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 0985-0009).  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. 

OMB # 0985-0009, exp. 11/30/2020

OMB # 0985-0009, exp. 11/30/2020

**Certification of Long-Term Care Ombudsman Program Expenditures**

**State Agency Expenditures:**  In accordance with Sections 307(a)(9) and 705(a)(4) of the Older Americans Act (OAA), I certify that for Fiscal Year ______ the State/Territory of ____________  expended on its statewide Long-Term Care Ombudsman Program not less than an amount expended by the State agency with funds received under Titles III and VII for Fiscal Year 2019. And that all Title VII Chapter 2 funds  were exclusively expended on the Long-Term Care Ombudsman Program, and that Title VII and Title III expenditures supplemented and did not supplant any Federal, State or local funds expended by the State or unit of general purpose local government to provide Ombudsman services.

**Area Agency Expenditures**:  I further certify that, in compliance with Section 306(a)(9) of the OAA, each area agency on aging in the State which expended Title III funds received under Section 304 (d)(1)(D) of the Act and/or Title VII funds on Ombudsman activities in FY 2019 expended at least this amount on the Ombudsman Program, as defined in Section 712 of the OAA, during the fiscal year and that these expenditures supplemented and did  not supplant any Federal, State or local funds expended by the State or unit of general purpose local government to provide Ombudsman services.

**______________________________________________**

Signature of authorized State official		Date

______________________________________________________

Signature of State Long-Term Care Ombudsman 	Date

**The following represents your state’s expenditures for FFY 2019 reported to the Administration on Aging:**

****Expenditures of these funds are subject to minimum funding requirements in the Older Americans Act (2020 Authorization). FY ______**expenditures must have met or exceeded these amounts.***

**Older Americans Act (2020) Provisions Related to Ombudsman Minimum Funding, Non-Supplantation Requirements, and State Authorization to Expend Title III-B Funds on Ombudsman Activities**

**Section 307(a)(9):**The (		**Section 307 (a)(9):** “The [State] plan shall provide assurances that – (A) the State agency will carry out, through the Office of the State Long-Term Care Ombudsman, a State Long-Term Care Ombudsman Program in accordance with section 712 and this title [III], and will expend for such purpose an amount that is not less than an amount expended by the State agency with funds received under this title [III] for fiscal year 2019, and an amount that is not less than the amount expended by the State agency with funds received under title VII for fiscal year 2019; and (B) funds made available to the State agency pursuant to section 712 shall be used to supplement and not supplant other Federal, State, and local funds expended to support activities described in section 712.”

**Section306(a)(9):**  (The a		**Section 306 (a)(9): “**[Each area agency on aging area plan shall] provide assurances that- (A) the area agency, in carrying out the State Long-Term Care Ombudsman Program under section 307(a)(9), will expend not less than the total amount of funds appropriated under this Act and expended by the agency in fiscal year 2019 in carrying out such a program under this title [III]; and (B) funds made available to the area agency on aging pursuant to section 712 shall be used to supplement and not supplant other Federal, State, and local funds expended to support activities described in section 712”

**Section 705(a)(4)**:  “[The State plan submitted under section 307 shall include] an assurance that the State will use funds made available under this subtitle for a chapter in addition to, and will not supplant, any funds that are expended under any Federal or State law in existence on the day before the date of enactment of this subtitle, to carry out****each of the vulnerable elder rights protections activities described in the chapter.”

**From the congressional**

**Authorization for State 		OAA authorization for expenditure of Title III-B funds for Ombudsman activities:**

**Section 304(d)(1):** “From any state’s allotment, after the application of section 308(b), under this section for any fiscal year... **(B)** such amount as the State agency determines to be adequate for conducting an effective ombudsman program under section 307(a)(9) shall be available for conducting such program.” 

*Please send this signed certification for the preceding fiscal year to the Administration on Aging by the date indicated on notification from the Administration on Aging.*

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 0985-0009).  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.