Attachment 9 Confidentiality Agreement.pdf

Office of Child Support Enforcement Agreement to Safeguard

By signing below, I acknowledge that I have completed the OCSE Security Awareness Training and I understand the agency’s security policy and procedures for safeguarding all child support program information, Personally Identifiable Information (PII), FPLS (Federal Parent Locator Service) Information, and Federal Tax Information (FTI). I acknowledge that I have access to child support confidential program data maintained by the Federal Office of Child Support Enforcement, as well as confidential information maintained by the State of Arkansas or contract companies both within the OCSE intranet or externally on the internet. An example of such data is listed below and is not limited to the following:

Federal Parent Locator Service – which includes data from the following external agencies:

The Federal Bureau of Investigation, Department of Veterans Affairs, Social Security Administration, Department of Defense, and Internal Revenue Service

National Directory of New Hires – which includes New Hire, quarterly wage and unemployment insurance data

Federal Case Registry – which includes data on IV-D and non-IV-D child support cases

Multi-State Financial Institution Data Match – which includes data from financial institutions

Tax Refund Offset Program – which includes data from the Internal Revenue Service

The Arkansas Department of Finance and Administration – which includes data from the Office of Driver Services and the Office of Motor Vehicles

Third-party employment and income identifier, such as The Work Number

The Department of Workforce Services – which includes unemployment compensation, employment data and earnings

I agree that I will obtain, use, or disclose such data only in connection with the performance of my official duties solely for authorized purposes.

I agree that it is my responsibility to take action to safeguard all data used in the course of my work, and it is my responsibility to report any incident that may compromise such data to my supervisor immediately.

I understand that failure to safeguard child support confidential program data, PII, FTI, and/or FPLS data may result in any or all of the following actions:

A fine up to $5,000 and/or imprisonment up to five years, along with the cost of prosecution for willfully disclosing or inspecting FTI. (IRC 7213 and 7213A)

Civil damages, brought about by the taxpayer whose information has been disclosed or inspected, of $1,000 or more for each act of unauthorized inspection or disclosure of FTI. (IRC 7431)

A fine up to $1,000 for each act of unauthorized access to or disclosure of information in the National Directory of New Hires. (42 U.S.C. § 653(l)(2))

Conviction of a Class B misdemeanor, which can result in a fine up to $1,000 and up to 90 days in jail. (Ark. Code Ann. § 9-14-210)

Administrative action including immediate dismissal.

I agree to provide a list to my supervisor the names of all relatives, friends, or other individuals with whom I am closely associated who have a child support case of any type, including the names of the

OCSE Agreement to Safeguard children on the case. I agree and understand that I am responsible for notifying my supervisor if I become aware of other relatives, friends, or associates who may become members in a child support case in the future.

I agree that my obligation to safeguard the confidentiality of any data obtained during the course of my employment shall survive the termination of my employment with the Arkansas Office of Child Support Enforcement and that I may be subject to criminal and civil penalties for disclosure after my employment ends.

Employee’s Signature Employee’s Printed Name Date

Supervisor’s Signature Supervisor’s Printed Name Date