202405 NEH Certification of Gifts/Pledges

OMB control number 3136-0134,
expiration date October 31, 2024

CERTIFICATION OF GIFTS/PLEDGES
FAIN

Report Number

Recipient
Organization

Date Submitted

Donor Category

Number of Donors

Amount Given

Individuals

$

Corporations or businesses

$

Public or private foundations

$

Labor unions, associations

$

Nonfederal government units

$

Affiliated groups

$

Special events, benefits

$

Other

$

Total amount

$

The amount certified in this letter includes pledges in the amount of

$

Documentation attached for pledges certified?
For General Support Grants to State Humanities Councils only
The matching funds released by this certification will be used as follows:

Regrants

$

All other categories $

I certify that the total amount has been received in the form of a gift or gifts which have been donated to my organization; meet the criteria for eligibility
established by NEH; will be expended for grant purposes during the grant period; and that documentation that substantiates the amounts, sources,
eligibility and expenditure of the gifts will be retained for three years following the submission to NEH of the final financial report for this grant. If
pledges are included in the total, I certify that (1) the pledges are legally enforceable, (2) the donors are obligated to pay the pledges during the grant
period, and (3) the immediate release of matching funds is necessary to carry out grant activities.

Institutional Grant Administrator

If you are using this form outside the NEH's electronic Grants Management System (eGMS), enter the name of the Institutional Grant Administrator (IGA)
in the field above. Print a copy for the IGA's signature, scan the signed copy, and e-mail it to [email protected].

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other suggestions for reducing this burden to NEH Office of Grant Management, Washington, D.C.
20503, [email protected].