Certification of Prison Records by Prison Officials

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0688 can be found here:

Documents and Forms

Document Name Document Type
OMB Certification Template 11_2009.doc Other-New Certification Template
Exhibit B--Certification of Prisoner Identity Information Template.doc Certification Template IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification of Prison Records by Prison Officials	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 422.107

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-New Certification Template			OMB Certification Template 11_2009.doc		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200,000	200,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Certification Template	Exhibit B--Certification of Prisoner Identity Information Template.doc	02/12/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.