources varies greatly by location and county The Program has been utilizing the strength based approach where we focus on skills and strengths the participant already possesses We utilize a client assessment questionnaire that has been very useful at identifying additional client barriers The client case plan is then developed with the client to overcome those identified barriers

During this past year we held several certificate training opportunities that are identified below We had (26) participants achieve a higher education goal and several others participated in GED programs or short term vocational training We had (29) participants successfully complete a Work Experience contract (24) Participants utilized Direct Placement for assistance with work ready clothing and tools Our average count of participants throughout the 11 county service area is around (133) per month which would be a little over (33) participants per office receiving services The Program provided (1053) referrals to clients for access to other resources and employment opportunities and we provided (3445) client appointments We had (115) participants reach a significant goal and received an incentive award A few goals that were obtained this last year include

bull Obtained a GED (4)

bull Participants obtaining unsubsidized employment (70)

bull Lifestyle changes by obtaining services in mental health or alcohol and drug treatment

bull Received cosmetology license and started own small business

bull Successful completion of a work experience placement

bull Successful competition of an On-the-Job Training position or education program

bull Long term cash assistance participant obtaining employment

bull Participate in the Increasing Your Success client conference

bull Participated in workshops hosted monthly in each area location

The Program provided the following workshops and certificate trainings to clients and youth

bull Flagging Certification - 25 participants certified

bull Oregon Liquor Control License -15 certified

bull Food Handlers -18 certified

bull Forklift Training - 10 certified bull Interview strategies monthly job club meetings Native Wellness trainings interview

skills resume development Kempo classes for youth Money Five (five week financial fitness class) social security first aidCPR employment skills financial strategies classes hosted by local Worksource offices Goodwill trainings life skills

bull The Program also sponsors quarterly youth activities in-conjunction with Housing Behavior Health and Education prevention programs These prevention activities were more frequent during summer months Program staff participated in the annual Youth Conference as well

Page 2 of 10

We worked closely with Tribal programs State and County agencies to identify funding resources training and employment opportunities We continuously partner with Siletz Vocational Rehabilitation and our Higher Education Department on mutual clients to combine resources and support for participants as they work towards their goals and objectives We often share client costs resulting in significant financial savings for multiple programs These partnerships allowed us to develop more than (24) new employment worksites that are utilized for Work Experience On-the Job Training and Direct Placement

Other ResourcesPartnerships

One of our most significant partnerships was with the Siletz Valley Early College Academy (SVECA) Once the Program outlined policies regarding TANF Purpose 3 and 4 we met with SVECA to collaborate on a career exploration class for students The objective is to introduce SVECA students to various vocational trade industries through hands-on projects in areas of mechanics plumbing carpentry electrical welding and other disciplines The elective class is targeting both middle and high school students The class focused on careers that students can obtain without a college education We know that not all youth plan to attend college and we want to prepare them for careers that pay a living wage when they graduate This is achieved by partnering with local volunteers and professionals Several occupational instructors presented weekly classes in their profession The professionals presented their greatest work achievements background of education and experience needed for the profession required safety requirements introduction and practice of basic tools for the project develop a project outline and assign tasks for students The students then complete the project with assistance from the professional and teacher This year the careers varied and included operation of small hand tools measuring cutting lumber small business development knifetool sharpening computer assemblyrepair urban forestryclimbing trees arborist and the students built a storage shed and homeless hut The shed was donated to SVECA and the homeless hut is being donated to a client in need of shelter The Program provided startup funds to make this class possible The funds were utilized for instructor fees and supplies The class will be self sustaining within the next several years SVECA provides the Program with quarterly reports on youth served expenditures narrative of activities and pictures

As part of our 477 review it was recommended that we develop a computer lab training center for clients We took this seriously and spent several months identifying funding and office space The Siletz Tribal Council has allocated tribal funding for the computer lab and a location was selected at the end of the year We hope to provide trainings and staff meetings through video conferencing The ability to video conference with each office will reduce travel and training costs

Challenges

An ongoing challenge we face each year is the amount of youth funding we receive from the Department of Labor (DOL) Our yearly allocation is not enough to fully serve one client We are faced with locating other funds to supplement the summer youth employment and education programs This year we served fewer youth then we did last year The burden of locating funding is becoming more difficult The Program prioritizes youth services so we ensure that all eligible and approved applicants are served We plan to address this issue with the State of Oregon and local workforce boards to see if there can be a partnership that will provide

Page 3 of10

additional funding and support for our youth We partner with our tribal Education Department to ensure youth receive services from either program

Our clientele face other challenges and barriers such as transportation The costs and issues vary by office location In the Portland area bus passes cost an average of $100 monthly and have increased slightly each year The cost is slightly lower in the other area offices The Siletz area faces the largest challenge Bus routes are limited and lengthy A one way trip to the Tribal casinoLincoln City from Siletz could take four hours or more Job searching in that area or traveling to the Tribal Administration Office is challenging The 477 Director is the Chairman of the Siletz Tribal Transit Service Committee and we are working to address these barriers Additional routes have been established and Tribal members can ride the local bus for free within Lincoln County Our goal is to add additional buses routes and reduce the length of routes

The Program prioritized upgrading the data collection and reporting programs in 2015-2016 Staff previously entered data in four separate databasesprograms to get reports and statistics required The Director and AMS identified necessary changes and worked with Eaglesun Systems to consolidate our process into one single program The process took over a year was costly and we experienced several setbacks The staff received training on the new system in September 2016 This phase of the project eliminated two previous databases The next phase will eliminate all other databases We continue to identify additional data entry needs and issues with our system We hope to have all aspects of this update completed in 2017 The completed system will allow staff to issue all forms and contracts monitor expenditures track year-end data submit TANF quarterly reports track employerscommunity partners track events under TANF purpose 3-4 electronic routing for signatures and create a near paperless file system

Increasing Your Success Client Conference 2016

Our 477-Plan states that we will host a yearly client conference and this year we called it lncr~asing Your Success The conference was held March 22d-24th at Aldersgate Retreat Center located just outside Salem OR This conference takes months of planning and to date it was our most successful We had 61 participants attend the conference They provided great reviews and suggestions to make the next one even better The clients enrolled in Temporary Assistance for Needy Families General Assistance for Single Adults Work Experience Classroom Training and Core Training were required to attend

Workshops included Diabetes team activities re-entry self care internships vs apprenticeships SSISSD healthy relationships online applicationsresumes dress for success native life skills dealing with trauma spending frenzy (life budgeting activity) and several other team building activities The Program provided certification training for food handlers cards and flagging 18 participants received their food handlers cards and 25 are now certified flaggers We hosted a culture night that included beaded necklaces drum stick making and painting

Page 4 of 10

2016 Increasing Your Success Conference-

The 4 77-Self Sufficiency Program has many client successes and these are a few of their stories

Angelica Espino Angelica is a 26 year old Siletz Tribal member She has utilized assistance several times since 2008 (TANF GA CRT and WEX) Angelica is a single parent of two young children Angelica completed her Associates of Arts Transfer Degree from Chemeketa Community College in 2013 Angelica then enrolled at Western Oregon University Through tremendous hard work and dedication Angelica graduated with a double major of Criminal Justice and Psychology with a Bachelors of Art Angelica was recently hired as a Tribal Services Specialist and is using her education and services provided by the Tribe to assist other tribal members

Page 5 of 10

Sheila Aviles Sheila participated in On-the-Job Training as the Administration Receptionist She has now completed training and is a regular full-time employee within the organization Sheila assists many of our programs and community events to ensure they are successful

Joseph Martin Joseph is a 26 year old Siletz Tribal member Joseph has been on and off General Assistance since 2010 After removing several barriers to employment Joseph completed a WEX at Valley Vapors in Salem OR The employer requested to expand on Josephs job duties and after additional training needs were identified Joseph entered and completed an OJT Contract Joseph has maintained employment with Valley Vapors

