T2769 Attachment F Confidentiality Agreement and Certificate of Non Disclosures.pdf
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- Solicitation number
- 25DPP01127
- Issued by
- New Jersey
About this file
This document is a Confidentiality Agreement and Certificate of Non-Disclosure for the State of New Jersey Department of the Treasury Division of Revenue, specifically related to Billing and Related Services for the Non-Tax Debt Collection Program. The agreement is designed to protect personal information about individuals pertaining to their non-tax debt, ensuring that such information remains confidential and is only used for the specific purposes of billing and debt collection services.
The confidentiality agreement outlines strict protocols for handling personal information, with significant legal consequences for breaches. Signatories acknowledge that misuse or unauthorized disclosure of personal information can result in criminal charges, potential fines and imprisonment, civil actions in Superior Court with actual and punitive damages, and possible termination of employment. The document is structured to comply with the Federal Fair Debt Collection Practices Act and aligns with the current contract for non-tax debt collection services in the State of New Jersey.
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Text version
ATTACHMENT F
Confidentiality Agreement And
Certificate of Non-Disclosure
State of New Jersey Department of the Treasury Division of Revenue
Billing and Related Services for the Non-Tax Debt Collection Program
I, ____________________________, with ____________________________________, (Print or Type Full Name) (Print Firm/Organization/Agency Name) acknowledge and understand that under the terms of the Federal Fair Debt Collection Practices Act (Title VIII) , and in accordance with the current contract for the collection services for the non-tax debt for the State of New Jersey, any personal information about an individual pertaining to his or her non-tax debt, supplied to or obtained for the billing and related services for the non-tax debt, is confidential in nature and may not be used for any purpose or be released to any party except in the performance of such billing and related services without prior written consent of the State of New Jersey Department of the Treasury Division of Revenue and Enterprise Services and/or the originating State of New Jersey entity.
I agree to keep confidential all personal information that I receive about an individual pertaining to his or her non-tax debt and will not disclose to a third party or use such information except as required in the performance of my job responsibilities to provide billing and related services for the non-tax debt.
I understand that misuse or disclosure by me of such personal information without prior written consent shall constitute a breach of confidentiality. I also understand that any violation of this agreement may result in criminal charges against me, which may result in a fine and/or imprisonment. I understand that violation of this agreement may also result in a civil action against me in Superior Court to include actual and punitive damages and payment of reasonable attorney and court fees. In addition, I understand and agree that breach of confidentiality may lead to the termination of my employment.
(Signature) (Date)
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