Written Application for the Independent Living Services for Older Individuals Who are Blind Formula Grant (SC)

Lynnae M. Ruttledge, Commissioner

Rehabilitation Services Administration, OSERS

U.S. Department of Education

400 Maryland Ave, SW Room PCP 5086

Washington, D.C. 20202

Dear Commissioner Ruttledge:

In accordance with Section 752 of the Rehabilitation Act of 1973, as amended (Act), we are applying for an Independent Living Services for Older Individuals Who are Blind

(IL-OIB) grant for fiscal years 2011-2013 on behalf of the State of ______________ for such amounts as our agency may be entitled to receive.

We agree to administer the formula grant program in accordance with the Federal requirements in the enclosed signed assurances.

The name of the director, the designated state agency, and the address of the agency are:

State law allows payment directly to the designated state agency or requires payment to be made to:

The DUNS number of the payee agency is __________________________.

______________________________

(Signature of Director)

______________________________

(State)

______________________________

(Date)