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Guidance to Tribes for Completing Supplemental Request for Information

The information submitted on this form will be used to determine the second distribution of the 

Coronavirus Relief Fund to Tribal governments using the Coronavirus Relief Fund Tribal 

Allocation Methodology posted on Treasury’s website on May 5, 2020. 

This information will be required to be submitted by tribal governments through an electronic 

form that will be made available on Treasury’s website early in the week of May 17. The 

required information should not be submitted to Treasury other than through the electronic form.

Treasury expects to require the requested data to be submitted by 11:59 pm Alaska Daylight 

Time on May 26, 2020. The submission deadline will be confirmed when the online portal is 

opened next week.

Employment Information

Enter the number of employees shown on line 1 of IRS Form 941 for each quarter of calendar 

year 2019. Include information separately for employees that are employed by the Tribal 

government directly and employees that are employed by any entity of which the Tribal 

government owns at least 51% of the ownership interests. Do not include any independent 

contractors or employees of independent contractors. If an entity was not in existence or 

otherwise had no employees for any calendar quarter in 2019, enter N/A for that quarter for the 

number of employees. 

If there is more than one employing entity or more than one Employer Identification Number 

(EIN) for either line in the form, provide a separate schedule with details for each employing 

entity. 

For each employer, submit a pdf file or other electronic copy of the supporting Form(s) 941 or 

equivalent third-party payroll service provider report(s) in electronic form. Employer 

identification information (name and EIN) and the information on line 1 of Form 941 is required; 

other information may be redacted. 

If an employer files IRS Form 944 rather than Form 941, check the box indicating that the 

employer does not file IRS Form 941. Employers who file Form 944 are exempt from reporting 

the quarterly number of employees on this form. 

Expenditure Information

Enter total governmental expenditures for the 12 months of the 2019 fiscal year in the line 

labeled “Total governmental expenditures”. Governmental expenditures include, but are not 

exclusive of, general government, public safety, health services, wellness services, substance 

abuse, general welfare and assistance, community services, cultural programs, education, 

recreation, housing, economic development, planning and development, sanitation, judicial, and 

similar activities, provided that capital outlays and debt service costs shall not be included within 

governmental expenditures.

In the line labeled “Total amount of federal financial assistance,” include amounts representing 

federal financial assistance included in the “Total governmental expenditures” line. 
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Submit a worksheet that shows how the dollar amounts are derived. Include links or relevant 

pages from financial documents to support the figures. Information provided on this form should 

be consistent with information presented by the relevant entity in any financial statement filed 

pursuant to the Single Audit Act or program-specific audit, as applicable.
SUPPLEMENTAL REQUEST FOR TRIBAL INFORMATION

Name of Tribe: 

NUMBER OF EMPLOYEES Q1 Q2 Q3 Q4

Employed by Tribe

Employed by Tribal entities

If the Tribe does not file IRS Form 941, check here:

Calendar Year 2019
SUPPLEMENTAL REQUEST FOR TRIBAL INFORMATION

Name of Tribe: 

EXPENDITURES Fiscal Year 2019

Total governmental expenditures 

Total amount of federal financial assistance