Forms and Regulatons for Grants to States for Construction and Acquisition of State Home Facilities

State Home Construction Grant Forms

Form No.	Form Title	Usage
10-0388-1	Documents & Information Required for State Home Construction & Acquisition Grants-Initial Application	State certifies all initial application requirements have been submitted to VA to request consideration for grant award for Construction or renovation project
10-0388-2	Certification of Compliance with Provisions of Davis-Bacon Act, (40 U.S.C. Sections 276a to 276a-7)	State completes this form certifying they are in compliance with the wage rates as determined by DOL for the State project
10-0388-3	State Home Construction Grant Program – Space Program Analysis – Nursing Home & Domiciliary	State completes this form for review by VA Construction & Facilities for Space requirements for Nursing Homes & Domiciliary
10-0388-4	State Home Construction Grant Program – Space Program Analysis – Adult Day Health Care	State completes this form for review by VA Construction & Facilities for Space requirements for Adult Day Health Care facilities
10-0388-5	Additional Documents & Information Required for State Home Construction & Acquisition Grants Application	State certifies all additional grant requirements have been submitted to VA prior to grant award
10-0388-6	Certification of State Matching Funds to Qualify for Group 1 on the Priority List	State completes this form and submits to VA to certify 35% matching funds for State Home project
10-0388-7	Certification Regarding Debarment, Suspension, and other Responsibility Matters	State completes this form and submits to VA to show compliance with the Federal laws regarding covered transactions
10-0388-8	Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals	State completes this form and submits to VA to certify they maintain a drug-free workplace
10-0388-9	Certification Regarding Lobbying	State completes this form and submits to VA to certify no funds have been utilized to influence a Federal Government Agency or Congress
10-0388-10	Certification of Compliance with Federal Requirements-State Home Construction Grant	State completes this form and submits to VA to certify that all requirements for State Home Construction project are met
10-0388-12	Certification Regarding Debarment, Suspension, Ineligibility & Voluntary Exclusion – Lower Tier Covered Transactions	The Contractor employed by the State completes this form and the State submits to VA to ensure Federal laws regarding covered transactions
10-0388-13	Documents and Information Required for State Home Construction & Acquisition Grants – Post Grant Requirements	State completes this form and submits to VA prior to the final payment of grant funds