Statement of Assurances
I (we) am (are) in receipt of the Preliminary Decision to designate ______________________________________ ______________________________________
(Name of Organization/Agency) as the AAA for the contract year beginning ___ (date) in ___ (PSA # and counties included).
I (we) hereby certify:
1 that I (we) am (are) authorized to transmit this Statement of Assurances on behalf of the above-named AAA designee; and
2 that ____________ (name of organization/ agency), if so designated, has the capability to develop an Area Plan responsive to the needs of the older persons in ____________ (PSA # and counties included), and to carry out, directly or through contractual arrangements, a program in accordance with the Area Plan for ____________ (PSA # and counties included); and
3 that ____________ (name of organization/ agency), if so designated, will abide by the Area Plan which it develops, as well as by any amendments added thereto by the Department; and
4 that said Area Plan will comply with all applicable regulations, policies, and priorities established by the Pennsylvania Department of Aging and by the Administration on Aging of the United States Department of Health and Human Services.
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(Signature) (Title) (Date)
6 Pa. Code § 30.14