Exhibit 2, 282 FW 3, Sample Supervisor Certification Form

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Exhibit 2, 282 FW 3
Sample Supervisor Certification Form

Supersedes Exhibit 2, 282 FW 3, 02/27/06

Date: August 22, 2011

Series: Records Management

Part 282: Records Operations

Originating Office: Division of Policy and Directives Management

PDF Version

CERTIFICATION - OFFICE SUPERVISOR

I, the ___________________ for the ____________________________________ located in

(insert title) (name of divisional, regional or field Office)

_____________________________________________, do hereby certify to ______________________,

(city and state of divisional, regional or field office) (name of Senior Contact)

in his/her capacity as the Senior Contact tasked with coordinating searches in the

___________________________ for records responsive to the June 1, 2011 request by Congressman

Jones regarding the Endangered Species Conservation Fund (ESO#________).

1. I have reviewed the instruction memorandum and attachments I have reviewed the instruction

memorandum and attachments pertaining to the June 1, 2011 request by Congressman Jones

regarding the Endangered Species Conservation.

2. I have directed every person in the office who might reasonably be believed to be a possible possessor

of potentially responsive documents to conduct a search and to sign a staff certification form.

3. I have assigned staff of the office to certify that a search and submission of documents, if any, was

conducted for potentially responsive documents created or stored, in places known by current staff to

be stored, by former employees of the office, if any.

4. I have also searched or supervised the search for responsive documents in my possession and control.

5. CHECK THE APPROPRIATE ALTERNATIVE:

I have reason to believe that the documents identified with this certification constitute all

documents within the possession or control of the staff in the office.

I have reason to believe that there are no responsive documents within the possession or control of the staff in the office, and accordingly, have not identified any documents.

6. The following is information needed to calculate costs associated with performing the search for and

production of documents in this office.

Hours/grades of individuals performing work:

Grade/Step Level	Number of Hours	Hourly Rate	Total Cost


















TOTALS

Grade/Step

Date: _____________ _____________________________________________________

(Signature)

_________________________________________________

Print name and title

For more information on the content of this exhibit or about this Web site, contact Krista Holloway of the Division of Policy and Directives Management.

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