Form 1 Certification of Maintenance

Certification of Maintenance of Effort

Certification of Maintenance Form

Certification of Maintenance of Effort

OMB: 0985-0009

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OMB NO. 0985-0009

Expires:xx/xx/20xx





Certification of Maintenance of Effort


Shape1 CERTIFICATION OF STATE RESOURCES EXPENDED, UNDER TITLE III OF THE OLDER AMERICANS ACT OF 1965, AS AMENDED, TO MEET THE REQUIRED LEVEL OF MAINTENANCE OF EFFORT DURING FISCAL YEAR


Shape2 STATE:





I, the undersigned, certify that the State resources expended to meet the maintenance of effort requirement set forth by Title III of the Older Americans Act, under the approved State plan,

for the period of October 1, were $ .

through September 30,



This amount is (check one):


Shape3 Shape4 Shape5 Less than the required level of maintenance of effort Equal to the required level of maintenance of effort More than the required level of maintenance of effort






Signature of Authorized State Official





Date


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWindows User
File Modified0000-00-00
File Created2021-01-21

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