I understand that:

• (1) a person who obtains or attempts to obtain, by fraudulent means, services to which the person is not entitled may be prosecuted under applicable state and federal laws;
• (2) I am entitled to be notified about my eligibility for services within 20 calendar days from the day CCS receives all required documents;
• (3) I, or my representative, may appeal denial, reduction, or termination of services;
• (4) services will be provided without regard to sex, race, creed, color, national origin, or disability;
• (5) the information on this application is confidential. I give permission to the Workforce Solutions of the Coastal Bend to contact a third party to verify income or family size or to use the Social Security numbers provided for identification and verification of Social Security benefits and income.

All information I have provided represents a complete and accurate statement of my (applicant) family’s circumstances at the time of application. I agree to report any changes to the information submitted within 10 calendar days of the change.

I have agreed to submit this application for services from Workforce Solutions of the Coastal Bend by electronic means. By signing this application electronically, I certify under penalty of perjury and false swearing that my answers are correct and complete to the best of my knowledge. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.