Form FCC Form 2301(b) FCC Form 2301(b) Incarcerated People’s Communications Services Annual Rep

Appendix C – Annual Certification Form

Incarcerated People’s Communications Services Annual Report Certification Form (FCC Form 2301(b)) Not yet approved by OMB OMB Control No. 3060-1222 / Month 2025 Estimated Time Per Response: 5 Hours Please Read Instructions Before Completing (To Be Completed by Service Provider)
1. Name of Service Provider	2. Reporting Period
3. Authorized Officer Name, Title
4. Mailing Address of Authorized 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 with first-hand knowledge of the truthfulness, accuracy, and completeness of the information provided must certify as follows: I swear under penalty of perjury that: I ________________________________________________________(name and title), am an officer of the above-named service provider and am authorized to submit the attached Annual Report on behalf of the service provider; I have examined the attached Annual Report, 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 Annual Report are true, accurate, and complete; and The above-named service provider is in compliance with the Federal Communications Commission’s rules governing incarcerated people’s communications services (IPCS). I acknowledge that failure to comply with the rules governing IPCS may result in civil or criminal prosecution.
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 IPCS provider’s response to Form 2301(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-PPM, Washington, DC 20554, Paperwork Reduction Project (3060-1222). 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 3060-1222.

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