Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Document	Type	Status	Availability
Form 1 Regugee Health Coordinator Survey	Form and Instruction	New	Repair queued
Form 1 Region XII Migrant and Seasonal Head Start T/TA Service Delivery Feedback	Form and Instruction	New	Repair queued
Form 1 Course Participant Knowledge Gain Assessment	Form and Instruction	New	Available
Form 1 OTIP NHTTAC General Fast Track	Form and Instruction	New	Repair queued
Form 1 National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New	Repair queued
Form 1 OHS TTA Network Training Feedback Form	Form and Instruction	New	Available
Form 1 Adoption Triad Survey	Form and Instruction	New	Available
Form 1 ANA Post Peer Panel Review Survey	Form and Instruction	New	Repair queued
Form 1 OAS-TA State Systems Specialist Network Feedback	Form and Instruction	Unchanged	Available
Form 1 OAS-On-Site Meeting Facilitation State Feedback Collection	Form and Instruction	Unchanged	Repair queued
Form 1 OAS-Administrator Feedback Collection	Form and Instruction	Unchanged	Repair queued
Form 1 OAS-TA Feedback Collection for Infant Toddler	Form and Instruction	Unchanged	Repair queued
Form 1 Follow-Up Needs Assessment Feedback Form	Form and Instruction	Unchanged	Available
Form 1 Institute Feedback Form	Form and Instruction	Unchanged	Repair queued
Form 1 OAS-Specialized Resources TA Feedback Collection	Form and Instruction	Unchanged	Repair queued
Form 1 Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting	Form and Instruction	Unchanged	Repair queued
Form 1 Human Trafficking Data Collection Pilot	Form and Instruction	Unchanged	Available
Form 1 ANA Sustainablility Servicers Survey	Form and Instruction	Unchanged	Available
Form 1 OCS-AFI Application Readiness Assessment Questions for Cohert Participants	Form and Instruction	Unchanged	Repair queued
Form 1 HS-ECLKC Tree Testing	Form and Instruction	Unchanged	Repair queued
Form 1 ANA Training and Technical Assistance Services Survey	Form and Instruction	Unchanged	Repair queued
Form 1 ANA 2016 Communication Survey	Form and Instruction	Unchanged	Repair queued
Form 1 PMFO New Director Mentor Iniative	Form and Instruction	Unchanged	Repair queued
Form 1 AFI Capacity Building Toolkit Usability Test	Form and Instruction	Unchanged	Repair queued
Form 1 AFI Grantee Workshop Evaluation Survey	Form and Instruction	Unchanged	Repair queued
Form 1 PMFO Fiscal Consulting Inititative Feedback Survey	Form and Instruction	Unchanged	Repair queued
Form 1 CWCB CapLEARN	Form and Instruction	Unchanged	Repair queued
Form 1 Child Welfare Capacity Building Collaborative Focus Group	Form and Instruction	Unchanged	Available
Form 1 OHS-Fiscal Consulting Survey	Form and Instruction	Unchanged	Repair queued
Form 1 OHS-Event Session Survey	Form and Instruction	Unchanged	Repair queued
Form 1 OHS-Conference Feedback Survey	Form and Instruction	Unchanged	Repair queued
Form 1 SOAR Human Trafficking Training End-of-Course Evaluation	Form and Instruction	Unchanged	Available
Form 1 Virtual Conference Session Evaluation	Form and Instruction	Unchanged	Repair queued
Form 1 CWIG Virtual Conference Exit Survey	Form and Instruction	Unchanged	Repair queued
Form 1 SOAR End of Course Evaluation	Form and Instruction	Unchanged	Repair queued
Form 1 OTIP	Form and Instruction	Unchanged	Repair queued
Form 1 National Foster Care and Adoption Directory Survey	Form and Instruction	Unchanged	Repair queued
Form 1 Center for States - 2015	Form and Instruction	Unchanged	Repair queued
Form 1 Investigation and Analysis of AFI	Form and Instruction	Unchanged	Repair queued
Form 1 Father Involvement Communication Checks	Form and Instruction	Unchanged	Available
Form 1 Child Welfare Information Gateways's Special Inititative Survey	Form and Instruction	Unchanged	Available
Form 1 BICS Vermont Grant Resolution Meeting Customer Satisfaction	Form and Instruction	Unchanged	Repair queued
Form 1 Center for States Media Consumption Survey	Form and Instruction	Unchanged	Available
Form 1 Constituency Group Survey	Form and Instruction	Unchanged	Available