Joseph Mike Joseph is a 35 year old member of the Duckwater Pauite Tribe Joseph relocated to Salem recently to be closer to his children who are attending Chemawa Indian School Joseph completed a WEX at City of Salem Parks and Recreation Division Joseph gained many valuable skills and he was offered a full-time permanent position with City of Salem Parks

Page 6 of 10

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

0MB Control No I 076-01 35 (Vers ion 2) Expiration Date 02282018

Public Law 102-477 Statistical Report Tribal Nation

Confederated Tribes of Siletz Indians Report Period

From 10 12015 To 9302016 I Participants Served Adults Youth Cash Assistance Recipients

A Total Participants 11 9 33 260 B Total Terminees 86 26 173 C Total Current Participants 33 7 87

II Terminee Outcomes Adult Youth Cash Assistance Recipients A Total with Employment Objective 52 16 11 5

I Entered Unsubsidized Employment 23 0 45 2 Other Employment Outcomes 46 16 100 3 Employment Ob jective Not Achieved I 0

-II

4 Average Adult Earnings Gain $ 1361 B Total with EducationalTraining Objective 67 24 85

I DegreeCertificate a Attempted 41 13 31 b Attained 9 2 8

2 Other Education Outcomes 64 24 71 3 Education Objective Not Achieved

) 0 14 C Misc Objective Achieved 86 26 173 D Other (Non-Positive) 0 0 0

Ill Terminee Characteristics Adult Youth Cash Assistance Recipients A Female 52 19 85 B Male 34 7 88

-C Education Level I Dropout 10 I 38 2 Student 2 10 2 3 High SchoolDiplomaGED 54 15 125 4 Post High School 20 0 8

D Veteran 4 0 I

IV Participant Activities Adult Youth Cash Assistance Recipients A Employment 75 20 150 B EducationTraining 92 31 150 C Misc ObjectiveSupportive Services 11 9 33 260 D OtherService Referral 11 9

)) 260

V Child Care and Development Activities Families Children Cash Assistance Recipients A Families Receiving Child Care B Chi ldren Receiving Child Care - - - - - -

I Ages Othrough 3 years 2 Ages 4 through 5 years -3 Ages 6 through 12 - - -- - -4 Ages 13 and older --- - - -

C Care Received - Type of Provider I Center Based - -2 Family Child Care Home -~- middot--- - -- - - -3 Group Home -- -4 Child s Home

Vl Jobs CreationEconomic Development Jobs Created AlAN Employed Businesses Assisted A Number 14 42 83

Report Prepared By (Print Name amp Sien) Phone Number 541-444-8247 Date I 192016 Kurtis Barker k~-

Siletz Tribal 477 Self-Sufficiency Program Narrative Report for PL 102-477

October 1 2015 to September 30 2016

The Siletz Tribal 477-Self Sufficiency Program (SSP) has provided services to both Siletz Tribal members as well as other Natives as outlined in the 477-Plan The program is operating with (6) Tribal Service Specialists (TSS) (3) Intake SpecialistsJob Coaches (1) Administrative amp Monitoring Specialist (AMS) and a Program Director The AMS position is being reevaluated and the staff in that position has been temporarily transferred into a vacant TSS position The 477 Self-Sufficiency Program is operated out of (3) area offices (Portland Salem Eugene) and our central office located in Siletz Oregon

The Intake SpecialistJob Coach is responsible for all new intakes client workshopstrainings and carries the caseload for all Department of Labor Programs (Work Experience On-the-Job Training Classroom Training Core Services) and they service our Emergency Assistance cases This position is also responsible for providing services for youth on Temporary Assistance for Needy FamiliesNon-Needy Caretaker Relative (TANF) through TANF Purpose 3 and 4 The Tribal Services Specialists are primarily responsible for the day to day case management of TANF and General Assistance (GA) cases recertification of those cases and providing comprehensive services to our hardest to serve clients Many of those are considered unemployable

During the reporting year the Program served 412 participants a slight decrease from the previous year of 457 participants Of the total clients participating in programs there were 245 with an employment objective of the terminees 68 (24) entered into unsubsidized employment with an average earnings of $1361 for adult participants The economic situation in Oregon has improved and it reflects that in our overall figures The average earnings gains were higher than the previous year of $1248 but our overall employment numbers were down from 80 gaining unsubsidized employment The majority of our programs experienced fewer client numbers compared to previous years The major decline in client numbers took place in our cash assistance programs We continue to experience low case load numbers for the TANF program We didnt experience an increase in caseload figures in any of the three reporting categories This is due to several families reaching the 60-month time limit and there are more jobs available in rural areas of the service area Weve noticed that the improved economy has resulted in employable clients remaining on services for a shorter period oftime More of our long term clients who are unemployable are receiving more targeted case management and several have been approved for socia l security benefits

As of October 2016 Oregon was ranked 14th highest unemployment rate compared nationally Oregon has a 48 percent unemployment rate and the national average is 47 percent Here is a breakdown of each county and major city that is served with in our 11 county service area

bull Cit y of Eugene 52 City of Portland 47 City of Salem 49

bull Benton County 38 Clackamas County 45 Lane County 52

bull Lincoln County 57 Linn County 56 Mari on County 49

bull Multnomah County 43 Polk County 50 Tillamook County 50

bull Washington County 42 Yamhill County 45

Page 1 of 10

The countiescities highlighted reflect higher unemployment rates than the State average Out of the eleven counties served six are still above or at the national average in unemployment and six counties remain above the state of Oregons unemployment average

The 477-Participants are working towards self sufficiency in various ways The case management strategy varies by office location due to the different population types they serve The Portland Salem and Eugene offices serve mostly urban populations while the Siletz central office serves mostly rural areas The amount of resources varies greatly by location and county The Program has been utilizing the strength based approach where we focus on skills and strengths the participant already possesses We utilize a client assessment questionnaire that has been very useful at identifying additional client barriers The client case plan is then developed with the client to overcome those identified barriers

During this past year we held several certificate training opportunities that are identified below We had (26) participants achieve a higher education goal and several others participated in GED programs or short term vocational training We had (29) participants successfully complete a Work Experience contract (24) Participants utilized Direct Placement for assistance with work ready clothing and tools Our average count of participants throughout the 11 county service area is around (133) per month which would be a little over (33) participants per office receiving services The Program provided (1053) referrals to clients for access to other resources and employment opportunities and we provided (3445) client appointments We had (115) participants reach a significant goal and received an incentive award A few goals that were obtained this last year include

bull Obtained a GED (4)

bull Participants obtaining unsubsidized employment (70)

bull Lifestyle changes by obtaining services in mental health or alcohol and drug treatment

bull Received cosmetology license and started own small business

bull Successful completion of a work experience placement

bull Successful competition of an On-the-Job Training position or education program

bull Long term cash assistance participant obtaining employment

bull Participate in the Increasing Your Success client conference

bull Participated in workshops hosted monthly in each area location

The Program provided the following workshops and certificate trainings to clients and youth

bull Flagging Certification - 25 participants certified

bull Oregon Liquor Control License -15 certified

bull Food Handlers -18 certified

bull Forklift Training - 10 certified bull Interview strategies monthly job club meetings Native Wellness trainings interview

skills resume development Kempo classes for youth Money Five (five week financial fitness class) social security first aidCPR employment skills financial strategies classes hosted by local Worksource offices Goodwill trainings life skills

bull The Program also sponsors quarterly youth activities in-conjunction with Housing Behavior Health and Education prevention programs These prevention activities were more frequent during summer months Program staff participated in the annual Youth Conference as well

Page 2 of 10

We worked closely with Tribal programs State and County agencies to identify funding resources training and employment opportunities We continuously partner with Siletz Vocational Rehabilitation and our Higher Education Department on mutual clients to combine resources and support for participants as they work towards their goals and objectives We often share client costs resulting in significant financial savings for multiple programs These partnerships allowed us to develop more than (24) new employment worksites that are utilized for Work Experience On-the Job Training and Direct Placement

