Contact Information Disclosure from Employment Service Providers Sample Clauses

Contact Information Disclosure from Employment Service Providers. I hereby authorize the release of the following information: Full Name, Local Address, Cell/Home Phone Number, Email address, and Test scores, if applicable, by the Florida Department of Children and Families/Refugee Services Program and the Refugee Services funded Employment service provider to the Refugee Services funded Adult Education provider so they can contact me to explain the educational services I might be eligible to receive. Client Rights • I have the right to revoke this authorization at any time by writing to the Florida Department of Children and Families and [Provider Name]. • I understand that signing this authorization is voluntary and my treatment, payment, enrollment, or eligibility for benefits is not contingent upon my authorization of this disclosure. • I understand that information disclosed under this authorization may be re-disclosed by the recipient, and this re-disclosure may no longer be protected by federal or state law. • The Florida Department of Children and Families and [Provider Name] will give me a copy of this form upon my request. • I understand that this authorization will expire at the conclusion or termination of the contract between the Florida Department of Children and Families and [Provider Name], unless I specify a different date. • My signature below indicates that I have read this form entirely, had the opportunity to ask questions, and authorize the use of a copy of this form for the disclosure of the information described above. Client Name Client Signature Date Provider Use Only: I have explained this form and its purpose to the client and the client has refused to sign. Provider Signature Date EXHIBIT C3 – CLIENT RELEASE OF INFORMATION FORM I EXHIBIT C4 – RSDS SECURITY ACCESS REQUEST FORM REFUGEE SERVICES DATA SYSTEM SECURITY ACCESS REQUEST (SAR) Date: Contract Number: Provider Name: Employee Requesting RSDS Access: Program Name: Employee Position Title: Employee Email Address: Purpose for Access: Attachments: DCF Security Agreement (form CF 0114), signed and dated by both the supervisor and employee requesting RSDS access. DCF Security Awareness Training Certificate (Internet training certificate). Date that DCF Security Awareness Training was completed by employee: DCF Security Awareness Training can be reached going to the DCF internet site at: xxxx://xxx.xxxxxxxxxxxx.xxx/about- us/dcf-training. You will need to follow the link “Security Awareness Training” at the top of the page. Supervisor’s Name Sup...
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Contact Information Disclosure from Employment Service Providers. I hereby authorize the release of the following information: Full Name, Local Address, Cell/Home Phone Number, Email address, and Test scores, if applicable, by the Florida Department of Children and Families/Refugee Services Program and the Refugee Services funded Employment service provider to the Refugee Services funded Adult Education provider so they can contact me to explain the educational services I might be eligible to receive. Client Rights • I have the right to revoke this authorization at any time by writing to the Florida Department of Children and Families/Refugee Services Program and XXXXXX • I understand that signing this authorization is voluntary and my treatment, payment, enrollment, or eligibility for benefits is not contingent upon my authorization of this disclosure. • I understand that information disclosed under this authorization may be re-disclosed by the recipient, and this re-disclosure may no longer be protected by federal or state law. • The Florida Department of Children and Families/Refugee Services Program and XXXXXXX. will give me a copy of this form upon my request. • I understand that this authorization will expire at the conclusion of my Refugee Services eligibility period (5 years from date of entry) unless I specify a different date. • My signature below indicates that I have read this form entirely, had the opportunity to ask questions, and authorize the use of a copy of this form for the disclosure of the information described above. Client Name Client Signature Date CF Standard Contract 2018 Part 2 of 2 47 Contract No.
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Related to Contact Information Disclosure from Employment Service Providers

  • Confidentiality of Services All services performed by Contractor, and any sub- contractor(s) if applicable, including but not limited to all drafts, data, information, correspondence, proposals, reports of any nature, estimates compiled or composed by Contractor, are for the sole use of City, its agents, and employees. Neither the documents nor their contents shall be released by Contractor or any subcontractor to any third party without the prior written consent of City. This provision does not apply to information that: (1) was publicly known, or otherwise known to Contractor, at the time it was disclosed to Contractor by City; (2) subsequently becomes publicly known through no act or omission of Contractor; or (3) otherwise becomes known to Contractor other than through disclosure by City.

  • Account Information Disclosure We will disclose information to third parties about your account or the transfers you make: - As necessary to complete transfers; - To verify the existence of sufficient funds to cover specific transactions upon the request of a third party, such as a credit bureau or merchant; - If your account is eligible for emergency cash and/or emergency card replacement services and you request such services, you agree that we may provide personal information about you and your account that is necessary to provide you with the requested service(s); - To comply with government agency or court orders; or - If you give us your written permission.

