DATA SHARING AGREEMENT - AMENDMENT 1 .PDF

Equal Opportunity Employer/Program 
 
J-119 Amendment (03/07) 
ARIZONA DEPARTMENT OF ECONOMIC SECURITY 
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 
      
Division of Aging and Adult Services (DAAS)/Refugee Resettlement Program (RRP) 
  
And  
      
Maricopa County Department of Public Health 
 
Agreement No.        
  
SECTION I.  ACTION 
 
The following change(s) will become effective when all approvals/signatures are completed. The Agreement is: 
 
 
 
Amended to include the following changes: Contract Max End date is revised to 9/30/2023   
      
 
 
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) 
 
 
Request is recommended for approval. 
 
 
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)       
 
 ______________________________________________________________________________________________  
 Requesting Entity Signature 
Date 
 
 
DES SIGNATORY  (PRINT NAME)       
 
 
 
 
 
 
 ______________________________________________________________________________________________  
 Des Data Managing Division or Administration Signature 
Date

Equal Opportunity Employer/Program 
 
Page 2 
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: 
 
 
THIS AMENDMENT CONFORMS to the DES Information Security Policy. 
 
 
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 
 
 
 
 
IN WITNESS WHEREOF, the parties agree to enter into this Agreement and its Amendments: 
 
FOR AND ON BEHALF 
OF MARICOPA COUNTY 
 
 
By_____________________________ 
Chairman, Board of Supervisors 
 
_______________________________ 
Date 
 
 
ATTEST: 
 
_______________________________ 
Office of the Clerk of the Board 
 
_______________________________ 
Date 
 
 
APPROVED AS TO FORM: 
 
_______________________________ 
Attorney for Maricopa County 
 
_______________________________ 
Date