Form FCC Form 2301 (b) FCC Form 2301 (b) Inmate Calling Services Annual Certification Form

OMB Control No. 3060-1222
Not Yet Approved by OMB

FCC Form 2301(b) Estimated Time Per Response: 5 Hours

Inmate Calling Services Annual Certification Form

Please Read Instructions Before Completing (To Be Completed by Service Provider)

1. Name of Service Provider	2. Reporting Year
3. Officer Name, Title
4. Mailing Address of Officer Street Address
City State Zip Code
5. Telephone Number
6. Email Address
Block 2: Certification
The chief executive officer (CEO), chief financial officer (CFO), or other senior executive with first-hand knowledge of the 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 Reports on behalf of the service provider; I have examined the attached Annual Reporting Forms and all requested information has been provided; Based on information known to me, or provided to me by employees responsible for the data being submitted, all statements of fact, as well as all data, are true and accurate; and The above-named service provider is in compliance with the Federal Communications Commission’s rules governing inmate calling services (ICS). I acknowledge that failure to comply with the rules governing ICS may result in civil or criminal prosecution.
9. Signature of Authorized Person	10. Date
11. Printed name of Authorized Person

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT

We have estimated that each response to this collection of information will take 5 hours. Our estimate includes the time to read the instructions, look through existing records, gather and maintain the required data, and actually complete and review the form or response. 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-PERM, Paperwork Reduction Project (3060-1222), Washington, DC 20554. We will also accept your comments via the Internet if your send them to pra@fcc.gov. 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

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