175546 DES FULLY EXECUTED DATA SHARING AGREEMENT.PDF

UIA-100013 FORFF (4-10)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Employment And Rehabilitation Services
P.O. Box 6123, Mail Drop 5279
Phoenix, AZ 85005-6123
DATA-SHARING AGREEMENT
BETWEEN
Itilaricopa County administered by its Human Services Department
(DES Division/Administration/Program/Office Name or External Organization Name)
AND
ARIZONA DEPARTMENT OF ECONOMIC SECURITY (DES)
DIVISION OF EMPLOYMENT AND REHABILITATION SERVICES (DERS)
Agreement Period: Data Sharing Agreement No.:
9 A9
Effective Date: 2017 End Date: -8/812027 175546
Contract Period (if applicable): Associated Contract No. (if applicable):
Effective Date: Initial End Date:
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with
Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits
discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability.
The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For
example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location,
or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a
program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a
program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in
alternative format or for further information about this policy, call 602-771-2670; TTY/TDD Services: 7-1-1.

U1A-10008 FORFF (4-10)— Page 2 Agreement No.; 175546
SECTION I. — DATA-SHARING AGREEMENT
TERMS AND CONDITIONS REGARDING CONFIDENTIAL UNEMPLOYMENT COMPENSATION INFORMATION
The Parties agree that:
1. The Requesting Entity, Maricopa County administered by its Human Services Department Workforce Development Division is
the entity to which DES may disclose confidential Unemployment Compensation (UC) information for use in the performance of
the Requesting Entity's duties under this Agreement, and which are consistent with 20 C.F.R. § 603.5(e).
2. 20 C.F.R. Part 603, which implements the requiretnents of Federal Unemployment Compensation law, sets out confidentiality
and disclosure regulations applicable to DES and to recipients of UC information, including agents or contractors of DES and
public officials.
3. Confidential UC information is defined in 20 C.F.R. § 603.2(b) and (j) as any information in the records of a State or State
unemployment compensation agency (currently in the DES Division of Rehabilitation Services IDERS] that pertains to the
administration of the State unemployment compensation law. This term includes those State wage reports collected under the
Income and Eligibility Verification System (Section 1137 of the Social Security Act [SSA]) that are obtained by the State
unemployment compensation agency for determining unemployment compensation monetary eligibility or are downloaded to the
State unemployment compensation agency's files as a result of a cross match but does not otherwise include those wage reports.
It does not include information in a State's Directory of New Hires, but does include any such information that has been
disclosed to the State unemployment compensation agency for use in the unemployment compensation program. It also does not
include the personnel or fiscal information of a State unemployment compensation agency.
4. In order to maintain the security of UC information consistent with the agreement requirements of 20 C.F.R. § 603.9 and .10, the
Requesting Entity agrees to the following terms and conditions:
a. Use the disclosed UC information only for purposes authorized by law as needed to perform the legitimate duties of the
Requesting Entity, consistent with this Agreement. [603.9(b)(1)(i)]
b. Appropriately safeguard UC information. [603.10(b)(1)(v)]
c. Store the disclosed UC information in a place physically secure from access by unauthorized persons. [603.9(b)(1)(ii)]
d. Store and process disclosed UC information maintained in electronic format, such as magnetic tapes or discs, in such a way
that unauthorized persons cannot obtain the information by any means. [603.9(b)(1)(iii)]
e. Utilize appropriate security measures and precautions to ensure that only authorized Requesting Entity personnel are given
access to disclosed UC information stored in computer systems. [603.9(b)(1)(iv)]
f. Requesting Entity personnel who request or receive UC information under this Agreement will be limited to those with a
need to access it for purposes listed in this Agreement, or in law, [603.10(b)(1)(ii)]
g. Instruct all Requesting Entity personnel having access to the disclosed UC information about confidentiality requirements,
the requirements of 20 C.F.R. Part 603, Subpart B, and the sanctions specified in State law for unauthorized disclosure of
information. See A.R.S. § 23-722.01(G) (civil penalty of $1,000 for unauthorized disclosure of UC information).
[603 .9(b)( I )(v)(A)]
h. By signing this Agreement, the Requesting Entity acknowledges that its personnel having access to the disclosed UC
information will, prior to being allowed access, have been instructed by the Requesting Entity in accordance with
paragraph (b)(I)(v)(A) of 20 C.F.R. § 603.9 and will adhere to the State's and DES's confidentiality requirements and
procedures, which are consistent with Subpart B of 20 C.F.R. Part 603 and the agreement required by 20 C.F.R. § 603.10.
[603 .9(b)(1)(v)(B)]
i. By signing this Agreement, the Requesting Entity acknowledges its agreement to fully and promptly report any infraction
of the rules set out in 20 C.F.R. § 603.9 and .10 and in this Agreement to the DES contact noted herein.
[603.9(b)(1)(v)(B)]
Dispose of UC information disclosed or obtained, and any copies thereof made by or in the possession of the Requesting
Entity, after the purpose for which the UC information is disclosed is served, except for disclosed UC information
possessed by any court. Disposal means return of the UC information to DES, or destruction of the UC information when
the agreement expires or is terminated, consistent with records retention schedules required by law. Disposal includes
deletion of personal identifiers by DES in lieu of destruction. [603.9(b)(1)(vi)]
k. Maintain a system sufficient to allow DES, the U.S. Department of Labor, or any other authorized entity, to perform an
audit of compliance with the requirements of 20 C.F.R. Part 603. [603.9(b)(1)(vii)]

