Attachment B SCDSS Contractor Security Disclosures.pdf

This is a security disclosure form required of independent contractors assigned to work with the South Carolina Department of Social Services (DSS). The form serves as a prerequisite document for contractor engagement on matters involving access to privileged, confidential, and restricted information regarding DSS processes, procedures, and confidential matters. Contractors must complete a comprehensive questionnaire addressing criminal history, including current indictments, prior convictions (distinguishing between felonies and misdemeanors with dates and jurisdictional details), and registry status. The form specifically requires disclosure of listing on State or Federal Registries of Convicted Sex Offenders and State or Federal Child Abuse and Neglect Central Registries, as well as notification of any ongoing investigations for offenses against children. Contractors must also confirm possession of a valid driver's license and acknowledge the form's accuracy through dated signatures with witness attestation.

The disclosure form establishes ongoing compliance obligations requiring contractors to notify DSS through their immediate supervisor if they are subsequently charged with any crime (misdemeanor or felony) or become the subject of a DSS abuse and neglect investigation during their assignment. This document functions as a mandatory pre-contract clearance mechanism designed to protect the integrity of DSS operations and safeguard vulnerable populations served by the agency. No pricing, term, or renewal information is contained within this security disclosure document, as it represents a qualification and clearance requirement separate from contract terms and conditions.