235514 MARICOPA COUNTY PUBLIC DEFENDER OFFICE UIA-1000A REQUEST (DERS).PDF

UIA-1000A FORFF (3-10)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF EMPLOYMENT AND REHABILITATION SERVICES (DERS)
DATA-SHARING REQUEST
BETWEEN
Maricopa County Public Defender Office
(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: 235514
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.: 235514
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)]
1. We would like to get all data available on subjects’ earnings history, unemployment benefits and demographic
data such as name, address, etc., and extended benefits. The information is to be used only to aid in the issues
relating to our clients while in the Maricopa County Superior Court system.
2. In cases where restitution is ordered, the Court shall consider all of the clients’ assets and income, including
Worker’s Compensation and SSI. (ARS 13-804)
3. Our office has other resources available to obtain information including social security numbers, license
information, full names, current and previous addresses, and DOB’s (MVD system and credit bureau). Your
system could assist us in locating individuals who can’t be found by those resources. Your data system is
especially helpful in finding a place of employment for clients and witnesses. We have learned through
experience that it is often much easier to contact these people at work if we know their place of employment,
especially for the service of subpoenas. (ARS 13-4101, 13-4104, 13-4072, and 13+4077, attached)
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.
UC information is accessed using Maricopa County equipment, using web interfaces built by DES. MC equipment is
patched on a monthly cycle. Security (user ids and passwords) for the web interfaces are controlled and managed by
DES. No UC data is downloaded from the DES servers.
Operating System: Win7; Virus Protection: Trend; Firewall: Checkpoint for Maricopa County Public Defender’s
Office.
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): Jason Overmyer, Client Services Mgr. Phone: (602) 506-7711 X31239
Contact Name
(2): Tamra Hicks, Administrator Phone: (602) 506-7711 X32617
Contact Address: 620 W. Jackson St, Ste. 4015, Phoenix, AZ 85003
Contact Name (1) E-Mail
Address: Jason.Overmyer@maricopa.gov
Contact Name (2) E-Mail
Address: Tamra.Hicks@maricopa.gov
Contact Fax
No.: (602) 372-2922
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)]
Daily

UIA-1000A FORFF (3-10) – Page 3 Associated Agreement No.: 235514
DATA SHARING REQUEST
Use Attachment if necessary
2. Will other individuals or entities interface with you as to UC information?
Yes X No If Yes, identify individual(s) or entity(ies) and reason(s):
3. Will UC information be disclosed/shared with another individual or entity?
Yes X No If Yes, identify individual(s) or entity(ies) and reason(s) for disclosure:
4. Will UC information be repackaged/included in other data bases, files, tapes, etc.?
Yes X No If Yes, identify format and reason(s):
5. Desired output (Printout, tape, terminal access/display, etc.)
Printout, terminal access/display
6. Describe safeguards in place to guard against unauthorized access/disclosure of the UC information
Computers are located in an employee’s office, which has a locked door; all employees must go through a security
door to access employee area.
Requester’s Name: Gary Kula Requester’s Title: Maricopa County Public Defender
Phone No.: (602) 506-7711 X33061 Fax No.: (602) 372-29221 Email: Gary.Kula@maricopa.gov
Mailing Address (No., Street, City, State, ZIP): 620 W. Jackson St, Ste. 4015, Phoenix, AZ 85003
Signature: Date: