PER CAPITA LOAN FUND POLICY
AS ESTABLISHED BY THE
APPROVED BY LEGISLATURE
FEBRUARY 10, 1998
REVISED & APPROVED ON 09/29/98
REVISED & APPROVED ON 09/21/98
REVISED & APPROVED ON 09/08/99
REVISED & APPROVED ON 11/06/01
REVISED & APPROVED ON 05/06/03
REVISED & APPROVED ON 10/02/07
REVISED & APPROVED ON 12/07/10
PER CAPITA LOAN FUND POLICY
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The Per Capita Loan Fund provides financial assistance to enrolled Tribal members.
In order for the loan to be repaid, the recipient pledges their next Per Capita distribution
LOAN TERMS -- Amount, Term, Fee:
The maximum loan amount requested is $1000.
Since the repayment of the Per Capita Loan will be automatically deducted from
the Tribal member’s next Per Capita distribution, all applicants are required to
sign the Ho-Chunk Nation Waiver & Assignment of Per Capita.
Except for elders, each application will be charged a handling fee of $50.00.
Applicant must be a Ho-Chunk Nation enrolled Tribal member.
Applicant must be 18 years of age and a qualified recipient of the Per Capita
Applicant must sign the Ho-Chunk Nation Waiver & Assignment of Per Capita.
If pending or outstanding claims against the applicant’s Per capita Distribution
a) The applicant must provide proof of payment to receive their maximum
loan amount less any applicable handling fee, or
b) A new loan will be made for no more than the current maximum loan
amount less any amount owed from the prior distribution and any
applicable handling fee.
Applicant must be 60 years of age on or before the date the application is
Elder applications received on the same day as a non-Elder application will be
Elders will not be charged a handling fee.
The Treasury Department will begin accepting applications for Per Capita Loans on the
5th day of the month following the last scheduled Per Capita distribution. The last day
applications are accepted for the current loan period will be at noon, three business days
prior to the 15th day of the month before the next scheduled Per Capita distribution.
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Applicants must complete and submit a loan application.
Applications will be processed within three business days. Any applications received
after 3:00 P.M. will be considered the next business day.
Legible FAXED copies of loan applications shall be accepted in lieu of an original
application. Faxed copies will be accepted and processed ONLY IF THE NOTARY
STAMP IS LEGIBLE. If the notary stamp is illegible, the Treasury Department will
contact the applicant to notify him/her that the application is not acceptable. The
Treasury Department may require the original application be on file before the check is
The Treasury Department will verify that applications meet all of the requirements in the
Per Capita Loan Fund Policy. All incomplete / incorrect applications will be returned
and the Tribal member must submit a new application.
All Per Capita Loan checks will be made payable to the Tribal member for the amount
approved and will be mailed to the address listed on the application.
If the eligibility requirements are not met, a letter will be mailed to the address on the application
stating the reason for denial.
MAILING OF LOAN CHECKS:
The first group of Per Capita Loan checks released are dated and mailed on the 15th day of the
month following the last scheduled Per Capita distribution. If the 15th falls on a weekend, the
checks will be dated and mailed on the Friday prior to that weekend.
LOST OR STALE DATED CHECKS
For checks believed to be lost, applicants may request and complete a Stop Payment
Form which will be processed no sooner than 10 calendar days after the date the original
check was issued.
Once the original Stop Payment Form is received by Treasury, a new check will be
issued to the Tribal member in accordance with the Treasury Department’s Stop Payment
procedures. Once a Stop Payment is performed on a check, that check MUST NOT be
cashed; doing so may result in ineligibility to receive a loan from the Ho-Chunk Per
Capita Loan Fund in the future.
Original stale dated checks brought to Treasury will be voided and a new check can be
issued at the request of the Tribal member, generally within 3 business days of the
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PER CAPITA LOAN APPLICATION
PLEASE PRINT CLEARLY
Name-Last, First, MI
Social Security # (last 4 digits)
Ho-Chunk Enrollment # (last 4 digits)
City State Zip
Date of Birth ELDERS-Please check this box
Amount Requesting (Maximum $1000)
(Area Code) Daytime Phone Number
***All Checks will be mailed to the address listed above***
Pursuant to Section 7 of the Ho-Chunk Nation amended and restated PER CAPITA DISTRIBUTION
ORDINANCE, this application DOES NOT change your Address with Enrollment nor does it satisfy your Annual
Address Verification with Enrollment for your quarterly Per Capita disbursements. Members shall be responsible
for providing address changes to the Enrollment Office as they occur.
HO-CHUNK NATION WAIVER & ASSIGNMENT OF PER CAPITA
The undersigned hereby gives the Ho-Chunk Nation permission to verify the information on this application. Upon
signing, I certify that I have read and understand the terms of the Per Capita Loan Fund Policy. I understand that any
false information or dishonesty may result in ineligibility to receive a loan from the Ho-Chunk Per Capita Loan
Fund now and in the future.
Upon receipt of a loan from the Ho-Chunk Nation, I hereby irrevocably waive my right to receive the next
scheduled per capita distribution and assign the pledged amount to the Ho-Chunk Nation including any applicable
handling fee. I understand that by signing this agreement I am giving irrevocable permission to the Ho-Chunk
Nation to automatically withhold any and all amounts due for repayment of my per capita loan from my next per
capita without any further consent from me. I understand that any amount of the per capita distribution that exceeds
the total balance of my loan will be returned to me.
SIGNATURE OF MEMBER
MY COMMISSION EXPIRES ON _______/_______/_______
For Office Use Only ***********************************
Treasury Dept Date Rec’d
HCN LOAN DEPARTMENT, P.O. BOX 640, BLACK RIVER FALLS WI 54615
(715) 284-1778 ~ (800) 779-2918 ~ FAX (715) 284-7887