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Fillable Printable Expiration Date:April 30, 2008 Verification Of Indian ..

Fillable Printable Expiration Date:April 30, 2008 Verification Of Indian ..

Expiration Date:April 30, 2008 Verification Of Indian ..

Expiration Date:April 30, 2008 Verification Of Indian ..

FORM BIA - 4432
OMB Control # 1076-0160
Expiration Date:April 30, 2008
VERIFICATION OF INDIAN PREFERENCE FOR EMPLOYMENT
IN THE BUREAU OF INDIAN AFFAIRS AND THE INDIAN HEALTH SERVICE
Complete one of the cateQories as stated in the Instructions and submit this form with your application for Federal employment.
CATEGORYA - MEMBERS OF FEDERALLY-RECOGNIZED INDIAN TRIBES, BANDS OR COMMUNITIES
This is to certify that the person named below is a member of the tribe shown:
Full Name
Enrollment No. Date of Birth Tribal Affiliation
I certify that the above information was taken from the official membership records of the Tribe (or records
maintained for the Tribe by the BIA) and acknowledge that falsification and misrepresentation of this information is punishable
under Federal Law, 18 U.S.C. 1001.
And if required, verification by the BIA Official maintaining the
Certification by Tribal Official:
official tribal rolls that the individual is listed on enrollment
maintained by the BfA at the request of the tribe.
Signature
Date
Signature of BIA Official
Date
Print Name & Title of Tribal Official
NamelTitie
Agency
CATEGORYB -DESCENDANTS OF MEMBERS OF FEDERALLY-RECOGNIZED INDIAN TRIBES, BANDS OR COMMUNITIES WHO
WERE RESIDING ON ANY INDIAN RESERVATION ON JUNE 1,1934
I certify that the person named below has established to my satisfaction that he/she is a descendant of an enrolled member of the
tribe named below and that he/she was living on an Indian reservation on June 1, 1934. The applicant's family history is outlined on
the attached family history chart.
Full Name
Date of Birth
Reservation of Residence on June 1, 1934
Full Name of Ancestor & Tribal Affiliation
Title and source of records upon which this is based:
BIA Official
Date
Title
Agency
--
FORM BIA - 4432
OMB Control # 1076-0160
Expiration Date:April 30, 2008
CATEGORYC -PERSONSWHOPOSSESSAT LEASTONE-HALFDEGREEINDIANBLOODDERIVEDFROMTRIBESINDIGENOUS
TOTHEUNITEDSTATES.
I certify that I have reviewed the documentation to support the below listed individual's claim to possess at least one-half degree
Indian blood. The applicant's family history is outlined on the attached family history chart and official records.
Full Name
Date of Birth
Degree of Blood and Tribal Derivation
Title & Source of Records upon which this is based:
BIA Official
Date
o Official Records of Tribal Affiliation & Blood Degree
o State or Academic Recognition of Indigenous Status
Title
Agency
CATEGORYD
-ALASKA NATIVE
I certify that the person named below is a member of an Alaska Native Tribe; or, an individual whose name appears on the roll of
Alaska Natives prior to July 31, 1981, and not subsequently disenrolled; or, an individual who was issued stock in a Native
corporation pursuant to 43 U.S.C. 1606(g){1){B){i).
Name
Date of Birth
Alaska Native Village/Corporation/Roll
Title and source of records upon which this is based:
BIA Official
Date
Title
Agency
INSTRUCTIONS FOR COMPLETING FORM BIA-4432
1. It is the res onsibili of the individual to establish evidenceof entitlementto Indian reference. Applicantsmust
submit as much background information as possible to verify eligibility for Indian preference. Falsification or
misrepresentation of information is punishable under Federal Law, 18 U.S.C. 1001.
CATEGORYA
MEMBERS OF FEDERALLY-RECOGNIZEDINDIANTRIBES, BANDS OR COMMUNITIES.
If you are a member of a
Federally-recognized tribe, you must request that your tribe complete this category. One of the following
procedures will apply and you will be advised by your tribe:
If your tribe has contracted or compacted the maintenance of tribal enrollment records under the
Indian Self-Determination and Education Assistance Act, Pub. L. 93-638, as amended, 25 U.S.C.
450, a verification signed by an authorized Tribal Representative(s) is sufficient.
If your tribe does not maintain tribal enrollment records, the tribe must certify that you are a
member and you must submit the form to the BIA official who maintains the official roll for the
tribe.
CATEGORY BAND C
2
FORM BIA - 4432 OMS Control # 1076-0160
Expiration Date:April 30, 2008
DESCENDANTS OF MEMBERS OF FEDERALLY RECOGNIZED INDIAN TRIBES, BANDS OR COMMUNITIES WHO WERE
RESIDING ON ANY INDIAN RESERVATION ON JUNE 1, 1934
PERSONS WHO POSSESS AT LEAST ONE-HALF DEGREE INDIAN BLOOD DERIVED FROM TRIBES INDIGENOUS TO THE
UNITED STATES
Ifyou are claiming preference based on any of these categories, you should provide as much
information as possible regarding your family history. This will be the only information which
the BIA will have to certify your lineal descent.
Ifyou are claiming preference based upon lineal descent from a member of a federally
recognized tribe,band or community, you must also document that you were residing within
the present boundaries of the reservation on June 1, 1934.
If you possess one-half
degree Indian blood from a tribeindigenous to the United States, you