Form 1 OCS CED Focus Group	Form and Instruction	Unchanged	Repair queued
Form 1 Special Initiative Survey	Form and Instruction	Unchanged	Repair queued
Form 1 Capacity Building Collaborative Customer Feedback for Learning Experiences	Form and Instruction	Unchanged	Available
Form 1 AFI Outreach Survey	Form and Instruction	Unchanged	Repair queued
Form 1 Collaborative Customer Feedback	Form and Instruction	Unchanged	Repair queued
Form 1 Center for States	Form and Instruction	Unchanged	Available
Form 1 AFI Capacity Building Visit	Form and Instruction	Unchanged	Repair queued
Form 1 Center for Urban Families (CFUF)	Form and Instruction	Unchanged	Available
Form 1 FEI Website Survey	Form and Instruction	Unchanged	Repair queued
Form 1 FEI Focus Group	Form and Instruction	Unchanged	Available
Justification for Increase in Fast Track Burden Ceiling 5-17.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-05-31	Repair queued
Supporting Statement for Fast Track 1-15.docx	Supporting Statement A	Uploaded 2015-02-04	Available
ACF Nonmaterial Nonsubstantive Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-11-19	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
229920	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey	Other-Survey	New
229919	Regugee Health Coordinator Survey	Form and Instruction	New
229876	Feedback on the "Looking forward to the 2019 National Survey of Early Care and Education" webinar	Other-Customer Feedback	New
229784	Comment Form: Fatherhood Research and Practice Network Learning Community	Other-Comment Card	New
229778	Customer feedback focus group with Healthy Marriage and Relationship Education (HMRE) program staff	Other-Focus Group	New
229777	Meeting Evaluation Form - CCDBG Implementation Research and Evaluation Planning Grantees	Other-Survey	New
229704	Region XII Migrant and Seasonal Head Start T/TA Service Delivery Feedback	Form and Instruction	New
229636	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Continuous Quality Improvement (CQI) Practicum Feedback Questions	Other-Survey	New
229632	Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2018 Annual Meeting	Other-Evaluation form	New
229599	Course Participant Knowledge Gain Assessment	Form and Instruction	New
229526	Rigorous Evaluation Technical Assistance (RETA) Feedback Form	Other-Word template	New
228918	OTIP NHTTAC General Fast Track	Form and Instruction	New
228799	National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	Form and Instruction	New
228681	ANA Language Summit Survey	Other-Survey	New
228217	OHS TTA Network Training Feedback Form	Form and Instruction	New
227797	Center for States Needs Assessment 2017	Instruction	New
227438	Adoption Triad Survey	Form and Instruction	New
227436	ANA Post Peer Panel Review Survey	Form and Instruction	New
226904	OAS-TA State Systems Specialist Network Feedback	Form and Instruction	Unchanged
226903	OAS-On-Site Meeting Facilitation State Feedback Collection	Form and Instruction	Unchanged
226902	OAS-Administrator Feedback Collection	Form and Instruction	Unchanged
226898	OAS-TA Feedback Collection for Infant Toddler	Form and Instruction	Unchanged
226784	Follow-Up Needs Assessment Feedback Form	Form and Instruction	Unchanged
226782	Institute Feedback Form	Form and Instruction	Unchanged
226773	OAS-Specialized Resources TA Feedback Collection	Form and Instruction	Unchanged
226527	Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting	Form and Instruction	Unchanged
226463	Human Trafficking Data Collection Pilot	Form and Instruction	Unchanged
226361	ANA Sustainablility Servicers Survey	Form and Instruction	Unchanged
225778	Participant Feedback Form for the CCDBG Implementation Research and Evaluation Planning Grantee Community of Practice Meeting	Other-Feedback From	Unchanged
225714	Feedback on Mother and Infant Home Visiting Program Evaluation (MIHOPE) Long-term Follow-up study design options	Other-Discussion Questions	Unchanged
225618	Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2017 Annual Meeting	Other-Survey	Unchanged