Other ResourcesPartnerships

One of our most significant partnerships was with the Siletz Valley Early College Academy (SVECA) Once the Program outlined policies regarding TANF Purpose 3 and 4 we met with SVECA to collaborate on a career exploration class for students The objective is to introduce SVECA students to various vocational trade industries through hands-on projects in areas of mechanics plumbing carpentry electrical welding and other disciplines The elective class is targeting both middle and high school students The class focused on careers that students can obtain without a college education We know that not all youth plan to attend college and we want to prepare them for careers that pay a living wage when they graduate This is achieved by partnering with local volunteers and professionals Several occupational instructors presented weekly classes in their profession The professionals presented their greatest work achievements background of education and experience needed for the profession required safety requirements introduction and practice of basic tools for the project develop a project outline and assign tasks for students The students then complete the project with assistance from the professional and teacher This year the careers varied and included operation of small hand tools measuring cutting lumber small business development knifetool sharpening computer assemblyrepair urban forestryclimbing trees arborist and the students built a storage shed and homeless hut The shed was donated to SVECA and the homeless hut is being donated to a client in need of shelter The Program provided startup funds to make this class possible The funds were utilized for instructor fees and supplies The class will be self sustaining within the next several years SVECA provides the Program with quarterly reports on youth served expenditures narrative of activities and pictures

As part of our 477 review it was recommended that we develop a computer lab training center for clients We took this seriously and spent several months identifying funding and office space The Siletz Tribal Council has allocated tribal funding for the computer lab and a location was selected at the end of the year We hope to provide trainings and staff meetings through video conferencing The ability to video conference with each office will reduce travel and training costs

Challenges

An ongoing challenge we face each year is the amount of youth funding we receive from the Department of Labor (DOL) Our yearly allocation is not enough to fully serve one client We are faced with locating other funds to supplement the summer youth employment and education programs This year we served fewer youth then we did last year The burden of locating funding is becoming more difficult The Program prioritizes youth services so we ensure that all eligible and approved applicants are served We plan to address this issue with the State of Oregon and local workforce boards to see if there can be a partnership that will provide

Page 3 of10

additional funding and support for our youth We partner with our tribal Education Department to ensure youth receive services from either program

Our clientele face other challenges and barriers such as transportation The costs and issues vary by office location In the Portland area bus passes cost an average of $100 monthly and have increased slightly each year The cost is slightly lower in the other area offices The Siletz area faces the largest challenge Bus routes are limited and lengthy A one way trip to the Tribal casinoLincoln City from Siletz could take four hours or more Job searching in that area or traveling to the Tribal Administration Office is challenging The 477 Director is the Chairman of the Siletz Tribal Transit Service Committee and we are working to address these barriers Additional routes have been established and Tribal members can ride the local bus for free within Lincoln County Our goal is to add additional buses routes and reduce the length of routes

The Program prioritized upgrading the data collection and reporting programs in 2015-2016 Staff previously entered data in four separate databasesprograms to get reports and statistics required The Director and AMS identified necessary changes and worked with Eaglesun Systems to consolidate our process into one single program The process took over a year was costly and we experienced several setbacks The staff received training on the new system in September 2016 This phase of the project eliminated two previous databases The next phase will eliminate all other databases We continue to identify additional data entry needs and issues with our system We hope to have all aspects of this update completed in 2017 The completed system will allow staff to issue all forms and contracts monitor expenditures track year-end data submit TANF quarterly reports track employerscommunity partners track events under TANF purpose 3-4 electronic routing for signatures and create a near paperless file system

Increasing Your Success Client Conference 2016

Our 477-Plan states that we will host a yearly client conference and this year we called it lncr~asing Your Success The conference was held March 22d-24th at Aldersgate Retreat Center located just outside Salem OR This conference takes months of planning and to date it was our most successful We had 61 participants attend the conference They provided great reviews and suggestions to make the next one even better The clients enrolled in Temporary Assistance for Needy Families General Assistance for Single Adults Work Experience Classroom Training and Core Training were required to attend

Workshops included Diabetes team activities re-entry self care internships vs apprenticeships SSISSD healthy relationships online applicationsresumes dress for success native life skills dealing with trauma spending frenzy (life budgeting activity) and several other team building activities The Program provided certification training for food handlers cards and flagging 18 participants received their food handlers cards and 25 are now certified flaggers We hosted a culture night that included beaded necklaces drum stick making and painting

Page 4 of 10

2016 Increasing Your Success Conference-

The 4 77-Self Sufficiency Program has many client successes and these are a few of their stories

Angelica Espino Angelica is a 26 year old Siletz Tribal member She has utilized assistance several times since 2008 (TANF GA CRT and WEX) Angelica is a single parent of two young children Angelica completed her Associates of Arts Transfer Degree from Chemeketa Community College in 2013 Angelica then enrolled at Western Oregon University Through tremendous hard work and dedication Angelica graduated with a double major of Criminal Justice and Psychology with a Bachelors of Art Angelica was recently hired as a Tribal Services Specialist and is using her education and services provided by the Tribe to assist other tribal members

Page 5 of 10

Sheila Aviles Sheila participated in On-the-Job Training as the Administration Receptionist She has now completed training and is a regular full-time employee within the organization Sheila assists many of our programs and community events to ensure they are successful

Joseph Martin Joseph is a 26 year old Siletz Tribal member Joseph has been on and off General Assistance since 2010 After removing several barriers to employment Joseph completed a WEX at Valley Vapors in Salem OR The employer requested to expand on Josephs job duties and after additional training needs were identified Joseph entered and completed an OJT Contract Joseph has maintained employment with Valley Vapors

Joseph Mike Joseph is a 35 year old member of the Duckwater Pauite Tribe Joseph relocated to Salem recently to be closer to his children who are attending Chemawa Indian School Joseph completed a WEX at City of Salem Parks and Recreation Division Joseph gained many valuable skills and he was offered a full-time permanent position with City of Salem Parks

Page 6 of 10

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

Siletz Tribal 477 Self-Sufficiency Program Narrative Report for PL 102-477

October 1 2015 to September 30 2016

The Siletz Tribal 477-Self Sufficiency Program (SSP) has provided services to both Siletz Tribal members as well as other Natives as outlined in the 477-Plan The program is operating with (6) Tribal Service Specialists (TSS) (3) Intake SpecialistsJob Coaches (1) Administrative amp Monitoring Specialist (AMS) and a Program Director The AMS position is being reevaluated and the staff in that position has been temporarily transferred into a vacant TSS position The 477 Self-Sufficiency Program is operated out of (3) area offices (Portland Salem Eugene) and our central office located in Siletz Oregon

The Intake SpecialistJob Coach is responsible for all new intakes client workshopstrainings and carries the caseload for all Department of Labor Programs (Work Experience On-the-Job Training Classroom Training Core Services) and they service our Emergency Assistance cases This position is also responsible for providing services for youth on Temporary Assistance for Needy FamiliesNon-Needy Caretaker Relative (TANF) through TANF Purpose 3 and 4 The Tribal Services Specialists are primarily responsible for the day to day case management of TANF and General Assistance (GA) cases recertification of those cases and providing comprehensive services to our hardest to serve clients Many of those are considered unemployable

During the reporting year the Program served 412 participants a slight decrease from the previous year of 457 participants Of the total clients participating in programs there were 245 with an employment objective of the terminees 68 (24) entered into unsubsidized employment with an average earnings of $1361 for adult participants The economic situation in Oregon has improved and it reflects that in our overall figures The average earnings gains were higher than the previous year of $1248 but our overall employment numbers were down from 80 gaining unsubsidized employment The majority of our programs experienced fewer client numbers compared to previous years The major decline in client numbers took place in our cash assistance programs We continue to experience low case load numbers for the TANF program We didnt experience an increase in caseload figures in any of the three reporting categories This is due to several families reaching the 60-month time limit and there are more jobs available in rural areas of the service area Weve noticed that the improved economy has resulted in employable clients remaining on services for a shorter period oftime More of our long term clients who are unemployable are receiving more targeted case management and several have been approved for socia l security benefits

