CM-2023-203 - 9/1/2023TEXAS WORKFORCE COMMISSION
PERFORMING AGENCY CONTRACT
TEXAS WORKFORCE COMMISSION
TWC Contract Number
I 2923EDE063
TITLE
INFORMATION RELEASE CONTRACT
Recipient
Name
City of Round Rock for the benefit of Round Rock Police Department
Street Address
2701 N. Mays St
Ci L/State/Zip
Round Rock, Texas 78665
Telephone Number
1 (512) 218-5524
Contract Period
This Contract shall begin on April 1,2024 ("Begin Date") and shall terminate on March 31, 2029
("End Date"), unless all parties have not executed this Contract before April 1, 2024 in which case the
Begin Date will be the date on which the last signature occurs. This Contract may not be renewed or
extended.
Funding Information
The total amount of this Contract will not exceed the sum of
$7,500.00
Remarks
This Contract is contingent on Recipient's acceptance of and compliance with the terms and conditions of
this Contract and any referenced attachments.
Summary
Information to be provided by TWC will include:
• wage records (WR),
• unemployment compensation claim benefit data (UI),
• employer master file (ER) inquiry.
Type of Access:
Online access only
Number of online users and rate:
1-10 for $1,5001year for five (5) years.
Prior contract reference: This contract replaces and supersedes all previous contracts, including
2922PEN026.
60, 2--,1) 2�3 - 2-,�)-?
Information Release Contract: February 2022
TWC Contract Number: 2923EDE063 CITY OF ROUND ROCK
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Signature Authority
Each person signing this Contract hereby warrants that he or she has been fully authorized by the
respective organization to:
• Execute this Contract on behalf of the organization, and
• Validly and legally bind the organization to all the terms, performances, and provisions of this
Contract.
Agency Approval
Recipient Approval
Agency: Texas Workforce Commission
Recipient: City of Round Rock for the benefit of
Round Rock Police Department
7/26/2023
xda&(, 2-5 -3 -
John Greytok Date
Laurie Hadley bate
Senior Adviser to the Executive Director
City Manager
Information Release Contract: February 2022
TWC Contract Number: 2923EDE063 - CITY OF ROUND ROCK
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TABLE OF CONTENTS
General Terms and
Conditions
Section I
Purpose and Legal Authority
Section 2
Term, Termination, and Amendment
Section 3
Consideration
Section 4
Protecting the Confidentiality of TWC Information
Section 5
Records and Audit
Section 6
Breach of Agreement, Default, and Remedies
Section 7
Miscellaneous
Attachment A
Statement of Work — Project Obligations
Attachment B
Safeguards for TWC Information
Attachment C
Texas Workforce Commission User Agreement
Attachment D
Cover Sheet for Transmitting User Agreement and Training Certificate
Attachment E
Intenlionally omitted
Attachment F
Certificate of Destruction for Contractors and Vendors
Attachment G
Quarter! Self -Assessment Report
Exhibit I
TWC Data Exchange Request and Safeguard Plan
Information Release Contract: February 2022
TWC Contract Number: 2923EDE063 — CITY OF ROUND ROCK
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PERFORMING AGENCY CONTRACT
TEXAS WORKFORCE COMMISSION
INFORMATION RELEASE CONTRACT
GENERAL TERMS AND CONDITIONS
SECTION 1 - Purpose and Legal Authority
1.1 This Contract sets forth the obligations of the Texas Workforce Commission ("Agency") and the
Recipient identified on the cover page (each a "Party" and together "the Parties") with respect to
Agency's release of confidential data to Recipient. The obligations of the Parties are set forth in detail in
Attachment A.
1.2 Subject to certain limitations, the Interlocal Cooperation Act, Texas Government Code, Chapter 791,
authorizes Recipient to enter into contracts for services with governmental entities, including state
agencies.
SECTION 2 - Term, Termination, and Amendment
2.1 This Contract is effective from the Begin Date to the End Date specified on the cover page.
2.2 Either Party may suspend or terminate this Contract at any time, on written notice to the other Party
specifying a termination date at least thirty (30) calendar days after the date of the notice. Suspension or
termination shall not relieve Recipient of the obligation to pay for all services provided before
suspension or termination at the rates specified herein. Recipient shall not be entitled to any refund of
the annual subscription fee if access to Agency records is online.
2.3 No modification will be valid unless in writing and signed by both Parties, except for rate revisions
made under Section 3.2 of these General Terms and Conditions.
SECTION 3 - Consideration
3.1 Recipient shall pay Agency for the services described, and at the rates set forth, in Attachment A.
3.2 Notwithstanding Section 3.1 of these General Terms and Conditions, Agency may unilaterally revise
rates upon written notice to Recipient of at least thirty (30) calendar days.
SECTION 4 - Protecting the Confidentiality of TWC Information
4.1 "TWC Information" means records maintained by Agency, and records obtained by Recipient from
Agency under this Contract, including (1) records and data compilations provided electronically, on
paper, or via online access or e-mail, (2) records and data compilations that Recipient has converted into
another format or medium (such as handwritten or electronic notes), and (3) records and data
compilations incorporated in any manner into Recipient's records, files or data compilations.
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4.2 Recipient shall protect the confidentiality of TWC Information and comply with all statutory, regulatory
and contract requirements. Confidentiality is required by Texas Labor Code §§ 301.081 and 301.085,
the Social Security Act of 1934, and 20 Code of Federal Regulations (C.F.R.) Part 603.
SECTION 5 — Records and Audit
Recipient shall keep and maintain complete and accurate records sufficient to allow Agency, the Texas State
Auditor's Office, the United States government, and their authorized representatives to determine Recipient's
compliance with this Contract.
