HomeMy WebLinkAbout20192060.tiffRESOLUTION
RE: APPROVE INCENTIVE PAYMENT MEMORANDUM OF UNDERSTANDING AND
AUTHORIZE CHAIR PRO-TEM TO SIGN - SOCIAL SECURITY ADMINISTRATION
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Incentive Payment Memorandum of
Understanding between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Department of Justice Services, and the
Social Security Administration, commencing upon full execution of signatures, with further terms
and conditions being as stated in said memorandum of understanding, and
WHEREAS, after review, the Board deems it advisable to approve said memorandum of
understanding, a copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Incentive Payment Memorandum of Understanding between the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Justice Services, and the Social Security Administration,
be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair Pro-Tem be, and hereby is,
authorized to sign said memorandum of understanding.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 3rd day of June, A.D., 2019.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: dactyl) V, .. " :ii EXCUSED
Barbara Kirkmeyer, Chair
Weld County Clerk to the Board
oun y A orney
Mike Freeman, Pro-Tem
Steve Moreno
Date of signature: OCc ( @0/t9
cct0.sCOE.)
OC.of / f'
2019-2060
JS0007
Justice Services Department
915 10th Street, #334 - P.O. Box 758
Greeley, CO 80632
Phone: (970) 336-7227
Fax: (970) 392-4677
To: Board of County Commissioners
From: Doug Erler, Director
Re: Consider Incentive Payment Memorandum of Understanding Between the Social
Security Administration and Weld County and Authorize Chair to Sign
Date: June 3, 2019
This item was originally presented to you as a Pass Around on 5/23/2019, and now comes for
your final review and approval. The Social Security Administration seeks to enter into an
agreement with Weld County, whereas the Justice Services Department would report its census
of offenders living at the Work Release Facility on a scheduled basis to the Social Security
Administration so that they can cross-check to determine payment suspension to any offender
sentenced by a Court to Work Release. In turn, the Social Security Administration will pay an
incentive payment to Weld County when they identify an offender who has been receiving
certain benefits just prior to or during their placement at Work Release. Payment could range
from $200 to $400, per identified offender. The Sheriff's Office currently completes this task on
its inmate population. Now that Work Release is in our department, we have been working with
the Sheriff, IT and the Social Security Administration to create separate reporting protocols. This
agreement would do this. The County Attorney's office and Accounting have reviewed the
proposed agreement and have no objections. Request to approve and authorize Chair to sign.
Thank you.
2019-2060
-3'50 OO 7
INCENTIVE PAYMENT MEMORANDUM OF UNDERSTANDING (IPMOU)
BETWEEN
THE SOCIAL SECURITY ADMINISTRATION
AND THE
WELD COUNTY JUSTICE SERVICES DEPARTMENT
I. Purpose
The purpose of this agreement is to set forth the terms and conditions under which a State or
local facility or institution (Reporter) will provide to the Social Security Administration (SSA)
information about certain individuals who are confined in a facility or institution by court order
in connection with a criminal offense at any time during the period covered by this agreement.
The Reporter may provide information on its own behalf or on behalf of other facilities and
institutions. SSA will pay the Reporter for the information in accordance with law. SSA may use
the information to administer its programs under the Social Security Act (Act), including but not
limited to: suspending Retirement, Survivors and Disability (RSDI) benefits under Title II of the
Act; suspending Supplemental Security Income (SSI) under Title XVI of the Act; and
investigating and monitoring the performance of representative payees who are confined in a
facility or institution by court order in connection with a criminal offense at any time during the
period covered by this agreement. SSA may also disclose information provided to SSA by the
Reporter in accordance with sections 202(x) and 1611(e) of the Act and as further described in
Section IX of this agreement.
II. Legal Authority
A. This agreement is entered into under sections 202(x)(3)(B) and 1611(e)(1)(I) of the Act,
which authorize SSA to enter into agreements with any interested State or local
institutions (such as jails, prisons, penal institutions, correctional facilities, or other
institutions (e.g., mental facilities) in which people are confined by court order at public
expense) to obtain information about certain confined individuals and to pay for this
information. Sections 202(x) and 1611(e) of the Act specify what information the
reporting institutions should provide to SSA and authorize SSA to disclose the
information obtained from institutions, in certain circumstances.
