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I understand that:
FEDERAL LAW GOVERNING FRAUD
I UNDERSTAND THAT:
Whoever, in any matter within the jurisdiction of any Department or Agency of the United States, knowingly and willfully, conceals or covers up by any trick, scheme or device, a material fact, or makes false, fictitious, or fraudulent statements or representation or makes any false writing or document, knowing the same to contain any false, fictitious statement or entry, shall be fined not more than $10,000 or imprisoned not more than 5 years or both.
I/We agree to supply all necessary information about my/our resources and income and to notify DHRD when my/our situation changes. I/We authorize DHRD to obtain information necessary to establish my/our eligibility for assistance from the appropriate Agencies and that this information shall be kept CONFIDENTIAL. I/We further agree that this information may be released for the purposes of investigation of fraud.
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