FY2010 State Librarian Certificate

State Librarian Certification
FY 2010 StLA Survey

I certify that, to the best of my knowledge and belief, the data submitted for the FY 2010
State Library Agencies Survey are accurate.

_______________________________________________________
State Library Agency Name
_______________________________________________________
State Librarian's Name (please print)
______________________________________________________
State Librarian's Signature
_____________________
Date

Estimated number of hours Respondent took to complete the
survey

Hours

The State Librarian can certify the data electronically or by paper.
Electronic certification: After the Key Holder locks the survey data, a message will automatically
be sent to your e-mail. Certify online by clicking on the specified link within the e-mail. No
additional action is necessary. Your Key Holder will be notified via e-mail that you completed
the certification.
Paper certification: The Key Holder should submit the completed form by regular mail or
fax to:
U.S. Census Bureau
Attn: Lisa Frid
Governments Division, Room 6K152D
4600 Silver Hill Road
Washington, D.C. 20233
Toll-free fax: (866) 394-0138