B. Section 202(x)(1)(A) of the Act requires SSA to suspend payment of Title II benefits to:
(1) beneficiaries confined in a jail, prison, or other penal institution or correctional
facility following a criminal conviction; (2) certain other individuals confined at public
expense in an institution or mental facility; and (3) beneficiaries considered to be
"sexually dangerous individuals."
C. For Title II recipients, section 202(x)(1)(A) suspends payments for any month ending
with or during, or beginning with or during, a period of more than 30 days throughout all
of which such individual is confined.
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D. For Title XVI recipients, section 1611(e)(1)(A) of the Act prohibits SSA from making
payments to inmates of public institutions (such as prisons or mental health institutions)
for any month during which the recipient is confined throughout the month.
E. Under sections 205(j)(1)(A), 1631(a)(2)(A)(iii), and 1631(a)(2)(B) of the Act, SSA may
investigate and monitor the performance of representative payees who are confined in a
facility or institution and may revoke their certification for payment of benefits if
warranted.
F. Section 552a(a)(8)(B)(viii) of Title 5, U.S.C., as amended by section 402(a)(2) of Public
Law 106-170, exempts this agreement, and information exchanged under this agreement,
from certain provisions of the Privacy Act relating to computer matches.
G. SSA's disclosure of information about individuals whose payments have been suspended
is authorized by and consistent with section 552a(b)(3) of the Privacy Act 1974, 5 U.S.C.
§ 552a(b)(3); section 401.150 of SSA's privacy regulations, 20 C.F.R. § 401.150; and
section 1106 of the Act, 42 U.S.C. § 1306.
III. Definitions
A. "Certain Other Individuals Confined at Public Expense" are individuals confined by
court order for more than 30 continuous days in any institution at public expense in
connection with:
(1) a verdict or finding that the individual is guilty of a criminal offense but insane; or
(2) a verdict or finding that the individual is not guilty of a criminal offense by reason of
insanity; or
(3) a finding that the individual is incompetent to stand trial under an allegation of a
criminal offense; or
(4) a similar verdict or finding with respect to such an offense based on similar factors
(such as a mental disease, a mental defect, or mental incompetence).
Such an individual is considered confined until: (1) he or she is released from the care
and supervision of such institution; and (2) such institution ceases to meet the
individual's basic living needs.
B. "Confined" refers to the status of an individual who is residing in, or under the custody
of, a state or local facility or institution by court order in connection with a criminal
offense at any time during the period covering this agreement.
C. "Confined individual" for purposes of correctional institution reporting refers to an
inmate who is residing in, or under the custody of a State or local correctional facility or
institution in connection with an arrest or conviction for committing a criminal offense. A
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confined individual for purposes of mental health institution reporting refers to an inmate
who had a prior connection with a criminal offense but was determined mentally not
responsible for his or her crime and was committed by court order to the custody of a
State or local mental health institution for treatment.
D. "Conviction" means the judgment in a criminal case that an individual is guilty of a
crime. It may result from a verdict or finding of guilty, a plea of guilty, or a plea of nolo
contendere (no contest).
E. "Disclosure" means the release of information (data) with or without the consent of the
individual(s) to whom the information pertains.
F. "Facility Identification Code" means the six -character code that SSA will assign to a
confining facility or institution that is covered by this agreement. This code must be
furnished with each submission of data to SSA concerning the facility/institution's
confined individuals in order for SSA to process any incentive payments due the
facility/institution under this agreement.
G. "More than 30 continuous days," for Title II purposes, means that an individual
remains confined in an institution for a period of more than 30 continuous days following
a conviction or court -ordered confinement. Suspension applies for a month where the
individual has been confined for any part of that month.
Example 1: Individual is convicted on April 28, enters an institution on April 30 and is
released on June 3. The individual would be confined for more than 30 continuous days.
Benefits would be suspended for all three months, April, May, and June.
Example 2: On February 2, a court orders an individual to undergo a mental evaluation
to determine his competency to stand trial. The individual's attending psychiatrist
provides his mental evaluation to the judge for a competency ruling. On May 1, based on
the individual's mental evaluation, the court finds that the individual is incompetent to
stand trial for a criminal offense and orders that the individual be confined in an
institution at public expense. The individual enters the institution on May 1 and is
released on December 30. The individual would be confined for more than 30
continuous days in an institution. Benefits would be suspended from May through
December.