225050	ACF Office of Regional Operations Customer Feedback for Learning Experiences	Other-Survey	Unchanged
224993	OCS-AFI Application Readiness Assessment Questions for Cohert Participants	Form and Instruction	Unchanged
224990	HS-ECLKC Tree Testing	Form and Instruction	Unchanged
224679	ANA Training and Technical Assistance Services Survey	Form and Instruction	Unchanged
224610	MIECHV Grantee Feedback on Data and Evaluation Technical Assistance	Other-Small group discussion	Unchanged
224345	ANA 2016 Communication Survey	Form and Instruction	Unchanged
223858	PMFO New Director Mentor Iniative	Form and Instruction	Unchanged
223811	Input on Agenda for 2017 Annual Meeting of Child Care and Early Education Policy Research Consortium	Other-Survey	Unchanged
223686	AFI Capacity Building Toolkit Usability Test	Form and Instruction	Unchanged
223591	AFI Grantee Workshop Evaluation Survey	Form and Instruction	Unchanged
223533	PMFO Fiscal Consulting Inititative Feedback Survey	Form and Instruction	Unchanged
223306	CWCB CapLEARN	Form and Instruction	Unchanged
223215	Child Welfare Capacity Building Collaborative Focus Group	Form and Instruction	Unchanged
223172	OHS-Fiscal Consulting Survey	Form and Instruction	Unchanged
223170	OHS-Event Session Survey	Form and Instruction	Unchanged
223166	OHS-Conference Feedback Survey	Form and Instruction	Unchanged
223017	SOAR Human Trafficking Training End-of-Course Evaluation	Form and Instruction	Unchanged
222295	Virtual Conference Session Evaluation	Form and Instruction	Unchanged
222294	CWIG Virtual Conference Exit Survey	Form and Instruction	Unchanged
221800	SOAR End of Course Evaluation	Form and Instruction	Unchanged
221738	OTIP	Form and Instruction	Unchanged
221682	Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinars 3&4	Other-null	Unchanged
221461	National Foster Care and Adoption Directory Survey	Form and Instruction	Unchanged
221111	Center for States - 2015	Form and Instruction	Unchanged
220980	Investigation and Analysis of AFI	Form and Instruction	Unchanged
220065	Father Involvement Communication Checks	Form and Instruction	Unchanged
220048	Child Welfare Information Gateways's Special Inititative Survey	Form and Instruction	Unchanged
220018	BICS Vermont Grant Resolution Meeting Customer Satisfaction	Form and Instruction	Unchanged
220013	Center for States Media Consumption Survey	Form and Instruction	Unchanged
219984	Tribal MIECHV Data System Planning	Other-Survey	Unchanged
219933	Constituency Group Survey	Form and Instruction	Unchanged
219265	OCS CED Focus Group	Form and Instruction	Unchanged
219240	Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar	Other-survey and polls	Unchanged
219077	Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting	Other-Feedback form	Unchanged
218714	Special Initiative Survey	Form and Instruction	Unchanged
218540	Capacity Building Collaborative Customer Feedback for Learning Experiences	Form and Instruction	Unchanged
218317	AFI Outreach Survey	Form and Instruction	Unchanged
218119	Collaborative Customer Feedback	Form and Instruction	Unchanged
218106	Comment Form: 2015 OPRE Innovative Methods Meeting	Other-Comment form	Unchanged
217606	Center for States	Form and Instruction	Unchanged
217090	Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting	Other-Survey	Unchanged
216671	AFI Capacity Building Visit	Form and Instruction	Unchanged
216659	Center for Urban Families (CFUF)	Form and Instruction	Unchanged
216644	FEI Website Survey	Form and Instruction	Unchanged
216642	FEI Focus Group	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0970-0401	ICR Reference No: 201706-0970-005
Status: Historical Active	Previous ICR Reference No: 201705-0970-010
Agency/Subagency: HHS/ACF	Agency Tracking No: OPRE
Title: Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/05/2017
	Date Received in OIRA: 06/29/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	05/31/2018	05/31/2018
Responses	44,124	0	14,124
Time Burden (Hours)	17,062	0	7,062
Cost Burden (Dollars)	0	0	0

