REFUGEE CONTRACT AMENDMENT (05).PDF

INTERGOVERNMENTAL 
AGREEMENT AMENDMENT 
ARIZONA DEPARTMENT OF 
ECONOMIC SECURITY 
1789 W. Jefferson, 4th Floor 
Phoenix, Arizona 85007 
(602) 542-2456
Page 1 of 2 
CONTRACTOR (Name and Address): 
Services Description: 
Coordination – Health Assessment 
Maricopa County Department of Public 
Health 
4041 N. Central Ave, Suite 1400 
Phoenix, AZ 85012 
Agreement Number: 
DI18-002141 
Amendment Number: 
One (1) 
THE PARTIES AGREE TO THE FOLLOWING AMENDMENT 
Pursuant to the Intergovernmental Agreement (IGA) Section 9.0 Amendments, the parties hereby agree to amend the 
Agreement as follows: 
1.
Add Section 3.3
3.3      Client Eligibility Requirements/Target Population: An individual who has been authorized by RRP to
receive services.  Proof of authorization includes Validation in the RRP on-line database. 
2.
Add Section 4.2
4.2       Client Eligibility Requirements/Target Population:
  4.2.1 Eligible clients include: 
o
Refugees admitted under INA § 207;
o
Asylees granted asylum under INS §208;
o
Cuban and Haitian Entrants as defined under 45 CFR § 401.2
o
Certain Amerasians;
o
Adult Victims of Trafficking certified by the U.S. Department of Health and Human Services
(DHHS) and Minor Victims of Trafficking;
o
Special Immigrant Visa Holders;
o
Permanent Residents who had held one of the above statuses in the past; or
o
Others as indicated by the Arizona Refugee Resettlement Program (RRP).
3.
Revise Section 5.6
5.6       Record in each client’s medical chart the alien identification number from the Arizona Refugee
Resettlement Program Online Data System.  
4.
Revise Section 5.14
5.14     Attend all RRP Quarterly Meetings and, if requested, present on the numbers of clients screened,
timelines in which clients were screened, trends, challenges and successes for the DME program. 
5.
Add Section 5.21
5.21 Maintain the capacity to serve all eligible clients per the eligibility requirements outlined in Section 4.2
6.
Add Section 5.22
5.22 Maintain ability to serve clients who present without Refugee Medical Screening identification Card.
C-86-18-010-3-05

INTERGOVERNMENTAL 
AGREEMENT AMENDMENT 
ARIZONA DEPARTMENT OF 
ECONOMIC SECURITY 
1789 W. Jefferson, 4th Floor 
Phoenix, Arizona 85007 
(602) 542-2456
Page 2 of 2 
EXCEPT AS PROVIDED HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT SHALL REMAIN UNCHANGED AND 
IN FULL FORCE AND EFFECTS.  THE AMENDMENT SHALL BECOME EFFECTIVE ON THE DATE OF LAST SIGNATURE UNLESS 
OTHERWISE SPECIFIED HEREIN.  BY SIGNING THIS AGMENDMENT ON BEHALF OF THE CONTRACTOR, THE SIGNATORY 
CERTIFIES HE/SHE HAS THE AUTHORITY TO BIND THE CONTRACTOR TO THIS CONTRACT. 
Agency Name 
Name of Contractor 
Arizona Department of Economic Security 
Authorized Signature 
Authorized Signature 
Type Name 
Typed Name 
Title 
Title 
Chief Procurement Officer 
Date 
Date 
IN ACCORDANCE WITH ARS §11-952 THIS CONTRACT AMENDMENT HAS BEEN REVIEWED BY THE UNDERSIGNED WHO HAVE 
DETERMINED THAT THIS CONTRACT AMENDMENT IS IN APPROPRIATE FORM AND WITHIN THE POWERS AND AUTHORITY 
GRANTED TO EACH RESPECTIVE PUBLIC BODY. 
ARIZONA ATTORNEY GENERAL'S OFFICE 
PUBLIC AGENCY LEGAL COUNSEL 
ASSISTANT ATTORNEY GENERAL  
DATE 
DATE 
Maricopa County Department of Public Health
Maricopa County
Clint Hickman
Chairman, Board of Supervisors
Attorney for County
ATTEST:______________________________________________________, Office of the Clerk of the Board
                                                                                                                        Date