Appendix G Certification Memo to States

OMB Control Number 0584-0446
Expiration Date xx/xx/xxxx

APPENDIX G CERTIFICATION MEMO TO STATES
U.S. DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
DEBT COLLECTION PROGRAMS
(Treasury Offset Program)

2022 DEBT CERTIFICATION AGREEMENT FOR FEDERAL NONTAX DEBTS
This Annual Debt Certification Agreement for Federal Nontax Debts (Certification Agreement)
is submitted by: _____________________ (State Agency).
Section I: Background
A. The U.S. Department of the Treasury, Bureau of Fiscal Service (Fiscal Service), provides debt
collection services to Federal agencies that are owed delinquent debt.
B. State agencies are generally required to refer delinquent nontax debts to Fiscal Service for debt
collection services on behalf of the Food and Nutrition Service (FNS). See 31 U.S.C.
§§ 3711(g) and 3716(c).
C. Upon submitting debts to Fiscal Service for debt collection services, State agencies are
required to certify to Fiscal Service, among other things, that the debts are valid, legally
enforceable, there are no bars to collection, and all requisite due process has been completed,
as set forth in this Certification Agreement.

Section II: General Provisions
The State Agency understands and agrees to the following:
A. Scope. The provisions of this Certification Agreement apply to all Debts submitted by
Electronic Transmission before, on or after the date of this Certification Agreement, by the
State Agency to Fiscal Service for collection through the Treasury Offset Program (TOP).
B. Certification Authority. Only an individual with delegated authority to certify a Debt on
behalf of the State Agency will submit a Debt to Fiscal Service via an Add Record or Update
Record. The State Agency will provide a copy of this Certification Agreement to any such
individual.

1

OMB Control Number 0584-0446
Expiration Date xx/xx/xxxx

C. Changes to Debt Information.
1. The State Agency understands its obligation to notify Fiscal Service: (a) of any change in
the amount, validity, or legal enforceability of the Debt; and (b) if the Debt becomes subject
to circumstances that legally preclude or bar collection.
2. The State Agency authorizes Fiscal Service to Update Records on its behalf, in accordance
with criteria established by the Fiscal Service, including without limitation for the purpose
of adding alias Debtor name information for a Debt certified by the State Agency. State
Agency will notify Fiscal Service as soon as it learns that any such updates are incorrect.
D. Recall, Inactivation and Closure of Debts.
The State Agency understands its obligation to recall a Debt submitted to the Cross-Servicing
Program and inactivate or close a Debt referred directly to the Treasury Offset Program, as
applicable, if the (a) Debtor has filed for bankruptcy and the automatic stay is in effect; (b) Debt
is not enforceable; (c) Debt is not valid or has been paid in full; (d) State Agency discovers that it
incorrectly certified the Debt; or (e) State Agency discovers any other reason that would render
its certification of the Debt to be invalid.
E. Social Security Number Fraud Prevention Act of 2017. The State Agency either: (1) does not
use an individual debtor’s social security number (SSN) in the account number it submits to Fiscal
Service; or (2) is actively taking steps to discontinue the use of SSNs in such account numbers by
December 31, 2020.
F. Immigration Sponsor Reimbursement Debts. The State Agency certifies that it either: (1) is
not owed any Immigration Sponsor Reimbursement Debts; (2) is owed Immigration Sponsor
Reimbursement Debts and has referred such debts to TOP as required by section 5(c) of the
Presidential Memorandum and has referred such debts to the Attorney General, as required by
section 5(d) of the Presidential Memorandum ; or (3) is owed Immigration Sponsor
Reimbursement Debts and has referred such debts to the Centralized Receivables Service and/or
Cross-Serving Program under the profile that identifies the debts as Immigration Sponsor
Reimbursement Debts in a manner that allows Fiscal Service to accomplish the requirements of
sections 5 (c)-(d) of the Presidential Memorandum.
Section III: Debt Certification
The State Agency understands that by submitting a Debt to Fiscal Service via an Add Record or
Update Record, the individual submitting the Debt is certifying to Fiscal Service, in writing, under
penalty of perjury, that, to the best of his or her knowledge and belief, the following is true and
correct:
A. General Prerequisites for Collection.
1. Valid Debts. The State Agency has made a final determination that the Debt is
valid and legally enforceable in the amount stated, and that the Debt is not subject
to any circumstances that legally preclude or bar collection.
2. Debt Data. All information in the Electronic Transmission of the Debt is accurate.
2

