ࡱ> AC@%` bjbjٕ *, 8$BD66$"h%%%R%%%:Q, gR} 06. E  %  R6 D  Department of Children and Families Disclosure Certification for Lobbyist Activities April 2, 2008 A lobbyist is any person, partnership, committee, association, corporation, labor union or any other organization that employs, engages or otherwise uses the services of any governmental affairs agent to influence legislation, regulation or governmental processes. Governmental processes is defined as any attempt to help a represented entity or group to engage in communication with, or to secure information from, an officer or staff member of the Executive Branch of State Government, authorized by law to administer governmental processes or perform other functions related, or perform any other functions related to such processes. Governmental processes shall include but are not limited to the promulgation of any executive order; rate setting; development, negotiation, award, modification or cancellation of a public contract; issuance, denial, modification, renewal, revocation or suspension of licenses or waivers; procedures for purchasing; rendition of addition of administrative determinations. Part I: Certification  FORMCHECKBOX  I hereby certify that no DCF contract funds are being used to contract and/or retain any person or party for Lobbyist activities. This includes amounts charged to General and Administrative Costs (G&A). Part II: Disclosure  FORMCHECKBOX  I hereby certify that the following costs are being charged to the current DCF contract for persons or parties involved in lobbying activities. This includes amounts charged to G&A costs with the below persons or parties for lobbyist activities. NameEmployee or ConsultantAddressCurrent DCF Contract Cost ________________________________________________________________________ Agency Name ___________________________________ _________________________________ Print Name Title ___________________________________ __________________________________ Authorized Signature Date     #/TUbcd   c d z { ijzk_Pk?*)h/hu~5>*CJOJQJ\^JaJ h/hu~CJOJQJ^JaJhs5h4mCJOJQJ^Jh4mCJOJQJ^Jhs5hCJOJQJ^J&h/hc;5CJOJQJ\^JaJ&h/h~_{5CJOJQJ\^JaJ h~_{5CJOJQJ\^JaJ hu~5CJOJQJ\^JaJ&h/hY5CJOJQJ\^JaJ&h/hu~5CJOJQJ\^JaJ&h/hY5CJOJQJ\^JaJ$Ucdq r c d z { Z [ o p z{ $7$8$H$a$gdu~$dh7$8$H$a$gd$dh7$8$H$a$gdPD 7$8$H$gdu~$a$gd $7$8$H$a$gdu~{ |   3 : Y Z [ o p q  ߶ߨxjUGh/hu~5CJ\aJ)hga:hu~5>*CJOJQJ\^JaJh8MCJOJQJ^JaJhuCJOJQJ^JaJ hPDhPDCJOJQJ^JaJ h/hCJOJQJ^JaJhPDCJOJQJ^JaJ h/hu~CJOJQJ^JaJ/jh~_{hfCJOJQJU^JaJh~_{CJOJQJ^JaJ#jh~_{CJOJQJU^JaJ 8>yz{Ƕǚ{pe{pe{Yp{p{p{p{p{pNhu~5CJ\aJh/h~_{5CJaJh~_{5CJ\aJh/h~_{CJaJh/h~_{5CJ\aJ h/hu~CJOJQJ^JaJhuCJOJQJ^JaJh%CJOJQJ^JaJ h/hCJOJQJ^JaJh~_{CJOJQJ^JaJ#jh~_{CJOJQJU^JaJ/jth~_{hfCJOJQJU^JaJ{Ekd$$Ifl\ *," |  t0644 lal$ h(|)$7$8$H$Ifa$gd/Hkd$$Ifl\ *," |  t0644 lal h(|)$7$8$H$IfgdDUHkd$$Ifl\ *," |  t0644 lal h(|)$7$8$H$IfgdDU^HHHH h(|)$7$8$H$IfgdDUkd$$Ifl\ *," |  t0644 lal^HHHH h(|)$7$8$H$IfgdDUkd4$$Ifl\ *," |  t0644 lal*+r^MMDDBB 7$8$H$gdu~  7$8$H$^ ` gdu~kd$$Ifl\ *," |  t0644 lal)*+qr䲪hHjhHU h/heCJOJQJ^JaJh/hu~CJaJhpF5CJ\aJh~_{5CJ\aJh/hu~5CJ\aJh/hs55CJ\aJr 7$8$H$gd/ 7$8$H$gdu~(/ =!"#$% tDeCheck1tDeCheck2$$Ifl!vh5 5|5 5#v #v|#v #v:Vl t6,,5 5|5 5al$$Ifl!vh5 5|5 5#v #v|#v #v:Vl t65 5|5 5al$$Ifl!vh5 5|5 5#v #v|#v #v:Vl t65 5|5 5al$$Ifl!vh5 5|5 5#v #v|#v #v:Vl t65 5|5 5al$$Ifl!vh5 5|5 5#v #v|#v #v:Vl t65 5|5 5al$$Ifl!vh5 5|5 5#v #v|#v #v:Vl t65 5|5 5al<@< u~NormalCJ_HmH sH tH DA@D Default Paragraph FontRi@R  Table Normal4 l4a (k(No Listj@j u~ Table Grid7:V06U@6 u~ Hyperlink >*B*ph4@4  Header  !4 @"4  Footer  !.)@1.  Page NumberH@BH tF Balloon TextCJOJQJ^JaJB'QB 4mComment ReferenceCJaJ8b8 4m Comment TextCJ@jab@ 4mComment Subject5\,$Ucdqrcdz{Z[opz{*+r0000000000000000000000000000000000000000000000000000000000J00J00 00J0/H0H0P/H0H0/H0H0/H0H0 /H0H0  4DH0J0H00H00H00H00H00\ {   {r  {pG G 8@0(  B S  ? FolioHit1Check1Check2d|qn2)Ub8*urn:schemas-microsoft-com:office:smarttagsdate p~220084DayMonthYear{YYp>>+.%!}<.87f#`hhh^h`5o(hH)h^`5o(hH)h 88^8`o(hH)h^`5o(hH()h ^`o(hH()h pp^p`o(hH()h   ^ `o(hH.h @ @ ^@ `o(hH.h   ^ `o(hH. hh^h`hH. 88^8`hH. L^`LhH.   ^ `hH.   ^ `hH. xLx^x`LhH. HH^H`hH. ^`hH. L^`LhH.+.%!.87         98ihHP* IF f\Pf~VnY4|N+/;223ga:c;tF&QK8MsUDUNDW{JPD|%s5= Qf%<AcDJwpF)k{@UU@~UU@@UnknownGz Times New Roman5Symbol3& z Arial5& zaTahoma"1hyǦzǦxKf//!4d2qXZ ?u~2Public Law 2005, Chapter 51vbaileyAuthorized User  Oh+'0  $0 P \ h tPublic Law 2005, Chapter 51vbailey Normal.dotAuthorized User3Microsoft Office Word@G@8j@@/՜.+,0  hp   NJ Department of Human Services' Public Law 2005, Chapter 51 Title  !"#$%&'()*+,-./12345679:;<=>?BRoot Entry FzDData 1Table* WordDocument*,SummaryInformation(0DocumentSummaryInformation88CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q