SECTION 6 — Breach of Agreement, Default, and Remedies
6.1 If Recipient or any official, employee, or agent of Recipient fails to comply with any provision of this
Contract, including timely payment of Agency's invoices, Agency may suspend services to Recipient
(including any data requests being processed) until Agency is satisfied that corrective action has been
taken to assure there will be no future breach.
6.2 In the absence of prompt and satisfactory corrective action to cure default and assure future compliance
with Contract requirements, Agency shall terminate this Contract immediately and Recipient shall
surrender to Agency all TWC Information that has not previously been returned to Agency, and any
other records relevant to this Contract.
6.3 Termination of this Contract under Section 6.2 of these General Terms and Conditions will not limit
Agency from pursuing penalties under state and federal law for the unauthorized disclosure of TWC
Information.
6.4 Agency shall undertake any other action under this Contract or under any law of this State or of the
United States, to enforce this Contract and to secure satisfactory corrective action and return of TWC
Information.
6.5 Agency shall take other remedial actions permitted under state or federal law to enforce this Contract
and 20 C.F.R. Part 603 including seeking damages, penalties, and restitution for all costs incurred by
Agency in enforcing this Contract and responding to Recipient's breach.
SECTION 7 — Miscellaneous
7.1 Texas Labor Code § 301.085 provides that unemployment compensation records are not "public
information" for purposes of the Public Information Act, Texas Government Code, Chapter 552.
Recipient shall not release any TWC Information in response to a request made under the Public
Information Act or any other law, regulation, or ordinance addressing public access to government
records.
Information Release Contract: February 2022
TWC Contract Number: 2923EDE063 CITY OF ROUND ROCK
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7.2 Recipient shall notify Agency within twenty-four (24) hours of the receipt of any subpoena, other
judicial request, or request for appearance for testimony upon any matter concerning TWC Information.
Federal regulations at 20 C.F.R. § 603.7 dictate the handling of subpoenas for TWC Information.
7.3 This Contract is made in and performed in the State of Texas, and shall be construed, interpreted, and
applied in accordance with the laws of the State of Texas, excluding its choice of law rules. Venue of
any court action brought directly or indirectly by reason of this Contract shall be in a court of competent
jurisdiction in Travis County, Texas. NOTHING IN THIS SECTION SHALL BE CONSTRUED
AS A WAIVER OF SOVEREIGN IMMUNITY BY AGENCY.
7.4 Agency's failure to enforce any provision of this Contract does not constitute a waiver of that provision
or any other.
7.5 Recipients agrees to indemnify and hold harmless Agency, the State of Texas, and their employees and
officials for any loss, damages, judgments, and costs arising or resulting from any acts or omissions or
alleged acts or omissions of Recipient or its employees, agents, contractors, and subcontractors,
including the inappropriate release or use of TWC Information.
7.6 Recipient shall be responsible and liable for any damages resulting from a breach by Recipient including
damages and losses of third parties. Recipient shall reimburse Agency for any costs incurred by Agency
in reimbursing third parties damaged by Recipient's breach and costs incurred in attempts by Agency to
limit third party losses resulting from Recipient's breach.
7.7 Recipient agrees to accept liability for any damage to Agency's hardware, software, or TWC
Information when such damage is caused by the actions of employees, contractors, subcontractors or
agents of Recipient, whether or not the individual was an authorized User under this Contract.
T8 If any provision of this Contract is held to be unenforceable by a court, this Contract will be construed as
if such provision did not exist, and the unenforceability of such provision will not render any other
provisions of this Contract unenforceable.
7.9 This Contract is the entire agreement between the Parties.
7.10 The subject headings used in this Contract are for convenience only and are not intended to expand or
limit meanings.
7.11 Attachments listed in the Table of Contents are incorporated in their entirety as terms and conditions of
this Contract.
7.12 The following provisions survive the expiration or earlier termination of this Contract: Sections 4.2, 5,
6.2, 6.3, 7.1, 7.2, 7.5, 7.6, and 7.7 of these General Terms and Conditions; Sections 3.3.3, 3.3.4, and
3.3.5 of Attachment A; and Attachment B.
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Attachment A
INFORMATION RELEASE CONTRACT BETWEEN TEXAS WORKFORCE COMMISSION
AND
CITY OF ROUND ROCK FOR THE BENEFIT OF ROUND ROCK POLICE DEPARTMENT
STATEMENT OF WORK--- PROJECT OBLIGATIONS
SECTION I - - Project Abstract
1.1 Contract Purpose. The purpose of this Contract is to provide Recipient with access to confidential
Agency data, to ensure that Recipient will maintain the confidentiality of the data, and to require
Recipient to reimburse Agency for costs of providing access at the rates set out in this Contract.
1.2 Authorized Use of TWC Information. Subject to the security and confidentiality provisions of this
Contract, Recipient is authorized to use TWC Information, as defined in Attachment B, item 1, solely
for the Limited Purpose(s) listed in the Request and Safeguard Plan and associated correspondence
which is incorporated into this Contract and marked as Exhibit 1. Recipient warrants that all statements
and information in Exhibit 1, Request and Safeguard Plan and associated correspondence true and
correct to the best of my knowledge and understands that their organization is bound by the
representations in Exhibit 1. Any other use of TWC Information by Recipient is a breach of this
Contract.
1.3 References. Section references are to sections of this Attachment A unless otherwise specified.
SECTION 2 — Obligations of Agency
2.1 Description of TWC Information Disclosed and Method of Access. Agency agrees to provide access to
the TWC information requested and via the method as described in Exhibit 1.
