VA 40-0895-6 State or Tribal Government Resources to Initially Fund t

OMB NUMBER: 2900-0559
Expiration Date: Nov. 30, 2023
Respondent Burden: 30 minutes

CERTIFICATION OF STATE OR TRIBAL GOVERNMENT RESOURCES TO INITIALLY FUND THE
ARCHITECTURAL AND ENGINEERING PORTION OF THE PROJECT DEVELOPMENT
(As required by 38 USC 2408 and 38 CFR Part 39)
Respondent Burden: Public reporting burden for this collection of information is estimated to average 30 minutes. Statutory authority for a State
Cemetery Grant is 38 U.S.C. 2408. The information requested is necessary to ensure that the State, Tribal or eligible County government provides
documentation as having legislative authority to support the project and the resources necessary to initially fund the architectural and engineering
portion of the project development. VA may not conduct or sponsor and you are not required to respond to this collection of information unless it
displays a valid OMB number. Respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspects of this
collection of information, including suggestions for reducing the burden to VA Clearance Officer (005R1B), 810 Vermont Avenue NW, Washington,
DC 20420. SEND COMMENTS ONLY. Please do not send applications for a grant to this address.
AMOUNT OF STATE OR TRIBAL GOVERNMENT RESOURCES TO YEAR FUNDS AVAILABLE OR EXPECTED TO BE AVAILABLE
INITIALLY FUND THE ARCHITECTURAL AND ENGINEERING
PORTION OF THE PROJECT DEVELOPMENT (10% of Construction
July 1,
Costs shown on SF424C, Line 9)
FUNDS WILL REMAIN AVAILABLE UNTIL
PROJECT FAI (Federal Application Identifier) NO.
(mm/dd/yyyy)

$
CERTIFICATION STATEMENT: I certify that the above information is correct and that no further State, Tribal or eligible
County Government action, other than administrative, is required to make these funds available.
NAME OF AUTHORIZED STATE, TRIBAL OR ELIGIBLE COUNTY GOVERNMENT TITLE OF AUTHORIZED STATE, TRIBAL OR ELIGIBLE COUNTY GOVERNMENT
BUDGET OFFICIAL
BUDGET OFFICIAL

SIGNATURE

DATE (mm/dd/yyyy)

ENCLOSURE: Copy of the Act, as approved by the Governor, authorizing the project and making available the State, Tribal or
eligible County Government matching funds for the project. (If the State has not appropriated the State or Tribal Government
matching funds, then sufficient documentation must be provided to show that the State or Tribal Government has available matching
funds for the project.)
VA FORM
APR 2023

40-0895-6