Form J-119 - Data Sharing Request/agreement Page 7
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8J-119 DSA (7-17) - Page 7 of 8
ROUTING INSTRUCTIONS FOR J-119
DATA- SHARING AGREEMENT BETWEEN DES ENTITIES:
1. Section I, II and III are completed, contact information is provided and the document is signed by the requesting
Division or Program Assistant Director, Program Administrator, or designee. The requesting entity Division or Program
Security Analyst sends the document to the Data Managing Division/Program Security Analyst. The DSA/PSA from
the Data Managing Division/Program will complete Section III and the recommendation in Section IV. If applicable,
the Division HIPAA Privacy Officer will complete the recommendation in Section IV. Reason must be given if request
is not recommended for approval. Section V is signed and dated by the Data Managing Assistant Director, Program
Administrator or designee.
EXCEPTION: All DERS UI Data Sharing Agreements will follow their own established process.
2. The data managing Division/Program Security Analyst forwards the Agreement to the Enterprise Delivery Team for
signature and approval of Information technology connectivity. Enterprise service delivery team sends DSA back to the
Division/Program security team for final signatures. The Agreement is signed, and dated by the Information Security
Administrator. The original Agreement is sent back to the Division/Program entered into the tracking list. The Agreement
is scanned PDF to the network share, for all data sharing agreements. DSA is not final until fully signed by all parties.
NOTE: When the Agreement is modified during the approval process, both entities must review the modifications and
re-sign/date the document.
DATA-SHARING AGREEMENT BETWEEN DES AND AN EXTERNAL ENTITY:
1. Section I, II and III are completed by the requesting entity, contact information is provided and the document is signed
by the requesting entity and Division or Program Assistant Director, Program Administrator, or designee. The Division
or Program Security Analyst sends the document out for signatures. If applicable, the Division HIPAA Privacy Officer
will complete the recommendation in Section IV. Reason must be given if request is not recommended for approval.
Section V is signed and dated by the requesting entity administrator and Data Managing Assistant Director, Program
Administrator or designee.
EXCEPTION: All DERS UI Data Sharing Agreements will follow their own established process.
2. The data managing Division/Program Security Analyst forwards the Agreement to the Enterprise Delivery Team for
signature and approval of Informaton technology connectivity. Enterprise service delivery team sends DSA back to the
Division/Program security team for final signatures. The Agreement is signed, and dated by the Information Security
Administrator. The original Agreement is sent back to the Division/Program entered into the tracking list. The Agreement
is scanned PDF to the network share, for all data sharing agreements. DSA is not final until fully signed by all parties.
NOTE: When the Agreement is modified during the approval process, both entities must review the modifications and
re-sign/date the document.
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