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AGREEMENT TO PROTECT CONFIDENTIAL PERSONAL INFORMATION

THIS AGREEMENT (the "Agreement”) is entered into on this ____day of ___________ by and

between the Ohio Department of Veterans Services, (ODVS) located at 77 S. High Street, 7

Floor,

Columbus, OH 43215, and ___________________________ with an address at

______________________ (the “Receiving Party”).

The Receiving Party hereto requests access to certain confidential personal information available

through the Defense Personnel Records Information System (“DPRIS”) for the sole purpose of assisting

veterans in obtaining benefits from the U.S. Veterans Administration and/or any state or local programs.

ODVS takes seriously the protection of personally identifiable information, as evidenced in

departmental policy #12-01. This policy provides requirements for protecting the privacy of people who

have personally identifiable information in its databases. As a federal database, DPRIS records are

subject to the Privacy Act of 1974, 5 U.S.C. 552(a) and other federal statutes and regulations.

Therefore, in consideration of the mutual promises and covenants contained in this Agreement,

and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged,

the parties hereto agree as follows:

Definition of Confidential Information.

Confidential personal information is personal information that falls within the scope of section

1347.15 of the Ohio Revised Code and that ODVS is prohibited from releasing under Ohio’s Public

Records law and/or the Federal Privacy Act of 1974.

Use of Confidential Information.

The Receiving Party agrees to not to access the DPRIS system from any other computer

than from their County Veterans Service office computer. The Receiving Party further agrees to use the

Confidential Information only solely for official, lawful purposes, including, (but not limited to):

administering a statutory provision or duty; complying with any state or federal program requirements;

drafting or processing a claim; or otherwise administering a program with individual participants or

beneficiaries. The receiving party further agrees it has a duty not to disclose any information without

proper authorization.

The receiving party acknowledges DPRIS is a Department of Defense Computer

system and that t

his computer system, including all related equipment, networks, and network devices

(specifically including Internet access) are provided only for authorized U.S. Government use. DoD

computer systems may be monitored for all lawful purposes, including insuring that their use is

authorized, for management of the system, to facilitate protection against unauthorized access, and to

verify security procedures, survivability, and operational security. Monitoring includes active attacks by

authorized DoD entities to test or verify the security of this system.

During monitoring, information may be examined, recorded, copied and used for

authorized purposes. All information, including personal information, placed or sent over this system may

Personal Information Confidentiality Agreement Template - Ohio Department Of Veterans Services