Information Collection

Certification of Maintenance of Effort

IC 10263 under ICR 201710-0985-004 · OMB 0985-0009.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0009 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Certification of Maintenance of Effort Form
1 Certification of Maintenance Certification of Maintenance Form.docx Form
2 Certification of Long Term Care Ombudsman Program Expend Certification of LTCO Program Expenditures.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification of Maintenance of Effort	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 1321.49

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Certification of Maintenance	Certification of Maintenance Form.docx		Yes	Yes	Fillable Fileable
Form	2	Certification of Long Term Care Ombudsman Program Expenditures	Certification of LTCO Program Expenditures.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.