Attestation Statement Clause Samples
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Attestation Statement. Provide the name, address and email of the parent or guardian of the child. The signature of the parent or guardian of the child verifies the accuracy of the information supplied. PAPERWORK BURDEN STATEMENT According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1810-0021. The time required to complete this portion of the information collection per type of respondent is estimated to average: 15 minutes per Indian student certification (ED 506) form; including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Office of Indian Education, U.S. Department of Education, ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇.▇., ▇▇▇/▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, D.C. 20202-6335. OMB Number: 1810-0021 Expiration Date: 02/29/2020. Student Name: (last) (first) Birthdate: Life-Threatening Conditions: (Care plan is REQUIRED) Nervous System Blood / Hematology Cardiac / Heart Allergy, Immune, Endocrine, Metabolic and Nutritional Gastrointestinal, Dental and Oral Musculoskeletal Cancer / Tumor Mental or Behavioral Health Respiratory / Breathing Skin Renal / Kidney Ear / Hearing Eye / Vision Other Health Concerns: Medical Devices Stoma Physical Activity / Mobility Issues: Parent/Legal Guardian Name (Please Print): OR OR OR OR Required Health Report To the Doctor: As part of the health education program in the school, it is the School Board policy for all kindergartners, 6th graders, and interscholastic athletes (grades 6-12) to have a complete physical examination. Please complete this form and have the parents return it to the school nurse. General health: In addition to the above information, did the examination reveal anything the school should know about the general health of this student, such as hearing, vision, emotional stability, etc? If so, please comment below: School
Attestation Statement. A Responsible Company Official must sign the Attestation Statement (Attachment B) indicating understanding of the Privacy Act restrictions relating to the use of this service. The signed and dated Statement must be submitted to SSA with this User Agreement. If the Responsible Company Official signing the original Attestation Statement leaves the company or no longer has authority to make legally binding commitments on behalf of the company, a new Responsible Company Official must submit a new signed Attestation Statement prior to the submission of any new SSN verification requests.
Attestation Statement. Notwithstanding the foregoing, no Performance Assurance Formatted: Indent: Hanging: 36
Attestation Statement. As an anticipated enrollee in North Carolina Central University’s School of Business, I have read, understand and accept all terms and conditions outlined within this program agreement. I also understand that the institution reserves the right to cancel or modify this program at any time. If the student is a minor (below the age of 18), a parent or legal guardian must also sign this agreement.
Attestation Statement. I verify that the information provided above is true and correct to the best of my knowledge and belief. Printed Name of Parent/Guardian Signature Address City State Zip Code Phone Number Email Date OMB Control No. 1810-0021 (Exp. 04/30/2023)
Attestation Statement. I verify that the information provided above is true and correct to the best of my knowledge and belief. Printed Name of Parent/Guardian Signature Address City State Zip Code Phone Number Email Date
Attestation Statement. Notwithstanding the foregoing, no Performance Assurance requirement will be required for the Customer’s TSR if the Customer has an NT Transmission Service Agreement, the Customer’s Eligible TSR is for transmission of a new Network Resource, and the Customer submits a statement attesting to the resource and generation conditions specified in section 29.2(viii) of the OATT.