OMB Control Number 0584-0446
Expiration Date xx/xx/xxxx

3. Email Addresses. If the State Agency provides an email address for a Debt, it is
appropriate to send notices for all purposes to that address.
4. Foreign Addresses. If the State Agency provides a foreign address for a Debt, it
is appropriate to send notices for all purposes to that address.
5. Promulgation of Regulations. The State Agency has promulgated all regulations
required by 31 CFR parts 285 and 900-904 to transfer debts to Fiscal Services for
collection by administrative offset, tax refund offset, Federal salary offset,
administrative wage garnishment, and other collection tools authorized and/or
required by Federal Claims Collection Standards (31 CFR Parts 900-904), as may
be amended, as well as other statues, regulations and policies applicable to
collection of the Debt.
6. Creditor Agency Profile Form. The State Agency Profile Form has been completed
by the Creditor Agency and is accurate and up-to-date.
7. Fraud and Antitrust Debts. The Debt: (a) does not appear to involve fraud, the
presentation of a false claim, a misrepresentation on the part of the debtor or any
party having an interest in the Debt, or conduct in violation of the antitrust laws, or
(b) was referred to the Department of Justice in accordance with 31 U.S.C. §3711
(b)(1) and 31 CFR § 900.3(a), and the Department of Justice returned the Debt to
the State Agency for further collection.
8. Compliance with Fiscal Service’s Privacy and Security Requirements. The State
Agency is compliant with the Fiscal Service Technical Guidance and all rules of
behavior for Fiscal Service’s debt collection systems. In addition, the State Agency
has confirmed that each individual that has access to information in Fiscal Service’s
system(s): (a) is familiar with applicable Fiscal Service Technical Guidance and
rules of behavior, (b) has a need to access the system(s), (c) accesses the system(s)
only to the extent the individual has a “need to know” the information, and (d) will
not re-disclose the information unless permitted by the Fiscal Service Technical
Guidance, rules of behavior, and applicable law.

B.

General Prerequisites for Collection through the Treasury Offset Program and/or the
Cross Servicing Program.
1. Delinquent Debts. The Debt is delinquent, and the Debtor is not paying the Debt
in accordance with any repayment agreement entered into with the State Agency.
2. Interest, Penalties, and Administrative Costs. The State Agency has complied with
all of the provisions of 31 U.S.C. § 3717 and 31 CFR §901.9, as well as other
statutes, regulations, agreements, and/or policies applicable to State Agency’s
assessment of interest, penalties, and administrative costs on the Debt. The State
3

OMB Control Number 0584-0446
Expiration Date xx/xx/xxxx

Agency has provided a written notice to the Debtor explaining the State Agency’s
requirements concerning the assessment of interest, penalties, and administrative
costs.
3. Debtor Disputes. The State Agency has considered any and all evidence presented
by the Debtor disputing the State Agency’s determination about the Debt, and there
are no pending appeals of such determination that would preclude collection of the
Debt.
4. Collection Efforts. The State Agency has made reasonable efforts to obtain
payment of the Debt, at a minimum, by demanding payment of the Debt.
5. Exception. Notwithstanding anything else in this Certification Agreement, with
regard to direct referrals of Debt to TOP, the State Agency may aggregate multiple
debts into a single referral, if: (a) it is currently operationally impossible for the
State Agency to separate the debts into separate referrals for each debt; (b) the State
Agency is making improvements so that it becomes operationally possible to refer
new debts to TOP separately, and also to separate all existing aggregated multiple
debts within TOP, by no later August 31, 2020; and (c) the State Agency ensures
that the referral lists the most recent delinquency date of the multiple debts included
in the referral.
C.

