Government Property Certification word version 10.20.22 (002) clean

U.S. DEPARTMENT OF LABOR GOVERNMENT PROPERTY CERTIFICATION Grant Recipient Name and Address: Grant Number: 1. I certify that the attached government property inventory list contains all property having a current per unit fair market value of $5,000 or more where DOL reserves the right to take title. 2. I certify that no government property was purchased having a current per unit fair market value of $5,000 or more. Therefore, we (grant recipient) have no further obligation to DOL. Certified by: Date:
Authorized Representative

O M B No.: 1205-0NEW      O M B Expiration Date: xx/xx/xxxx     O M B Burden Hours: 5 minutes

Paperwork Reduction Act Statement: These reporting instructions have been approved under the Paperwork reduction Act of 1995. Persons are not required to respond to this collection of information unless it displays a valid OMB control number. Public reporting burden for this collection of information includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Submission is mandatory under SSA 303(a)(6). Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Grants Management, Room N.4716, 200 Constitution Ave., NW, Washington, DC, 20210.