Sample Staff Certification Form

CERTIFICATION - STAFF

I, ____ on the staff of _____, of the (Name) (Office Supervisor) _____ of ____ do hereby certify to the Office (name of divisional, regional or field office) (bureau or office) Supervisor, that:

1. I have reviewed the instruction memorandum and attachments pertaining to the June 1, 2011 request by Congressman Jones regarding the Endangered Species Conservation Fund (ESO #            ).

2. I have undertaken a good faith search for all potentially responsive documents within the undersigned’s possession or control;

ALSO

If I was assigned to search for all potentially responsive documents created or stored by a former employee, in places known by current staff of the office to be kept by the former employee, please give the former employee’s name: __.

3. CHECK THE APPROPRIATE ALTERNATIVE:

I have reason to believe that the documents identified with this certification constitute (i) all documents within the possession or control of the undersigned, and/or (ii) if certifying for a former employee, all documents created or stored, and in places known by current staff to be stored, by the above named former employee.

OR

I have reason to believe that there are no potentially responsive documents (i) within the possession or control of the undersigned, or (ii) if certifying for a former employee, all documents created or stored, and in places known by current staff to be stored, and accordingly, has not identified any documents.

4. The following is information needed to calculate costs associated with my performing the search for and production of records.

Hours/grades of individuals performing work:

Lev Number of R Tal

Date:

(Signature – Print Name and Title)