Free Form 02AG006E (AG-29) - Oklahoma

*02AG006E-001*
OKLAHOMA DEPARTMENT OF HUMAN SERVICES

Voluntary Withdrawal of Title III Project
When an Older Americans Act Title III funded project elects to voluntarily terminate a contract prior to the end of a grant year, procedures in paragraphs 1 through 3 must be followed. 1. The Title III project gives the Area Agency on Aging (AAA) at least 90 days written notification prior to scheduled termination date, with justification for voluntary withdrawal. The chairperson of the project's governing board and the project director must sign the written notice. Documents in A and B of this paragraph must accompany the written notice. A. Complete list of all grant-acquired equipment, with signature of project staff verifying a complete inventory within the last 30 days. B. Complete list of all entities and organizations, contracted or otherwise, including contact name, address, and phone number with whom the project conducts all areas of program business, including, but not limited to, property owners, staff insurance and retirement carriers, transportation, food vendors, utility providers, maintenance, and transportation services. 2. The Title III project delivers documents in A and B of this paragraph to the AAA office no later than 60 days prior to the scheduled termination date. Documents to be delivered include: A. originals of all active Older Americans Act assessment forms; and B. all Older Americans Act program data, including computer data. 3. The Title III project notifies the AAA of the planned disposition of grant-acquired equipment or supplies at least 30 days prior to the scheduled termination date. The Title III project elects one of the dispositions in A through C of this paragraph. A. Surrender all grant-acquired equipment and supplies to the AAA. All grant-acquired equipment or supplies is surrendered no later than two weeks prior to the scheduled termination date. B. Keep the grant-acquired equipment or supplies. The AAA is reimbursed the full replacement costs for all grant-acquired equipment or supplies kept by the Title III project no later than two weeks prior to the scheduled termination date. C. Dispose of the grant-acquired equipment or supplies. The Title III project contacts the AAA at least 30 days prior to the scheduled termination date to receive disposition instructions. Project name Grantee/applicant organization

Project director signature Chairperson board of directors signature

Title Title

Date Date

OKDHS revised 4-20-2007

02AG006E (AG-29)

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