2.2 Availability. Online access will routinely be available Monday through Friday, 8:00 a.m, to 5:00 p.m.
Central Time, excluding State holidays, although Agency does not guarantee access during these
periods. Agency may terminate or limit access without notice based on business necessity or in the
event of an emergency.
2.3 Method of transfer. Agency will transfer TWC Information to Recipient only as specified in the
Request and Safeguard Plan or by other methods approved in writing in advance by Agency Chief
Information Security Officer or his/her designee.
SECTION 3 — Obligations of Recipient
3.1 Online Access.
3.1.1 Direct Oversight of Users. Recipient shall ensure that all individuals with online access through
user TWC system log -in accounts ("Users,") are direct Recipient employees.
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3.1.2 Annual Fee and Payment. Recipient shall pay Agency the annual subscription fee applicable to
the access identified in Exhibit 1, Request and Safeguard Plan. The annual subscription fee
covers the twelve (12) month period that begins on the Begin Date. Payment of the annual
subscription fee is due within thirty (30) calendar days of Recipient's execution of this Contract.
The annual subscription fee is nonrefundable and will not be prorated in case of early
termination of this Contract or suspension of services. If access identified in the Request and
Safeguard Plan in Exhibit 1 is for multiple years, the Recipient shall pay Agency the annual
subscription fee for each subsequent contract year within thirty (30) calendar days of the
beginning of each contract year. If the contracting entity is a city or county, also known as a
"local entity", Recipient shall send payment to Texas Workforce Commission, Revenue and
Trust Management, P.O. Box 322, Austin, TX 78767-0322.
3.1.3 User Documents. All prospective online Users must execute a Texas Workforce Commission
User Agreement ("User Agreement"), Attachment C, and complete online TWC Cybersecurity
Awareness Training ("Security Training").
3.1.4 User Document Submission and Maintenance. Before Agency EAGLE Administration will
invite a prospective User, Agency EAGLE Administration must receive from Recipient Contact
Person (designated in Exhibit 1, Request and Safeguard Plan) a copy of the completed Texas
Workforce Commission User Agreement ("User Agreement"), Attachment C and the Security
Training certificate with a completed Transmittal Cover Sheet ("Cover Sheet"), Attachment D.
Agency may deny access to any prospective User on security grounds. Recipient must maintain
on file all original Training Certificates and User Agreements, which are subject to on -site and
desk review audits.
3.1.5 Annual User Renewal. For multi -year, extended, and new contracts continuing, extending, or
replacing a prior contract with online access, each year, on the first day of the month following
the anniversary of the Begin Date the Recipient Contact Person shall provide new User
Agreements and the Security Training certificate. The User Agreements and Security Training
certificates shall be submitted with a completed Cover Sheet no earlier than 30 days before the
first day following the anniversary of the Begin Date. The User Agreements and Training
Certificates shall be executed and dated no more than thirty (30) calendar days before
submission. Failure by Recipient Contact Person to timely provide annual User Agreements,
shall result in Agency terminating User access.
3.1.6 Notice of User Employment Change. Recipient Contact Person shall notify Agency EAGLE
Administration within three (3) calendar days of a User's termination, resignation, or
reassignment into a position not requiring access to TWC Information, so that the User's
password can be immediately revoked. Failure to provide such notice is a breach of this
Contract and may result in immediate suspension of all online access, termination of this
Contract, and other penalties provided by law and this Contract.
3.1.7 Monthly Review. For contracts with over twenty-five (25 users), Recipient Contact Person shall
review the list of current Users monthly to ensure that the Users have not left employment or
changed job duties or otherwise no longer need access. Recipient shall document their process
for comparing the current users list with the list of employees needing access. The
documentation of the review process should be maintained on file for review by Agency upon
request.
Information Release Contract Attachments February 2022
TWC Contract Number. 2923EDE063 CITY OF ROUND ROCK
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3.1.8 Notice of Suspected Violations. Recipient shall notify Agency of any suspected or confirmed
User violation of the confidentiality and security provisions within twenty-four (24) hours of
discovery and shall take appropriate corrective action.
3. l .9 Changes to TWC Information Prohibited. Users shall not change or update any TWC
Information contained in Agency's computer stored files. Users shall not use any automated
system or software to make multiple queries of Agency's computer stored files.
3. l .10 Instructions. Recipient shall be solely responsible for disseminating to Users any instructions
provided by Agency regarding navigation of online access to TWC Information.
3.2 Offline Access. If Offline access is selected in Exhibit 1, Request and Safeguard Plan, the provisions of
this section apply.
3.2. l Offline Request Submission. For matches of wage records to SSNs, unemployment
compensation claim benefit data to SSNs, or employer tax records to EIDs or FEINs, to be
performed by Agency staff, Recipient shall submit a completed Request for Texas Workforce
Commission Records, Attachment E, with the file of SSNs, EIDs, or FE1Ns to be matched.
Recipient shall submit the file electronically in compliance with the Information Technology
Department contract listed on Exhibit 1, Request and Safeguard Plan. Agency shall not be
responsible for the confidentiality of any information submitted by Recipient.
3.2.2 Offline Rates. Rates for Offline requests are calculated on a per -request basis as specified in
Exhibit 1, Request and Safeguard Plan.
3.2.3 Payment. Recipient's payment is due within thirty (30) calendar days of receipt of invoice for
information requested Offline.
3.2.4. Tracking of Offline Access. Each quarter, the Recipient shall submit to the Agency Point of
Contact a list of the data requests made and data received during the prior quarter including
information necessary for identifying each transfer of data, whether a match against Recipient
data, a scheduled transfer, or a transfer upon request. The quarterly filing dates are January 15,
April 15, July 15, and October 15.
