FY 2004 Assurances for the Help America to Vote Act

This is to certify that the undersigned P&A (name/location) ____________ agrees to expend the Funds received under this Program Instruction (03-01) in accordance with Title II, Part 5, Subtitle D, 42 USC 15461 and 15462 of the Help America Vote Act of 2002, P.L. 107-252, and all other applicable statutes and regulations.

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P&A															Date

Please mail to:

Administration for Children and Families
Office of Administration, Division of Mandatory Grants
Attention:   Joe Lonergan
370 L’Enfant Promenade, S.W.
Washington, D.C. 20447