FCC Form 2303(b) 2023 IPCS MDC Certification Form

APPENDIX C

Incarcerated People’s Communications Services 2023 Mandatory Data Collection Certification Form (FCC Form 2303(b)) OMB Control No. 3060-XXXX / Not Approved by OMB Estimated Time Per Response: 5 Hours Please Read Instructions Before Completing (To Be Completed by Provider)
1. Name of Provider	2. Reporting Period: Calendar Year 2022
3. Authorized Officer Name, Title
4. Mailing Address of Officer Street Address
City State Zip Code
5. Telephone Number
6. Email Address
7. Certification
The Chief Executive Officer (CEO), Chief Financial Officer (CFO), or other senior executive officer with first-hand knowledge of the truthfulness, accuracy, and completeness of the information provided certifies as follows: I swear under penalty of perjury that: I, __________________________________________________ (name and title), am an officer of the above-named Provider and am authorized to submit the attached Mandatory Data Collection response on behalf of the Provider; I have examined the attached Mandatory Data Collection response and all requested information has been provided; Based on information known to me, or provided to me by employees responsible for the information being submitted, and on my own reasonable inquiry, all statements and information contained in the attached Mandatory Data Collection response are true, accurate, and complete.
8. Signature of Authorized Officer		9. Date
10. Printed Name of Authorized Officer

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT

We have estimated that each ICS provider’s response to Form 2303(b) will take 5 hours. Our estimate includes the time to read the instructions, look through existing records, gather and maintain the required data, and complete and review the form. If you have any comments on this estimate, or on how we can improve the collection and reduce the burden it causes you, please write the Federal Communications Commission, AMD-PERM, Washington, DC 20554, Paperwork Reduction Project (3060-XXXX). We will also accept your comments via the Internet if you send them to [email protected]. Please DO NOT SEND COMPLETED APPLICATIONS TO THIS ADDRESS. Remember—you are not required to respond to a collection of information sponsored by the Federal government, and the government may not conduct or sponsor this collection, unless it displays a currently valid OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB Control Number of 3060-XXXX.

THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, P.L. 104-13, OCTOBER 1, 1995, 44 U.S.C. 3507.