General Prerequisites for Collection by Administrative and Tax Refund Offset. If, in
the State Agency Profile Form, the State Agency has authorized Fiscal Services to collect
the Debt by offsetting Federal and State tax and nontax payments:
1. Compliance with Offset Laws. The State Agency has complied withal of the provisions
of the 31 U.S.C. § § 3711(g)(90(A)-(B), 3716 and 3720A, 31 CFR Part 285, and Federal
Claims Collection Standards (31 CFR Parts 900-904), as well as other statues,
regulations, and policies applicable to the collection of the Debt by offset.
2. Due Process Prerequisites. At least 60 days prior to the Certification Date, the State
Agency has provided, or made a reasonable attempt to provide, in accordance with
applicable offset regulations, each Debtor with:
a. a written notification, at the Debtor’s most current known address, of the
nature and the amount of the Debt, the intention of the State Agency to
collect the Debt through offset, including offset of Federal and State
payments, and an explanation of the rights of the Debtor;
b. an opportunity to inspect and copy the records of the State Agency with
respect to the Debt;
c. an opportunity for review of the State Agency’s determination with
respect to the Debt, including an opportunity to present evidence that all
4

OMB Control Number 0584-0446
Expiration Date xx/xx/xxxx

or part of the Debt is not delinquent or legally enforceable; and
d. an opportunity to enter into a written repayment agreement with the State
Agency under terms acceptable to the State Agency.
3. Due Process Prerequisites for Certain Older Debts. For a Debt outstanding more than ten
years on or before December 28, 2009, the State Agency sent the notice described in
Section III.B.2.a to the last known address of the Debtor after the Debt was outstanding for
more than ten years, and afforded the Debtor the opportunities described in Sections
III.B.2.b. - II.B.2.d. at that time. This requirement does not apply to any Debt that could
be collected by offset without regard to any time limitation prior to December 28, 2009.
D.

Prerequisites for Collection by Federal Salary Offset. If, through a Salary Offset
Instruction, FNS has authorized Fiscal Services to collect the Debt by offsetting Federal
salary payments:
1. Compliance with Federal Salary Offset Laws. The State Agency has complied
with all of the provisions of 5 U.S.C. § 5514, 31 U.S.C § 3711(g)(9)(C), 5 CFR §
§550.1101-1110, and 31 CFR § 285.7, as may be amended, as well as other statues,
regulations and policies applicable to collection by salary offset;
2. Federal Offset Bypass. The State Agency will not remove the Federal Salary bypass Indicator placed on debts by FNS.
Section IV: Debt Recertification

With respect to the Debt submitted to Fiscal Service (or its predecessor) prior to the execution of
this Certification Agreement, if the Debt remains subject to collection by offset through the
Treasury Offset Program.
A.

Compliance with General Prerequisites for Collection. The Creditor Agency recertifies, in writing, under penalty of perjury, that, to the best of its knowledge and belief,
all of the general prerequisites for collection set forth in Section III are true and correct.

5

OMB Control Number 0584-0446
Expiration Date xx/xx/xxxx

Section V: Authority
By signing below, I certify that I have delegated authority to execute this Certification
Agreement on behalf of the head of State Agency and understand this agreement applies to all
Debts submitted by Electronic Transmission before, on, or after the date of the Certification
Agreement to Fiscal Service for collection through the Cross-Servicing Program, and/or the
Treasury Offset Program.
Signature: ________________________________
Print Name: ______________________________
Title: ____________________________________
Date: ____________________________________

6

OMB Control Number 0584-0446
Expiration Date xx/xx/xxxx

7