1-PII Questionnaire.xlsx

XLSX spreadsheet 15 KB Posted

Attached to
USBE - Child Nutrition Programs Financial Document Review
Solicitation number
USBE-JB26274-PS
Issued by
Utah

About this file

This is a Personally Identifiable Information (PII) Questionnaire submitted to the Utah State Board of Education (USBE) in connection with a Child and Adult Care Food Program (CACFP) financial document review solicitation. The questionnaire identifies all data elements that will be used, stored, or collected by a system or application supporting the contract. The document catalogs extensive categories of student PII including assessment data, standardized test scores, communications records, behavioral data, demographics, enrollment information, special indicators, contact information, performance metrics, program memberships, survey responses, and student work samples. Additionally, the questionnaire addresses educator PII such as name, gender, date of birth, identification numbers, school and class assignments, salary and license information, as well as parent or guardian contact information and credit card data handling protocols.

The questionnaire serves as a compliance and data governance tool for USBE to understand what personal information will be processed by potential contractors. By itemizing specific data elements across student, educator, and parent categories, USBE ensures that any awarded contractor demonstrates awareness of privacy obligations and regulatory requirements associated with federal child nutrition programs. This documentation is critical for procurement transparency and establishing baseline expectations regarding data handling, security, and protection measures that must be maintained throughout the contract period.

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Text version

Sheet1

Instructions: Please check which data elements will be used by system and return to USBE
Data TypeData ElementCheck if used by system or provide additional information
Student PIIAssessmentStandardized test score
Observation data
Other assessment data (Please specify)
CommunicationsOnline communications that are captured (emails, blog entries)
ConductConduct or behavioral data
DemographicsDate of Birth
Place of Birth
Gender
Ethnicity or race
Language information (native, preferred, spoken, etc)
Other demographic information (Please specify)
EnrollmentStudent attendance data
Student school enrollment
Student grade level
Assigned educator
Specific curriculum programs
Year of graduation
Other enrollment information (please specify)
Special IndicatorEnglish language learner information
Low income status
Medical alerts /health data
Student disability information
Specialized education services (IEP or 504)
Living situations (homeless/foster care)
Other indicator information-Please specify:
Student Contact InformationAddress
Email
Phone
Name
Student ID Number
Student PerformanceProgram/application performance (typing program-student types 60 wpm, reading program-student reads below grade level)
Student Program MembershipAcademic or extracurricular activities a student may belong to or participate in
Student Survey ResponsesStudent responses to surveys or questionnaires
Student workStudent generated content; writing, pictures etc.
Other student work data -Please specify:
OtherPlease list each additional data element used, stored or collected by your application
Educator PIIEducator informationName
Gender
Date of Birth
Identification number
School assignment
Class assignment
Salary information
License information
Parent PIIParent/Guardian Contact InformationAddress
Email
Phone
Name
Other information (Please specify)
PCICredit CardPCI protected data
Other information (Please specify)

File details come from the government source that posted it. Updated .