H. "Record" means any item, collection, or grouping of information about an individual
that is maintained by an entity including, but not limited to, the individual's criminal
history, name, Social Security number (SSN), aliases, date of birth, gender, date of
confinement, place of confinement, and prisoner or inmate status.
I. "Reporter Identification Code" means the four -character code assigned by SSA to the
Reporter that is party to the agreement and that will report information on its own behalf
and/or on behalf of other facilities/institutions identified in this agreement.
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J. "Representative Payee" means the person, agency, organization, or institution selected
by SSA to receive and manage benefits on behalf of an incapable SSA beneficiary. This
includes a parent who is receiving benefits on behalf of the parent's minor child.
K. "Sexually Dangerous Individuals" are individuals, who immediately upon completion
of a prison sentence for a criminal offense (an element of which is sexual activity), are
confined for more than 30 continuous days by court order in an institution at public
expense. These individuals are confined in an institution based on a determination or
finding that they are sexually dangerous persons, sexual predators, or similar
determinations or findings.
L. "State or Local Facility or Institution" means: (1) State or local jails, prisons, penal
institutions, or correctional facilities; or (2) State or local institutions or facilities, such as
mental facilities, where individuals may be confined by court order in connection with a
criminal offense.
M. "Throughout the month," for Title XVI purposes, means that a Title XVI recipient is
confined in an institution at the beginning of a calendar month and remains confined
throughout the entire month. Suspension applies in any month throughout which an
individual is an inmate of a jail, prison, or other similar facility, or a public institution
where an individual is confined by court order.
Example 1: If an individual enters an institution on April 30 and is released on June 3,
the individual would be considered to be confined throughout May.
Example 2: If an individual enters an institution on May 1 and is released on June 30, the
individual would not have been confined in an institution throughout either
May or June.
Under the SSI program, an individual who is confined in a public institution is considered
as remaining confined in a public institution if the individual is transferred from one such
institution to another or if the individual is temporarily absent for a period of not more
than 14 consecutive days. An individual is also considered confined in an institution
throughout the month if the individual is confined at the start of a month but dies in the
institution during the month.
IV. Responsibilities of the Parties
A. Reporter Responsibilities:
(1) General - Provide SSA with identifying information for confined individuals in
accordance with subsections (2) through (4) below.
(2) Data Element Requirements - Provide SSA with the following data elements related
to the identity of the confined individuals, if available:
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(a) Social Security Number (provide all numbers the individual has been known to
use);
(b) Name (provide first, middle, and last names, all combination of names, and Social
Security numbers the individual has been known to use);
(c) Date of Birth (known or alleged);
(d) Confinement Date (provide the date the individual was admitted to the facility or
the date custody of the individual began);
(e) Date of Conviction for Criminal Offense (for correctional institution reporting) or
Date of court order commitment (mental health institution reporting);
(f) Facility Identification Code;
(g) Date of Work Release;*
(h) Date of Release from Confinement or Anticipated Dates of Release; *
(i) Taxpayer Identification Numbers; *
(j) Prison Assigned Inmate Numbers (if applicable); *
(k) Last Known Addresses; * and
(1) Other identifying information as required in the attached Enumeration Verification
System (EVS) User Package for Penal Institutions and Mental Facilities (EVS
User Package) (Attachment A) and any amendments to this package published
subsequent to the effective date of this agreement.
The Reporter will furnish SSA with reports (electronic file or paper report, if appropriate)
containing the data elements listed in (a —f) and (1) above for confined individuals whose
confinement commences after the parties sign this agreement. In addition, upon written
notification from SSA that it has the capacity to accept the additional data elements listed
in (g -k), the Reporter will furnish SSA with monthly prisoner reports containing all data
elements listed above (provided such data is available). The Reporter will follow the
specific prisoner record reporting format information and monthly reporting instructions
in the attached EVS User Package and any amendments to this package published
subsequent to the effective date of this agreement.
*Do not report these data elements at this time. In the future, SSA will contact the Reporters and
request that each Reporter expand its monthly prisoner reports to include these additional data
elements.
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(3) Method of Delivery - Send the data to SSA via a secure electronic media, as
negotiated with SSA, such as Government -to -Government Services Online (GSO) or
a form of secure file transfer.