U1A-100013 FORFF (4-10) — Page 3 Agreement No.: 175546
SECTION I. — DATA-SHARING AGREEMENT
TERMS AND CONDITIONS REGARDING CONFIDENTIAL UNEMPLOYMENT COMPENSATION INFORMATION
I. Allow on-site inspections of the Requesting Entity's records, data systems and facilities containing DES UC information to
assure that the requirements of the State's law and the Agreement required by 20 C.F.R. Part 603 are being met.
[603.10(b)(1)(vi)]
m. That the Requesting Entity's requests to DES for UC information, and DES's responses, may be in an agreed upon format,
and that the timing of the requests and responses will be reasonable under the circumstances and in light of the particular
legal needs relating to the UC information requested. [603.10(b)(1)(iii)]
n. All Requesting Entity personnel who will access or use UC information are to sign a User Affirmation Statement
(J-129) as a condition of accessing or using requested UC information.
5. Costs. The costs to DES of making a disclosure of UC information to the Requesting Entity, calculated in accordance with 20
CFR § 603.8(c), must be paid by the recipient Requesting Entity of the information or another source paying on behalf of the
recipient Requesting Entity, either in advance or by way of reimbursement. If the Requesting Entity recipient is not a public
official, such costs, except for good reason, must be paid in advance. Payment in advance means full payment of all costs before
or at the time the disclosed information is given in hand or sent to the recipient. Payment or reimbursement of costs must include
any initial start-up costs associated with making the disclosure. [603.8(c)]
Except as provided in 20 C.F.R. § 603.8(b), UC grant funds may not be used to pay any of the costs of making any disclosure of
UC information.
6. Redisclosure of Confidential Unemployment Compensation Information. Redisclosure of UC information is governed by 20
C.F.R. § 603.9(c). The parties agree that DES, on behalf of its UC agency division, the Division of Employment &
Rehabilitation Services (DERS), authorizes the Requesting Entity, as the recipient of confidential UC information, to redisclose
this information only as follows:
a. to the individual or employer who is the subject of the information;
b. to an attorney or other duly authorized agent representing the individual or employer;
c. in any civil or criminal proceedings for or on behalf of a recipient agency or entity;
d. in response to a subpoena, court decision, or request from an individual with subpoena authority, only as provided in 20
C.F.R. § 603.7;
e. to an agent or contractor of a public official only if the person redisclosing is a public official, if the redisclosure is
authorized by State law, and if the public official retains responsibility for the uses of the confidential UC information by the
agent or contractor;
f. from one public official to another if the redisclosure is authorized by State law;
g when so authorized by 20 C.F.R. § 303(e)(5), SSA (redisclosure of wage information by a State or local child support
enforcement agency to an agent under contract with such agency for purposes of carrying out child support enforcement)
and by State law; or
h. when specifically authorized by a written release that meets the requirements of 20 C.F.R. § 603.5(d)(to a third party with
informed consent).
i. in response to a request made under the Freedom of Information Act (5 U.S.C. 552), to the extent permitted.
The parties further agree that information redisclosed under paragraphs 6 (e) and (f) must be subject to the safeguards in 20
C.F.R. § 603.9(b). [603.9(c)(2)]
7. Breach of UC Information Provisions. If the Requesting Entity, or any official, employee or agent thereof, fails to comply with
any provision of this Agreement required by 20 C.F.R. § 603.10, including timely payment of DES costs billed to the Requesting
Entity, when applicable, this data sharing Agreement must be suspended, and further disclosure of UC information (including
any disclosure being processed) to the Requesting Entity is prohibited, until DES is satisfied that corrective action has been taken
and there will be no further breach. In the absence of prompt and satisfactory corrective action, the Agreement shall be cancelled,
and the Requesting Entity is required to surrender to DES all UC information (and copies thereof) obtained under this Agreement
which has not previously been returned to DES, and any other UC information relevant to the Agreement. [603.10(c)]
In the event the Requesting Entity fails to take corrective action or to return or destroy UC information as required, the
Requesting Entity understands that DES will take appropriate legal action. [603.10(c)(2)]

