Any form prepared by the Administrative Office, the Executive Office or the Office of Disciplinary Counsel for use under these rules, and which is intended to elicit facts upon the basis of which a public officer or employee performs in an official capacity, may pursuant to 18 Pa.C.S. § 4904(b) (relating to statements "under penalty") contain a statement to the effect that false statements made therein are punishable.
204 Pa. Code § 93.3