3.3 Additional Requirements.
3.3.1 Security Safeguards. Recipient shall establish, maintain, and comply with security safeguards
and procedures to protect the confidentiality of all TWC Information. Recipient shall comply
with the requirements in Safeguards for TWC Information, Attachment B. Failure to comply
with any requirement of Attachment B is a breach of this Contract.
3.3.2 Suspension. Agency may suspend all services without notice if Agency suspects a violation of
the security safeguard provisions in Attachment B. Services will remain suspended until Agency
has fully investigated any suspected security violations and is satisfied that resumption of
services will not result in security breaches. In the event of an extended suspension of services,
Agency will notify Recipient as soon as possible.
3.3.3 Enduring Obligation. Termination or expiration of this Contract will not end Recipient's
responsibility to protect the confidentiality of TWC Information remaining in Recipient's
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possession, under Recipient's control, or held by a third party subject to contract or agreement
with Recipient.
3.3.4 Audit. Recipient's security safeguards and procedures, as well as Recipient's access to and use
of TWC Information, are subject to monitoring, evaluation, and audit by Agency.
3.3.5 Inspections. Recipient shall cooperate fully with any on -site inspections and monitoring
activities of Agency. So that Agency may audit Recipient's compliance with the requirements of
state and federal law and this Contract, Recipient shall permit Agency access to all sites
containing TWC Information (including sites where data is maintained electronically), and to all
workplaces used by personnel who have access to TWC Information.
3.3.6 Self -Assessment Report. Recipient shall submit to Agency a fully executed Quarterly Self -
Assessment Reporl, Attachment G, on the next -occurring quarterly filing date after the Begin
Date, and on each quarterly filing date for as long as this Contract is in effect. The quarterly
filing dates are January 15, April l5, July 15, and October 15. Each report must be completed
after the end of the prior calendar quarter and must have been signed within fifteen (15) days
preceding submission. Failure by Recipient to submit to Agency a timely Quarterly Self -
Assessment Report may result in the following consequences: the first instance of a late
Quarterly Self -Assessment Report shall result in a late notice being issued by TWC. A failure by
Recipient to timely respond to the first late notice by the time specified in the notice or Recipient
receiving a second late notice, may result in TWC terminating the Contract for cause.
3.3.7 Identity Theft Protection. In case of unauthorized disclosure of TWC Information by Recipient,
Recipient shall purchase identity theft protection service for all individuals whose information
was disclosed without authorization. The protection service shall cover each individual for a
two-year period and must include, at a minimum, automatic fraud alerts to the individual.
3.3.8 Si nificant Chan e. Recipient agrees to notify Agency in writing within ten (10) calendar days
of any significant change affecting Recipient and Recipient's identity, including but not limited
to changes in its ownership or control, name, governing board membership, authority of
governing board, officeholders, or vendor identification number.
3.39 Computer Resources. Recipient shall provide and maintain its own computer hardware and
software to accomplish the necessary computer communications linkages with Agency.
3.3. l0 Data Source. Agency does not warrant or guarantee the accuracy of TWC Information. TWC
Information includes data provided to Agency by third parties, including employers and
employees.
SECTION 4 --- Contact Persons
4.1 Designation. The Parties designate the primary liaisons as specified in Exhibit 1. Request and Safeguard
Plan.
Agency Contact Person
Contract Management Team
Information Release Contract Attachments- February 2022
TWC Contract Number: 2923EDE063 CITY OF ROUND ROCK
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External Data Exchange Contracts (EDE)
Procurement and Contract Services Department
Texas Workforce Commission
1117 Trinity Street, Room 342T
Austin, TX 78701
Phone: (737) 400-5482
Fax: (512)936-0219
Email: DEContracts twc.texas. ov
4.2 Notice. Any notice required under this Contract must be given to the Recipient's Contact Person specified
in Exhibit 1. Request and Safeguard Plan or the Agency Contract Person.
4.3 Notice to Alternate. If Recipient designates an alternate Contact Person in Exhibit 1, Request and
Safeguard Plan, written notification by Agency to one (1) of the Recipient Contact Persons will satisfy any
notification requirement of this Contract.
4.4 Change. Recipient may request a change in Recipient Contact Person by submitting to Agency Contact
Person a written request on organizational letterhead signed by the person who signed this Contract on
behalf of Recipient, or by a successor with authority to bind Recipient contractually. The request must
include the TWC Contract Number, the name of the person being replaced, and the name of the new
Recipient Contact Person, with job title, work address, phone number, and email address. No change in
Recipient Contact Person is effective until acknowledged in writing by Agency.
4.5 Communications. Recipient shall include the TWC Contract Number in all communications with Agency.
SECTION 5 — Parties Option for Extension and Effect on Other Contracts
The Parties agree that this Contract supersedes and replaces all prior contracts, if any, between them for
information release or data sharing as specified in Exhibit 1. Request and Safeguard Plan.
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Attachment B
SAFEGUARDS FOR TWC INFORMATION
"Recipient" in this Contract shall maintain sufficient safeguards over all TWC Information to prevent unauthorized
access to or disclosure of TWC Information:
"TWC Information" means records maintained by Agency (TWC), and records obtained by Recipient from
Agency under this Contract, including (1) records and data compilations provided electronically, on paper, or via
online access or e-mail, (2) records and data compilations that Recipient has converted into another format or
medium (such as handwritten or electronic notes), and (3) records and data compilations incorporated in any
manner into Recipient's records, files, or data compilations.
2. Monitorina. Recipient shall monitor its Users' access to and use of TWC Information and shall ensure that TWC
Information is used only for the following "Limited Purpose" as set forth in Exhibit 1, Request and Safeguard Plan.
