Fillable Printable VA Form 10-0388-2

VA Form 10-0388-2

OMB Number: 2900-0661

Estimated Burden: 1 hour

VA FORM

JUL 2013

10-0388-2

PAGE 1 OF 1

CERTIFICATION OF COMPLIANCE

WITH PROVISIONS OF THE DAVIS-BACON ACT

(40 U.S.C. Sections 276a to 276a-7)

FAI NUMBER

PROJECT LOCATION

PROJECT DESCRIPTION

The Paperwork Reduction Act of 1995requires 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)

I certify that the above information submitted to VA is true and correct to the best of my knowledge and ability.

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

I certify that I have obtained the latest prevailing wage rates from the U.S. Department of Labor for the State Home

project located in and that these rates have been

incorporated into the construction contract for the proposed State Veterans Home project in compliance with the

Davis-Bacon Act.

TITLE 38 U.S.C. 8135(A) 8

TITLE OF AUTHORIZEDSTATE OFFICIAL

NAME OF AUTHORIZEDSTATE OFFICIAL