UIA-l000B FORFF (4-10)— Page 4 Agreement No.: 175546
SECTION II. — DATA-SHARING AGREEMENT
STATUTORY TERMS AND CONDITIONS FOR AGREEMENT NOT CONTRACTING FOR SERVICES
1. Availability of Funds for the Next State Fiscal Year. Funds may not presently be available for performance under this Contract
beyond the current state fiscal year. If funds are not allocated and available for the continuance of this Contract, this Contract
may be terminated by DES at the end of the period for which funds are available.
No liability shall accrue to DES in the event this provision is exercised, and DES shall not be obligated or liable for any future
payments or for any damages as a result of termination under this paragraph.
2. Availability of Funds for the Current State Fiscal Year. Should the State Legislature enter back into session and reduce the
appropriations or for any reason these goods or services are not funded, DES may take any of the following actions:
Reduce payments or units authorized;
Accept a decrease in price offered by the contractor;
Cancel the Contract;
Cancel the Contract and re-solicit the requirements.
The Director of DES shall have the sole and unfettered discretion in determining the availability of funds, DES and the
Contractor may mutually agree to reduce reimbursement to the Contractor when the payment type is Fixed Price with Price
Adjustment by executing a contract amendment.
3. Cancellation for conflict of interest. Pursuant to A.R.S. § 38-511, the State, its political subdivisions or any department or agency
of either may, within three years after its execution, cancel any contract without penalty or further obligation, made by the State,
its political subdivisions or any department or agency of either if any person significantly involved in initiating, negotiating,
securing, drafting or creating the Contract on behalf of the State, its political subdivisions or any department or agency of either
is, at any time while the Contract or any extension of the Contract is in effect, an employee or agent of any other party to the
Contract in any capacity or a consultant to any other party to the Contract with respect to the matter of the Contract. A
cancellation made pursuant to this provision shall be effective when the Contractor received written notice of the cancellation,
unless the notice specifies a later time,
4. Arbitration. The parties to this Agreement agree to resolve all disputes arising out of or relating to this Contract through
arbitration, after exhausting applicable administrative review, to the extent required by A.R.S. § 12-1518, except as may be
required by other applicable statutes (Title 41).
5. Applicable Law. This Contract shall be governed and interpreted by the laws of the State of Arizona.

