4:045 E2 Notice of Claim and Intent to Seek Debt Recovery, Challenge; and Response to Challenge
Print on district letterhead or on form with district name and address.
The information in this Notice of Claim is confidential; disclosure is limited to staff members who have a business need to be informed.
Section 1 – Notice of Claim and Intent to Seek Payment of a Delinquent Debt. The District completes this section and sends the entire Notice of Claim to the person or entity that is the subject of the claim.
To: ________________________ ________________________________
Name Address
Our records show that you owe the School District $___________ for: (Describe the reason for the debt and date(s) incurred): ___________________________________________________________________
After attempts at the school-building level to notify you of this debt and obtain payment, your debt has been referred to the District’s Business Office. This debt is past due and legally enforceable. Unless this debt is paid on or before , the District will seek collection to the fullest extent of the law. That means that you may see a decrease in a future payment(s) that the State makes to you by the amount of the debt that you owe the District, plus a recovery fee until your debt is paid.
You may challenge this claim any time before by completing Section 2 below and returning this Notice of Claim to the Superintendent’s office. If you challenge the debt, you will be invited to an informal proceeding in which the District Business Office will describe the claim and you can explain why you believe the claim is invalid and/or the amount is wrong. A decision finding the debt enforceable will be automatically reviewed by me or my designee (who is not a subordinate of the individual making the enforceability finding).
____________________________________ ________________
Superintendent Date
Section 2 – Challenge. The individual or entity who wants to challenge the claim must complete this section and return the entire Notice of Claim to the Superintendent’s office.
I am challenging the claim. Please check all that apply.
_____ I am submitting with this Notice of a Claim a written explanation of why I believe the claim is invalid or the amount is wrong.
_____ I would like to explain why I believe the claim is invalid or the amount is wrong during an informal proceeding by telephone or at a meeting in the District Office.
_____ I am requesting a copy of this Challenge to My Notice of Claim.
____________________________________________ _____________
Individual or entity challenging the claim Date
__________________________________________
Contact Number
Section 3 – Findings. The Business Office completes this section and forwards the entire Notice of Claim to the Superintendent’s office along with relevant supporting information and any material or explanation received from the individual or entity challenging the claim.
The Business Office finds that this debt should be considered:
_____ Satisfied.
_____ Enforceable.
_________________________________________ _______________
Business Office Date
Section 4 – Review of Findings and Response to Challenge. The Superintendent or designee who reviewed the findings completes this section and sends a copy of the Notice of Claim to the person or entity who challenged the claim.
_____ This debt is satisfied.
_____ Your challenge is denied. You must pay the debt by _____________ to avoid further collection efforts.
_______________________________________ ________________
Superintendent Date
Section 5 – Certification of Past Due Debt to the Ill. Office of the Comptroller (IOC). The Superintendent or designee who reviewed the findings completes the process of certifying to the IOC Local Debt Recovery Program that the District has provided the Debtor with the due process necessary to begin the IOC Offset process pursuant to an existing Intergovernmental Agreement with the IOC.
Date Adopted: December 10, 2014
