VA Form 40-0895-12: Debarment Certification Download – VA Form 40-0895-12 is the official Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion—Lower Tier Covered Transactions (Contractor). This one-page form is used primarily in the VA State Veterans Cemetery Grants Program and other VA grant-related processes. It ensures that contractors (lower tier participants) involved in projects funded by VA grants are eligible to receive federal funds.
The form is required under regulations implementing Executive Order 12549 on Debarment and Suspension, as detailed in Title 2 of the Code of Federal Regulations (nonprocurement rules). It helps protect the integrity of federal assistance programs by verifying that participants are not debarred, suspended, or otherwise excluded.
Purpose of VA Form 40-0895-12 in VA Grants
This certification is a key compliance document for lower tier covered transactions, such as subcontracts or sub-grants under a primary VA grant (e.g., for establishing, expanding, or improving state veterans cemeteries). By signing it, the lower tier participant (typically a contractor) certifies that neither the company nor its principals are currently:
- Debarred
- Suspended
- Proposed for debarment
- Declared ineligible
- Voluntarily excluded from federal programs
The form supports government-wide efforts to prevent fraud, waste, and abuse in federal funding. A participant in a covered transaction can generally rely on this certification unless they have reason to believe it is inaccurate.
Who Must Complete VA Form 40-0895-12?
- Contractors and subcontractors (lower tier participants) working on VA-funded projects, especially under the Veterans Cemetery Grants Program.
- Entities receiving federal financial assistance through subawards or contracts below the primary grant level.
- Authorized representatives of the company involved in the transaction.
It is typically submitted as part of the application or post-award documentation package for VA grants. States, territories, and tribes applying for cemetery grants must ensure their contractors provide this form.
Key Instructions and Certification Statements
The form includes detailed instructions and requires the following commitments:
- The certification is a material representation relied upon when entering the transaction.
- Immediate written notice must be provided if the certification becomes erroneous due to changed circumstances.
- The lower tier participant agrees not to knowingly enter into transactions with debarred or excluded parties (unless authorized).
- The clause must be included (without modification) in all lower tier covered transactions and solicitations.
- Participants may check the System for Award Management (SAM.gov) for exclusions but are not required to establish extensive record-keeping systems beyond prudent business practices.
If the prospective participant cannot certify, they must attach an explanation. False certifications can lead to remedies including suspension or debarment.
How to Fill Out and Submit VA Form 40-0895-12?
- Download the form directly from the official VA website: Download VA Form 40-0895-12 (PDF).
- Provide company name and address, Federal Application Identifier (FAI) number if applicable, name and title of the authorized representative, signature, and date.
- The OMB number is 2900-0559 (expires October 31, 2026), with an estimated respondent burden of 15 minutes.
- Submit as part of the grant application package or to the contracting entity as required by the VA or primary grantee.
Always use the latest version (September 2023) from the VA forms library.
Related VA Forms and Resources
This form is often used alongside others in the VA cemetery grants process, such as:
- VA Form 40-0895-7 (Primary Covered Transactions)
- VA Form 40-0895-14 (Checklist of Major Grant Requirements)
For full program details, visit the official Veterans Cemetery Grants Program page: VA Cemetery Grants.
Why Compliance Matters for US Contractors and Grantees?
Maintaining eligibility is critical for businesses working with federal funds. Debarment checks are performed government-wide via SAM.gov. Non-compliance can result in loss of funding opportunities, contract termination, or further exclusions. Prudent contractors verify status regularly and flow down the certification requirement to their own subcontractors.
Frequently Asked Questions (FAQs) about VA Form 40-0895-12
Q: Is VA Form 40-0895-12 required for all VA contracts?
A: It is specifically for lower tier covered transactions in nonprocurement contexts like grants, particularly cemetery grants.
Q: Where can I check debarment status?
A: Use the official System for Award Management at SAM.gov.
Q: What if circumstances change after signing?
A: Provide immediate written notice to the party to whom the proposal was submitted.
For the most current information, always refer to official VA and federal sources, as requirements can be updated.
This article provides guidance based on official VA documentation and federal regulations as of the latest available information. Consult the VA or a compliance expert for specific project advice.