January 18, 1995

[PROGRAM INSTRUCTION]{.underline}

AOA-PI-95-02

TO : STATE AGENCIES ADMINISTERING PLANS UNDER TITLE VII OF THE OLDER
AMERICANS ACT OF 1965, AS AMENDED

SUBJECT : Instructions for Filing the Financial Status Report (Form 269)
and Supplemental Form for Funds Received Under Title VII of the Older
Americans Act

LEGAL AND RELATED

REFERENCES : Older Americans Act of 1965, As Amended

The purpose of this Program Instruction is to:

! inform States of new requirements for reporting on the status of funds
received under Title VII of the Older Americans Act and related
expenditure requirements under the Act and

! transmit the requisite forms for reporting the information required:

**P the Financial Status Report (Form SF-269)** for reporting the status
of Title VII funds received by the State and

**P a supplemental form for reporting funding expended on the Long-Term
Care Ombudsman Program**, pursuant to Sections 307(a)(21) and 306(a)(11)
of the Act.

[The Financial Status Report - SF-269]{.underline}

States should continue to report the status of Title VII funds they
receive on the SF-269. A copy, with Title VII designation, is attached.
Instructions are on the back of the form. Please copy both sides of this
form for future use.

For the purpose of completing the SF-269, States are not required to
identify the separate amounts allocated for each Title VII chapter.

The Title VII SF-269 should be submitted to the AoA Regional
Administrator, according to the following schedule:

P by April 30 for the first six months of a fiscal year

P by October 30 for the last six months of a fiscal year

The SF-269 for a fiscal year\'s funding should be submitted on the above
schedule until all funds have been expended or returned to the Federal
government. The final, closeout Title VII Financial Status Report must
be submitted to the Regional Administrator within 90 days after the two
years following the Federal funding period for which funds were
appropriated. Ninety days after the close of a Federal fiscal year is
December 30.

We would like to remind you that funds must be obligated by a State
during the Federal fiscal year for which they were appropriated; i.e.,
funds may not be obligated after September 30 of the year for which they
were appropriated. However, for the reason stated in the next paragraph,
the obligation of funds in a given fiscal year need not be totally
liquidated until the last day of the second fiscal year after the year
for which the funds were awarded.

AoA, since FY 1989, has exempted States from following the provision of
45 CFR 92.23, which requires liquidation of obligated funds within 90
days following the close of the fiscal year for which the funds were
appropriated. The exemption was necessitated by the need for additional
time for area agencies on aging to liquidate Title III funds. The
exemption extended the period of time for liquidation of obligated funds
for two fiscal years after the fiscal year for which they were
appropriated. In order to establish consistency between Title III and
Title VII funds, AoA is extending this exemption to Title VII funds. (A
provision in the Notice of Proposed Rulemaking for Title VII \[See
November 15, 1994 [Federal Register]{.underline}, par. 1327.15(a)\]
which incorporates 45 CFR 92 will be deleted in the final regulations.)

[Certification of Ombudsman Required Minimum Funding Levels]{.underline}

Due to a technical amendment to the 1992 Amendments to the Older
Americans Act, the minimum ombudsman funding requirements in the Act did
not become effective until fiscal year 1994. For

FY 1994, the certification form should be completed and submitted to the
Regional Administrator by January 30, 1995. For FY 1995 and subsequent
years, it should be submitted 30 days after the close of a fiscal year
(October 30), along with the SF-269.

EFFECTIVE DATE : Final SF-269 for FY 1993 Title VII funds due December
30, 1995; Title VII SF-269\'s due April 30 and October 30 and December
30 (closeout) for FY 1994 and subsequent years;

Certification of Ombudsman Required Minimum Level for FY 1994 due
January 30, 1995 and October 30 in subsequent years.

ATTACHMENTS : A. Financial Status Report for Title VII --- SF-269 (Long
Form) (Not included with electronic submission of this PI)

B. Supplemental Form to Title VII 269: Certification of Ombudsman
Required Minimum Funding Level

INQUIRIES: State Agencies should address inquiries to Regional AoA
Administrators, DHHS Regional Office.

Fernando Torres-Gil

Assistant Secretary for Aging

copies: State Long Term Care Ombudsmen

**Certification of Ombudsman Required Minimum Funding Level**

Certification of Federal and non-Federal expenditures in compliance with
Sections 307(a)(21) and 306(a)(11) of the Older Americans Act, as
Amended^1^[^1]

**State Agency Expenditures**: I, the undersigned, certify that the
State Agency** expended** the following funds in carrying out its
Ombudsman Program under Section 712 of the Older Americans Act:

**Source Base Year (FY \'91) FY 199 \_\_\_**

Federal - OAA Title VII \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_^2^[^2]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Federal - Title III-B

\[OAA Section 304(d)(1)(B)\] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Other Federal \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

State Funds \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Other (do not include \"in kind\") \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Total \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature and Title of Authorized State Official Date

**Area Agency Expenditures**: I further certify that, in compliance with
the requirement of Section 306(a)(11) of the Act, each Area Agency on
Aging in the State which expended Title III funds received under
304(d)(1)(D) of the Act on ombudsman activities in FY 1991 expended at
least this amount on the Ombudsman Program, as defined in Section 712 of
the Act, during the past fiscal year.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature Date

[^1]: 1 See AoA Program Instructions (PI) 94-02 and 94-03 for
    interpretation of these statutory provisions.

[^2]: 2 For FY 1991 and 1992, this funding was the special Title III
    ombudsman allotment to States in the Departments of Labor, Health
    and Human Services, and Education and Related Agencies Appropriation
    Act. Congress transferred this allotment to the new Title VII
    beginning in FY 1993. Enter in the FY 1991 column for this item the
    amount of the FY 1991 ombudsman allocation expended in FY 1991.