Illinois Statutes Chapter 20. Executive Branch § 505/9.3. Declarations by parents and guardians

§ 9.3. Declarations by parents and guardians. Information requested of parents and guardians shall be submitted on forms or questionnaires prescribed by the Department or units of local government as the case may be and shall contain a written declaration to be signed by the parent or guardian in substantially the following form:

“I declare under penalties of perjury that I have examined this form or questionnaire and all accompanying statements or documents pertaining to my income, or any other matter having bearing upon my status and ability to provide payment for care and training of my child, and to the best of my knowledge and belief the information supplied is true, correct, and complete”.

A person who makes and subscribes a form or questionnaire which contains, as herein above provided, a written declaration that it is made under the penalties of perjury, knowing it to be false, incorrect or incomplete, in respect to any material statement or representative bearing upon the parent's or guardian's status as a parent or guardian, or upon the parent's or guardian's income, resources, or other matter concerning the parent's or guardian's ability to provide parental payment, shall be subject to the penalties for perjury provided for in Section 32-2 of the Criminal Code of 2012. 1

Parents who refuse to provide such information after three written requests from the Department will be liable to the extent liability is consistent with the standards and rules described in Section 9.1.