10-Child Support Certification.pdf

Printed Name of Contractor

TEXAS

JUVENILE

JUSTICE

DEPARTMENT

Child Support Certification

Section 231.006, Family Code, prohibits the payment of state funds under a grant, contract, or loan to:

1. a person who is more than 30 days delinquent in paying child support; and

2. a business entity in which the obligor is a sole proprietor, partner, shareholder, or owner with an ownership interest of at least 25 percent.

The ineligibility continues until:

1. all arrearages have been paid;

2. the person is in compliance with a written repayment agreement or court order as to any existing delinquency; or

3. the court of continuing jurisdiction over the child support order has granted the obligor an exemption from paying the arrearages as part of a court-supervised effort to improve earnings and child support payments.

The ineligibility under Section 231.006, Family Code, does not apply to governmental entities or to nonprofit entities.

It is the responsibility of the contractor to verify that no person who is a sole proprietor, partner, shareholder, or owner with at least a 25% ownership interest is ineligible to receive payment from state funds under Section 231.006. A state agency is authorized to terminate a contract if it determines that the certification statement (below) is inaccurate or false. In the event it is determined to be false, the vendor is liable to the state for attorney’s fees, costs necessary to complete the contract (including the cost of advertising and awarding a second contract), and any other damages provided by law or contract.

Section 231.006 requires each bid or application for a contract, grant, or loan to include the name and Social Security number of the individual or sole proprietor or of each partner, shareholder, or owner with an ownership interest of at least 25 percent of the business entity submitting the bid or application.

The contractor certifies that the following is a complete list of the names and social security numbers of either:

(a) the individual or sole proprietor who is the contractor; or (b) each partner, shareholder, or owner with an ownership interest of at least 25% of the contractor/business entity:

Printed Name: Social Security Number:

Printed Name: Social Security Number:

Printed Name: Social Security Number:

CERTIFICATION STATEMENT

Under Section 231.006, Family Code, the vendor or applicant certifies that the individual or business entity named in this contract, bid, or application is not ineligible to receive the specified grant, loan, or payment and acknowledges that this contract may be terminated and payment may be withheld if this certification is inaccurate.

Signature of Authorized Representative

Note: With few exceptions, you are entitled upon request: (1) to be informed about the information the agency collects about you; and (2) under Sections 552.021 and 552.023 of the Government Code, to receive and review the collected information. Under Section 559.004 of the Government Code, you are also entitled to request, in accordance with the agency’s procedures, that incorrect information that the agency has collected about you be corrected.

SWORN TO AND SUBSCRIBED before me on the day of , 20 .

Printed Name of Authorized Representative

Notary Public, State of Texas

Notary’s Printed Name

My Commission Expires:

TJJD-FIS-180 (11/21) www.tjjd.texas.gov Page 1 of 1