Attachment J-2 Release of Information Privacy Act Waiver.docx

DOCX document 80 KB Posted

Attached to
Supportive Housing Services (Up to 180 Days)
Solicitation number
9594CS26Q0075
Issued by

About this file

This is a Privacy Act Waiver and Release of Information form required as part of the Supportive Housing Services solicitation (9594CS26Q0075) issued by the Court Services and Offender Supervision Agency (CSOSA). The document serves as a template that contractors must utilize to obtain authorized release of participant information necessary for service delivery under the contract. The waiver establishes the legal framework permitting CSOSA and its contractors to access, use, and share confidential information about program participants, typically individuals under court supervision or requiring housing assistance. The form requires participant authorization and includes provisions outlining what information may be released, to whom it may be disclosed, and the purposes for which it may be used in connection with the supportive housing program. This attachment is essential for compliance with federal privacy regulations and enables contractors to coordinate services across multiple agencies and service providers as needed to deliver comprehensive supportive housing assistance for eligible individuals. Contractors responding to this solicitation must be prepared to implement privacy protection procedures and ensure all staff are trained on appropriate handling of sensitive participant data in accordance with Privacy Act requirements and this waiver framework.

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Other files

File Type Posted
Amendment 0002 9594CS26Q0075.pdf PDF
Amendment 0001 9594CS26Q0075.pdf PDF
Amd 0001 Revised Attachment J-18 Solicitation Price Sheet.docx DOCX document
Amd 0001 Exhibit A Responses to Questions Recieved.pdf PDF
Attachment J-13 Contractor Confidentiality and Nondisclosure Agreement.docx DOCX document
Attachment J-10 CSOSA Food and Nutrition Requirements.pdf PDF
Attachment J-15 Pre-award Inspection Check List.docx DOCX document
Attachment J-16 Past Performance Questionnaire.docx DOCX document
Attachment J-11 Security Form for Temporary Contractors.docx DOCX document
Attachment J-18 Solicitation Price Sheet.docx DOCX document
Attachment J-12 CSOSA Credit Release.docx DOCX document
Attachment J-9 CSOSA Supportive Housing Building Requirements.pdf PDF
Solicitation 9594CS26Q0075.pdf PDF
Attachment J-17 FAR 52.212-3 Offeror Reps & Certs.docx DOCX document
Attachment J-14 Cover Letter.docx DOCX document
Attachment J-7 Vendor Referral Letter (Billing Authorization).docx DOCX document
Attachment J-1 Section C Statement of Work.pdf PDF
Attachment J-5 Release of Information-Substance Abuse Treatment.pdf PDF
Attachment J-4 Release of Information-Health Records.pdf PDF
Attachment J-6 Release of Information-Mental Health-Sex Offender.pdf PDF
Attachment J-3 Relase of Information and Waiver General Third Party Disclosure.docx DOCX document
Attachment J-8 Monthly Program Activity Report.docx DOCX document
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Attachment J-2 Release of Information-Privacy Act Waiver

Court Services and Offender Supervision Agency for the District of Columbia

Attachment J-2:RELEASE OF INFORMATION PRIVACY ACT WAIVER

I, [Name], hereby authorize and give my prior written consent pursuant to 5 U.S.C. § 552a(b) to the Court Services and Offender Supervision Agency for the District of Columbia, to disclose the information noted below concerning me to the recipient(s) noted below for the purpose noted below.

Information to be disclosed:

Recipient(s):

Purpose of disclosure:

I declare under penalty of perjury that the foregoing is true and correct.

Executed this day of , 202_.

Signature

CSOSA-OGC-0005

Revision: August 2008 Print Form Reset Form image1.png

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