(4) Timing and Scope of Reports - Submit the data elements required by subsection (2) to
SSA in the following sequence and manner:
(a) If this is the Reporter's first-time submitting data, it must submit a report on total
population of confined individuals, commonly referred to as a census report.
(b) Next, the Reporter must submit files monthly; the file must be submitted for the
calendar month preceding the month in which the report is submitted. The
monthly report should consist of:
• data for those individuals who are admitted to the facility/institution at any
time during the period from the first day of the reporting month to the last day
of that month (e.g., newly admitted confined individuals); and
when available, data for those individuals already in the custody of the
facility/institution who have subsequently been convicted since the
facility/institution initially began reporting data to SSA.
(c)
To be eligible for the maximum incentive payment of $400 under the Title XVI
incentive payment schedule (see Section VI(C)(1)(b) for details), the Reporter
must submit files every 15 calendar days. The file must be submitted for each 15 -
calendar day period in a month preceding the day in which the report is submitted.
Each 15 -day report should consist of:
• data for those individuals who are admitted to the facility/institution at any
time during the period from the first day of the first 15 -day reporting
period to the 15th day of that reporting period (e.g., newly admitted
confined individuals); and,
• when available, data for those individuals already in the custody of the
facility/institution who have subsequently been convicted since the
facility/institution initially began reporting data to SSA.
(d) Every two years, the Reporter must provide SSA with a periodic inmate
population report, upon SSA's written request. In the request, SSA will specify
the requested inmate population and provide the Reporter with the reporting
format and instructions for sending such periodic inmate population reports.
B. SSA Responsibilities:
(1) Match the data elements received from the Reporter against the following systems of
records:
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(a) Master Files of Social Security Number Holders and SSN Applications, System of
Records Notice (SORN) 60-0058, originally published at 75 Federal Register
(Fed. Reg.) 82121on December 29, 2010 and updated on July 5, 2013 at 78 Fed.
Reg. 40542; February 13, 2014 at 79 Fed. Reg. 8780; July 3, 2018 at 83 Fed. Reg.
31250-31251; and November 1, 2018 at 83 Fed. Reg. 54969;
(b) Master Representative Payee File, SORN 60-0222, originally published at
78 Fed. Reg. 23811 on April 22, 2013 and updated on July 3, 2018 at 83 Fed. Reg.
31250-31251 and November 2, 2018 at 83 Fed. Reg. 55228;
(c) Master Beneficiary Record (MBR), SORN 60-0090, originally published at
71 Fed. Reg. 1826 on January 11, 2006 and updated on December 10, 2007 at 72
Fed. Reg. 69723; July 5, 2013 at 78 Fed. Reg. 40542; July 3, 2018 at 83 Fed. Reg.
31250-31251; and November 1, 2018 at 83 Fed. Reg. 54969; and
(d) Supplemental Security Income Record and Special Veterans Benefits, SORN
60-0103, originally published at 71 Fed. Reg. 1830 on January 11, 2006 and
updated on December 10, 2007 at 72 Fed. Reg. 69723; July 3, 2018 at 83 Fed.
Reg. 31250-31251 and November 1, 2018 at 83 Fed. Reg. 54969.
(2) After validating or locating the proper Social Security number, SSA will:
(a) determine if the individual is receiving SSI or RSDI benefits;
(b) determine whether the individual has received an SSI benefit in the month
preceding the first month throughout which such individual was confined;
(c) determine whether the individual has received an RSDI benefit in the month
preceding the first month during which such individual was confined;
(d) determine whether the individual has been confined throughout the month for SSI
or confined for more than 30 continuous days for RSDI;
(e) notify the individual of SSA's planned suspension action and provide the
individual with an opportunity to contest the planned action under applicable
regulations, if the law requires SSA to suspend SSI or RSDI;
(f) suspend SSI and RSDI payments as required by law and notify the individual of
the suspension action and his/her right to appeal;
(g) determine whether such individual is acting as a representative payee;
(h) investigate and determine whether revocation of representative payee certification
is appropriate under applicable law as cited in Article II;
(i) pay the Reporter as specified under this agreement; and
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(j) provide the Reporter with a notice of the amount of the incentive payment, the
payment date, the total number of suspended individuals, and a list of the
individuals suspended. SSA will include with such list only the minimal
identifying information from its Prisoner Update Processing System (SORN 60-
0269, originally published at 64 Fed. Reg. 11076 on March 8, 1999 and updated
on December 10, 2007 at 72 Fed. Reg. 69723; July 5, 2013 at 78 Fed. Reg. 40542;
and November 1, 2018 at 83 Fed. Reg. 54969) that is necessary for SSA and the
Reporter to account for payments made under this agreement.
