Agreement - Data Sharing Agmt 225512 with AZDES

UIA-1000B FORFF (4-10)

ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Employment and Rehabilitation Services

DATA-SHARING AGREEMENT

BETWEEN

City of Glendale, Arizona Police 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:
Effective Date:

End Date: 5-years from effective date

Data Sharing Agreement No.: 225512

Contract Period (if applicable):
Effective Date:

Initial End Date:

Associated Contract No. (if applicable):

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-1000B FORFF (4-10) - Page 2 Agreement No.: 225512

SECTION I. - DATA-SHARING AGREEMENT
TERMS AND CONDITIONS REGARDING CONFIDENTIAL UNEMPLOYMENT COMPENSATION INFORMATION

The Parties agree that:

1 The Requesting Entity, Glendale Police Department 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 requirements 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 Employment and Rehabilitation Services [DERS)) 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)]
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 formats, 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)(1)(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)(1)(v)(A) of 20 C.F.R. § 603.9 and will adhere to State and DES’ confidentiality requirements and procedures, that 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))

J. 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 a 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)]

UIA-1000B FORFF (4-10) — Page 3 Agreement No.: 225512

SECTION I. - DATA-SHARING AGREEMENT
TERMS AND CONDITIONS REGARDING CONFIDENTIAL UNEMPLOYMENT COMPENSATION INEORMATION

|. Allow on-site inspections of those portions 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 (J129)
or equivalent 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;
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-1000B FORFF (4-10) - Page 4 Agreement No.: 225512

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.

SECTION III. - DATA-SHARING AGREEMENT
ADDITIONAL INFORMATION AND CONDITIONS

l. Per the attached request, UC Data/File(s)/Screen(s)/Transaction(s) being provided:

a. Online access to GUIDE Screen W6, accessed by Transaction BGO!
. Online access to TEAM screens EAMT, EBIT, AADM, WAGE, and WAGA, accessed by Transaction TEAM
c. Copies of wage reports filed by employers may be obtained by contacting the UI Tax Custodian of Records by
phone at 602-771-3717 or 602-771-3924, or by email to UITRecordsRequest@azdes.gov

UIA-1000B FORFF (4-10) ~ Page 5 Agreement No.: 225512

DES Policy 1-38-8280 and DES 1-38-8120: This applies to all DES personnel, contractors, volunteers, and vendors
who have access to any DES data, systems, facilities, or clients.

2. A Request for Terminal Access and Other Activity (J-125) or other equivalent methods, shall be used to request specific
access for each authorized staff member. Email the completed form to: |SAAdmin@azdes.gov to receive access.

3. All staff coming in contact with confidential unemployment insurance data shall complete the DES Initial Security Awareness
training prior to obtaining access to confidential data and complete the Refresher Security Awareness Training annually as
directed.

Agreement No.: 225512
UIA-1000B FORFF (3-10) — Page 6

SECTION IIL. —- DATA-SHARING AGREEMENT
ADDITIONAL INEQRMATION 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: Sgt. Joseph Dziawura

Requesting Entity Name: Glendale Police Department

Unit Name: —_ Criminal Investigations Division, Digital Forensics

th Ht
Street Number: 6835 N. 57" Drive

City: Glendale State: AZ zip: 85301

Mailing Address (if different):

623-930-3088
623-930-3146 FAX Telephone Number:

Telephone Number:

E-Mail Address: _jdziawura@glendaleaz.com

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. Ifthe Requesting Entity has connectivity problems or access logon problems, contact the Resolution Center Help
Deskof the Division of Technology Services, Customer Support Services Center (DTS/CSSC) at 602-364-4419 or
18888757144 for assistance.

ii.For all other contacts and notices to DERS, including wherever this agreement requires the Requesting Entity to notifyor
otherwise contact DERS, such notices or contacts shall be made to UI Data Security, PO Box 6123 — Mail Drop 52T9,
Phoenix, AZ 85005-6123.

5. The UI Program requires cost recovery (per Section I, Subsection 5) when there is no reciprocity of mutual benefit between the
UI Program and the Requesting Entity.

