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Acknowledgement of Notice of Statutory Requirement to Comply with the Confidentiality and Privacy
<br /> Provisions of the Violence Against Women Act,as Amended(required for all applicants)
<br /> Under section 40002(b)(2)of the Violence Against Women Act,as amended(42 U.S.C.13925(b)(2)),grantees and subgrantees with funding from the
<br /> Office on Violence Against Women are required to meet the following terms with regard to nondisclosure of confidential or private information and to
<br /> document their compliance.By signature on this form,applicant for the STOP Grant acknowledges that that they have notice that,if awarded funds,they
<br /> will be required to comply with this provision,and will mandate that subgrantees,if any,comply with this provision,and will create and maintain
<br /> documentation of compliance,such as policies and procedures for release of victim information,and will mandate that subgrantees,if any,will do so as
<br /> well.
<br /> (A)In general
<br /> In order to ensure the safety of adult,youth,and child victims of domestic violence,dating violence,sexual assault,or stalking,and their families,grantees
<br /> and subgrantees under this subchapter shall protect the confidentiality and privacy of persons receiving services.
<br /> (B)Nondisclosure
<br /> Subject to subparagraphs(C)and(D),grantees and subgrantees shall not--
<br /> (i)disclose,reveal,or release any personally identifying information or individual information collected in connection with services requested,utilized,or
<br /> denied through grantees'and subgrantees'programs,regardless of whether the information has been encoded,encrypted,hashed,or otherwise
<br /> protected;or
<br /> (ii)disclose,reveal,or release individual client information without the informed,written,reasonably time-limited consent of the person(or in the case of
<br /> an unemancipated minor,the minor and the parent or guardian or in the case of legal incapacity,a court-appointed guardian)about whom information
<br /> is sought,whether for this program or any other Federal,State,or Tribal grant program,except that consent for release may not be given by the abuser of
<br /> the minor,incapacitated person,or the abuser of the other parent of the minor.
<br /> If a minor or a person with a legally appointed guardian is permitted by law to receive services without the parent's or guardian's consent,the minor or
<br /> person with a guardian may release information without additional consent.
<br /> (C)Release
<br /> If release of information described in subparagraph(B)is compelled by statutory or court mandate--
<br /> (i)grantees and subgrantees shall make reasonable attempts to provide notice to victims affected by the disclosure of information;and
<br /> (ii)grantees and subgrantees shall take steps necessary to protect the privacy and safety of the persons affected by the release of the information.
<br /> (D)Information sharing
<br /> (i)Grantees and subgrantees may share--
<br /> (I)nonpersonally identifying data in the aggregate regarding services to their clients and nonpersonally identifying demographic information in order to
<br /> comply with Federal,State,or Tribal reporting,evaluation,or data collection requirements;
<br /> (II)court-generated information and law enforcement-generated information contained in secure,governmental registries for protection order
<br /> enforcement purposes;and
<br /> (III)law enforcement-generated and prosecution-generated information necessary for law enforcement and prosecution purposes.
<br /> (ii)In no circumstances may--
<br /> (I)an adult,youth,or child victim of domestic violence,dating violence,sexual assault,or stalking be required to provide a consent to release his or her
<br /> personally identifying information as a condition of eligibility for the services provided by the grantee or subgrantee;
<br /> (II)any personally identifying information be shared in order to comply with Federal,Tribal,or State reporting,evaluation,or data collection
<br /> requirements,whether for this program or any other Federal,Tribal,or State grant program.
<br /> (E)Statutorily mandated reports of abuse or neglect
<br /> Nothing in this section prohibits a grantee or subgrantee from reporting suspected abuse or neglect,as those terms are defined and specifically
<br /> mandated by the State or Tribe involved.
<br /> (F)Oversight
<br /> Nothing in this paragraph shall prevent the Attorney General from disclosing grant activities authorized in this Act to the chairman and ranking members
<br /> of the Committee on the Judiciary of the House of Representatives and the Committee on the Judiciary of the Senate exercising Congressional oversight
<br /> authority.All disclosures shall protect confidentiality and omit personally identifying information,including location information about individuals.
<br /> (G)Confidentiality assessment and assurances
<br /> All applicants must document their compliance with the confidentiality and privacy provisions required under this section by checking the"Acceptance
<br /> of these Conditions"box below. As the duly authorized representative of the applicant,I hereby acknowledge that the applicant has received notice that
<br /> if awarded funding they will comply with the above statutory requirements.This acknowledgement shall be treated as a material representation of fact
<br /> upon which the Department of Commerce,Office of Crime Victims Advocacy will rely if a grant is issued.
<br /> Everett Police Department
<br /> Applicant Agency Name Date
<br /> Ray Stephanson,Mayor ✓ Acceptance of
<br /> Name and Title of Authorized Representative the •1C>11t1o11S
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