V. Reporter Records
These records are compiled from Weld County Justice Services Department Reporters must
contact Susan Hibbert or designee to establish electronic processes, such as GSO, with SSA
systems.
VI. Incentive Payment Process
A. SSI (Title XVI) Incentive Payments:
SSA will pay an incentive payment to a Reporter covered by this agreement for
information on a confined individual that the Reporter furnishes to SSA within the time
periods specified below, if the confined individual is:
(1) receiving an SSI payment for the month preceding the first month throughout which
the confined individual is in such facility/institution; and
(2) determined by SSA to be ineligible for a SSI payment for the first month of
confinement as a result of the information provided by the Reporter under this
agreement.
B. RSDI (Title II) Incentive Payments:
SSA will pay an incentive payment to a Reporter covered by this agreement for
information on a confined individual that the Reporter furnishes to SSA within the time
periods specified below, if the confined individual is:
(1) receiving an RSDI payment for the month preceding the first month during which the
confined individual is in a facility/institution; and
(2) determined by SSA to be ineligible for an RSDI payment for any part of the first
month as a result of the information provided by the Reporter under this agreement.
C. SSA Payment:
(1) SSA will pay the Reporter according to the following schedule:
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(a) For RSDI payments:
• $400 if the Reporter furnishes the information to SSA on an inmate's
confinement within 30 days after the inmate's confinement begins in the
facility; or
• $200 if the Reporter furnishes an inmate's confinement information to SSA
after 30 days but within 90 days after the inmate's confinement date at the
facility.
(b) For SSI payments:
• $400 if the Reporter furnishes the information to SSA on an inmate's
confinement within 15 days after the inmate's confinement begins in the
facility; or
• $200 if the Reporter furnishes an inmate's confinement information to SSA
after 15 but within 90 days after the inmate's confinement date at the facility.
NOTE: We will not pay an incentive payment for RSDI or SSI inmate information
received after 90 days from the start of an inmate 's confinement.
(c) We will pay a Reporter an incentive payment for each inmate report that leads to
suspension of social security benefits under Title II or Title XVI. In some
instances, a beneficiary may receive payments under both Title II and Title XVI.
If we suspend payments under only one title, we fund the incentive payment from
that Title's trust fund. If we suspend payments under both titles at the same time,
we pay the Reporter only one full incentive payment. However, we fund 50% of
the incentive payment from each Title's trust fund.
(2) If SSA cannot validate the SSN of a confined individual, SSA will take no further
action to suspend the confined individual's SSI or RSDI benefits.
(3) SSA will not pay an incentive payment for information about a confined individual if,
prior to SSA's receipt of the information, SSA has already determined that the
individual is ineligible for SSI or RSDI payments, or if the only action taken by SSA
is to suspend the individual from serving as a representative payee.
(4) Payments made by SSA under this agreement represent incentive payments for data
provided under this agreement when the data results in the suspension of SSI
payments to confined individuals or suspension of RSDI payments for confined and
convicted individuals.
(5) The time SSA requires to verify the data, determine whether suspension of an
individual's SSI or RSDI payment is appropriate, and provide due process to an
individual subject to a suspension action may vary from case to case and may last
several months. Accordingly, several months may elapse from the time the Reporter
provides information to the time SSA makes a payment.
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(6) SSA will pay incentive payments to the Reporter on a monthly basis by electronic
transfer of funds. The Reporter will name a financial institution and provide the
information required on the attached Automated Clearing House
Vendor/Miscellaneous Payment Enrollment Form (SF 3881) to receive its incentive
payments by electronic transfer of funds.
(7) SSA will provide the Reporter with a notice of the amount of the incentive payment,
the payment date, the total number of suspended individuals, and a list of individuals
suspended, subject to the limitations noted in Section IV(B)(2)(j). Disputes involving
these incentive payments and any allegations regarding improperly paid incentive
payments will be considered by the Regional Prisoner Coordinator designated in
section XII.A. The Reporter should forward a written request describing the dispute
in detail to the Regional Prisoner Coordinator designated in Article XII.A. within 30
days of its receipt of the relevant incentive payment notice.
