Fillable Printable VA Form 10-0388-10

VA Form 10-0388-10

OMB Number: 2900-0661

Estimated Burden: 1 hour

VA FORM

JUL 2013

10-0388-10

PAGE 1 OF 1

CERTIFICATION OF COMPLIANCE WITH FEDERAL REQUIREMENTS

STATE HOME CONSTRUCTION GRANT

FAI NUMBER

PROJECT LOCATION

PROJECT DESCRIPTION

The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of this

Act. The public reporting burden for this collection of information is estimated to average 1 hour 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. We may not collect or sponsor and you are

not required to respond to, a collection unless it has a valid OMB Control Number. This collection of information is collected under the authority of 38 U.S. Code Sections

8133(a) and 8135(a). VA will use this information, along with other documents submitted by the States to determine the feasibility of the projects for VA participation, to

meet VA requirements for a grant award and to rank the projects in establishing the annual fiscal year priority list. Although response is voluntary, VA will be unable to

authorize a grant without a complete package. Your failure to furnish this information will have no effect on any of other benefits to which you are entitled.

SIGNATURE (Sign in ink)

DATE (mm/dd/yyyy)

TITLE OF AUTHORIZED STATE OFFICIAL

NAME OF AUTHORIZED STATE OFFICIAL

CERTIFICATION - THE LAW PR0VIDES SEVERE PENALTIES FOR WILLFUL SUBMISSION OF FALSE INFORMATION.

I certify that to the best of my knowledge and belief all Federal requirements: (1) outlined in 38 Code of Federal

Regulations Part 59 as they pertain to this State Home project; (2) assurances outlined in SF 424D; and (3) all

mandatory comments resulting from the design development review by the U.S. Department of Veterans Affairs (VA)

have been incorporated into construction contact(s) for this State Veterans Home project.