WA ST Dept of Commerce 10/15/2021 (2)

ATTACHMENT D REQUIREMENT TO REPORT ACTUAL OR IMMINENT BREACH OF PERSONALLY IDENTIFIABLE INFORMATION (Non-Profit Victim Services Providers Only) 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. By signature on this form,the non-profit victim services applicant for the STOP Grant acknowledges that, if awarded funds, they will be required to comply with the following conditions, and will mandate that subgrantees, if any, comply as well. Applicant and award recipients, and subrecipients at any tier, must have written procedures in place to respond in the event of an actual or imminent breach (as defined in OMB M-17-12) if it (or a subgrantee)-- 1) creates, collects, uses, processes, stores, maintains, disseminates, discloses, or disposes of personally identifiable information (PII) (as defined in 2 C.F.R. 200.79)within the scope of an OVW grant-funded program or activity, or 2) uses or operates a Federal information system (as defined in OMB Circular A-130). The Applicant's breach procedures must include a requirement to report actual or imminent breach of personally identifiable information to the Authorized Representative identified on the Face Sheet of the Grant no later than 24 hours after an occurrence of an actual breach, or the detection of an imminent breach. Additionally, grantee must address how it will prevent such a breach from happening again. Subrecipient's breach procedures must include a requirement to report actual or imminent breach of personally identifiable information to the Grantee no later than 24 hours after an occurrence of an actual breach, or the detection of an imminent breach. Subgrantees must address how they will prevent such a breach from happening again. Applicant and award recipients, and subrecipients at any tier, are prohibited from disclosing, revealing, or releasing personally identifying information or individual information collected in connection with services requested, utilized, or denied through the Grantee's (and any subgrantee's) programs, regardless of whether the information has been encoded, encrypted, hashed, or otherwise protected (34 U.S.C. § 12291(b)(2)). As the duly authorized person to legally bind the applicant to a grant, I hereby certify that the applicant will comply with the above requirements, if awarded a grant. I also acknowledge,as part of grant monitoring,OCVA staff may request a copy of grantee's breach procedures. City of Everett Applicant Agency Name N/A Name of Authorized Official or Delegate Title of Authorized Official or Delegate Signature of Authorized Official or Delegate Date AFFR : EE:=,5TC F--e,' Eavid C.Hall, Washington State STOP Formula Grant Program Renewal Application for FFY 2022 19