Authority/Reference(s) Texas Government Code §573; Texas Government Code §2261
Revision Date September 1, 2019


DFPS staff and staff augmentation contractors who manage any DFPS contracts, or a portion of a DFPS contract, must sign and submit Form 5643, DFPS Nondisclosure and Conflict of Interest Certification:

  • Within 30 days of hire date or prior to receiving access to SCOR (whichever comes first);
  • When transferring to another DFPS contracting position; and
  • Annually during the month of May each calendar year thereafter.

Instructions for completing, submitting, and maintaining Form 5643 can be found on the form itself. Additionally, when requesting access to SCOR, HHS-PCS requires Form PCS-130 to be submitted electronically.

In the event contract staff becomes aware of a change to a personal circumstance that could be (or creates the appearance of) a conflict, all of the following steps should be done as soon as possible:

  • Contract staff signs and submits a revised Form 5643.
  • Contract staff’s supervisor reviews Form 5643 to evaluate for a conflict.
  • If a conflict of interest is found, the supervisor must take action to document the controls and oversight that will be put in place to mitigate the risk. (e.g. contract reassignment).
  • If Form 5643 requires executive leadership signature, then the supervisor coordinates within their program’s guidelines to obtain executive leadership signatures.
  • The supervisor submits the completed form to COS for review.
  • COS processes and archives Form 5643 for any future inquiries or audits.