Program Instructions

AoA-PI-02-01 October 26, 2001 

TO : STATE AGENCIES ADMINISTERING PLANS UNDER TITLE III OF THE OLDER AMERICANS ACT OF 

1965, AS AMENDED 

SUBJECT : New Revised AoA Supplemental Form to the SF-269 Report for Formula Grants Under Title 

III 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 the States of the new, revised AoA Supplemental 

Form to the SF-269 and to transmit a copy with instructions for completion.

On August 24, 2001, OMB approved the revision to the AoA Supplemental Form to the SF-269 which 

was published for comments in the June 13, 2001 issue of the Federal Register. A copy of this 

supplemental form with instructions on completing both the SF-269 and the supplemental form is 

attached. This revised supplemental form replaces the AoA supplemental form currently in use and 

must now be used in reporting all open Title III grant years. States should duplicate the supplemental 

form for future use. The SF-269 can be found at http://www.whitehouse.gov/omb/grants

The effective date for using the revised supplemental form is the first financial reporting period for FY 

2002 (October 1, 2001 to March 31, 2002). There is no change to the frequency of reporting or the 

due dates for receipt in the Regional Offices. Reporting for the first six months of a fiscal year 

(October 1- March 31) is due in the Regional Office by April 30. Reporting for the second six months of 

a fiscal year (April 1 - September 30) is due in the Regional Office by October 30. All open grant years 

will be reported on this schedule until all obligations are liquidated within the allowable two year 

period following the year of the awarding of the grant. Grants awarded with realloted funds have an 

additional year for obligation liquidation. 

This supercedes AoA-PI-95-01 and all previous instructions regarding the use of AoA Supplemental 

Forms to the SF-269. 

EFFECTIVE DATE : October 1, 2001 

ATTACHMENTS : AoA Supplemental Form to the SF-269 and Instructions 

INQUIRIES : Inquiries should be addressed to the Regional Administrators for Aging, DHHS Regional 

Offices. 
Josefina G. Carbonell

Assistant Secretary for Aging 

THE ADMINISTRATION ON AGING (AOA)

ADDITIONAL INSTRUCTIONS FOR COMPLETING THE FINANCIAL STATUS REPORT AND

THE SUPPLEMENTAL FORM TO THE SF-269 

General Instructions: 

(1) All amounts reported should be rounded off to the nearest dollar; no cents should be reported. 

(2) Leave blank items 10.c and 10. g since the Deductive and the Matching or Cost Sharing 

alternatives are not allowed. 

(3) The amount reported in item 10.e should represent non-State, subrecipient contributions (i.e. 

those non-Federal resources contributed by AAA's, nutrition and service providers, etc.). 

(4) The amount reported in item 10.h should represent those outlays made from State resources. 

(5) Item 10.k should include the total Federal and State share of unliquidated obligations. These 

would include State funds awarded to AAA's etc. which have not been earned/expended. 

(6) Item 10.l, the State's share from 10.k above. 

(7) Please note that program income used in accordance with the Additional alternative (item 10.r) is 

a CUMULATIVE AMOUNT and should not be included in the total outlays on line 10.a. 

Since the current form does not have multiple columns for reporting more than one program function, 

State Agencies are required to break down the following items on the Supplemental Form to the SF 

269. 

ITEM 10i Total recipient share of outlays. 

Section 304 and 308 of the Older Americans Act and Section 1321.47 of the Title III regulations 

require a non-Federal share/match of 25 percent for State and Area Plan administration (and 15 

percent for all services, except Title III-E which requires a 25 percent non-Federal share/match for 

services). 

Breakdown Item 10i, Column III, to identify the total Non-Federal amount expended for State and 

Area Plan Administration. 

ITEM 10 j Federal share of net outlays. 
Section 304 and 308 of the Older Americans Act and Section 1321.47 of the Title III regulations 

require a non-Federal share/match of 25 percent for State and Area Plan administration (and 15 

percent for all services, except Title III-E which requires a 25 percent non-Federal share/match). 

Breakdown Item 10j, Column III, to identify the total Federal amount expended for State and Area 

Plan Administration. 

ITEM 10.o Total Federal funds authorized for this funding period. 

The breakdown of Item 10o should be the State's allocation of Federal funds for the following program 

functions in the indicated sections of the supplemental form: 

State Administration/Administrative Activities. 

Sections 308(a)(1) and (b)(2) provide the authority for States to expend the greater of 5% of their 

total allotment or $500,000 for this function. Provide the total amount of Title III funds used for State 

Administration on line 1. This total must be broken down further to identify the amount of funds 

utilized from each program allotment. 

Part B, Supportive Services.

Sections 308(b)(5) provide the authority for States to transfer between Parts B and C. Provide the 

amount utilized by the State after transfers for this allotment on line 2. 

Long-Term Care Ombudsman.

Sections 304(d)(1)(B) and 307(a)(9) provide the authority to utilize Part B funds for Long-Term Care 

Ombudsman services. Provide the amount of Title III-B funds utilized by the State Agency in support 

of the Statewide Long-Term Care Ombudsman program. This amount should be excluded from the 

Part B amount in item 2 above. 

Part C1, Congregate Meals. 

Sections 308(b)(4) and (5) provide the authority for States to transfer between Subparts C1 and C2. 

Provide the amount utilized by the State after transfers for this allotment on line 4. 

Part C2, Home Delivered Meals. 

Sections 308(b)(4) and (5) provide the authority for States to transfer between Subparts C1 and C2. 

Provide the amount utilized by the State after transfers for this allotment on line 5. 

Part D, Disease Prevention and Health Promotion Services. 
Section 303(d) authorizes funds for grants under Part D. Provide the amount of Title III funds utilized 

for preventive health services on line 6. 

Part E, National Family Caregiver Support Program

Sections 303(e)(1) and (2) authorizes funds for grants under Part E. Provide the amount of Title III 

funds utilized for caregiver services on line 7. 

Area Plan Administration. 

Sections 304(d)(1)(A) and 308(a)(3) provide the authority for States to utilize a maximum of 10% of 

their total allotment (after application of State Plan Administration) for Area Plan Administration. This 

total must be broken down further to identify the amount of funds utilized from each program 

allotment. 

ITEM 10 p Unobligated funds. 

Breakdown the total unobligated Federal funds by Part/Subpart. 

ITEM 10 R Disbursed program income using the additional alternative.