As of October 2016 Oregon was ranked 14th highest unemployment rate compared nationally Oregon has a 48 percent unemployment rate and the national average is 47 percent Here is a breakdown of each county and major city that is served with in our 11 county service area

bull Cit y of Eugene 52 City of Portland 47 City of Salem 49

bull Benton County 38 Clackamas County 45 Lane County 52

bull Lincoln County 57 Linn County 56 Mari on County 49

bull Multnomah County 43 Polk County 50 Tillamook County 50

bull Washington County 42 Yamhill County 45

Page 1 of 10

The countiescities highlighted reflect higher unemployment rates than the State average Out of the eleven counties served six are still above or at the national average in unemployment and six counties remain above the state of Oregons unemployment average

The 477-Participants are working towards self sufficiency in various ways The case management strategy varies by office location due to the different population types they serve The Portland Salem and Eugene offices serve mostly urban populations while the Siletz central office serves mostly rural areas The amount of resources varies greatly by location and county The Program has been utilizing the strength based approach where we focus on skills and strengths the participant already possesses We utilize a client assessment questionnaire that has been very useful at identifying additional client barriers The client case plan is then developed with the client to overcome those identified barriers

During this past year we held several certificate training opportunities that are identified below We had (26) participants achieve a higher education goal and several others participated in GED programs or short term vocational training We had (29) participants successfully complete a Work Experience contract (24) Participants utilized Direct Placement for assistance with work ready clothing and tools Our average count of participants throughout the 11 county service area is around (133) per month which would be a little over (33) participants per office receiving services The Program provided (1053) referrals to clients for access to other resources and employment opportunities and we provided (3445) client appointments We had (115) participants reach a significant goal and received an incentive award A few goals that were obtained this last year include

bull Obtained a GED (4)

bull Participants obtaining unsubsidized employment (70)

bull Lifestyle changes by obtaining services in mental health or alcohol and drug treatment

bull Received cosmetology license and started own small business

bull Successful completion of a work experience placement

bull Successful competition of an On-the-Job Training position or education program

bull Long term cash assistance participant obtaining employment

bull Participate in the Increasing Your Success client conference

bull Participated in workshops hosted monthly in each area location

The Program provided the following workshops and certificate trainings to clients and youth

bull Flagging Certification - 25 participants certified

bull Oregon Liquor Control License -15 certified

bull Food Handlers -18 certified

bull Forklift Training - 10 certified bull Interview strategies monthly job club meetings Native Wellness trainings interview

skills resume development Kempo classes for youth Money Five (five week financial fitness class) social security first aidCPR employment skills financial strategies classes hosted by local Worksource offices Goodwill trainings life skills

bull The Program also sponsors quarterly youth activities in-conjunction with Housing Behavior Health and Education prevention programs These prevention activities were more frequent during summer months Program staff participated in the annual Youth Conference as well

Page 2 of 10

We worked closely with Tribal programs State and County agencies to identify funding resources training and employment opportunities We continuously partner with Siletz Vocational Rehabilitation and our Higher Education Department on mutual clients to combine resources and support for participants as they work towards their goals and objectives We often share client costs resulting in significant financial savings for multiple programs These partnerships allowed us to develop more than (24) new employment worksites that are utilized for Work Experience On-the Job Training and Direct Placement

Other ResourcesPartnerships

One of our most significant partnerships was with the Siletz Valley Early College Academy (SVECA) Once the Program outlined policies regarding TANF Purpose 3 and 4 we met with SVECA to collaborate on a career exploration class for students The objective is to introduce SVECA students to various vocational trade industries through hands-on projects in areas of mechanics plumbing carpentry electrical welding and other disciplines The elective class is targeting both middle and high school students The class focused on careers that students can obtain without a college education We know that not all youth plan to attend college and we want to prepare them for careers that pay a living wage when they graduate This is achieved by partnering with local volunteers and professionals Several occupational instructors presented weekly classes in their profession The professionals presented their greatest work achievements background of education and experience needed for the profession required safety requirements introduction and practice of basic tools for the project develop a project outline and assign tasks for students The students then complete the project with assistance from the professional and teacher This year the careers varied and included operation of small hand tools measuring cutting lumber small business development knifetool sharpening computer assemblyrepair urban forestryclimbing trees arborist and the students built a storage shed and homeless hut The shed was donated to SVECA and the homeless hut is being donated to a client in need of shelter The Program provided startup funds to make this class possible The funds were utilized for instructor fees and supplies The class will be self sustaining within the next several years SVECA provides the Program with quarterly reports on youth served expenditures narrative of activities and pictures

As part of our 477 review it was recommended that we develop a computer lab training center for clients We took this seriously and spent several months identifying funding and office space The Siletz Tribal Council has allocated tribal funding for the computer lab and a location was selected at the end of the year We hope to provide trainings and staff meetings through video conferencing The ability to video conference with each office will reduce travel and training costs

Challenges

An ongoing challenge we face each year is the amount of youth funding we receive from the Department of Labor (DOL) Our yearly allocation is not enough to fully serve one client We are faced with locating other funds to supplement the summer youth employment and education programs This year we served fewer youth then we did last year The burden of locating funding is becoming more difficult The Program prioritizes youth services so we ensure that all eligible and approved applicants are served We plan to address this issue with the State of Oregon and local workforce boards to see if there can be a partnership that will provide

Page 3 of10

additional funding and support for our youth We partner with our tribal Education Department to ensure youth receive services from either program

Our clientele face other challenges and barriers such as transportation The costs and issues vary by office location In the Portland area bus passes cost an average of $100 monthly and have increased slightly each year The cost is slightly lower in the other area offices The Siletz area faces the largest challenge Bus routes are limited and lengthy A one way trip to the Tribal casinoLincoln City from Siletz could take four hours or more Job searching in that area or traveling to the Tribal Administration Office is challenging The 477 Director is the Chairman of the Siletz Tribal Transit Service Committee and we are working to address these barriers Additional routes have been established and Tribal members can ride the local bus for free within Lincoln County Our goal is to add additional buses routes and reduce the length of routes

The Program prioritized upgrading the data collection and reporting programs in 2015-2016 Staff previously entered data in four separate databasesprograms to get reports and statistics required The Director and AMS identified necessary changes and worked with Eaglesun Systems to consolidate our process into one single program The process took over a year was costly and we experienced several setbacks The staff received training on the new system in September 2016 This phase of the project eliminated two previous databases The next phase will eliminate all other databases We continue to identify additional data entry needs and issues with our system We hope to have all aspects of this update completed in 2017 The completed system will allow staff to issue all forms and contracts monitor expenditures track year-end data submit TANF quarterly reports track employerscommunity partners track events under TANF purpose 3-4 electronic routing for signatures and create a near paperless file system

Increasing Your Success Client Conference 2016

Our 477-Plan states that we will host a yearly client conference and this year we called it lncr~asing Your Success The conference was held March 22d-24th at Aldersgate Retreat Center located just outside Salem OR This conference takes months of planning and to date it was our most successful We had 61 participants attend the conference They provided great reviews and suggestions to make the next one even better The clients enrolled in Temporary Assistance for Needy Families General Assistance for Single Adults Work Experience Classroom Training and Core Training were required to attend

Workshops included Diabetes team activities re-entry self care internships vs apprenticeships SSISSD healthy relationships online applicationsresumes dress for success native life skills dealing with trauma spending frenzy (life budgeting activity) and several other team building activities The Program provided certification training for food handlers cards and flagging 18 participants received their food handlers cards and 25 are now certified flaggers We hosted a culture night that included beaded necklaces drum stick making and painting

Page 4 of 10

2016 Increasing Your Success Conference-

The 4 77-Self Sufficiency Program has many client successes and these are a few of their stories

Angelica Espino Angelica is a 26 year old Siletz Tribal member She has utilized assistance several times since 2008 (TANF GA CRT and WEX) Angelica is a single parent of two young children Angelica completed her Associates of Arts Transfer Degree from Chemeketa Community College in 2013 Angelica then enrolled at Western Oregon University Through tremendous hard work and dedication Angelica graduated with a double major of Criminal Justice and Psychology with a Bachelors of Art Angelica was recently hired as a Tribal Services Specialist and is using her education and services provided by the Tribe to assist other tribal members

