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GT-400210

R. 01/16

RISE Program Level-one Information Sharing Agreement

Page 2

_______________________________/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. 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 pursuant 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.

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.

6. Mutually acceptable techniques and methods of information sharing will be developed when and as

required by the operating officials of the respective parties to this Agreement with the overall objective

of providing the most useful data, with a minimum of interruption of operating routines, and the least

amount of additional expense.

7. Information sharing frequency shall be either monthly or quarterly as specified in Attachment A of this

Agreement.

8. The following data elements relating to licensing or registration activity during each period will be

exchanged by the parties to this Agreement within 20 days of the end of that month or quarter:

Registrant’s, licensee’s or taxpayer’s name (business and owner).

Mailing address (including ZIP code).

Business location address (including ZIP code).

Telephone number (business and owner).

Federal employer identification number or *social security number.

*Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for

the administration of Florida’s taxes. SSNs obtained for tax administration purposes are confidential under

sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records. Collection

of your SSN is authorized under state and federal law. Visit our Internet site at and

select “Privacy Notice” for more information regarding the state and federal law governing the collection,

use, or release of SSNs, including authorized exceptions.

Business type code (NAICS or SIC code).

Form Gt-400210 - Registration Information Sharing And Exchange (Rise) Program Level-One Agreement Page 2

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