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Form letter

DEPARTMENT OF HEALTH, EDUCATION AND WELFARE
OFFICE OF THE SECRETARY
Washington, D.C. 20201

Date:

Dear _______________________________ :

I certify that the full allotment to the State of _________________ is required for carrying out the State plan for Fiscal Year 1980.

Of the full allotment to the State of __________________ I certify that $ will not be required for carrying out the State plan for Fiscal Year 1980.

I certify that the State of ________________ will be able to use $ ________________ in excess of the State's allotment for carrying out the State plan for FiscalYear 1980.

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Signature of State Certifying Officer

Attachment I: Table indicating each State's allotment, awards to date, and balance