Exhibit S, Federal Funding Accountability and Transparency Act (FFATA) Certification.pdf

FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)

CERTIFICATION

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Legal Name of Contractor: FFATA Contact # 1 Name, Email and Phone Number:

Primary Address of Contractor: FFATA Contact #2 Name, Email and Phone Number:

ZIP Code: 9-digits Required www.usps.com Primary DUNS Number: 9-digits Required http://www.dnb.com/us/

State of Texas Comptroller Vendor Identification Number (VIN) 14 Digits

Printed Name of Authorized Representative Signature of Authorized Representative

Title of Authorized Representative Date

The certifications enumerated below represent material facts upon which HHSC relies when reporting information to the federal government required under federal law. If HHSC later determines that the Contractor knowingly rendered an erroneous certification, HHSC may pursue all available remedies in accordance with Texas and U.S. laws. Signor further agrees that it will provide immediate written notice to HHSC if at any time Signor learns that any of the certifications provided for below were erroneous when submitted or have since become erroneous by reason of changed circumstances. If the Signor cannot certify all of the statements contained in this section, Signor must provide written notice to HHSC detailing which of the below statements it cannot certify and why.

RFP No. HHS0015252 Exhibit S http://www.usps.com/ http://www.dnb.com/us/

FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)

CERTIFICATION

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As the duly authorized representative (Signor) of the Contractor, I hereby certify that the statements made by me in this certification form are true, complete and correct to the best of my knowledge.

Did your organization have a gross income, from all sources, of less than $300,000 in your previous tax year? Yes No

If your answer is "Yes," skip questions "A," "B," and "C" and finish the certification.

If your answer is "No," answer questions "A" and "B."

A. Certification Regarding Percent (%) of Annual Gross from Federal Awards.

Did your organization receive 80% or more of its annual gross revenue from federal awards during the preceding fiscal year? Yes No

B. Certification Regarding Amount of Annual Gross from Federal Awards.

Did your organization receive $25 million or more in annual gross revenues from federal awards in the preceding fiscal year? Yes No

If your answer is "Yes" to both question "A" and "B," you must answer question "C."

If your answer is "No" to either question "A" or "B," skip question "C" and finish the certification.

C. Certification Regarding Public Access to Compensation Information.

Does the public have access to information about the highly compensated officers/senior executives in your business or organization (including parent organization, all branches, and all affiliates worldwide) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? Yes No

If your answer is “Yes” to this question, where can this information be accessed?

If your answer is “No” to this question, you must provide the names and total compensation of the top five highly compensated officers below.

Provide compensation information here:

RFP No. HHS0015252 Exhibit S