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Abstract: This is a generic request to seek feedback from the public on service delivery. This is in accordance with the Administrations's commitment to improving service delivery.

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Authorizing Statute(s): PL: Pub.L. 110 - 134 125 Name of Law: Head Start Act of 2007
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 69492	11/21/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 3606	01/23/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 76

IC Title	Form No.	Form Name
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2018 Annual Meeting
Regugee Health Coordinator Survey	1	Survey of Refugee Health Coordinators
Customer feedback focus group with Healthy Marriage and Relationship Education (HMRE) program staff
Center for States	1	Center for States Intensive Capacity Building Project
Center for States Media Consumption Survey	1	Media Consumption Survey Instrument
Father Involvement Communication Checks	1	Fatherhood Screener Comm Check
Tribal MIECHV Data System Planning
Virtual Conference Session Evaluation	1	Generic Request
Feedback from Child Care and Early Education Policy Research Consortium (CCEEPRC) Members on the CCEEPRC 2017 Annual Meeting
Follow-Up Needs Assessment Feedback Form	1	Follow-up Needsw Assessment Feedback Form
ANA Language Summit Survey
FEI Focus Group	1	Focus Group
Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinars 3&4
CWIG Virtual Conference Exit Survey	1	Exit Survey
ANA 2016 Communication Survey	1	ANA Comms Survey Questions Survey Monkey
Child Welfare Capacity Building Collaborative Focus Group	1	VirtualConference FocusGroupGuide
CWCB CapLEARN	1	CapLearn registration fields
Institute Feedback Form	1	Institute Feedback Form
OAS-TA State Systems Specialist Network Feedback	1	TA State Systems Network Feedback
OAS-On-Site Meeting Facilitation State Feedback Collection	1	Meeting Facilitation
Rigorous Evaluation Technical Assistance (RETA) Feedback Form
Feedback on the "Looking forward to the 2019 National Survey of Early Care and Education" webinar
FEI Website Survey	1	FEI Website Survey
OCS CED Focus Group	1	CED Grantee Needs Assessmenr
Constituency Group Survey	1	Fast Track Instrument
Investigation and Analysis of AFI	1	AFI Outreach Instruments
SOAR End of Course Evaluation	1	Justification
OHS-Conference Feedback Survey	1	PMFO Conference Survey
OCS-AFI Application Readiness Assessment Questions for Cohert Participants	1	AFI Instruction and Instruments.
Feedback on Mother and Infant Home Visiting Program Evaluation (MIHOPE) Long-term Follow-up study design options
Human Trafficking Data Collection Pilot	1, 1	OTIP DCP Survey Questionnaire ,   DCP Stakeholder Interview Guide
Comment Form: 2015 OPRE Innovative Methods Meeting
Collaborative Customer Feedback	1	Capacity Building Collaborative Customer Feedback Instrument
Center for States - 2015	1	Center for States Needs Assessment Survey 2016
OHS-Event Session Survey	1	Event Session Survey
PMFO Fiscal Consulting Inititative Feedback Survey	1	PMFO Fiscal Consulting Survey
PMFO New Director Mentor Iniative	1	NDMI Live Learning Event Survey
Input on Agenda for 2017 Annual Meeting of Child Care and Early Education Policy Research Consortium
HS-ECLKC Tree Testing	1	ECLKC Tree Testing Script
ACF Office of Regional Operations Customer Feedback for Learning Experiences
OAS-Specialized Resources TA Feedback Collection	1	SCBC Task 2
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) TA Satisfaction Survey
Center for Urban Families (CFUF)	1	National Responsible Fatherhood Clearinghouse (NRFC)
Capacity Building Collaborative Customer Feedback for Learning Experiences	1	Capacity Building Collaborative Customer Feedback Instrument
Feedback from participants at the Enhancing the Cultural Responsiveness of Social Services Webinar
Child Welfare Information Gateways's Special Inititative Survey	1	CWIG Special Inititiative Survey for OMB 1-20-16