  • Contractor Designation of Trade Secrets or Otherwise Confidential Information If the Contractor considers any portion of materials to be trade secret under section 688.002 or 812.081, F.S., or otherwise confidential under Florida or federal law, the Contractor must clearly designate that portion of the materials as trade secret or otherwise confidential when submitted to the Department. The Contractor will be responsible for responding to and resolving all claims for access to Contract-related materials it has designated trade secret or otherwise confidential.

  • CENTURYLINK OSS INFORMATION 57.1 Subject to the provisions of this Agreement and Applicable Law, CLEC shall have a limited, revocable, non-transferable, non-exclusive right to use CenturyLink OSS Information during the term of this Agreement, for CLEC’s internal use for the provision of Telecommunications Services to CLEC End Users in the State.

  • Confidentiality of Contractor Information The Contractor acknowledges and agrees that this Contract and any and all Contractor information obtained by the State in connection with this Contract are subject to the State of Vermont Access to Public Records Act, 1 V.S.A. § 315 et seq. The State will not disclose information for which a reasonable claim of exemption can be made pursuant to 1 V.S.A. § 317(c), including, but not limited to, trade secrets, proprietary information or financial information, including any formulae, plan, pattern, process, tool, mechanism, compound, procedure, production data, or compilation of information which is not patented, which is known only to the Contractor, and which gives the Contractor an opportunity to obtain business advantage over competitors who do not know it or use it. The State shall immediately notify Contractor of any request made under the Access to Public Records Act, or any request or demand by any court, governmental agency or other person asserting a demand or request for Contractor information. Contractor may, in its discretion, seek an appropriate protective order, or otherwise defend any right it may have to maintain the confidentiality of such information under applicable State law within three business days of the State’s receipt of any such request. Contractor agrees that it will not make any claim against the State if the State makes available to the public any information in accordance with the Access to Public Records Act or in response to a binding order from a court or governmental body or agency compelling its production. Contractor shall indemnify the State for any costs or expenses incurred by the State, including, but not limited to, attorneys’ fees awarded in accordance with 1 V.S.A. § 320, in connection with any action brought in connection with Contractor’s attempts to prevent or unreasonably delay public disclosure of Contractor’s information if a final decision of a court of competent jurisdiction determines that the State improperly withheld such information and that the improper withholding was based on Contractor’s attempts to prevent public disclosure of Contractor’s information. The State agrees that (a) it will use the Contractor information only as may be necessary in the course of performing duties, receiving services or exercising rights under this Contract; (b) it will provide at a minimum the same care to avoid disclosure or unauthorized use of Contractor information as it provides to protect its own similar confidential and proprietary information; (c) except as required by the Access to Records Act, it will not disclose such information orally or in writing to any third party unless that third party is subject to a written confidentiality agreement that contains restrictions and safeguards at least as restrictive as those contained in this Contract; (d) it will take all reasonable precautions to protect the Contractor’s information; and (e) it will not otherwise appropriate such information to its own use or to the use of any other person or entity. Contractor may affix an appropriate legend to Contractor information that is provided under this Contract to reflect the Contractor’s determination that any such information is a trade secret, proprietary information or financial information at time of delivery or disclosure.

  • Exclusions from Confidential Information Receiving Party's obligations under this Agreement do not extend to information that is: (a) publicly known at the time of disclosure or subsequently becomes publicly known through no fault of the Receiving Party; (b) discovered or created by the Receiving Party before disclosure by Disclosing Party; (c) learned by the Receiving Party through legitimate means other than from the Disclosing Party or Disclosing Party's representatives; or (d) is disclosed by Receiving Party with Disclosing Party's prior written approval.

  • CONFIDENTIALITY OF PERSONAL INFORMATION ‌ 35 Provider shall protect all Personal Information, records and data from unauthorized disclosure 36 in accordance with 42 CFR §431.300 through §431.307, RCWs 70.02, 71.05, 71.34 and for 37 individuals receiving SUD services, in accordance with 42 CFR Part 2 and WAC 388-877B. 38 Provider shall have a process in place to ensure all components of its provider network and 39 system understand and comply with confidentiality requirements for publicly funded 40 behavioral health services. Pursuant to 42 CFR §431.301 and §431.302, personal information 41 concerning applicants and recipients may be disclosed for purposes directly connected with 42 the administration of this Contract and the State Medicaid Plan. Provider shall read and 43 comply with all HIPAA policies.

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