Page 5 of 10

Sheila Aviles Sheila participated in On-the-Job Training as the Administration Receptionist She has now completed training and is a regular full-time employee within the organization Sheila assists many of our programs and community events to ensure they are successful

Joseph Martin Joseph is a 26 year old Siletz Tribal member Joseph has been on and off General Assistance since 2010 After removing several barriers to employment Joseph completed a WEX at Valley Vapors in Salem OR The employer requested to expand on Josephs job duties and after additional training needs were identified Joseph entered and completed an OJT Contract Joseph has maintained employment with Valley Vapors

Joseph Mike Joseph is a 35 year old member of the Duckwater Pauite Tribe Joseph relocated to Salem recently to be closer to his children who are attending Chemawa Indian School Joseph completed a WEX at City of Salem Parks and Recreation Division Joseph gained many valuable skills and he was offered a full-time permanent position with City of Salem Parks

Page 6 of 10

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

The countiescities highlighted reflect higher unemployment rates than the State average Out of the eleven counties served six are still above or at the national average in unemployment and six counties remain above the state of Oregons unemployment average

The 477-Participants are working towards self sufficiency in various ways The case management strategy varies by office location due to the different population types they serve The Portland Salem and Eugene offices serve mostly urban populations while the Siletz central office serves mostly rural areas The amount of resources varies greatly by location and county The Program has been utilizing the strength based approach where we focus on skills and strengths the participant already possesses We utilize a client assessment questionnaire that has been very useful at identifying additional client barriers The client case plan is then developed with the client to overcome those identified barriers

During this past year we held several certificate training opportunities that are identified below We had (26) participants achieve a higher education goal and several others participated in GED programs or short term vocational training We had (29) participants successfully complete a Work Experience contract (24) Participants utilized Direct Placement for assistance with work ready clothing and tools Our average count of participants throughout the 11 county service area is around (133) per month which would be a little over (33) participants per office receiving services The Program provided (1053) referrals to clients for access to other resources and employment opportunities and we provided (3445) client appointments We had (115) participants reach a significant goal and received an incentive award A few goals that were obtained this last year include

bull Obtained a GED (4)

bull Participants obtaining unsubsidized employment (70)

bull Lifestyle changes by obtaining services in mental health or alcohol and drug treatment

bull Received cosmetology license and started own small business

bull Successful completion of a work experience placement

bull Successful competition of an On-the-Job Training position or education program

bull Long term cash assistance participant obtaining employment

bull Participate in the Increasing Your Success client conference

bull Participated in workshops hosted monthly in each area location

The Program provided the following workshops and certificate trainings to clients and youth

bull Flagging Certification - 25 participants certified

bull Oregon Liquor Control License -15 certified

bull Food Handlers -18 certified

bull Forklift Training - 10 certified bull Interview strategies monthly job club meetings Native Wellness trainings interview

skills resume development Kempo classes for youth Money Five (five week financial fitness class) social security first aidCPR employment skills financial strategies classes hosted by local Worksource offices Goodwill trainings life skills

bull The Program also sponsors quarterly youth activities in-conjunction with Housing Behavior Health and Education prevention programs These prevention activities were more frequent during summer months Program staff participated in the annual Youth Conference as well

Page 2 of 10

We worked closely with Tribal programs State and County agencies to identify funding resources training and employment opportunities We continuously partner with Siletz Vocational Rehabilitation and our Higher Education Department on mutual clients to combine resources and support for participants as they work towards their goals and objectives We often share client costs resulting in significant financial savings for multiple programs These partnerships allowed us to develop more than (24) new employment worksites that are utilized for Work Experience On-the Job Training and Direct Placement

Other ResourcesPartnerships

One of our most significant partnerships was with the Siletz Valley Early College Academy (SVECA) Once the Program outlined policies regarding TANF Purpose 3 and 4 we met with SVECA to collaborate on a career exploration class for students The objective is to introduce SVECA students to various vocational trade industries through hands-on projects in areas of mechanics plumbing carpentry electrical welding and other disciplines The elective class is targeting both middle and high school students The class focused on careers that students can obtain without a college education We know that not all youth plan to attend college and we want to prepare them for careers that pay a living wage when they graduate This is achieved by partnering with local volunteers and professionals Several occupational instructors presented weekly classes in their profession The professionals presented their greatest work achievements background of education and experience needed for the profession required safety requirements introduction and practice of basic tools for the project develop a project outline and assign tasks for students The students then complete the project with assistance from the professional and teacher This year the careers varied and included operation of small hand tools measuring cutting lumber small business development knifetool sharpening computer assemblyrepair urban forestryclimbing trees arborist and the students built a storage shed and homeless hut The shed was donated to SVECA and the homeless hut is being donated to a client in need of shelter The Program provided startup funds to make this class possible The funds were utilized for instructor fees and supplies The class will be self sustaining within the next several years SVECA provides the Program with quarterly reports on youth served expenditures narrative of activities and pictures

As part of our 477 review it was recommended that we develop a computer lab training center for clients We took this seriously and spent several months identifying funding and office space The Siletz Tribal Council has allocated tribal funding for the computer lab and a location was selected at the end of the year We hope to provide trainings and staff meetings through video conferencing The ability to video conference with each office will reduce travel and training costs

Challenges

An ongoing challenge we face each year is the amount of youth funding we receive from the Department of Labor (DOL) Our yearly allocation is not enough to fully serve one client We are faced with locating other funds to supplement the summer youth employment and education programs This year we served fewer youth then we did last year The burden of locating funding is becoming more difficult The Program prioritizes youth services so we ensure that all eligible and approved applicants are served We plan to address this issue with the State of Oregon and local workforce boards to see if there can be a partnership that will provide

Page 3 of10

additional funding and support for our youth We partner with our tribal Education Department to ensure youth receive services from either program

Our clientele face other challenges and barriers such as transportation The costs and issues vary by office location In the Portland area bus passes cost an average of $100 monthly and have increased slightly each year The cost is slightly lower in the other area offices The Siletz area faces the largest challenge Bus routes are limited and lengthy A one way trip to the Tribal casinoLincoln City from Siletz could take four hours or more Job searching in that area or traveling to the Tribal Administration Office is challenging The 477 Director is the Chairman of the Siletz Tribal Transit Service Committee and we are working to address these barriers Additional routes have been established and Tribal members can ride the local bus for free within Lincoln County Our goal is to add additional buses routes and reduce the length of routes

The Program prioritized upgrading the data collection and reporting programs in 2015-2016 Staff previously entered data in four separate databasesprograms to get reports and statistics required The Director and AMS identified necessary changes and worked with Eaglesun Systems to consolidate our process into one single program The process took over a year was costly and we experienced several setbacks The staff received training on the new system in September 2016 This phase of the project eliminated two previous databases The next phase will eliminate all other databases We continue to identify additional data entry needs and issues with our system We hope to have all aspects of this update completed in 2017 The completed system will allow staff to issue all forms and contracts monitor expenditures track year-end data submit TANF quarterly reports track employerscommunity partners track events under TANF purpose 3-4 electronic routing for signatures and create a near paperless file system

Increasing Your Success Client Conference 2016

Our 477-Plan states that we will host a yearly client conference and this year we called it lncr~asing Your Success The conference was held March 22d-24th at Aldersgate Retreat Center located just outside Salem OR This conference takes months of planning and to date it was our most successful We had 61 participants attend the conference They provided great reviews and suggestions to make the next one even better The clients enrolled in Temporary Assistance for Needy Families General Assistance for Single Adults Work Experience Classroom Training and Core Training were required to attend

Workshops included Diabetes team activities re-entry self care internships vs apprenticeships SSISSD healthy relationships online applicationsresumes dress for success native life skills dealing with trauma spending frenzy (life budgeting activity) and several other team building activities The Program provided certification training for food handlers cards and flagging 18 participants received their food handlers cards and 25 are now certified flaggers We hosted a culture night that included beaded necklaces drum stick making and painting