BICS Vermont Grant Resolution Meeting Customer Satisfaction	1	VT BICS Draft Questionaire 2-8-16
OTIP	1	OTIP Fast Track Request
National Foster Care and Adoption Directory Survey	1	NFCAD Survey
AFI Capacity Building Toolkit Usability Test	1	Fast Track Toolkit Survey Instrument
MIECHV Grantee Feedback on Data and Evaluation Technical Assistance
ANA Sustainablility Servicers Survey	1	3 Year Posst Project Survey
Soliciatation of Opinions for 2017 ACF Native American Grantee Meeting	1	IC for 2017 ACF Grantee Meeting
Course Participant Knowledge Gain Assessment	1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1	EBPAS-36 ,   Instructor Experience Survey Final ,   Instructor Unit Survey ,   Instructor Unit Survey Final ,   Participant Experience Survey Final ,   Unit Post Test Final ,   Unit 2 Post Test Final ,   Unit 2Pre Test Final ,   Unit 3 Post-Test Final ,   Unit 3 Pre Test Final ,   Unit 4 Post-Test Final ,   Unit 4 Pre Test Final ,   Unit 5 Post Test Final ,   Unit 5 Pre Test Final ,   Unit 6 Post-Test Final ,   Unit 6 Pre Test Final
Meeting Evaluation Form - CCDBG Implementation Research and Evaluation Planning Grantees
Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting
OHS-Fiscal Consulting Survey	1	Fiscal Consulting Survey
AFI Grantee Workshop Evaluation Survey	1	Grantee Workshop Survey Instrument
ANA Training and Technical Assistance Services Survey	1	ANA TTA Survey Questions
OAS-TA Feedback Collection for Infant Toddler	1	SCBC Task 3
Center for States Needs Assessment 2017
Comment Form: Fatherhood Research and Practice Network Learning Community
AFI Capacity Building Visit	1	AFI Capacity Building Visit Feedback Form
AFI Outreach Survey	1	AFI Outreach Assessment
Special Initiative Survey	1	Special Initiative Survey
Input from Child Care Policy Research Consortium Members for CCPRC 2015 Annual Meeting
SOAR Human Trafficking Training End-of-Course Evaluation	1	SOAR End-of-Course Evaluation
Participant Feedback Form for the CCDBG Implementation Research and Evaluation Planning Grantee Community of Practice Meeting
OAS-Administrator Feedback Collection	1	Administrator Feedback Collection
ANA Post Peer Panel Review Survey	1	ANA Survey
OHS TTA Network Training Feedback Form	1	Feedback Form
National Human Trafficking Training and Technical Assistance Center Scholarship Application Forms	1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1	Consultant ,   Coordination ,   FG Demographic Survey ,   FocusGroupGuide ,   Followup ,   GeneralTraining ,   Interview Guide ,   Pilot ,   RequesterFeedback ,   ResourceTool ,   SOAR Blended Learning Participant Form ,   SOAR Conference ,   SOAR Online Participant Form ,   SOAR Organizational Feedback ,   SOAR SpcializedTTA ,   WebinarParticipant
Region XII Migrant and Seasonal Head Start T/TA Service Delivery Feedback	1	Service Delivery Feedback Form
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Continuous Quality Improvement (CQI) Practicum Feedback Questions
Adoption Triad Survey	1	Adoption Triad
OTIP NHTTAC General Fast Track	1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1, 1	Advisory Committee Feedback ,   Call Center Feedback ,   Conference Session Feedback ,   General Conference Feeback ,   HTFellowship POST Program ,   HT Fellowship PREP Program ,   OTIP Grantee Feedback ,   Scholarship Applicant Org ,   ScholarshipAoplicant ,   Short Term TTA Feedback ,   Specialized TTA Feedback ,   Survivor Fellow Feedback ,   Survivor Fellow Feedback ,   Website Feedback

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	44,124	14,124	0	0	30,000	0
Annual Time Burden (Hours)	17,062	7,062	0	0	10,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

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 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;

(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.

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

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/29/2017

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