175546 WIOA - DERS UI 1000A MARICOPA CTY.PDF

UIA-1000A FORFF (3-10)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Employment And Rehabilitation Services
P.O. Box 6123, Mail Drop 5279
Phoenix, AZ 85005-6123
DATA-SHARING 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 necessary
1a. Purpose of this request. (What Unemployment Compensation (UC) information 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 WIOA was signed into law as Public Law 113-128.
As a participant in the WIOA, 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 III - 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
determine eligibility for program enrollment and to verify
In GUIDE we need access to the following:
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
- Validate Separation Data such as layoffs, recently
Claimant Contact Information 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 necessary
1b. 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.3rd Floor, Phoenix, AZ 85004
Contact Name (1) E-Mail
Address: ColomboT@mail.maricopa.gov
Contact Name (2) E-Mail
Address: DShepherd@mail.maricopa.gov
Contact Fax No.: 602-372-9794
1c. 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 necessary
2. Will other individuals or entities interface with you as to UC information?
Yes No If Yes, identify individual(s) or entity(ies) and reason(s):
Arizona Call-A-Teen Youth Resources (ACYR).
If Yes at your locations, complete Attachment A.
If Yes at other locations, complete separate data sharing agreement(s).
3. Will UC information be disclosed/shared with another individual or entity?
Yes 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, complete separate data sharing agreement(s).
4. Will UC information be repackaged/included in other data bases, files, tapes, etc.?
Yes 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., Street, City, State, ZIP): 301 W. Jefferson, 10th Floor, Phoenix, AZ 85003
Signature: Date:

Attachment A Agreement # 175546
WORKFORCE PARTNER INFORMATION
Identifier Partner Agency Name Program Name Type of Service Provided
A Arizona Call-A-Teen Youth Youth Program WIOA
Resources
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
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.