UIA-1000B FORFF (4-1G)— Page 5 Agreement No.: 175546
SECTION III. — DATA-SHARING AGREEMENT
ADDITIONAL INFORMATION AND CONDITIONS
1. Access provided:
AJC - Access/data provided are the wages indicated in Section 1, Item la of the Data-sharing Request, ivhen available.
GUIDE - Access will be provided to the following information/screens:
01 Summary Information
02 Non-monetary Determinations
04 Employer Information
07 Benefit Payment History
12 Claim Information
13 Benefit Payment Information
25 Claimant Information
58 Employer Base Information Inquiry
W6 Wage Inquiry/Information
as per "Information Requested" in the table in Section I, Item I a for the purposes identified in Section I, Item la of the Data-
sharing Request.
Note: If in Section I, Item I a there is an "NA" in the table for GUIDE, then access to GUIDE will not be authorized in this
agreement.
Note: If access to the 55 (Name Search) and 57 (Employer Inquiry) screens was authorized in a previous agreement, access is
no longer permitted per U. S. Department of Labor ruling on allowable UC inquiries.
2. A Request for Terminal Access and Other Activity (J-125) or equivalent, shall be used to request specific access for each
authorized staff member.
3. All staff coining in contact with confidential unemployment insurance data shall complete the DES Initial Security Awareness
training within 21 days of obtaining access to confidential data and complete the Refresher Security Awareness Training
annually as directed.

UIA-10008 FORFF 13-10) — Page 6 Agreement No.: 175546
SECTION III. — DATA-SHARING AGREEMENT
ADDITIONAL INFORMATION AND CONDITIONS
4. Contact Information
a. The Requesting Entity will provide a current mailing address to be used to notify the Requesting Entity of any changes to
Unemployment Insurance (UI) applications that would affect any access provided to the Requesting Entity under the terms
of this Agreement, or for any other agreement maintenance deemed necessary by the DERS.
Name and Title of Contact Person: Diana Shepherd, Special Programs Supervisor EO Officer
Requesting Entity Name: Marieopa County Human Services Department
Unit Name: Workforce Development Division
Street Number: 735 N. Gilbert Rd., Suite 134
City: Gilbert State: AZ ZIP: 85234
Mailing Address (if different):
Voice Telephone Number: 602-372-9784 FAX Telephone Number: 602-372-9794
E-Mail Address: SheerdD@mail.rnaricopa.gov
The Requesting,. Entity is required to provide to the DERS timely notification of any change in requester contact or requester
billing address information.
b. DES Contact Information
i, If the Requesting Entity has connectivity problems or access loe.-on problems, contact the Resolution Center Help Desk
of the Division of Technology Services, Customer Support Services Center (DTS/CSSC) at 602-364-4419 or I -888-
875-7144 for assistance.
ii. For all other contacts and notices to DERS, including wherever this agreement requires the Requesting Entity to notify
or otherwise contact DERS, such notices or contacts shall be made to Ul. Data Security, P. 0. Box 6123 — Mail Drop
807B/5279, Phoenix, AZ 85005-6123.
5. The U1 Program requires cost recovery (per Section 1, Subsection 5) when there is no reciprocity of mutual benefit between the
UI Program and the Requesting, Entity.
The Agency will reimburse the UlA for data sharina, costs as specified in the EA/U1A Data Disclosure Information and Fee
Schedule (PAU-592, 11-09 or most current version).
LI Cost recovery not applicable
El Cost recovery applicable (if checked, complete the following billing infOrmation):
Name and Title of Contact Person: Thomas Colombo, Assistant Director, MCHSD Workforce Development Division
Requesting Entity Name: Maricopa County Human Services Department EN CHSD)
Unit Name: Workforce Development Division
Street Number: 234 N Central Avenue, 3 rd Floor
City: Phoenix State: AZ ZIP: 85004
Mailing Address (if different):
Voice Telephone Number: 602-372-2733 FAX Telephone Number:
E-Mail Address: ColomboTq mail.maricopa. c,,ov

