TEMPLATE Checklist Item A13 Number of Beds-Distance.docx

** If a state proposes new beds that exceed the maximum number of state home beds as defined in 38 CFR 59.40, the state must provide documentation to justify an exception on the basis of great travel distances (greater than two hours) between a significant population center and an existing state home. Note that this is a template, and you are free to adapt as needed or submit supplemental documentation to meet this requirement. Delete any instructions that are italicized once updated. Submit as PDF.**

February 10, 2019 (Insert date)

Anna Gaug Program Manager U.S. Department of Veterans Affairs State Home Construction Grant Program (10NA5) 810 Vermont Avenue NW Washington, D.C. 20005

Re: Insert project title or description, location (city or county, state)

Dear Ms. Gaug, This document is to fulfill checklist item A.13 and certifies that this application does not exceed the maximum number of state home beds as defined in 38 CFR 59.40.

If the application does exceed the maximum number of state home beds as defined in 38 CFR 59.40, the state must provide documentation to justify an exception on the basis of great travel distances (greater than two hours) between a significant population center and an existing state home.

Sincerely, Insert signature

Insert signature block