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GT-400211

R. 01/16

Page 2

RISE Program Level-two Information Sharing Agreement

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Florida Department of Revenue

(Print Name of Government Entity)

Only authorized employees of the Government Entity with an official use for the information

as stated in paragraph A, shall be allowed access to the information. Information shall be

furnished directly to the Government Entity by the Department. A certified public accountant

hired according to s. 125.0104 or 212.0305, F.S., by the Government Entity may obtain access

to the information from the Government Entity, not from the Department. All authorized

employees of the Government Entity are responsible for familiarity and compliance with the

confidentiality provisions of s. 213.053(2), F.S., as amended, and Chapter 12-22, F.A.C., related

to the use of any state tax information received according to this Agreement.

The RISE participant must supply a list of authorized employees as stated in paragraph D, to

the RISE Coordinator of the Department not less than annually by January 31. Such list shall

include the name and position of each authorized employee.

Each authorized employee as stated in paragraph D, is required to execute by January 31 of

each year the certification of familiarity with the confidentiality requirements of s. 213.053, F.S.,

and Chapter 12-22, F.A.C., found in Attachment C of this Agreement. Any person who becomes

an authorized employee subsequent to January 31 must execute a separate certification of

familiarity. In each instance, all certifications shall be forwarded to the RISE Coordinator of the

Department within 15 business days of the hire date or change of employment status.

In the event that a person signing this Agreement or an authorized employee leaves

employment or changes employment status such that he or she no longer has an official use

for the information, the Government Entity must notify the RISE Coordinator within 15 business

days of the employee’s termination or change of employment status.

The Government Entity must notify the RISE Coordinator in each instance when it contracts

with a certified public accountant pursuant to s. 125.0104 or 212.0305, F.S. Such notification

shall include the name and address of the certified public accountant, date of the contract, and

extent of service to be provided. Every contract between a Government Entity and a certified

public accountant according to s. 125.0104 or 212.0305, F.S., must contain a provision which

informs that the certified public accountant is subject to the confidentiality requirements of

s. 213.053, F.S., and Chapter 12-22, F.A.C.

The Government Entity is required to keep and maintain records regarding any state tax

information furnished to any certified public accountant as stated in paragraph H., for 5 years

from the date of the disclosure.

5. The Department may conduct on-site security reviews to ensure that adequate procedures are in place

to safeguard confidential tax information received under RISE and this Agreement and prevent any

unauthorized disclosures of that information.

Form Gt-400211 - Registration Information Sharing And Exchange (Rise) Program Level-Two Agreement Page 2