VA Form 40-0895-6 Certification of State or Tribal Government Matching Arc

OMB NUMBER: 2900-XXXX
Respondent Burden: 30 minutes

CERTIFICATION OF STATE OR TRIBAL GOVERNMENT MATCHING ARCHITECTURAL AND
ENGINEERING FUNDS TO QUALIFY FOR GROUP 1 ON THE PRIORITY LIST
(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 or Tribal 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 DEPARTMENT OF VETERANS AFFAIRS ESTIMATED YEAR FUNDS AVAILABLE OR EXPECTED TO BE AVAILABLE
ARCHITECTURAL AND ENGINEERING STATE MATCHING FUNDS
(FROM THE APPROVED PRE-APPLICATION)
August 15,
PROJECT FAI (Federal Application Identifier) NO.

$

FUNDS WILL REMAIN AVAILABLE UNTIL
(mm/dd/yyyy)

CERTIFICATION STATEMENT: I certify that the above information is correct and that no further State or Tribal Government
action, other than administrative, is required to make these funds available.
NAME OF AUTHORIZED STATE OR TRIBAL GOVERNMENT BUDGET OFFICIAL TITLE OF AUTHORIZED STATE OR TRIBAL GOVERNMENT 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 or Tribal
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
MAR 2010

40-0895-6

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