Grant Renewal Application WA ST Dept of Commerce

Washington State STOP Formula Grant Program Renewal Application for FFY 2019 CONFIDENTIALITY AND PERSONALLY IDENTIFYING INFORMATION (Victim Services Providers Only) Requirement to Comply with the Confidentiality and Privacy Provisions of VAWA for Victim Services Community-based victim service providers providing direct services to victims are required to comply with the provisions of 34 U.S.C. 12291(b)(2), nondisclosure of confidential or private information, which includes creating and maintaining documentation of compliance, such as policies and procedures for release of victim information. Frequently Asked Questions (FAQs) on the VAWA Confidentiality Provision can be found here. Applicants unable to comply with the statutory eligibility requirements of confidentiality will be prohibited from receiving these funds. In addition to completing the form Acknowledgement of Notice of Statutory Requirement to Comply with the Confidentiality and Privacy Provisions of the Violence Against Women Act, as Amended, please respond to the questions below: y8y Policy and Procedures on Breach of Confidentiality Does your organization have the following: 1. A policy/procedure on notification to victims when a breach of confidentiality has occurred? jig Yes ❑ No 2. A policy/procedure to notify the authorized representative of the award,who will be identified on the Face Sheet of your grant, no later than 24 hours after an occurrence of a breach? J Yes ❑ No 3. A policy/procedure to report to the authorized representative of the award the circumstances of the breach and how your organization will address it to prevent it from happening again? I:g Yes ❑ No ( As the duly authorized representative of the applicant, I hereby certify that the above is true and correct. /17 Signature of Agen 's Authorized Official 24 J