The Agency will reimburse the UI Program for data sharing costs as specified in the EA/UIA Data Disclosure Information and
Fee Schedule (PAU-592, 11-09 or most current version).

O Cost recovery is not applicable

Ox Cost recovery applicable (if checked, complete the following billing information):

Name and Title of Contact Person: Diana Grimm, Account Specialist

Requesting Entity Name: City of Glendale

Unit Name: Police Department

Agreement No.: 225512

. thre.
Street Number: 6835 N. 57" Drive

City: Glendale State: AZ zip: 85301

Mailing Address (if different):

Voice Telephone Number;_623-930-3219 FAX Telephone Number: N/A

E-Mail Address: 4gtimm@glendaleaz.com

Agreement No.: 225512
UIA-1000B FORFF (4-10) ~ Page 7

SECTION HI. —- DATA-SHARING AGREEMENT
ADDITIONAL INFORMATION AND CONDITIONS

6. Use/Verification of the UC Wage Data

a. The wage and employer data on the UC files are reported to the Tax Section of the UI 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
UI 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 DERS 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 degradation of DERS operations due to insufficient computer capacity occurs.

8. The data-sharing agreement period is for 5 years from the effective date entered on Page 1 in the Agreement Period box unless this
data-sharing agreement is attached to a separate associated contract, in which case the agreement period is for the dates entered in
the Contract Period box on Page 1. The Initial End Date is as determined in an 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 data-sharing agreement replaces agreement 14515.

Agreement No.: 225512
UIA-1000B FORFF (4-10) - Page 8

SECTION IV. - DATA-SHARING AGREEMENT
APPROVALS.

DEPARTMENT OF ECONOMIC SECURITY, SECURITY, RISK & COMPLIANCE
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:

THIS AGREEMENT CONFORMS to DES Information Security Policy.
Oo

Qo 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: — Dan Wilkins

Title: | Chief Information Security Officer

Signature: Date:

I attest to the correctness of the information provided in the Data Sharing Request and agree to the terms and conditions listed in Sections
I, II, and III 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. I 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 terms 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. The 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: Chris Briggs, Chief of Police

Signature: fs Situ Date: pine =

ATTEST: APPROVED AS TO FORM:

Julie K. Bower, City Clerk (SEAL) Michael D. Bailey, City Attorney

Agreement No.: 225512

DATA MANAGING PROGRAM

Print Signatory Name: —Lesa Manning

Title: DERS Data Sharing Unit Supervisor

Signature: : Date:

DEPARTMENT OF ECONOMIC SECURITY, DIVISION OF EMPLOYMENT AND REHABILITATION SERVICES

Print Signatory Name: Anna Hunter

Title: Assistant Director

Signature: Date: _

UIA-1000A FORFF (3-10)

ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF EMPLOYMENT AND REHABILITATION SERVICES (DERS)

DATA-SHARING REQUEST

BETWEEN

City of Glendale, Arizona Police 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: 225512

Equal Opportunity Employer/Program ¢ Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VIL), 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.: 225512

DATA SHARING REQUEST

Use Attachment if necessary

la. 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)]

The Glendale Police Department investigates cases involving Identity Theft's where an unknown subject
uses a victim's Social Security Number to obtain employment or benefits. The Glendale Police
Department needs this information to obtain the location of where the SSN is being used in order to
properly investigate the case further to to refer the case to the proper jurisdiction. The information

we receive from Arizona Department of Economic Security will only be used to further a criminal
investigation.

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.

The City of Glendale currently maintains a Microsoft Window 10 Professional with Microsoft's Active Directory access structure.
The server and desktop hardware are patched on a monthly schedule and have Crowdstrike anti-virus protection installed.
The city has a vendor that provides internal and external intrusion detection scans to meet PCI compliance.

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): Brad Gresham Phone: (623)930-2162
Contact Name
(2): Sgt. Joseph Dziawura, Supervisor, Digital Forensics Phone: (623)930-3146

Contact Address: ©835N. 57th Drive Glendale, AZ 85301

Contact Name (1) E-Mail

Address: bgresham@glendaleaz.com
Contact Name (2) E-Mail

Address: jdziawura@glendaleaz.com
Contact Fax

No.: (623)930-3088

Ic. 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)]

Cases are reviewed weekly and requests to DES for information will be made weekly.

