AMENDMENT TO DATA SHARING AGREEMENT WITH DES.PDF

12/13/2019

ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Division of Employment and Rehabilitation Services
3443 N. Central Ave. e Suite 1500, Mail Drop 5279
Phoenix, AZ 85012
Phone: 602-542-2460 ¢ Fax: 602-771-9031

DATA-SHARING AGREEMENT AMENDMENT
between

Maricopa County Workforce

And
ARIZONA DEPARTMENT OF ECONOMIC SECURITY (DES)

C-22-18-013-3-02
Agreement No. 175546

SECTION I. ACTION
The following change(s) will become effective when all approvals/signatures are completed. The Agreement is:

[X] | Amended to include the following changes:

1. In item #2 of the Data Sharing Request document the referenced agent (Arizona Call-A-Teen Youth Resources) of Maricopa
County Workforce is hereby terminated.

2. Chicanos Por La Causa, DK Advocates, and ResCare Workforce Services are added as contractors for Maricopa County
Workforce.

Except as specified above, all the terms of the original Agreement will continue to be in effect.

SECTION I. RECOMMENDATIONS (Completed by data managing Program Security Representative)

0 Request is recommended for approval.

[ ] Request is not recommended for approval. Reason(s):

tant fe~ 2) 3 [20/9

Donna Ruiz: e W. Date
Signature of Program Security Representative

SECTION III. APPROVAL (Completed by the requesting entity and the data managing program)

Signature Date Signature Date

Michael Wisehart
Assistant Director, DERS

Print Name/Title

SECTION IV. APPROVAL (Completed by the Information Risk management Officer)

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:

[] THIS AMENDMENT CONFORMS to the DES Data Security Policy.

[] THIS AMENDMENT DOES NOT CONFORM to the DES Data Security Policy. Implementation of this Amendment cannot
proceed until the following action is taken:

Todd Luther: Date
Signature of Chief Information Security Officer