Public reporting burden for this collection of information is estimated to average 15 minutes 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Office of Management and Budget, Paperwork Reduction Project (0348-0041), Washington, D.C. 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the Awarding Agency. Further, certain federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.
|
Fld Name / |
Instruction |
|
Signature of Authorized Official
|
Enter the signature of the Authorized Official ( if this form is submitted electronically, it will automatically contain an electronic signature). |
|
Title |
Enter the Title of the Authorized Official |
|
Applicant Organization |
Enter the Applicant Organization
|
|
Date Submitted |
Enter the Date these assurances are submitted. |