Recipient shall also ensure that TWC Information is used only for purposes authorized by law and in compliance
with all other provisions of this Contract.
3. Storage. Recipient shall store TWC Information in a place physically secure from access by unauthorized persons.
4. Protection. Recipient shall store and process TWC Information, including that maintained in electronic format, such
as magnetic tapes or discs, in such a way that unauthorized persons cannot obtain TWC Information by any means.
5. Access. Recipient shall undertake precautions to ensure that only authorized personnel are given access to TWC
Information stored in computer systems.
6. Instruction. Recipient shall instruct all personnel having access to TWC Information about all confidentiality
requirements including the requirements of 20 C.F.R. Part 603 as well as the sanctions specified in this Contract and
under slate and federal law for unauthorized disclosure of TWC Information. Recipient acknowledges that all
personnel who will have access to TWC Information have been instructed as required.
Disposal. Recipient shall dispose of TWC Information and any copies thereof after the Limited Purpose(s) is
achieved, except for TWC Information possessed by any court. Disposal means return of TWC Information to
Agency or destruction of TWC Information, as directed by Agency. Disposal includes deletion of personal
identifiers in lieu of destruction. In any case, Recipient shall dispose of all TWC Information within thirty (30)
calendar days after the termination, cancellation, or expiration of this Contract, in accordance with Attachment F,
Certificate of Destruction for Contractors and Vendors, which is attached to this Contract and incorporated for all
purposes.
8. System. Recipient shall establish and maintain a system sufficient to allow an audit of compliance with the
requirements of this Attachment S and the other provisions of this Contract.
9. No Disclosure or Release. Recipient shall not disclose or release any TWC Information other than as permitted in
this Contract, without prior written consent of Agency.
10. Unauthorized Disclosure. It is a breach of this Contract to disclose TWC Information orally, electronically, in
written or printed form, or in any other manner without the prior written consent of Agency:
10.1 to any contract employee of Recipient or any individual not employed by Recipient;
10.2 to another government entity, including a law enforcement entity;
10.3 to Recipient employees who do not have a need to use TWC Information for the Limited Purpose.
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1 l . Authorized Disclosure. TWC Information may only be disclosed:
11.1 to employees under the direct hiring -and -firing control of Recipient who have a need to use the TWC
Information for the Limited Purpose(s); and
11.2 in a criminal judicial proceeding if the TWC Information is introduced in court as a sealed record with access
limited to the prosecutor, defendant, judge, and jury.
12. Security Violation. Recipient shall monitor access of Users and shall notify Agency within twenty-four (24) hours if
a security violation of this Contract is detected, or if Recipient suspects that the security or integrity of TWC
Information has or may have been compromised in any way.
13. Format, TWC Information is subject to the requirements of this Contract even if the TWC Information is converted
by Recipient into another format or medium, or incorporated in any manner into Recipient's records, flies, or data
compilations.
14. Access Limited. Recipient shall limit access to TWC Information to its employees who need access to achieve the
Limited Purpose.
15. Mobile Device and Removal. Recipient shall not place TWC Information on mobile, remote, or portable storage
devices, or remove storage media from Recipient's facility, without the prior written authorization of Agency.
16. Public Information Act. Under Texas Labor Code § 301.085, TWC Information is not "public information" for
purposes of the Public Information Act, Texas Government Code, Chapter 552. Recipient shall not release any TWC
Information in response to a request made under the Public Information Act or under any other law, regulation, or
ordinance addressing public access to government records.
17. Subpoena. Recipient shall notify Agency within twenty-four (24) hours of the receipt of any subpoena, other judicial
request, or request for appearance for testimony upon any matter concerning TWC Information. Federal regulations
dictate the handling of subpoenas for TWC Information. Recipient shall comply with the requirements of 20 C.F.R.
§ 603.7 in responding to any subpoena, other judicial request, or request for appearance for testimony upon any
matter concerning TWC Information.
18. Federal Regulation. Recipient shall comply with all requirements of Safeguards for TWC Information as required by
20 CFR Part 603 and this Contract relating to safeguarding TWC Information and ensuring its confidentiality.
19. Unauthorized Lookup. A User shall not access TWC Information listed under the User's SSN or the SSN of a co-
worker, family member, or friend.
20. Screening - Online Users. Recipient shall screen potential Users and seek online access only for employees that
Recipient has determined pose no threat to the security of TWC Information.
21. Screening All Handlers. Recipient shall permit access to TWC Information only to employees that Recipient has
determined pose no threat to the security of TWC Information.
22. Internet. Recipient shall not transmit any TWC Information over the Internet unless it is encrypted using at least
256-bit AES encryption and the current FIPS 140 series encryption standards.
23. Screen Dump. Recipient's security guidelines shall ensure that any screen dump or other extraction of TWC
Information will be protected from unauthorized use or disclosure.
24. No Transfer. Recipient shall not transfer the authority or ability to access or maintain TWC Information under this
Contract to any other person or entity.
Information Release Contract Attachments February 2022
TWC Contract Number: 2923EDE063 - CITY OF ROUND ROCK
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Attachment C
TEXAS WORKFORCE COMMISSION USER AGREEMENT
(User's Printed Name) (User's Social Security Number)
(User's work phone number) (Print User's work street address)
(Print User's employer) (Print User's work email)
acknowledge that I will be assigned a personal User ID and password to gain access to the Texas Workforce Commission (TWC)
computer system. Under no circumstances will t allow my User ID or password to be used by any other individual, nor will I use one
belonging to anyone else. As an online User with access to confidential TWC data ("TWC Information"), I understand that I will be
held personally accountable for my actions and for any activity performed under my User ID. I understand that the use of TWC
Information is limited to the following "Limited Purpose(s)" only: to assist in criminal investigations; to assist in locating defendants,
witnesses, and fugitives in criminal cases; to assist in locating persons with outstanding warrants and to assist in locating probation
absconders. I understand that TWC maintains a record of the individuals and employers whose TWC Information I gain access to, and
that I am not allowed access to TWC Information about any individual or employer except as necessary for the Limited Purpose(s). I
understand that I am not allowed access to TWC Information about myself.
