Att O Confidentiality Agreement.pdf

Indiana Department of Revenue Vendor, Contractor, or Subcontractor Confi dentiality Agreement

Indiana Code section 6-8.1-7-1(a) and Chapter 45 of the Indiana Administrative Code, Section 15-7, et seq., make all information acquired in administering taxes confi dential. The Indiana Administrative Code and applicable statutes (collectively “Code”) hold a vendor, contractor or subcontractor and their employees who sell a product or provide a service to the Indiana Department of Revenue, or who access Department data, to the strict confi dentiality provisions of the Code. Confi dential tax information includes, but is not limited to, information obtained in connection with the administration of a tax or information or parameters that would enable a person to ascertain the audit selection or processing criteria of the Indiana Department of Revenue for a tax administered by the Department.

INSTRUCTIONS: Read this entire form before you sign it. If you do not complete this agreement, you will be denied access to the Indiana Department of Revenue and federal tax information. After you sign and date this form, keep a copy for your records. Send the original to: Disclosure Offi cer, Indiana Department of Revenue, 100 N. Senate Avenue, Room N-248 Indianapolis, IN 46204-2253.

Company Name and Address (Street or RR#, City, State, Zip Code) Offi cial or Employee Name

Name of State of Indiana Agency Employee Identifi cation Number or Driver’s License Number

Sub-Contractor’s Name if Product/Service Furnished to Contractor

Describe here or in a separate attachment the product or service being provided to the State of Indiana Agency.

Confi dentiality Provisions. It is illegal to reveal or browse the following, except as authorized:

All tax return information obtained in connection with the administration of a tax. This includes information from a tax return or audit and any information about the selection of a return for audit, assessment or collection, or parameters or tolerances for processing returns.

All Indiana Department of Revenue or federal tax returns or tax return information made available, including information marked “Offi cial Use Only”. Tax returns or tax return information shall not be divulged or made known in any manner to any person except as may be needed to perform offi cial duties. Access to Department or federal tax information, in paper or electronic form, is only allowed for compliance or collection purposes, or otherwise permitted under 45 IAC 15-7-1.

Disclosure of return information to other employees of your department, agency, division or offi ce, must meet statutorily-defi ned criteria and must be required for them to perform their offi cial duties.

Confi dential information shall not be disclosed by a department employee to confi rm information made public by another party or source which is part of any public record. IC 6-8.1-7-1(a).

Penalty. Violating confi dentiality laws is a felony, with penalties as described:

Agency Discipline Absence of criminal prosecution does not prevent your agency from pursuing internal sanctions for unauthorized accessing, browsing, or disclosing state or federal tax returns or tax return information.

Indiana Penalties IC 6-8.1-7-1(a) prohibits the disclosure of any Indiana tax return or information contained in a return. Browsing is defi ned as exam-ining a return or return information acquired without authorization and without a need to know the information to perform offi cial duties. Violators of IC 6-8.1-7-1 are guilty of a Class C misdemeanor and subject to any and all fi nes and penalties so prescribed. State employees will be immediately dismissed from state service upon conviction.

Federal Penalties If you willfully disclose federal tax returns or tax return information to a third party, you are guilty of a felony with a fi ne of $5,000 or imprisonment for fi ve years, or both, plus prosecution costs according to the Internal Revenue Code (IRC) §7213, 26 USC 7213.

CAV-1

SF 53349

(R/08-07)

In addition, inspecting, browsing or looking at a federal tax return or tax return information without authorization is a felony viola-tion of IRC §7213A, 26 USC 7213A, subjecting the violator to a $1,000 fi ne or imprisonment for one year, or both, plus prosecution costs. Taxpayers affected by violations of §7213A must be notifi ed by the government and may bring a civil action against the federal government and the violator within two years of the violation. Civil damages are the greater of $1,000 or actual damages incurred by the taxpayer, plus the costs associated with bringing the action, 26 USC 7431.

CERTIFICATION

I acknowledge that I have read this Agreement, which is intended to help me understand applicable Indiana and Federal law related to the protection of confi dential information. I understand that failure to comply with applicable law, including the laws referenced in this Agreement, may subject a violator to criminal and civil penalties.

Name: ___________________________________________ (print)

Signature ________________________________________

Date: ____________________________________________

WITNESS

Name: ___________________________________________ (print)

Signature: ________________________________________

Date: ____________________________________________