UIA-1000B FORFF {4-10) — Page 7 Agreement No.: 175546
SECTION III. — DATA-SHARING AGREEMENT
ADDITIONAL INFORMATION AND CONDITIONS
6. Use/Verification of the UC Wage Data
a. The wage and employer data on the UC tiles are reported to the Tax Section of the U1 Program by individual employers.
Since the UI Tax Section is not the originator of the data, the Tax Section cannot attest to its accuracy or completeness.
The Ul Program may not be held accountable for any errors in the data and accepts no responsibility for any consequences
resulting from the use of erroneous data.
b. Prior to taking any official action based on the wage and employer data in the UC files, the Requesting Entity will confirm
the identity of the individual for whom wages were reported.
c. If UC wage or employer information does not appear to be in accord with information reported by the client to the
Requesting Entity, the Requesting Entity will contact the employer to confirm the data. In so doing, the Agency will not
divulge the UI Program as the source of the data. If the employer confirms that the individual worked and earned the wages
reported, the source of the information is then the employer. If the employer verifies that the wage and employer data do
not pertain to the client or the amount is incorrect, then the UC data should be considered invalid for third party
verification purposes.
d. Under no circumstances may the Requesting Entity reveal to its client the source of UC information or any of the details
obtained from the UlA including employer name, dates or amounts reported.
7. The data-sharing agreement is subject to termination by either party providing 30 days written notice to the other, except that
the DERS may terminate the Agreement immediately if a degradation of DERS operations due to insufficient computer capacity
occurs.
8. The data-sharing agreement period is for ten years from the effective date entered on Page 1 in the Agreement Period box.
If this data-sharing agreement is attached to a separate associated contract, the agreement period is for the dates entered in the
Contract Period box on Page I. The Initial End Date is as determined in the associated contract.
If the associated contract is extended, the data-sharing agreement period is extended automatically to correspond with the
extension of the associated contract.
9. This agreement replaces data sharing agreement number 12101 which expired January 24, 2015.

IMA-100013 FORFF (4-10) — Pages Agreement No.: 175546
SECTION IV. — DATA-SHARING AGREEMENT
APPROVALS
DEPARTMENT OF ECONOMIC SECURITY, INFORMATION RISK MANAGEMENT
This signed Agreement meets all requirements necessary to permit the controlled sharing of DES data while simultaneously
providing for the protection of the data. I certify that:
1E1 THIS AGREEMENT CONFORMS to DES Information Security Policy.
LI THIS AGREEMENT DOES NOT CONFORM to DES Information Security Policy. Implementation of the
Agreement cannot proceed until the following action is taken:
Print Signatory Name: Jeffrey Raynor
Title: Chief Information Security Officer
Signature: Date: q "2-o (1
I attest to the correctness of the information praided in the Data Sharing Request, and agree to the terms and conditions listed in
Sections I, II and UI of the Data-Sharing Agreement. I agree to comply with all provisions of the DES Data Security Policy not in
conflict with this Agreement. Should any violations of the DES Data Security Policy occur, this Agreement may be terminated. 1
further understand that DES will periodically review the terms of the Agreement to ensure it conforms with DES Policies and
Procedures. In the event changes in either federal or state law or regulations occur that conflict with the terms of the Agreement or
render the terns of the Agreement void, impracticable, or otherwise impossible, this Agreement will terminate immediately. A new
Agreement or an amendment to the existing Agreement will be initiated to provide for any changes that cannot be accommodated
within the provisions of the existing Agreement. Contractor shall hold harmless and indemnify the State of Arizona and its Department
of Economic Security for any liability resulting from acts or omissions attributable to the Contractor.
To be executed below by duly authorized representatives:
REQUESTING ENTITY
Print Signatory Name: Denny Barney
Title: Chairman, Mapi,copa Coupty Board of Supervisors
Date: SEP 1 4 2017
SEP 1 4 2017
ofroff a-7
RITY, DIVISION OF EMPLOYMENT ANWREHABILITATION SERVICES
Print Signatory Name: Michael Wisehart
Title: Assistant Director
Signature: Date 9. 21.

