0985-0009 Certification of Maintenance

OMB NO. 0985-0009

Expires: 08-31-2011

Certification of Maintenance of Effort

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

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, ______ through September 30, ______ were $______________________.

This amount is (check one):

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