Fillable Dcf Database Access Request Form (Page 2 of 4) in pdf

SECURITY AGREEMENT FORM

The Department of Children and Families has authorized you:

_____________________________________________________________________

Employee’s or Other System User’s Name/Organization

to have access to sensitive data using computer-related media (e.g., printed reports, microfiche, system

inquiry, on-line update, or any magnetic media).

Computer crimes are a violation of the department’s Standards of Conduct. In addition to departmental

discipline, committing computer crimes may result in Federal or State felony criminal charges.

I understand that a security violation may result in criminal prosecution according to the provisions of

Federal and State statutes and may also result in disciplinary action against me according to the

department’s Standards of Conduct in the Employee Handbook.

By my signature below, I acknowledge that I have received, read, understand and agree to be bound by

the following:

• The Computer Related Crimes Act, Chapter 815, F.S.

• Sections 7213, 7213A, and 7431 of the Internal Revenue Code, which provide civil and criminal penalties

for unauthorized inspection or disclosure of Federal tax data.

• 6103(l)(7) of the Internal Revenue Code, which provides confidentiality and disclosure of returns and

return information.

• CFOP 50-2.

• It is the policy of the Department of Children and Families that no contract employee shall have access to

IRS tax information or FDLE information, unless approved in writing, by name and position to access

specified information, as authorized by regulation and/or statute.

• It is the policy of the Department of Children and Families that I do not disclose personal passwords.

• It is the policy of the Department of Children and Families that I do not obtain information for my own or

another person’s personal use.

• I will only access or view information or data for which I am authorized and have a legitimate business

reason to see when performing my duties. I shall maintain the integrity of all confidential and sensitive

information accessed.

• “Casual viewing” of employee or client data, even data that is not confidential or otherwise exempt from

disclosure as a public record, constitutes misuse of access and is not acceptable.

• The Department of Children and Families will perform regular database queries to identify misuse of

access.

• Chapter 119.0712, Florida Statutes, and the Driver Privacy Protection Act (DPPA).

PRIVACY ACT STATEMENT: Disclosure of your social security number is voluntary, but must be provided

in order to gain access to department systems. It is requested, however, pursuant to Section 282.318,

Florida Statutes, the Security of Data and Information Technology Resources Act. The Department

requests social security numbers to ensure secure access to data systems, prevent unauthorized access

to confidential and sensitive information collected and stored by the Department, and provide a unique

identifier in our systems.

_____________________________________

______________________________________

_______________

Print Employee or Other System User Name

Signature of Employee or Other System User

Date

_____________________________________

______________________________________

_______________

Print Supervisor Name

Signature of Supervisor

Date

CF 114, PDF 03/2013 Distribution of Copies: Original – Personnel File/Other System User File; Copy – Employee/Other System User

Dcf Database Access Request Form Page 2

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