must submit state or academic records that document this status, as well as officialrecords
that establish your degree of Indian blood, such as census records. You must also complete
the attached FAMILY HISTORY.
Category D
ALASKA NATIVE OR DESCENDANT OF AN ALASKA NATIVE. You may contact the Bureau of IndianAffairsoffice
servicing your village or corporation for completion of this category.
2. INSTRUCTIONS TO BIA OFFICIALS:
This form has been designed for the verification that an applicant is entitled to Indian preference in employment.
.Ifcategory A membership is verified through records maintained for the Tribe by the BIA, a tribalrepresentative
must also sign the verification. Ifthe applicant does not meet the tribal enrollment criteria,the form should not
be completed. If the applicant cannot document at least one-half degree Indian blood derived from tribes
indigenous to the United States, the form should not be completed.
Upon verificationby a BIA Regional
Director, Superintendent or other designed responsible BIA official,the applicant willbe entitled to preference in
employment.
3. INSTRUCTIONSTO PERSONNEL OFFICERS:
Receipt of a properly verified FORM BIA 4432, together with an acceptable application,"Personal Qualifications
Statemenf', entitlesan applicant to preference in employment.
4. PAPERWORK REDUCTION ACT NOTICE:
The informationcollectionrequirement contained in §§ 92.16 and 19.19 is approved by the Office of
Management and Budget under the Paperwork Reduction Act of 1995, 44 U.S.C. 3507(d), and assigned
clearance number 1076-0160. This information is collected to verify that individuals are eligible for preference
when appointments are made to vacancies in positions in the Bureau of Indian Affairs. It should take the
applicant about 30 minutes to complete the form. A Federal agency may not conduct or sponsor, and a person
is not required to respond to, a collection of information unless itdisplays a currently valid OMB control number.
Ifyou have any questions regarding the burden estimation, please contact the BIA Clearance Officer.
5. PRIVACY ACT STATEMENT:
3
This information is collected as provided pursuant to the PrivacyAct, 5 U.S.C. § 552a, for individualscompleting
application forms for Federal employment with the Bureau of Indian Affairs (001) or the Indian Health Service
(DHHS). We are authorized to collect information to verify Indian ancestry or Indian tribal membership by 25
U.S.C. § 2, 4 Stat. 564 and 15 Stat. 228; 25 U.S.C. § 9, 4 Stat. 738; 25 U.S.C. § 43; 36 Stat. 272; 25 U.S.C.§
44,28 Stat. 313; 25 U.S.C. § 46, 22 Stat. 88 and 23 Stat. 697; 25 U.S.C. § 348, 24 Stat. 398 and 31 Stat. 1085;
25 U.S.C. § 472, 48 Stat. 986; 25 U.S.C. § 472a, 93 Stat. 1057 and 94 Stat. 695; 25 U.S.C. § 479, 48 Stat. 988;
and 5 U.S.C. § 8336. The information collected will be used to determine eligibility for Indian preference and
may be disclosed to the Department of the Interior Office of Personnel, the United States Office of Personnel
Management, and the Indian Health Services Office of Personnel.
6. EFFECTS OF NON-DISCLOSURE:
Disclosure of the information requested on this form (Form BIA4432) is voluntary. However, considerationfor
Indian preference in employment under 25 CFR Part 5 requires proof that (a) you are a member of any
recognized Indian tribe currently under Federal jurisdiction; (b) you are a descendant of a member residing
within the present boundaries of any Indian reservation on June 1, 1934; (c) you are an Eskimo or another
aboriginal person of Alaska as defined by the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.);or
(d) you possess one-half or more Indian blood of tribes that are indigenous to the United States. Indian
Reorganization Act of June 18, 1934,25 U.S.C. 472.
4
Family History Chart
ForCategoriesB, C& D
OMB Control # 1076-0160
Expiration Date:0413012008
(IV) Great-grandfather
BD:
(III) Grandfather
Tribe:
BD:
Tribe:
(IV) Great-grandmother
BD:
(II) Father
Tribe:
BD:
Tribe:
(IV) Great-grandfather
BD:
(III) Grandmother
Tribe:
BD:
Tribe:
(IV) Great-grandmother
BD:
(:) Applicant
Tribe:
ED:
Tribe:
DOB:
(IV) Great-grandfather
BD:
(III) Grandfather
Tribe:
BD:
Tribe:
(IV) Great-grandmother
BD:
(II) Mother
Tribe:
BD:
Tribe:
(IV) Great-grandfather
BD:
(III) Grandmother
Tribe:
Tribe:
BD:
(IV) Great-grandmother
BD:
Tribe:
OMS Control # 1076-0160
Expiration Date: 04/30/2008
Addendum -Family History Chart
Great-Grandfather or Great-Grandmother
(VIII) Great-great-great-great-grandfather
BD:
(VII) Great-great-great-grandfather
Tribe:
BD:
Tribe:
(VIII) Great-great-great-great-grandmother
BD:
(VI) Great-great-grandfather
Tribe:
BD:
Tribe:
(VIII) Great-great-great-great-grandfather
BD:
(VII) Great-great-great-grandmother
Tribe:
BD:
Tribe:
(VIII) Great-great-great-great-grandmother
BD:
(V) Great-grandfather or Great-grandmother
Tribe:
BD:
(VIII) Great-great-great-great-grandfather
Tribe:
BD:
(VII) Great-great-great-grandfather
Tribe:
BD:
Tribe:
(VIII) Great-great-great-great-grandmother
BD:
(VI) Great-great-grandmother
Tribe:
BD:
Tribe:
(VIII) Great-great-great-great-grandfather
BD:
(VII) Great-great-great-grandmother
Tribe:
BD:
Tribe:
(VIII) Great-great-great-great-grandmother
BD:.
Tribe:
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