Acl Moe

OMB NO. 0985-0009
Expires: xx/xx/20xx

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,
were $

through September 30,

.

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

Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such
collection displays a valid OMB control number (OMB 0985-000). Public reporting burden for this collection of information is
estimated to average 30 minutes per response, including time for gathering and maintaining the data needed and completing and
reviewing the collection of information.