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SAMPLE OF CERTIFICATION MEMORANDUM

The following sample of a certification must be used and typed on letterhead and coordinated
with the General Counsel and Legislative Affairs (for Interim and Final Rules!
("se #$A or $ervice $ecretary Letterhead
(date
%&%'RA()"% F'R G&(&RAL C'"($&L 'F T*& )&#ART%&(T 'F )&F&($&
(ATT(! )o) R&G"LAT'R+ #'LIC+ 'FFIC&R
$",-&CT! Certification of Rule Compliance with &.ecutive and Legislative Re/uirements
Re/uest the attached rule be published in the Federal Register0 Certifications follow!
Executive Order 12866, Reu!"t#r$ P!"%%i% "%d Revie&'
It has been determined that 12 CFR part [insert part number] is not a significant regulatory
action0 The rule does not!
(3 *ave an annual effect on the economy of 4355 million or more or adversely affect in a
material way the economy6 a section of the economy6 productivity6 competition6 7obs6 the
environment6 public health or safety6 or $tate8 local8 or tribal governments or communities6
(2 Create a serious inconsistency or otherwise interfere with an action ta9en or planned by
another Agency6
(1 %aterially alter the budgetary impact of entitlements8 grants8 user fees8 or loan programs8 or
the rights and obligations of recipients thereof6 or
(: Raise novel legal or policy issues arising out of legal mandates8 the #resident;s priorities8 or
the principles set forth in this &.ecutive 'rder0
U%(u%ded M"%d"te) Re(#r* Act +Sec, 2-2, Pu., L, 1-/0/1
It has been certified that this rule does not contain a Federal mandate that may result in the
e.penditure by $tate8 local and tribal governments8 in aggregate8 or by the private sector8 of 4355
million or more in any one year0
Pu.!ic L"& 26034/, Reu!"t#r$ F!exi.i!it$ Act' +4 U,S,C, 6-11
It has been certified that this rule is not sub7ect to the Regulatory Fle.ibility Act (< "0$0C0 =53
because it would not8 if promulgated8 have a significant economic impact on a substantial
number of small entities0 >Insert a succinct statement explaining the reason for such
certification0?
Pu.!ic L"& 260411, P"5er&#r6 Reducti#% Act' +// U,S,C, C7"5ter 341
It has been certified that this rule does not impose reporting or record9eeping re/uirements under
the #aperwor9 Reduction Act of 3@@<0
or
It has been certified that this rule does impose reporting or record9eeping re/uirements under the
#aperwor9 Reduction Act of 3@@<0 The reporting and record9eeping re/uirements have been
submitted to '%, for review0
Executive Order 13132, Feder"!i)*'
It has been certified that this rule does not have federalism implications8 as set forth in &.ecutive
'rder 313120 This rule does not have substantial direct effects on!
(3 The $tates6
(2 The relationship between the (ational Government and the $tates6 or
(1 The distribution of power and responsibilities among the various levels of Government0
[Signature of PSA or Service Secretary]
AAAAAAAAAAAAAAAAAAAAAAAA
[GC Coordination]
AAAAAAAAAAAAAAAAAAAAAAAA
>LA Coordination if an
Interim or inal !ule?

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