UIA-1000A FORFF (340)
C. - 2 - F-0 1 3 -3- oo
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Employment And Rehabilitation Services
P.O. Box 6123, Mail Drop 5279
Phoenix, AZ 85005-6123
DATA-SHARING REQUEST
BETWEEN
Maricopa County administered
by its Human Services Department
(DES Division/Administration/Program/Office Name or External Organization Name)
AND
ARIZONA DEPARTMENT OF ECONOMIC SECURITY (DES)
DIVISION OF EMPLOYMENT AND REHABILITATION SERVICES (DERS)
To be attached to associated Data-Sharing Agreement: 175546
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the
Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination
Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on
race, color, religion, sex, national origin, age, and disability. The Department must make a reasonable accommodation to
allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the
Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged
print materials. It also means that the Department will take any other reasonable action that allows you to take part in and
understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able
to understand or take part in a program or activity because of your disability, please let us know of your disability needs in

advance if at all possible. To request this document in alternative format or for further information about this policy, call
602-771-2670; TTY/TDD Services: 7-1-1.
UIA-1000A FORFF (3-10)— Page 2 Associated Agreement No.: 175546
DATA SHARING REQUEST
Use Attachment if necesswy
la. Purpose of this request. (What Unemployment Compensation (UC) infbrmation is being requested and why? How
will it be used?)
(Give details/specifics ) [20 C.F.R. § 603 .10(b)(1)(i)]
On July 22, 2014, the W1OA was signed into law as Public Law 113-128.
As a participant in the W1OA, the Maricopa County administered by its Human Services Department
(Requesting Entity), performs the following work within the WIOA program Title I. (Fill in based on selections below
or describe WIOA purpose if other.)
WIOA's "core" programs include:
Title I - Adult, Dislocated Worker and Youth programs administered by the United States Department of Labor
(USDOL)
Title II - The Adult Education and Literacy program administered by the U. S. Department of Education (USDoED)
Title HI - Wagner-Peyser Employment Service administered by the USDOL
Title IV- Programs under the Rehabilitation Act Title I that provides services to individuals with disabilities,
administered by USDoED
WIOA also authorizes the Job Corps program, the YouthBuild program, Native American programs, and Migrant and
Seasonal Farmworker programs, as well as evaluation and multistate projects.
Information Requested Purpose and how the information will be used
MAINFRAME The access will be used to determine wage and benefit
GUIDE (BG01) information to complete eligibility income calculations to
In GUIDE we need access to the following: determine eligibility for program enrollment and to verify
wage and employment information on participants in the
Summary Information WIOA Program to ensure compliance with the United States
Nonmonetary Determinations Department of Labor (US DOL) regulations for WIOA
Employer Information performance outcomes, In addition, it may be used to:
Benefit Payment History - Verify all contact information, verify eligibility, weekly
Claim Profile Information amount, status of claim
Benefit Payment Information - Verify issues
Claimant Contact Information - Validate Separation Data such as layoffs, recently
separated military veterans, etc,
EBI [Employer Base Information] Inquiry - Validate weekly Benefit History
Wage Inquiry - Verify overpayments, filing dates, etc.
- Verify issues, deductions, disqualification
- Verify e-mail and updates to contact information
- Provide employer information
INTERNET Access to view Unemployment Insurance quarterly wage
Arizona Job Connection (AJC) data stored within AJC. This will include actual amount
earned (in dollars) by quarter. The requested earnings
include three quarters prior to participation in the program(s)
and up to five quarters after exiting from the program(s).

The data will be used specifically to determine wage
information on participants in the WIOA program to ensure
compliance with WIOA performance outcomes.

