Paperwork notice
OMB Control No. 2900-0883, an estimated burden of 5 minutes and an expiration date of 11/30/2026.
10-0144
Certification Regarding Lobbying
- Agency
- VA
- Revision
- December 2023
- Fillable fields
- 10
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0144: Certification Regarding Lobbying
VA Form 10-0144 is the U.S. Department of Veterans Affairs Certification Regarding Lobbying, under the heading Certification for Contracts, Grants, Loans, and Cooperative Agreements. It is a grant document signed by a certifying official, not a benefit application for Veterans, and VA's form page lists it under VHA with no public use description.
The form says the certification is made in compliance with Section 319 of Public Law 101-121, and that submitting it is a prerequisite for making or entering into the transaction, imposed by section 1352, title 31 U.S. Code. It also says completion is required to obtain and retain this Federal grant.
The PDF is one page: three numbered statements, then fields for the certifying official, the project and the state agency. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-0144
Legal basis
Section 319 of Public Law 101-121 and the Interim Final guidance published as part VII of the December 20, 1989, Federal Register.
Item (1): Federal appropriated funds
No Federal appropriated funds have been paid or will be paid to any person for influencing an agency officer or employee, a Member of Congress or congressional staff in connection with a Federal contract, grant, loan or cooperative agreement.
Item (2): Other funds
If other funds have been paid or will be paid for that kind of influencing, the undersigned completes and submits Standard Forms-LLL in accordance with its instructions.
Item (3) and penalty
The certification language goes into all subawards. The form says anyone who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Signature block
Signature of certifying official, date, name and title of certifying official, project (FAI number), and name and address of state agency.
How to complete VA Form 10-0144
- 1
Read the three statements
The certifying official certifies them to the best of their knowledge and belief.
- 2
Check whether item (2) applies
Where other funds have been paid for influencing, item (2) points to Standard Forms-LLL, Disclosure Form to Report Lobbying.
- 3
Enter the project and state agency
Fill in the project (FAI number) and the name and address of the state agency.
- 4
Sign and date it
The certifying official signs, dates and enters a name and title.
Why fill Form 10-0144 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes
No mailing address
The form and VA's page print no mailing address or submission method. The form calls submission a prerequisite for making or entering into the transaction.
Edition
The PDF is dated DEC 2023 and carries OMB Control No. 2900-0883, which expires 11/30/2026. VA's page lists a form revision date of September 2006.
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Who uses VA Form 10-0144?
The form is completed for a Federal award, not by an individual Veteran.
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Questions about Form 10-0144
What is VA Form 10-0144?
It is a certification that no Federal appropriated funds have been or will be paid to influence Federal officials or Members of Congress in connection with a Federal contract, grant, loan or cooperative agreement.
Is VA Form 10-0144 for Veterans?
No. It is signed by a certifying official for a state agency's project, and VA's page lists it under VHA with no public use description.
When is Standard Form-LLL needed?
Item (2) says that if funds other than Federal appropriated funds have been paid or will be paid for influencing, the undersigned completes and submits Standard Forms-LLL, Disclosure Form to Report Lobbying.
What is the penalty for not filing?
The form says any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Do subcontractors certify too?
Item (3) says the certification language is included in the award documents for all subawards at all tiers, including subcontracts and subgrants, and that all subrecipients certify and disclose accordingly.