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ATTACHMENT D <br />REQUIREMENT TO REPORT ACTUAL OR IMMINENT BREACH <br />OF PERSONALLY IDENTIFIABLE INFORMATION <br />(Non -Profit Victim Services Providers Only) <br />Community -based victim service providers providing direct services to victims are required to comply with the <br />provisions of 34 U.S.C. 12291(b)(2), nondisclosure of confidential or private information, which includes creating <br />and maintaining documentation of compliance, such as policies and procedures for release of victim information. <br />Frequently Asked Questions (FAQs) on the VAWA Confidentiality Provision can be found here. Applicants unable <br />to comply with the statutory eligibility requirements of confidentiality will be prohibited from receiving these <br />funds. By signature on this form, the non-profit victim services applicant for the STOP Grant acknowledges that, <br />if awarded funds, they will be required to comply with the following conditions, and will mandate that <br />subgrantees, if any, comply as well. <br />Applicant and award recipients, and subrecipients at any tier, must have written procedures in place to respond <br />in the event of an actual or imminent breach (as defined in OMB M-17-12) if it (or a subgrantee)-- 1) creates, <br />collects, uses, processes, stores, maintains, disseminates, discloses, or disposes of personally identifiable <br />information (PII) (as defined in 2 C.F.R. 200.79) within the scope of an OVW grant -funded program or activity, or <br />2) uses or operates a Federal information system (as defined in OMB Circular A-130). <br />The Applicant's breach procedures must include a requirement to report actual or imminent breach of personally <br />identifiable information to the Authorized Representative identified on the Face Sheet of the Grant no later than <br />24 hours after an occurrence of an actual breach, or the detection of an imminent breach. Additionally, grantee <br />must address how it will prevent such a breach from happening again. <br />Subrecipient's breach procedures must include a requirement to report actual or imminent breach of personally <br />identifiable information to the Grantee no later than 24 hours after an occurrence of an actual breach, or the <br />detection of an imminent breach. Subgrantees must address how they will prevent such a breach from happening <br />again. <br />Applicant and award recipients, and subrecipients at any tier, are prohibited from disclosing, revealing, or <br />releasing personally identifying information or individual information collected in connection with services <br />requested, utilized, or denied through the Grantee's (and any subgrantee's) programs, regardless of whether the <br />information has been encoded, encrypted, hashed, or otherwise protected (34 U.S.C. § 12291(b)(2)). <br />As the duly authorized person to legally bind the applicant to a grant, I hereby certify that the applicant will comply <br />with the above requirements, if awarded a grant. I also acknowledge, as part of grant monitoring, OCVA staff may <br />request a copy of grantee's breach procedures. <br />City of Everett <br />Applicant Agency Name <br />N/A <br />Name of Authorized Official or Delegate Title of Authorized Official or Delegate <br />Signature of Authorized Official or Delegate Date <br />Washington State STOP Formula Grant Program Renewal Application for FFY 2022 19 <br />