Provider Certification. I declare under penalty of perjury that the above information is true and that these children were provided services at the above location and on the days and times listed above. I understand that I must repay any overpayment resulting from false or incorrect information and that I may be prosecuted for fraud.
Appears in 4 contracts
Samples: CCDF Program Participant Agreement, CCDF Program Participant Agreement, CCDF Program Participant Agreement