Page 4 of 10

2016 Increasing Your Success Conference-

The 4 77-Self Sufficiency Program has many client successes and these are a few of their stories

Angelica Espino Angelica is a 26 year old Siletz Tribal member She has utilized assistance several times since 2008 (TANF GA CRT and WEX) Angelica is a single parent of two young children Angelica completed her Associates of Arts Transfer Degree from Chemeketa Community College in 2013 Angelica then enrolled at Western Oregon University Through tremendous hard work and dedication Angelica graduated with a double major of Criminal Justice and Psychology with a Bachelors of Art Angelica was recently hired as a Tribal Services Specialist and is using her education and services provided by the Tribe to assist other tribal members

Page 5 of 10

Sheila Aviles Sheila participated in On-the-Job Training as the Administration Receptionist She has now completed training and is a regular full-time employee within the organization Sheila assists many of our programs and community events to ensure they are successful

Joseph Martin Joseph is a 26 year old Siletz Tribal member Joseph has been on and off General Assistance since 2010 After removing several barriers to employment Joseph completed a WEX at Valley Vapors in Salem OR The employer requested to expand on Josephs job duties and after additional training needs were identified Joseph entered and completed an OJT Contract Joseph has maintained employment with Valley Vapors

Joseph Mike Joseph is a 35 year old member of the Duckwater Pauite Tribe Joseph relocated to Salem recently to be closer to his children who are attending Chemawa Indian School Joseph completed a WEX at City of Salem Parks and Recreation Division Joseph gained many valuable skills and he was offered a full-time permanent position with City of Salem Parks

Page 6 of 10

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

We worked closely with Tribal programs State and County agencies to identify funding resources training and employment opportunities We continuously partner with Siletz Vocational Rehabilitation and our Higher Education Department on mutual clients to combine resources and support for participants as they work towards their goals and objectives We often share client costs resulting in significant financial savings for multiple programs These partnerships allowed us to develop more than (24) new employment worksites that are utilized for Work Experience On-the Job Training and Direct Placement

Other ResourcesPartnerships

One of our most significant partnerships was with the Siletz Valley Early College Academy (SVECA) Once the Program outlined policies regarding TANF Purpose 3 and 4 we met with SVECA to collaborate on a career exploration class for students The objective is to introduce SVECA students to various vocational trade industries through hands-on projects in areas of mechanics plumbing carpentry electrical welding and other disciplines The elective class is targeting both middle and high school students The class focused on careers that students can obtain without a college education We know that not all youth plan to attend college and we want to prepare them for careers that pay a living wage when they graduate This is achieved by partnering with local volunteers and professionals Several occupational instructors presented weekly classes in their profession The professionals presented their greatest work achievements background of education and experience needed for the profession required safety requirements introduction and practice of basic tools for the project develop a project outline and assign tasks for students The students then complete the project with assistance from the professional and teacher This year the careers varied and included operation of small hand tools measuring cutting lumber small business development knifetool sharpening computer assemblyrepair urban forestryclimbing trees arborist and the students built a storage shed and homeless hut The shed was donated to SVECA and the homeless hut is being donated to a client in need of shelter The Program provided startup funds to make this class possible The funds were utilized for instructor fees and supplies The class will be self sustaining within the next several years SVECA provides the Program with quarterly reports on youth served expenditures narrative of activities and pictures

As part of our 477 review it was recommended that we develop a computer lab training center for clients We took this seriously and spent several months identifying funding and office space The Siletz Tribal Council has allocated tribal funding for the computer lab and a location was selected at the end of the year We hope to provide trainings and staff meetings through video conferencing The ability to video conference with each office will reduce travel and training costs

Challenges

An ongoing challenge we face each year is the amount of youth funding we receive from the Department of Labor (DOL) Our yearly allocation is not enough to fully serve one client We are faced with locating other funds to supplement the summer youth employment and education programs This year we served fewer youth then we did last year The burden of locating funding is becoming more difficult The Program prioritizes youth services so we ensure that all eligible and approved applicants are served We plan to address this issue with the State of Oregon and local workforce boards to see if there can be a partnership that will provide

Page 3 of10

additional funding and support for our youth We partner with our tribal Education Department to ensure youth receive services from either program

Our clientele face other challenges and barriers such as transportation The costs and issues vary by office location In the Portland area bus passes cost an average of $100 monthly and have increased slightly each year The cost is slightly lower in the other area offices The Siletz area faces the largest challenge Bus routes are limited and lengthy A one way trip to the Tribal casinoLincoln City from Siletz could take four hours or more Job searching in that area or traveling to the Tribal Administration Office is challenging The 477 Director is the Chairman of the Siletz Tribal Transit Service Committee and we are working to address these barriers Additional routes have been established and Tribal members can ride the local bus for free within Lincoln County Our goal is to add additional buses routes and reduce the length of routes

The Program prioritized upgrading the data collection and reporting programs in 2015-2016 Staff previously entered data in four separate databasesprograms to get reports and statistics required The Director and AMS identified necessary changes and worked with Eaglesun Systems to consolidate our process into one single program The process took over a year was costly and we experienced several setbacks The staff received training on the new system in September 2016 This phase of the project eliminated two previous databases The next phase will eliminate all other databases We continue to identify additional data entry needs and issues with our system We hope to have all aspects of this update completed in 2017 The completed system will allow staff to issue all forms and contracts monitor expenditures track year-end data submit TANF quarterly reports track employerscommunity partners track events under TANF purpose 3-4 electronic routing for signatures and create a near paperless file system

Increasing Your Success Client Conference 2016

Our 477-Plan states that we will host a yearly client conference and this year we called it lncr~asing Your Success The conference was held March 22d-24th at Aldersgate Retreat Center located just outside Salem OR This conference takes months of planning and to date it was our most successful We had 61 participants attend the conference They provided great reviews and suggestions to make the next one even better The clients enrolled in Temporary Assistance for Needy Families General Assistance for Single Adults Work Experience Classroom Training and Core Training were required to attend

Workshops included Diabetes team activities re-entry self care internships vs apprenticeships SSISSD healthy relationships online applicationsresumes dress for success native life skills dealing with trauma spending frenzy (life budgeting activity) and several other team building activities The Program provided certification training for food handlers cards and flagging 18 participants received their food handlers cards and 25 are now certified flaggers We hosted a culture night that included beaded necklaces drum stick making and painting

Page 4 of 10

2016 Increasing Your Success Conference-

The 4 77-Self Sufficiency Program has many client successes and these are a few of their stories

Angelica Espino Angelica is a 26 year old Siletz Tribal member She has utilized assistance several times since 2008 (TANF GA CRT and WEX) Angelica is a single parent of two young children Angelica completed her Associates of Arts Transfer Degree from Chemeketa Community College in 2013 Angelica then enrolled at Western Oregon University Through tremendous hard work and dedication Angelica graduated with a double major of Criminal Justice and Psychology with a Bachelors of Art Angelica was recently hired as a Tribal Services Specialist and is using her education and services provided by the Tribe to assist other tribal members

Page 5 of 10

Sheila Aviles Sheila participated in On-the-Job Training as the Administration Receptionist She has now completed training and is a regular full-time employee within the organization Sheila assists many of our programs and community events to ensure they are successful

Joseph Martin Joseph is a 26 year old Siletz Tribal member Joseph has been on and off General Assistance since 2010 After removing several barriers to employment Joseph completed a WEX at Valley Vapors in Salem OR The employer requested to expand on Josephs job duties and after additional training needs were identified Joseph entered and completed an OJT Contract Joseph has maintained employment with Valley Vapors

Joseph Mike Joseph is a 35 year old member of the Duckwater Pauite Tribe Joseph relocated to Salem recently to be closer to his children who are attending Chemawa Indian School Joseph completed a WEX at City of Salem Parks and Recreation Division Joseph gained many valuable skills and he was offered a full-time permanent position with City of Salem Parks