UIA-1000A FORFF (3-10) — Page 3 Associated Agreement No.: 225512

DATA SHARING REQUEST
Use Attachment if necessary
2. Will other individuals or entities interface with you as to UC information?

Yes L]No_ IfYes, identify individual(s) or entity(ies) and reason(s):

Other Detectives within the Glendale Police Department.

3. Will UC information be disclosed/shared with another individual or entity?
Kl Yes []No IfYes, identify individual(s) or entity(ies) and reason(s) for disclosure:

Information will be shared with the investigating Detective from Glendale or the agency where the crime occurred. This information
is necessary to further this type of investigation. This information will only be shared with Law Enforcement personnel during a
criminal investigation.

4. Will UC information be repackaged/included in other data bases, files, tapes, etc.?
Xl Yes LIJNo IfYes, identify format and reason(s):

This information will become part of the permanent investigation and will be submitted to the Records Department for retention. This
information will be linked to Glendale's Records Management System which is solely operated, administered, and accessible to/by
lendale personnel.

5. Desired output (Printout, tape, terminal access/display, etc.)

Print out of requested information or information in an electronic form which can be used to further a criminal investigation.

6. Describe safeguards in place to guard against unauthorized access/disclosure of the UC information

The City of Glendale has policies protecting the information it retains and City Information Technology personnel that ensure the integrity
of the City Network.

DES shall be notified within 24 hours when an information breach occurs. Notification must be in accordance with timelines based on State and Federal
law.

Requester’s Name: Joseph Dziawura Requester’s Title: Investigation's Sergeant

Phone No.; (623)930-3146 (623)930-3088 Fax No.: Email: jdziawura@glendaleaz.com

Date: IED 27

Mailing Address (No., Street, City, State, ZIP): 6835 N. 57th Drive Glendale, AZ 85301

Signature:

CONTINUED CITY OF GLENDALE SIGNATURE PAGE

ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DIVISION OF EMPLOYMENT AND REHABILITATION SERVICES (DERS)
DATA-SHARING AGREEMENT

ATTEST:

Julie K. Bower, City Clerk (SEAL)

APPROVED AS TO FORM:

Michael D. Bailey, City Attorney

DEPARTMENT OF ECONOMIC SECURITY
UNEMPLOYMENT INSURANCE

DATA DISCLOSURE INFORMATION
AND FEE SCHEDULE

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 an
alternative format or for further information about this policy, contact your EA Data Security Unit; TTY/TDD Services: 7-1-1.

Arizona De; ent of
= Economic Security
PAU-592 (10-13)

I.

UIA Policy Regarding Data Disclosure

Unemployment Insurance Administration (UIA) data is confidential and protected by both federal and state legislation
regarding confidentiality. Requests for the release of UIA data will be granted under the following conditions:

1.

The requesting entity must document that it has some basis in the law, which requires that the information be obtained,
or that it has some other legitimate reason for making the request.

Releasing the information to the requesting entity must not in any way be contrary to any applicable state or federal law
or regulation and must not cause any detriment to the UI Program, its employees, or its clients.

Occasional requests for data may be submitted to a UIA Custodian of Records without the need for a data-sharing
agreement. Any requesting entity, which submits an average of five or more requests for benefits (claimant) or tax
(employer) information per month for any three consecutive months, must apply for a data-sharing agreement.

If applicable under AAC R6-3-1403.A, or Section 303(i)(1)(A) of the Social Security Act, requests sent to either the
Custodian of Benefits Records or the Custodian of Tax Records must be accompanied by a release signed by the
appropriate claimant or employer before the information is disclosed.

If a data-sharing agreement is in effect between UIA and a requesting entity, each request for disclosure must be made
in conformity with the terms of the agreement, using only the method(s) stipulated.

If a data-sharing agreement is not required, requests for benefit or claimant information should be mailed to the
Custodian of Benefits Records; requests for tax or employer information should be mailed to the Custodian of Tax
Records.

