Certification of Maintenance of Effort

ICR 201710-0985-004

OMB: 0985-0009

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2017-10-25
IC Document Collections
IC ID
Document
Title
Status
10263 Modified
ICR Details
0985-0009 201710-0985-004
Historical Active 201406-0985-001
HHS/ACL
Certification of Maintenance of Effort
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 11/24/2017
Retrieve Notice of Action (NOA) 10/27/2017
  Inventory as of this Action Requested Previously Approved
11/30/2020 36 Months From Approved
56 0 0
28 0 0
0 0 0

The information contained on the Certification of Maintenance of Effort form will be used by the Administration on Aging to verify the amount of state expenditures and make comparisons with the average annual expenditures for the period of three consecutive fiscal years preceeding the given year to assure that a state is in compliance with 45 CFR 1321.49 and 42 USC 3027(a) and 42 USC 3058d.

PL: Pub.L. 45 - 49 1321 Name of Law: grantee cert of maintenance
   PL: Pub.L. 109 - 365 374 Name of Law: null
  
None

Not associated with rulemaking

  82 FR 33135 07/19/2017
82 FR 49027 10/23/2017
No

1
IC Title Form No. Form Name
Certification of Maintenance of Effort 1, 2 Certification of Maintenance ,   Certification of Long Term Care Ombudsman Program Expenditures

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 56 0 0 0 0 56
Annual Time Burden (Hours) 28 0 0 0 0 28
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$5,087
No
    No
    No
No
No
No
Uncollected
Jason Bennett 202 357-3408 Jason.Bennett@aoa.hhs.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/27/2017


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