UiA-1000A FORFF (3-10)— Page 3 Associated Agreement No.: 175546
DATA SHARING REQUEST
Use Attachment if necessaty
b. Information Technology and connectivity
The Requesting Entity describes the information technology (IT) environment that will connect to DES, be explicit —
consult your IT personnel for assistance.
AJC: Connectivity will be through the Internet via the LWIOA network.
GUIDE: GUIDE shall be accessed on the DES mainframe. Connectivity to the DES mainframe shall be through the
CISCO VPN. DES requires remote connections to use a 2 factor authentication method. The CISCO VPN connection
meets this requirement by requiring the user to use FOB authentication as well as a logon ID and password. The
requesting agency has purchased FOBS and will also purchase 3270E emulation software and licenses for each
workstation.
The Requesting Entity is to enter its contact information below; provide what is required for successful communication
between the requesting individual or entity and the DES IT Staff.
Contact Name (1): Thomas Colombo Phone: 602 -372-2733
Contact Name (2): Diana Shepherd Phone: 602-372-9784
Contact Address: 234 N Central Ave.ri Floor, Phoenix, AZ 85004
Contact Name (1) E-Mail
Address: ColomboT@mail.maricopa.gov
Contact Name (2) E-Mail
Address: DShepherdmail.maricopa.gov
Contact Fax No.: 602 -372-9794
lc. Methods and timing of request(s) and response(s) (How often and in what format will UC information be requested
and provided?) [20 C.F.R. § 603.10(b)(1)(iii)]
Access to the data will be available to be reviewed by Requesting Entity staff at any time. Authorized individuals will
be able to access GUIDE, if requested, during the normal operating hours of the system. Access to UI data in AJC will
be available at any time, but data will only update into AJC from UI on a quarterly basis.
Formats for utilizing the data may include the following: Viewing and/or printing AJC reports for verification of wage,
work history or last date of work. UI information on the mainframe, if requested and authorized, will be in the form of
on-line access to wage and benefits screens.

UIA-1000A FORFF (3-10)— Page 4 Associated Agreement No.: 175546
DATA SHARING REQUEST
Use Attachment if necessaiy
2. Will other individuals or entities interface with you as to UC information?
Yes EI No If Yes, identify individual(s) or entitAies) and reason(s):
Arizona Call -A-Teen Youth Resources (ACYR).
If Yes at your locations, complete Attachment A.
If Yes at other locations comnlete senarate data sharing agreement(s)
3. Will UC information be disclosed/shared with another individual or entity?
Yes Z No If Yes, identify individual(s) or entity(ies) and reason(s) for disclosure:
If Yes at your locations, complete Attachment A.
If Yes at other locations comnlete senarate data sharing agreement(s)
4. Will UC information be repackaged/included in other data bases, files, tapes, etc.?
111 Yes Z No If Yes, identify format and reason(s):
5. Desired output (Printout, tape, terminal access/display, etc.)
AJC: Output will be through internal printable reports contained within the application and accessed via the Internet.
GUIDE: Output may include any of the following: Viewing and/or printing reports for verification of U.I. benefits or
history of U.I. benefits received; also to verify work history and verify approved training weekly form.
6. Describe safeguards in place to guard against unauthorized access/disclosure of the UC information
The requester is complying with, or will comply with, all applicable Arizona Department of Economic Security
(ADES) IT and security policies to ensure the protection of ADES confidential data. Access is restricted to authorized
personnel on a need to know basis; system is password protected and accessed through a log-in process. Automated
equipment is maintained in a physically secured environment. Paper documents containing confidential information is
appropriately secured and/or destroyed when no longer in need. (Per DERS Requirements).
Chairman, Board of
Requester's Name: Denny Barney Requester's Title: Supervisors
Phone No.: 602-5061776 Fax No.: Email:
Mailing Address (No., Aet, City, Ae, ZIP): 301 W. Jefferson, 10 th Floor, Phoenix, AZ 85003
Signature: Date: AUG 2 4 2017
AUG 24 2017
et41- cKg-5, -16/1- 1erk of the Board

Attachment A Agreement # 175546
WORKFORCE PARTNER INFORMATION
Identifier Partner Agency Name Program Name Type of Service Provided
Arizona Ca-A-Teen Youth Youth Program WIOA
Resources
The Requesting Entity will be responsible for any partners that are listed above. Only employees in each partner
organization who are properly authorized and receive appropriate training will be given access. Applicable only to
partner staff located at LWIOA Locations_covered by this data sharing agreement.