I will not enter any unauthorized data or make any changes to data. I will not disclose any TWC Information orally, electronically, in
written or printed form, or in any other manner without prior written authorization from TWC. I will not disclose any TWC
Information to other governmental entities, including law enforcement entities.
I understand that under Texas Labor Code §301.085, all TWC Information I obtain under this User Agreement is confidential and that
it is a criminal offense to solicit, disclose, receive or use, or to authorize, permit, participate in, or acquiesce in another person's use of
TWC Information that reveals: (1) identifying information regarding any individual or past or present employer; or (2) information
that foreseeably could be combined with other publicly available information to reveal identifying information regarding any
individual or past or present employer. This offense is punishable by as much as a year in jail, a fine up to $4,000, or both.
understand that under Texas Penal Code §33.02(a), it is a criminal offense to knowingly access a computer, computer network, or
computer system without the effective consent of the owner. Depending on the circumstances, the offense is punishable by
confinement in jail for up to 180 days or up to 99 years or life in prison, a fine of up to $2,000 or up to $10,000, or both.
1 have read and had explained to me the confidentiality and security requirements of 20 C.F.R. § 603.9 and of my employer's contract
with TWC. I understand and agree to abide by these requirements. I understand that if I violate any of these requirements or any
provision of this User Agreement, 1 will jeopardize my employer's contract with TWC.
Signature of User Date signed
Supervisor Approval.• I have instructed the User listed above about all confidentiality requirements applicable to TWC Information
obtained under the contract with TWC, including the requirements of 20 C.F.R. § 603.9 and the sanctions specified in the Contract and
in state law for unauthorized disclosure of TWC Information.
Signature of Supervisor Printed Name Date signed
Approval of Contract Signatory or Contact Person named in Contract:
Signature of Contract Signatory or Recipient Contact Person Printed Name Date signed
All fields on this User Agreement are required. Employer must retain signed original and give a copy to User. Employer must send copy of executed User
Agreement to TWC EAGLE Administration as specified on the required Cover Sheet, Attach meni D to this Contract. An incomplete User Agreement will be
rejected.
Information Release Contract Attachments February 2022
TWC Contract Number. 2923EDE063 - CITY OF ROUND ROCK
Page 8 of I
TEXAS WORKFORCE COMMISSION
INFOMRATION RELEASE CONTRACT
Attachment D
TRANSMITTAL COVER SHEET
FOR NEW USER AGREEMENTS AND TRAINING CERTIFICATES
AND EXISTING USER TRAINING CERTIFICATES
To: EAGLE Administration
via email to: EAGLEsupgort(c-)twc.texas.Qov
(Document must be scanned and encrypted before sending)
via fax to: 512-463-6394
Number of pages including cover sheet: _
via mail to: EAGLE Administration
Texas Workforce Commission
101 East 151h Street, Room 0108
Austin, TX 78778-0001
From: _ (Recipient Contact Person)
(Recipient Contact Person email)
Re: User Agreement(s) and Training Certificate(s) attached
Instructions:
• User Agreement and Training Certificate must be submitted together for each individual.
Only one cover sheet is required if submitting documents for more than one User at the same time.
For questions regarding the User Agreement, please email EAGLEsupport Qt we. texas. Roy
Note: An incomplete User Agreement will be rejected
Information Release Contract Attachments- February 2022
TWC Contract Number: 2923EDE063 CITY OF ROUND ROCK
Page 9 of 13
TEXAS WORKFORCE COMMISSION
INFOMRATION RELEASE CONTRACT
Texas Workforce Commission Attachment F
Certificate of Destruction for Contractors and Vendors
Hard copy and electronic media must be sanitized prior to disposal or release for reuse. The TWC tracks, documents, and verifies media sanitization
and disposal actions. The media must be protected and controlled by authorized personnel during transport outside of controlled areas. Approved
methods for media sanitization are listed in the NIST Special Publication 800-88, Guidelines for Media Sanitization.
http://csrc.nist.aovlpublicationslnistpubs/800-88INISTSPBO0-88 with-enata.pdf
Contact Name
Title
Company Name and Address
Phone
You may attach an inventory of the media if needed for bulk media disposition or destruction.
Media Type
Media Title / Document Name
HARD COPY I
I ELECTRONIC
Media Description
(Paper, Microfilm, Computer Media, Tapes, etc.)
Dates of Records
Document I Record Tracking Number
TWC Item Number Make / Model
Serial Number
CLEAR
Who Completed?
Who Verified?
Item Sanitization
PURGE
Phone
Phone
DESTROY
DATE Completed
Sanitization Method and/or Product Used
Final Disposition of Media
Reused Internally Destruction / Disposal
Reused Externally _ Returned to Manufacturer
Other
Comments:
If any TWC Data is retained, indicate the type of storage media, physical locations(s), and any planned destruction date.
Description of TWC Data Retained and Retention Requirements:
Proposed method of destruction for TWC approval:
Type of storage media?
Physical location?
Planned destruction date?
Within five (5) days of destruction or purging, provide the TWC with a signed statement containing the date of clearing, purging or destruction,
description of TWC data Geared, purged or destroyed and the method(s) used.
Authorized approval has been received for the destruction of media identified above and has met all TWC Records Retention Schedule requirements
including state, federal and/or internal audit requirements and is not pending any open records requests.
