(6) ___________________________________ agrees to furnish any additional State funds needed to
complete the project.
(7) ___________________________________ agrees that, upon completion of the project, it will provide
adequate financial support to maintain and operate the facility.
(8) ___________________________________ agrees that it will operate and maintain the facility in
conformance with State standards and with all applicable State and local laws, codes, regulations and ordinances, and in
conformance with NCA Shrine standards prescribed by VA.
(9) ___________________________________ agrees that it will make such reports in such form and
containing such information as the Secretary may from time to time reasonably require, and give the Secretary, upon
demand, access to the records upon which such information is based.
The Secretary of the Department of Veterans Affairs hereby approves the project. After _____________________
certifies its
construction or
modification costs as set forth in paragraph (5) above, the Secretary agrees to make
partial payments of the grant to cover the costs certified. VA payments will be limited to the unpaid obligated balance of
the grant for actual incurred costs for this project. If all funds have not been used by the State for the purpose of the project
within three years after being so made available, the United States shall be entitled to recover any such unused funds from
the State. This project is subject to the recapture provisions stated in 38 CFR 39.10.
IN WITNESS WHEREOF, the parties have hereunto affixed their signature on the dates indicated:
(State or Tribal Government Authorizing Official)
(Date)
(Director, State Cemetery Grants Service)
(Date)
Respondent Burden: Public reporting burden for this collection of information is estimated to average 2 hours. Statutory authority for
a State Cemetery Grant is 38 U.S.C. 2408. The information requested is necessary to ensure that State or Tribal government identify
the parties (VA and applicant), identify the scope of the project and indicate how the grant award funds will be reimbursed to the
applicant. VA may not conduct or sponsor and you are not required to respond to this collection of information unless it displays a
valid OMB number. Respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspects of this
collection of information, including suggestions for reducing the burden to VA Clearance Officer (005R1B), 810 Vermont Avenue
NW, Washington, DC 20420. SEND COMMENTS ONLY. Please do not send applications for a grant to this address.
VA FORM 40-0895-11, OCT 2010, PAGE 2 OF 2
1
2