Page 6 of 10

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

additional funding and support for our youth We partner with our tribal Education Department to ensure youth receive services from either program

Our clientele face other challenges and barriers such as transportation The costs and issues vary by office location In the Portland area bus passes cost an average of $100 monthly and have increased slightly each year The cost is slightly lower in the other area offices The Siletz area faces the largest challenge Bus routes are limited and lengthy A one way trip to the Tribal casinoLincoln City from Siletz could take four hours or more Job searching in that area or traveling to the Tribal Administration Office is challenging The 477 Director is the Chairman of the Siletz Tribal Transit Service Committee and we are working to address these barriers Additional routes have been established and Tribal members can ride the local bus for free within Lincoln County Our goal is to add additional buses routes and reduce the length of routes

The Program prioritized upgrading the data collection and reporting programs in 2015-2016 Staff previously entered data in four separate databasesprograms to get reports and statistics required The Director and AMS identified necessary changes and worked with Eaglesun Systems to consolidate our process into one single program The process took over a year was costly and we experienced several setbacks The staff received training on the new system in September 2016 This phase of the project eliminated two previous databases The next phase will eliminate all other databases We continue to identify additional data entry needs and issues with our system We hope to have all aspects of this update completed in 2017 The completed system will allow staff to issue all forms and contracts monitor expenditures track year-end data submit TANF quarterly reports track employerscommunity partners track events under TANF purpose 3-4 electronic routing for signatures and create a near paperless file system

Increasing Your Success Client Conference 2016

Our 477-Plan states that we will host a yearly client conference and this year we called it lncr~asing Your Success The conference was held March 22d-24th at Aldersgate Retreat Center located just outside Salem OR This conference takes months of planning and to date it was our most successful We had 61 participants attend the conference They provided great reviews and suggestions to make the next one even better The clients enrolled in Temporary Assistance for Needy Families General Assistance for Single Adults Work Experience Classroom Training and Core Training were required to attend

Workshops included Diabetes team activities re-entry self care internships vs apprenticeships SSISSD healthy relationships online applicationsresumes dress for success native life skills dealing with trauma spending frenzy (life budgeting activity) and several other team building activities The Program provided certification training for food handlers cards and flagging 18 participants received their food handlers cards and 25 are now certified flaggers We hosted a culture night that included beaded necklaces drum stick making and painting

Page 4 of 10

2016 Increasing Your Success Conference-

The 4 77-Self Sufficiency Program has many client successes and these are a few of their stories

Angelica Espino Angelica is a 26 year old Siletz Tribal member She has utilized assistance several times since 2008 (TANF GA CRT and WEX) Angelica is a single parent of two young children Angelica completed her Associates of Arts Transfer Degree from Chemeketa Community College in 2013 Angelica then enrolled at Western Oregon University Through tremendous hard work and dedication Angelica graduated with a double major of Criminal Justice and Psychology with a Bachelors of Art Angelica was recently hired as a Tribal Services Specialist and is using her education and services provided by the Tribe to assist other tribal members

Page 5 of 10

Sheila Aviles Sheila participated in On-the-Job Training as the Administration Receptionist She has now completed training and is a regular full-time employee within the organization Sheila assists many of our programs and community events to ensure they are successful

Joseph Martin Joseph is a 26 year old Siletz Tribal member Joseph has been on and off General Assistance since 2010 After removing several barriers to employment Joseph completed a WEX at Valley Vapors in Salem OR The employer requested to expand on Josephs job duties and after additional training needs were identified Joseph entered and completed an OJT Contract Joseph has maintained employment with Valley Vapors

Joseph Mike Joseph is a 35 year old member of the Duckwater Pauite Tribe Joseph relocated to Salem recently to be closer to his children who are attending Chemawa Indian School Joseph completed a WEX at City of Salem Parks and Recreation Division Joseph gained many valuable skills and he was offered a full-time permanent position with City of Salem Parks

Page 6 of 10

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

2016 Increasing Your Success Conference-

The 4 77-Self Sufficiency Program has many client successes and these are a few of their stories

Angelica Espino Angelica is a 26 year old Siletz Tribal member She has utilized assistance several times since 2008 (TANF GA CRT and WEX) Angelica is a single parent of two young children Angelica completed her Associates of Arts Transfer Degree from Chemeketa Community College in 2013 Angelica then enrolled at Western Oregon University Through tremendous hard work and dedication Angelica graduated with a double major of Criminal Justice and Psychology with a Bachelors of Art Angelica was recently hired as a Tribal Services Specialist and is using her education and services provided by the Tribe to assist other tribal members

Page 5 of 10

Sheila Aviles Sheila participated in On-the-Job Training as the Administration Receptionist She has now completed training and is a regular full-time employee within the organization Sheila assists many of our programs and community events to ensure they are successful

Joseph Martin Joseph is a 26 year old Siletz Tribal member Joseph has been on and off General Assistance since 2010 After removing several barriers to employment Joseph completed a WEX at Valley Vapors in Salem OR The employer requested to expand on Josephs job duties and after additional training needs were identified Joseph entered and completed an OJT Contract Joseph has maintained employment with Valley Vapors

Joseph Mike Joseph is a 35 year old member of the Duckwater Pauite Tribe Joseph relocated to Salem recently to be closer to his children who are attending Chemawa Indian School Joseph completed a WEX at City of Salem Parks and Recreation Division Joseph gained many valuable skills and he was offered a full-time permanent position with City of Salem Parks

Page 6 of 10

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

Sheila Aviles Sheila participated in On-the-Job Training as the Administration Receptionist She has now completed training and is a regular full-time employee within the organization Sheila assists many of our programs and community events to ensure they are successful

Joseph Martin Joseph is a 26 year old Siletz Tribal member Joseph has been on and off General Assistance since 2010 After removing several barriers to employment Joseph completed a WEX at Valley Vapors in Salem OR The employer requested to expand on Josephs job duties and after additional training needs were identified Joseph entered and completed an OJT Contract Joseph has maintained employment with Valley Vapors

Joseph Mike Joseph is a 35 year old member of the Duckwater Pauite Tribe Joseph relocated to Salem recently to be closer to his children who are attending Chemawa Indian School Joseph completed a WEX at City of Salem Parks and Recreation Division Joseph gained many valuable skills and he was offered a full-time permanent position with City of Salem Parks

Page 6 of 10

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

Rose Stone Rose has been a long term 477 participant Shes used Temporary Assistance for Needy Families General Assistance Work Experience TWEX and Onshythe-Job Training After overcoming numerous barriers she s now completed training and is employed with the Siletz Tribal Health Clinic Business Office

Jasmine Fernandez is a 21 year old Siletz tribal member Jasmine has utilized the Summer Youth Employment Program Work Experience and General Assistance since 2014 Jasmine attended classes at Chemeketa Community College to become a Certified Dental Assistant Jasmine completed her dental assisting practicum at Smile Keepers in Salem Jasmine just successfully passed her Radiation Health and Safety Exam Infection Control Exam and General Chairside Assisting Exam to become a Certified Dental Assistant Jasmine is hoping to hear back about possible employment at Smile Keepers

David Ben is a Siletz Tribal member David relocated to Oregon from California to attend school at OSU David utilized GASA services on and off since 201 2 He then utilized CRT In June 201 6 David graduated with his Bachelors Degree in Biology with a concentration in Marine Biology

Page 7 of 10

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

Laura Golba is a 47 year old Siletz Tribal Member Laura has utilized GASA TANF and CRT Laura struggled with addiction issues and lost custody of her children She was utilizing GASA until they were returned to her Laura was accepted in to the Marion County Transitional Treatment and Recovery Community aka Woodmansee program in June of2015 and was able to successfully complete all four phases On May 18 20 16 Laura graduated from the Woodmansee Program At the graduation Laura was able to discuss her accomplishments and hergrowth from the person she was when she first entered the program Laura has been able to develop new skills and maintain a clean and sober life style Laura was offered employment at the graduation Laura utilized CRT services to assist in obtaining her GED

The 477-Self Sufficiency Program held numerous workshops and trainings throughout the year