Records Destroyed by:
Records Destruction Verified by:
Signature
Date
Signature Date
Be sure to enter name and contact Info for who completed the data destruction and who verified data destruction in the fields above -
Send the signed Certificate of Destruction to:
TWC: Information Security Office, Rm. 0330A, 101 E. 15th Street, Austin, TX 78778-0001
GP Revised: 09-02.15
Information Release Contract Attachments February 2022
TWC Contract Number: 2923EDE063 CITY OF ROUND ROCK
Page 10 of 13
TEXAS WORKFORCE COMMISSION
INFOMRATION RELEASE CONTRACT
Texas Workforce Commission
Certificate of Destruction for Contractors and Vendors
INSTRUCTIONS FOR CERTIFICATE OF DESTRUCTION
Attachment F
Hard copy and electronic media must be sanitized prior to disposal or release for reuse. The TWC tracks, documents, and verifies media sanitization
and disposal actions. The media must be protected and controlled by authorized personnel during transport outside of controlled areas. Approved
methods for media sanitization are listed in the NIST Special Publication 800-88. Guidelines for Media Sanitization,
htti):Ilcsrc.nist.gov/publications/nistoubs/800-88/NISTSP800-88 with-errata.pdf
IRS Publication 1075 directs us to the FISMA requirements and NIST guidelines for sanitization and disposition of media used for
federal tax information (FTI). These guidelines are also required for sensitive or confidential information that may include personally
identifiab.e information (Pit) or protected health information (PHI). NIST 800-88, Appendix A contains a matrix of media with minimum
recommended santtizat on techniques for clearing, purging, or destroying various media types. This appendix is to be used with the
decision flowchart provided ;n NIST 800-88, Section 5.
There are two primary types of media in common use:
• Hard Copy Hard copy media is physical representations of information. Paper printouts, printer and facsimile ribbons, drums,
and platens are all examples of hard copy media.
Electronic for soft copy). Electronic media are the bits and bytes contained in hard drives, random access memory (RAM),
read-only memory (ROM), disks. memory devices, phones, mobile computing devices, networking equipment, and many other
types I sted in NIST SP 800 88, Appendix A.
1. For media being reused within your organization, use the CLEAR procedure for the appropriate type of media. Then validate the
media is cleared and document the media status and disposition.
2. For media to be reused outside your organization or if leaving your organization for any reason, use the PURGE procedure for the
appropriate type of media. Then validate the media is purged and document the media status and disposition. Note that some
PURGE techniques such as degaussing will typically render the media (such as a hard drive) permanently unusable.
3. For media that will not be reused, use the DESTRUCTION procedure for the appropriate type of media. Then validate the media is
destroyed and document the media status and disposition.
4 For media that has been damaged (i.e., crashed drive) and cannot be reused use the DESTRUCTION procedure for the
appropriate type of media. Then validate the media is destroyed and document the media status and disposition.
5. If immediate purging of all data storage components is not possible, data remaining in any storage component will be protected to
prevent unauthorized disclosures Within twenty (20) business days of contract expiration or termination, provide TWC with a signed
statement detailing the nature of TWC data retained type of storage media, physical location, planned destruction date, and the
proposed methods of destruction for TWC approval.
6 Send the signed Certificate of Destruction to:
Texas Workforce Commission
Information Security Office
Room 0330A
101 E. 151h Street
Austin, TX 78778-0001
FAX to 512-463-3062
or send as an email attachment to:
cisoO,twc.texas.aov
Final Distribution of
Original to Chief Information Security Officer
Copy to: 1. Your Company Records Management Liaison - or - Information Security Officer
Certificate
2. TWC Contract Manager
GP Revised: 09-02-
Information Release Contract Attachments February 2022
TWC Contract Number: 2923EDE063 CITY OF ROUND ROCK
Page I 1 of 13
TEXAS WORKFORCE COMMISSION
INFOMRATION RELEASE CONTRACT
Attachment G
QUARTERLY SELF -ASSESSMENT REPORT
Failure to submit this report by due date can result in termination of all access to TWC Information.
The period covered is -Year: Quarter ❑ Q1, ❑ Q2, ❑ Q3, ❑ Q4
The entity receiving TWC Information under TWC Contract ("Recipient") confirms it is in compliance with the
requirements of the Contract and the Safeguards for TWC Information (Attachment B of the Contract), during the
previous period, to include the following:
1.
Recipient used the disclosed TWC Information only for purposes authorized by law and
Yes: _ No:
consistent with the Limited Purpose set forth in Exhibit L Request and Safeguard Plan of the
Contract.
2.
Recipient stored the disclosed TWC Information in a place physically secure from access by
Yes: _ No:
unauthorized persons. This includes hard copies of the information.
3.
Recipient stored and processed disclosed TWC Information maintained in electronic format
Yes: No:
outside of the recipient computer systems in such a way that unauthorized persons cannot
obtain the TWC Information by any means.
4.
Recipient took precautions to ensure that only authorized personnel were given access to
Yes: No:
disclosed TWC Information that is stored in recipient's computer systems.
5.
Recipient has instructed all personnel having access to the disclosed TWC Information about
Yes: _ No:
confidentiality requirements, the requirements of 20 C.F.R. § 603.9 found in Safeguardsfor
TWC Information (Attachment B), and the sanctions specified in State law for unauthorized
disclosure. (Each violation is a Class A Misdemeanor, punishable by a fine of $4,000, a year
in }ail, or both).
6.
Recipient adhered to confidentiality requirements and procedures that are consistent with and
Yes: _ No:
meet the requirements of the TWC Contract.
