Certification Form

Certification for Paperwork Reduction Act Submissions
On behalf of this Federal Agency, I certify that collection of information encompassed by this request complies with 5
CFR 1320.9 and related provisions of 5 CFR 1320.8(b)(3).
Title:

(150 characters max)

OMB #:

Mandatory Civil Rights Data Collection
1870-0504

Docket ID#: (for office use only) ED-2013-ICCD-0179

The following topics summarize the proposed information collection that certification covers. By signing below, you
are certifying your Principal Office’s compliance. If you are unable to certify any of these provisions, please identify
and explain the reason in number 18 of your accompanying Supporting Statement:

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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 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 control number;

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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;

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I.

It uses effective and efficient statistical survey methodology (if applicable);

J.

It makes appropriate use of information technology; and

K. It reflects appropriate input from all agency offices, such as OPEPD and OGC. POs must ensure all policy
issues are addressed prior to ICRAS submittal (i.e., any policy issues with grant applications) so the ICR is ready
for public viewing.

Your office must certify approval of all submitted information collection requests. Your signature authorizes
PIRMS to post the information collection request for public comment. If this collection should not be publicly
available, please provide reasons to PIRMS via e-mail to [email protected] with your official ICRAS submittal.
PIRMS does not share Information collections tied to a proposed or draft rule with the public until the publication date
of that rule.

Stephanie Valentine

Digitally signed by Stephanie Valentine
DN: c=US, o=U.S. Government, ou=U.S. Department of Education,
cn=Stephanie Valentine, 0.9.2342.19200300.100.1.1=9268290280
Date: 2014.03.27 12:35:31 -04'00'

Digital Signature of Principal Office Official or Designee