THIS REPORT FORM IS COMPLETED BY
PRIVATE ATTORNEYS WHO WISH TO PARTICIPATE IN THE EEOC REFERRAL
PROGRAM WHICH FUNCTIONS TO REFER CHARGING PARTIES, WHO REQUEST
LEGAL ASSISTANCE, TO PARTICIPATING ATTORNEYS. THE DATA ON THE FORM
ENABLES THE EEOC TO IDENTIFY THE ATTORNEY TO A CHARGING PARTY WHO
REQUESTS LEGAL ASSISTANCE AND APPRISES THE EEOC OF THE ATTORNEY'S
QUALIFICATIONS, EXPERIENCES, AND OTHER INFORMATION PERTINENT TO THE
ATTORNEY'S LAW PRACTICES IN ORDE
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.