3038-0033-Certification Signature Page (2005)

OMB Form 83-1

19. Certification for Paperwork Reduction Act Submissions
On behalf of this Federal agency, I certify that the collection of information encompassed by this request

complies with 5 CFR 1320.9.

NOTE: The text of 5 CFR 1320.9, and the related provisions of 5 CFR 1320.8(b)(3), appear at the end of
the instructions. The certification is to be made with reference to those regulatory provisions as set forth
in the instructions.

The following is a summary of the topics, regarding the proposed collection of information, that the

certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping

practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8(b)(3) about:
(i) Why the information is being collected;
(ii) Use of the information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective
management and use of the information to be collected (see note in Item 19 of the instructions);
(i) It uses effective and efficient statistical methodology (if applicable); and
U) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item below and explain
the reason in Item 18 of the Supporting Statement.

Date

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