Statement of Responsibility

Texas Department of State Health Services Funding Information Center 

Books, DVDs and CDs in the Texas Department of State Health Services Funding Information Center collection are inventoried state property. The person requesting and receiving item(s) assumes all responsibility for borrowed item(s). Borrower responsibility includes:

1. Prompt return of items by the scheduled date. The borrower is responsible for return shipping costs. Any borrower having two (2) late returns will have their borrowing privileges suspended. You may renew items by contacting the Funding Information Center. Borrowers with outstanding materials will not be shipped any more orders. DSHS Library will view failure to return borrowed items when we request them as theft of state property, a violation of Section 31.03, Texas Penal Code, the conviction of which could, depending on value, result in a fine not to exceed $500 (Class C Misdemeanor), to confinement of up to 10 years and a fine up to $10,000 (Third Degree Felony). Please return the items by U.S. mail, UPS or other insured carrier. A return mailing address label is enclosed for return of item(s).

2. Replacement of lost or damaged item(s). The item(s) returned by U.S. mail should be insured for at least $25 each. Borrowers will be liable for returned uninsured shipment lost in transit. If an item is lost or damaged, the Funding Information Center will invoice the borrower for the full replacement value of the item(s).

3. Copyright compliance. Do not duplicate items without prior written permission from the copyright owner. Violations of federal copyright law will result in the immediate suspension of library borrowing privileges and prosecution by the copyright owner can result in financial penalties and/or jail.

4. Privacy Notification. With a few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any incorrect information. See for more information on Privacy Notification. (Reference: Government Code, Section 552.021, 552.023, 559.003 and 559.004)

I acknowledge financial responsibility to the State of Texas should items borrowed be lost, stolen, or damaged from the date I receive the items until the publication(s) have been returned to the library. I have read and agree to the terms in the Statement of Responsibility listed above. 

Please email, mail or fax this completed form to the Funding Information Center.


Name/Organization: ____________________________________________________________________________________
Mailing Address: _______________________________________________________________________________________

City: _____________________________________ Zip: ______________ County: __________________________________

Email Address: ________________________________________________________________________________________

Phone: ____________________________________________  Fax: _____________________________________________

Signature: ____________________________________________________________________________________________

Date: _____________________________________