The Program hosted a five week financial fitness class in June They were provided training on the following Detail s of a paycheck withholdings savings tacking financial records protecting identity fraudscams smart shopping planning expenses and setting limits b01Towing credit scores and reporting Each participant was also offered the opportunity to set up a checking and savings account directly after the last training session

The 477-SSP Program in Salem partnered with Education Staff to attend a Youth Leadership Conference held by Native Youth Leadership Alliance (NYLA) The youth learned leadership skills and built a plan to become future leaders in Indian Country The event was sponsored by the Confederated Tribes of Grand Ronde Education Department

Page 8 of 10

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

The Salem and Eugene Area offices provided the Native Wellness Curriculum for their participants Staff were trained several years ago on the curriculum and have used it sporadically This year the program hosted full workshops using the entire curriculum The clients really enjoyed the trainings Each participant received a mini smudge kit for successfully completing the series of trainings

Tribal Services Specialist James Williams hosts a Kempo class for youth The class ran from August - October The class is Tuesdays and Thursdays James has had up to 13 youth attend and has 8 attend on a regular basis 2 youth have gained their yellow belt and 3 more are really close to earning their belt The class provides youth prevention teaches discipline and increases their self esteem and motivation The youth love this class and we look forward to expanding it in 2017

These are just a handful of the successful participants that we have within the 477-Self Sufficiency Program We continually strive to provide better comprehensive services for the participants and fami lies Their continued success motivates us to do better and we enjoy working with them to overcome barriers to self sufficiency

Tribal T ANF reporting requirements are included on page 10 of this report

Page 9 of 10

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

Confederated Tribes of Siletz Indians 2015 Annual Report ANNUAL REPORT DESCRIPTION OF ELEMENT

REPORTING ELEMENTS

286275

(b)(l) Definition of Work Activities-

(b)(2) Description of transitional services provided to families no longer receiving assistance due to employment-

(b)(3) Description of how monthly assistance is reduced when participant refuses to participate in work without good cause-

(b)(4) Average monthly number of payments for child care services made by the Tribal TANF program through the use of disregards-

(b )(5) Description of any non-recurring short-term benefits provided including (i) the eligibility criteria associated with such benefits including any restrictions on the amount duration or frequency of payments and (ii) any policies that limit such payments to families that are eligible for TANF assistance or that have the effect of delaying or suspending a familys eligibility for assistance and (iii) any procedures or activities developed under the TANF program to ensure that individuals diverted from assistance receive information about referrals to or access to other program benefits (such as Medicaid and food stamps) that might help them make the transition from Welfare-to-Work

(b)(6) Description of the procedures the tribal TANF program has established and is maintaining to resolve displacement complaints pursuantto 286110 This description must include the name of the Tribal TANF grantee agency with the lead responsibility for administering this provision and explanations of how the Tribal TANF grantee has notified the public about these procedures and how an individual can register a complaint

(b) (7) Tribes electing the FVO must provide a description of the strategies and procedures in place to ensure that victims of domestic violence receive appropriate alternative services as well as an aggregate figure for the total number of good cause domestic waivers granted

(b)(l) Included in TANF Plan Section VII Work Requirements Subsection D Countable Participation Work Activities Pages 12-14

(b)(2) Included in TANF Plan Section XI Support Services Subsection D Transitional Supportive Services Page 18

(b)(3) Included in TANF Plan Section XV NonshyCooperation Disqualifications Pages 19-21

(b)(4) The Siletz TANF Program does not provide a childcare disregard to families

(b)(5) Included in TANF Plan Section XIII Emergency Assistance Page 19 The budget cap is set annually by the Program Director The 2016 cap was $1200 per family and can only be utilized once in a 24 month period All clients are assessed during the initial intake and during recertification All clients who are eligible to apply for other services are referred to those Many of those services include food stamps Medicaid USDA commodities and Oregon Healthcare Plan

(b)(6) The Siletz TANF Program does not utilize federal TANF funds for job placement activities We utilize State funds that are refunded to the Tribe If there was to be a complaint pursuant to 286110 we would utilize the standard appeal procedures set is the TANF Plan Section XVII Appeal Rights and Due Process Page 23-25 The public is notified during the public comment period The process is also available online and the information would be provided at request

(b)(7) The Siletz TANF Program did not include the FVO in the TANF Plan The Program does often refer clients to the Siletz Tribal CARE Program This Program provides domestic violence services and advocacy The TANF Program also refers participants to the State of Oregon Domestic Violence Program for relocation support services if needed The Program will ensure that TANF participants receive exemptions when the requirements are met in section VI of the TANF Plan

Page 10 of10

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

0MB Control No 1076-0135 Expiration Date 022820 18

US Department of the Interior Public Law 102-477

Annual Financial Expenditure Report (Version 2)

I Tribeffribal Organization 2 Other Identifying Number Assigned by DOI

Confederated Tribes of Siletz Indians

3 Mail ing Address (Provide complete mailing address)

PO Box 549 Si letz OR 97380

4 Submission (Mark One) 5 Final Report fo r Plan Period

Original 0 Revised 0 Yes reg No

6 Annual Report Period 7 Plan Period Covered by this Report

From 10 0 1 20 15 To 09 30 20 16 From 10 0 1 2015 To 09 30 20 18 (MonthDayYear) (Month DayYear) (MonthDayYear) (MonthDayYear)

Column II Column Column III

8 Transactions This Annual Report Previously Reported Cumulat iveffotal

Period

a Total Funds Avai lable $ - $2258288 $ 225828800

b Cash Assistance Expenditures $240254 $ 24025400 $ -

c Child Care Services Expenditures $0 $ -$ -

cl Education Employment Training and Supportive Services Expenditures

$ - $480369 $ 48036900

i TANF Purposes 3 and 4 (non-add) $ - $14026 $ 1402600

ii Other TANF Assistance (non-add) $ - $0 $ -

c Program Operations Expenditures $ - $598516 $ 5985 1600

i Child Care Quality Improvement (non-add) $ - $0 $ -

f AdministrationIndirect Cost Expenditures $ - $555098 $ 55509800

g Total Federal Expenditures (Sum of lines b through f) $ - $1 888263 $ 188826300

h Total Unexpended Funds $ - $ 37002500 $ 37002500

9 Certi fication This is to certify that the information reported on all parts of this form is accurate and true to the best of my knowledge and bel ief and that the tribe has complied with al l direct ly applicable statutory requirements and with those direct ly app licable regulatory requirements which have not been waived

a~ daumicro fo ~e~ c Date Report Submitted

Brenda Bremner General Manager

b Type Name and Title

I 13020 16

d Questions regarding this report - Contact (Type Name Title Phone and Email Address)

Kurtis Barker 477-SelfSumciency Program Director (54 1) 444-8247 Kurtisbctsi nsnus

Confederated Tribes of Siletz Indians PO Box 549 (541) 444-2532 1-800-922- 1399

Siletz O regon 97380 FAX (541) 444-2307

Thursday December 15 20 16

PL 102-477 FINANCIAL STATUS REPORT CERTIFICATIONS

As Authorized Certifying Official I hereby certify that

I2a None of the funds in the approved budget which originated in Section 401 or Title IIB of the Job Training Pa1inersh1p Act (JTPA) were used in violation of the Acts prohibition on the use of funds for economic development activities (Section 141 (q))

12b None of the fu nds in the approved budget which originated in Section 401 or Title IIB of the Job Training Partnership Act (JTPA) were used in v10lation of the Act s restrictions on assisting employer relocations (Section 141 C)

12c We did not receive investment income from program funds

12d There were no refunds or rebates received

12e The amount of funds utilized for administrative costs was within the limits authorized and in accordance with the Tribes approved P L 102-4 77 plan

12f There were no fu nds received for Child Care Development under the Tribes PL 102-477 plan and no funds were used for the Child Care Development per the Tribe s PL 102-477 plan

Signature of Authorized Certifying Official

Brenda Bremner General Manager Confederated Tribes of Siletz Indians