Sample Supervisor Certification Form

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/their 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.

OR

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

Date:

(Signature)