DES AMENDMENT FOR NEW HIRE AGREEMENT.DOC

J-119 Amendment (03/07)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY C-22-14-059-3-05
Information Security Administration
1720 W Madison, Room C3, SC 820Z, Phoenix AZ 85007
Phone: 602-771.2670 • Fax: 602-542-4014
DATA-SHARING AGREEMENT AMENDMENT
Arizona Department of Economic Security
(Data Managing Division, Program, Administration)
And
(Maricepa County)
Agreement No. 12001
SECTION I. ACTION
The following change(s) will become effective when all approvals/signatures are completed. The Agreement is:
E Amended to include the following changes: (Use additional page if necessary) Agreement 12001 will remain in effect for 10 years
from the effective date. Termination Date: 02-04-2025.
Except as specified above, all the terms of the original Agreement will continue to be in effect.
SECTION II. RECOMMENDATIONS (Completed by data managing Division or Program Security Analyst)
Ej Request is recommended for approval.
p Request is not recommended for approval. Reason(s):
Signature of Division or Program Security Analyst Date
SECTION III. APPROVAL (Completed by the requesting entity and the data managing division or program)
REQUESTING ENTITY SIGNATORY (PRINT NAME)
Steve Chucn Chairman, Mancopa County Board of Supervisors Date
DES SIGNATORY (PRINT NAME)
Des Data Managing Division or Administration Signature Date
Approved as to Form:
Maricopa County Attorney
Attested to:
Maricopa County Clerk of the Board
Equal Opportunity Employer/Program

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SECTION IV. APPROVAL (Completed by the Information Security Administrator)
This signed Amendment meets all requirements necessary to permit the controlled sharing of the DES data while
simultaneously providing for the protection of the data. I certify that:
EI THIS AMENDMENT CONFORMS to the DES Information Security Policy.
0 THIS AMENDMENT DOES NOT CONFORM to the DES Information Security Policy. Implementation of this
Amendment cannot proceed until the following action is taken:
Signature of Information Security Administrator Date
J-119 Amendment
Equal Opportunity Employer/Program