The following conditions apply to all UIA data shared with a requesting entity:

1. If the requesting entity fails to comply with any provision of an agreement, including non-payment of fees, the
agreement may be suspended, and further disclosure of data prohibited.

2. — If the requesting entity fails to comply with any provision of an agreement or is responsible for any consequence which
is in violation of an agreement or in any way compromises the confidentiality of the data, the requesting agency may be
liable for any costs incurred by the UIA in seeking to rectify the situation. Such costs may include damages, penalties,
and restitution.

3. Unauthorized disclosure of confidential information as provided by ARS §23-722 and ARS §41-1959 may result in class
3 or class 2 misdemeanors, respectively.

4. Computer fraud as defined in ARS §13-2316 may result in either a class 3 or a class 6 felony.

List of Fees

The costs below are those identified by the UIA as reimbursable. They include fees pertaining to the establishment and maintenance
of data-sharing agreements as well as fees relating more directly to the costs of data disclosure. They consist of all development,
data transfer, and administrative costs associated with the data-sharing process, as provided by the Office of Management and
Budget Circular A-87.

Federal regulations specifically state that Unemployment Insurance funds may not be used to pay costs for data disclosure. The fees
in Section II will be the amounts applied unless superseded by any statute or other authority. An invoice will be sent to the
requesting entity at the time the agreement is implemented that will identify initial charges. Payment will be due within 30 days of
agreement execution unless otherwise indicated. Isolated requests, not covered by an agreement, must be accompanied by payment.
Any requests received without proper remuneration will not be honored.

A. DSA Start-up Cost ............. $300.00

Start-up fees include those costs incurred by the Division of Employment and Rehabilitation Service (DERS) Data Security
Unit in preparation for making the requested disclosure of data. These primarily consist of the time expended to establish a
data-sharing agreement, to handle billings and receipts, and to establish and verify that sufficient security procedures are in

place.
B. Management /Business UI Analysts............ $29.20 per hour
C. Training - GUIDE and/or TEAM ............ $29.20 per hour

UIA training is optional for data-sharing agreements. If the requester wishes to have training in the use of UIA screens,
it will be provided by UIA staff.

D. Costs for data disclosed by a custodian of records (delivered by mail):

The per-inquiry fees include costs to review each request, the time spent to produce the response, and equipment usage. Unless
otherwise specified in a data-sharing agreement, fees must accompany each request.

The UIA will charge the actual cost for any UIA information sent to the requester through the U. S. Postal Service or
delivered by other means. Unless other arrangements are made or covered in a data-sharing agreement, a self-addressed
stamped envelope or other delivery payment must accompany each request.

1. Requests to Benefits Custodian of Records
2. Requests to Tax Custodian of Records.

$ 2.00 per Social Security Number inquiry plus postage/delivery
$ 1.00 for the first page,$ .25 per additional page

plus postage/delivery
3. Postage/Delivery...............0.. Actual cost or $2.00 per page for FAX
E. Subpoenas............ § .10 per page plus staff time and postage.

Per ARS §12-351, reimbursement for subpoenas includes the cost of document reproduction, plus clerical costs incurred in
locating and making the document(s) available, billed at the rate of $.10 per page and $10.00 per hour per person.

Il. Contact information

Organizations within and outside of the Arizona Department of Economic Security that would like additional information Tegarding
any item on this fee schedule should contact the following unit:

Arizona Department of Economic Security
DERS Data Security Unit
Mail Drop 52T9 P.O. Box 6123
Phoenix, Arizona 85005-6123
Email: dersdsa@azdes.gov

For Custodian of Records information, contact:

UI Benefits Custodian of Records: U|CusiodianOfRecords@azdes. gov
UI Tax Custodian of Records: || TRecordsRequesi@azdes. gov

The Department of Economic Security Unemployment Insurance Administration (UIA) has prepared this pamphlet in order to
conform to federal and state regulations governing data-sharing, confidentiality and cost recovery. The information contained in this
publication explains the conditions under which UIA data may be disclosed, and the fees charged by the UIA for that disclosure.