VII. Notice, Verification, and Opportunity to Contest
A. SSA will verify information obtained under this agreement prior to SSA initiating any
adverse action against an individual. Pursuant to its applicable regulations, SSA will
inform the individual by written notice that it has received specified information
indicating that the individual is confined under the jurisdiction of a named prison system
or other public institution beginning (month/year) and that, by law, SSI payments and/or
RSDI benefits must be suspended. SSA will afford the individual the opportunity to
contest and submit information concerning the planned action to suspend such
payments/benefits and to appeal SSA's determination to suspend payments/benefits in
accordance with applicable regulations.
B. SSA is responsible for determining the most suitable representative payee to receive Title
II and Title XVI payments. When SSA informs a representative payee of a change of
representation for the affected beneficiary or recipient, based in part on the current
payee's incarceration or confinement, the representative payee has 30 days to contest
SSA's decision.
C. SSA's final decision on the representative payee issue does not affect the eligibility or
entitlement of a represented individual to the continued receipt of Social Security benefits
or SSI payments. In the event that there is any adverse effect on the monthly benefits or
payments to the beneficiary or recipient as a result of the data match under this
agreement, or if a decision is made to change the representative payee, the beneficiary or
recipient will receive notice of the change.
VIII. Security Procedures
A. General Requirements
For information disclosed and systems used to disclose information under this agreement,
SSA and the Reporter will comply with applicable requirements of the Privacy Act of
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1974, 5 U.S.C. § 552a; the Federal Information Security Management Act (FISMA),
44 U.S.C. Chapter 35, Subchapter II, as amended by the Federal Information Security
Modernization Act of 2014 (Pub. L. No. 113-283); related Office of Management and
Budget (OMB) circulars and memoranda, such as Circular A-130, "Managing
Information as a Strategic Resource" (July 28, 2016), and Memorandum M-17-12,
"Preparing for and Responding to a Breach of Personally Identifiable Information"
(January 3, 2017); National Institute of Standards and Technology (NIST) directives; the
Federal Acquisition Regulations; and other Federal laws, regulations, and directives that
include requirements for safeguarding Federal information systems and personally
identifiable information (PII). SSA and the Reporter recognize and will implement any
applicable laws, regulations, NIST standards, and OMB directives including those
published subsequent to the effective date of this agreement.
FISMA requirements apply to all Federal contractors, organizations, or entities that
possess or use Federal information, or that operate, use, or have access to Federal
information systems on behalf of an agency. Both parties are responsible for oversight
and compliance of their contractors and agents.
B. PII Loss Reporting and Breach Notification
If SSA experiences a suspected or actual loss of PII received from the Reporter under the
terms of this agreement, SSA will follow the loss reporting guidelines and breach
notification procedures issued by OMB and notify the Reporter of the incident.
If an employee, contractor, or agent of the Reporter becomes aware of suspected or actual
loss of PII received from SSA under the terms of this agreement (i.e., information about
suspended individuals), he or she must immediately contact the Reporter's Systems
Security Contact identified below or his/her delegate. The Reporter must then notify the
SSA Regional Prisoner Coordinator and SSA Systems Security Contact identified below.
If, for any reason, the Reporter is unable to notify the SSA Regional Prisoner Coordinator
or the SSA Systems Security Contact within 1 hour, the Reporter must report the incident
by contacting SSA's National Network Service Center at 1-877-697-4889. The Reporter
will use the worksheet, attached as Attachment B, to quickly gather and organize
information about the incident. In the future, SSA may update this worksheet to ensure
continued compliance with OMB requirements. If SSA provides the Reporter with an
updated worksheet, the Reporter will use the updated worksheet. The Reporter must
provide to SSA information gathered about the incident and timely updates as any
additional information about the loss of PII as it becomes available.
If the party that experienced the breach determines that the risk of harm requires
notification to affected individuals or other remedies, that agency will carry out these
remedies without cost to the other party.
C. Administrative Safeguards
SSA and the Reporter will restrict access to the data received under this agreement to
only those authorized employees, officials, and contractors ("personnel") who need it to
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perform their official duties in connection with the uses of the data authorized in this
agreement. Further, SSA and the Reporter will advise all personnel who will have access
to the data received under this agreement of the confidential nature of the data, the
safeguards required to protect the data, and the civil and criminal sanctions for
noncompliance contained in the applicable Federal laws.
