VA Form 40-0895-12: Debarment Certification 2026

VA Form 40-0895-12: Debarment Certification 2026 – This form is a key requirement for contractors and lower-tier participants involved in Veterans Affairs (VA) State Cemetery Grants Program projects. It ensures compliance with federal regulations to protect the integrity of government-funded initiatives.

What Is VA Form 40-0895-12?

VA Form 40-0895-12 (revised September 2023) is the official Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion—Lower Tier Covered Transactions. It is used primarily by contractors (lower-tier participants) in VA grant programs, such as those for constructing, expanding, or improving state veterans cemeteries.

The form requires the authorized representative to certify that neither the company nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in federal transactions. OMB Control Number: 2900-0559 (expires October 31, 2026). Estimated burden: 15 minutes.

Why Is This Certification Required?

This certification stems from Executive Order 12549 (Debarment and Suspension) and related regulations in 2 CFR Part 180. It implements government-wide standards to prevent fraud, waste, and abuse in federal programs.

For VA State Cemetery Grants (authorized under 38 U.S.C. 2408), the form ensures that contractors receiving federal funds through grants or subawards meet eligibility standards. It is listed in VA grant application checklists and must be submitted as part of compliance with federal requirements.

Failure to provide accurate certification can lead to remedies including suspension, debarment, or other legal actions.

Key Provisions and Instructions on the Form

The form includes detailed instructions that lower-tier participants must follow:

  • Certification Statement: By signing, you affirm that the company and principals are eligible.
  • Ongoing Responsibility: Provide immediate written notice if circumstances change.
  • Flow-Down Requirement: Include this certification clause in all lower-tier subcontracts and solicitations.
  • Reliance on Certifications: Participants may rely on these certifications unless they know they are false.
  • Definitions: Terms follow those in the regulations implementing Executive Order 12549.

The form has fields for the company name/address, project FAI number, participant name/title, signature, and date.

Who Needs to Complete VA Form VA40-0895-12?

  • Contractors and subcontractors (lower-tier participants) on VA State Cemetery Grant projects.
  • Entities involved in covered transactions below the primary (state/tribal government) level.
  • Any party receiving federal financial assistance through these grants where the certification is required.

Primary participants (e.g., states) typically use a related form like VA Form 40-0895-7.

How to Check Debarment and Suspension Status?

Before signing, verify status via the official System for Award Management (SAM.gov) Exclusions search (no login required for basic searches).

Search by entity name, Unique Entity ID, CAGE code, or individual details. Check both the company and key principals. Maintain records of your searches for compliance.

Step-by-Step Guide to Completing and Submitting the Form

  1. Review the full form and instructions carefully.
  2. Confirm eligibility by searching SAM.gov.
  3. Complete company and project details.
  4. Have an authorized representative sign and date.
  5. Submit as part of your grant-related proposal or contract package to the VA or relevant state entity.

Download the official VA Form 40-0895-12 here: Download VA Form 40-0895-12 (PDF) (Direct from VA.gov).

Always use the latest version from the official VA website.

Importance for Contractors and Grant Recipients

This certification upholds the integrity of VA programs supporting veterans’ cemeteries. It protects taxpayer funds and ensures only responsible entities participate. Non-compliance can jeopardize project funding, lead to exclusion from future opportunities, and trigger audits or penalties.

Contractors should integrate debarment checks into their standard compliance processes for all federal or federally assisted work.

  • VA State Cemetery Grants Program: Official information on eligibility and requirements.
  • SAM.gov Exclusions: Primary database for checking status.
  • Related VA forms for primary covered transactions and other grant compliance.

For the most current guidance, consult the VA Cemetery Grants page or contact the State Cemetery Grants Service.

This article is for informational purposes only and is not legal advice. Requirements can change; always verify directly with official VA sources and legal counsel for your specific situation.