D. Physical Safeguards
SSA and the Reporter will store the data received under this agreement in an area that is
physically and technologically secure from access by unauthorized persons during duty
hours as well as nonduty hours or when not in use (e.g., door locks, card keys, biometric
identifiers). Only authorized personnel will transport the data received. SSA and the
Reporter will establish appropriate safeguards determined by a risk -based assessment of
the circumstances involved.
E. Technical Safeguards
SSA and the Reporter will process the data received under this agreement under the
immediate supervision and control of authorized personnel in a manner that will protect
the confidentiality of the data, so that unauthorized persons cannot retrieve any data by
computer, remote terminal, or other means. Systems personnel must enter personal
identification numbers when accessing data on the agencies' systems. SSA and the
Reporter will strictly limit authorization to those electronic data areas necessary for the
authorized analyst to perform his or her official duties.
F. Application of Policy and Procedures
SSA and the Reporter will adopt policies and procedures to ensure that the parties use the
information contained in their respective records or obtained from each other solely as
provided in this agreement. SSA and the Reporter will comply with these guidelines and
any subsequent revisions.
G. Onsite Inspection
SSA has the right to monitor the Reporter's compliance with FISMA and other security
and safeguarding requirements in applicable laws, regulations, and directives. SSA has
the right to make onsite inspections for auditing compliance, if necessary, for the duration
or any extension of this agreement.
IX. Records Usage, Duplication, Redisclosure
A. Reporter's Responsibilities:
(1) The Reporter will use and access the information on suspended individuals (SSA data)
only for accounting purposes authorized in this agreement.
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(2) The Reporter will not use the SSA data to extract information about individuals for any
purposes not specified in this agreement.
(3) The Reporter will not duplicate or re -disclose SSA data, within or outside of the
Reporter's agency/entity, without the written permission of SSA, except as required by
Federal law or authorized by this agreement. SSA will not give such permission unless
the law requires re -disclosure or disclosure is required to accomplish the purposes of this
agreement; where the law does not require re -disclosure, the decision whether to grant
permission will be within SSA's discretion. For such permission, the Reporter must
specify in writing what data it is requesting be duplicated or re -disclosed and to whom,
and the reasons that justify such duplication or re -disclosure.
(4) The Reporter will enter into a written agreement with each of its contractors and agents
who need SSA data to perform their official duties whereby such contractor or agent
agrees to abide by all relevant Federal laws, restrictions on access, use, and disclosure,
and security requirements in this agreement. The Reporter will provide its contractors
and agents with copies of this agreement and all related attachments before initial
disclosure of SSA data to such contractors and agents. Prior to signing this agreement,
and thereafter at SSA's request, the Reporter will obtain from its contractors and agents a
current list of the employees of such contractors and agents with access to SSA data and
provide such lists to SSA, upon request.
(5) The Reporter's employees, contractors, and agents who access, use, or disclose SSA data
in a manner or purpose not authorized by this agreement may be subject to civil and
criminal sanctions pursuant to applicable Federal statutes.
B. SSA's Responsibilities:
(1) SSA will use the information provided by the Reporter to:
a. determine which of the confined/convicted individuals are receiving payments, and to
suspend these payments as required by law;
b. investigate and monitor the performance of representative payees; and
c. administer the Social Security Act (for example, SSA may use the prison information
collected for data analytics purposes to detect patterns that may identify fraud in the
programs administered by SSA).
(2) SSA may also use and disclose the information obtained pursuant to this agreement as
authorized by sections 202(x) and 1611(e) of the Act or as otherwise required by law.
(3) SSA may store information provided by the Reporter within its PUPS, SORN No. 60-
0269. When SSA does so, it may disclose information provided by Reporter based on the
published routine uses in that SORN.
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X. Records Retention and Disposition
A. SSA will retire all identifiable records in accordance with the applicable Federal Records
Retention Schedules (44 U.S.C. § 3303a).
B. The Reporter will retain all data received from SSA only for the period required for the
purposes described in this agreement and will then securely destroy all such data. The
Reporter may retain data received from SSA to meet evidentiary requirements, provided
that it retire such data in accordance with applicable state or local laws governing the
Reporter's retention of records.
XI. Duration, Modification, and Termination of the Agreement
This agreement shall be effective as of the date signed below by the Reporter Contacts and Weld
County Board of Commissioners. Any modification or amendment of this agreement must be in
writing and agreed to by both parties. Notwithstanding the foregoing, in the event of a change in
applicable federal law or regulation that requires changes to the terms and conditions of this
agreement, SSA may unilaterally make such modification or amendment by giving advance
written notice to the Reporter. The Reporter will have 30 calendar days from the date it receives
such notice to contact SSA if it desires to terminate this agreement in light of the modification or
amendment.
Either party may terminate this agreement by giving the other party 90 calendar days of notice in
writing. This agreement will remain in effect until terminated by either party.
XII. Contacts
The contacts for this agreement follow. Either party may update the below contacts, as needed,
by providing written notification of the contact change to [insert which contact is appropriate].
A. SSA Contacts
SSA Regional Prisoner Coordinator
SUSAN HIBBERT
ADDRESS: 1961 Stout St., Ste. 06-145, Denver, CO 80294
TELEPHONE: (303) 844-2695
FAX: (303) 844-4280
EMAIL: Susan.Hibbert(a,ssa.gov
SSA Policy Contact
Judy Sale
Office of Representative Payee and Due Process
6401 Security Boulevard, 2-C-15 Robert M. Ball Building
Baltimore, MD 21235-6401
Telephone: (410) 965-8581
Email: Judy.Sale@ssa.gov
15
SSA Systems Security Contact
Jennifer Rutz, Director
Office of Information Security
Division of Compliance and Assessments
6401 Security Boulevard, Suite 3208 Annex
Baltimore, MD 21235
Telephone: (410) 966-8253
Email: Jennifer.Rutz@ssa.gov
SSA Technical Contact for Computer Operation:
NAME: Susan Hibbert
ADDRESS: 1961 Stout St., Ste. 06-145, Denver, CO 80294
TELEPHONE: (303) 844-2695
FAX: (303) 844-4280
EMAIL: Susan.Hibbert(a ssa.gov
B. Reporter Contacts
Reporter Contact for Incentive Payments:
NAME: Doug Erler
ADDRESS: 915 10th Street, #334 Greeley, CO 80632
TELEPHONE: (970) 400-4847
EMAIL: derler(a�co.weld.co.us
Reporter Contact for the Electronic File Process:
NAME: Dianna Campbell
ADDRESS: 1390 N. 17th Ave, Greeley, CO 80631
TELEPHONE: (970) 400-2990
EMAIL: dcampbell(a weldgov.com
Reporter Contact for Accounting Information:
NAME: Barb Connelly and/or Chris D'Ovidio
ADDRESS: 1150 O Street Greeley, CO 80632
TELEPHONE: (970) 400-4445 or (970) 400-4447
EMAIL: bconnelly(a,co.weld.co.us or cdovidio(aco.weld.co.us
XIII. Integration Clause
This IPMOU, the EVS User Package (Attachment A), and the PII Loss Reporting Worksheet
(Attachment B) constitute the entire agreement of the parties with respect to its subject matter.
There have been no representations, warranties, or promises made outside of this agreement.
This agreement shall take precedence over any other documents that may be in conflict with it,
including any similar agreements entered into previously by the Reporter and SSA concerning
disclosure of records of individuals confined in public institutions.
16
XIV. Authorized Signatures
The signatories below warrant and represent that they have the competent authority on behalf of
their respective entities to enter into the obligations set forth in this agreement.
Electronic Signature Acknowledgement: The signatories may sign this document
electronically by using an approved electronic signature process. Each signatory electronically
signing this document agrees that his/her electronic signature has the same legal validity and
effect as his/her handwritten signature on the document, and that ii has the same meaning as
his/her handwritten signature.
Social Security Administration
Michelle King
Deputy Commissioner
for Budget, Finance, and Management
Date: February 13, 2019
Social Security Administration Region VIII
Regional Commissioner
r.
NAME: ;
This field will be signed by our Regional Commissioner following review of your signed
agreement
DATE:
17
ATTEST: e1
Weld • nt C erk to th- : oard
BY
Deputy Clerk to the
APPROVED AS TO FUN
APPROVED AS TO FORM:
Aq* County Attorney
Controller
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Mike Freeman, Pro-Tem
JUN 0 3 2039
APPROVED AS TO SUBSTANCE:
Departm
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