7.
Recipient agreed to report any infraction(s) of these requirements and procedures to TWC
Yes: No:
fully and promptly.
8.
Recipient disposed of disclosed TWC Information, and any copies thereof made by Recipient,
Yes: No:
after the purpose for which the TWC Information was disclosed, is served, or as required by
court order. (Disposal means return of the TWC Information to TWC or destruction of the
TWC Information, as directed by TWC. Disposal includes deletion of personal identifiers in
lieu of destruction.)
9.
Recipient ensured that the disclosed TWC information is not retained with personal identifiers
Yes: No:
for longer than such period of time as TWC deems appropriate.
10.
Recipient maintained a system sufficient to allow an audit of compliance with the
Yes: _ No:
requirements of 20 C.F.R. § 603.9 found in Safeguards for TWC Information (Attachment B)
and the TWC Contract.
Information Release Contract Attachments- February 2022
TWC Contract Number: 2923EDE063 CITY OF ROUND ROCK
Page 12 of 13
TEXAS WORKFORCE COMMISSION
INFOMRATION RELEASE CONTRACT
11. Attached is a description of the system referred to in Item 10. Recipient ensured that any
Yes: No:
copies of any logs sent to TWC do not contain Sensitive PI1. Remember to secure originals
containing PII.
12. Recipient maintained as a minimum, the encryption requirements of FIPS 140-2 and encrypt
Yes: No:
the data at the minimum of 256-bit AES encryption.
13. Annual Renewal of Contract User Agreement and training certifications per the Contract
Yes: No:
terms are on file and copies have been submitted to EAGLEsupportatwc.texas. gov.
14. All users have completed the training within the previous 12 months.
Yes: No:
15. Do you re -disclose to other entities under Section 6, Redisclosure Authorization, Roles and
Responsibility, of Attachment A of the contract?
Yes: No:
If yes, Receiving Agency ensures that contract personnel are held to the same standard of
processing, training, and protecting information as Recipient Agency employees who have a need
Yes: No:
to use the TWC information for the Limited Purpose.
By signature hereon, the Contract signatory or the entity's internal auditor certifies that:
All statements and information submitted in response to this Quarterly Self -Assessment Report are current, accurate, and
complete.
Signature Date
Printed Name and Title
Return this Report to:
External Data Sharing Contracts Manager I Procurement and Contract Services Department
Texas Workforce Commission j 1 1 l7 Trinity Street, Room 342T I Austin, Texas 78701
Email: SelfAssessmentReports a,twc.texas.Rov
Fax: 512-936-021
Information Release Contract Attachments February 2022
TWC Contract Number: 2923EDE063 - CITY OF ROUND ROCK
Page 13 of 13
Exhibit 1. TWC Data Exchange Request and Safeguard Plan
All statements and information on this form and associated correspondence relating to the Request and
Security Plan (RSP) are incorporated by reference into the data exchange Contract with TWC as Exhibit 1.
Recipient agrees to {provide written notice to TWC of any changes to the responses contained in this RSP
during the Contract term immediately but no later than three (3) calendar days from the date of change.
Email changes to DEcontracts0twc.texas.xov. After review and approval by TWC, the notice of changes shall
be incorporated by reference into the Contract under Exhibit 1. Any changes to the responses requested by
Recipient and accepted by TWC in this Exhibit 1 shall amend the corresponding information in the GTC and
A-H.
This document is confidential under Texas Government Code regarding infrastructure
security and shall be redacted from release in response to a request for information or
documents. Contact TWC upon such a request.
1. ILegal name of requesting governmental I City of Round Rock / Round Rock Police Department
entitv/Responsible Financial Partv
2. 1 Entity Tax IDq 74-6017485
3. Street Address — Line 1 2701 N Mays St
4. Street Address — Line 2
5. City, State, Zip Round Rock, TX 78665
6. INew request or renewal of an existing
contract?
7.—TType of entity and authority to contract
8. 1 Legal Purpose(s) for requesting
information
(Check all that apply)
9 Requested length of contract term
New request
Extension of existing agreement
Previous/Current Contract q: 2922PEN026
❑ There are other contracts between TWC, and the party not
affected by this Contract, which, are as follows:
Texas Local Government Code, Chapter 791, Interlocal
Cooperation Act (e.g., cities, counties)
❑ Texas Government Code, Chapter 771, Interagency
Cooperation Act (e.g„ state agency)
❑ Federal Agency Authority
❑ if state a enc -please--s LciN authority -
® to assist in criminal investigations
® to assist in locating defendants, witnesses, and fugitives in
criminal cases
® to assist in locating persons with outstanding warrants
® to assist in locating probation absconders
❑ to assist in determining eligibility for public
assistance/services
❑ other: please specify: (language will be inserted into
contract)
U 1 year 2 years 3 years 4 years 5 years
lRenewal Option up to a total of S years combined)
Texas Workforce Commission I Nov 2022
10. Requested start date
11. Information requested
(Check the data being requested)
12. E Method of receiving data
For federal entities only: to correspond with start of fiscal
year starting: j
®Wage Records (WR):
Wage Detail Inquiry: View wage information for an individual.
Coworker Search: View wages reported by an employer.
®UI Benefits and Claimant Info (UI):
Personal information: View demographic information for an
individual.
Claims: View unemployment insurance claim information.
Payments: View unemployment insurance payment info.
Employer Search: Search employers by name or address.
® Employer Records (ER)
Em to er Master File: Search Employer Master File and view
state unemployment tax information.
® Online access: Contractor access for lookup by SSN through
a password -protected log -in account. Number of individuals
needing access accounts:
01-10 (The subscription rate is $1,500 per year.)
❑11-25 (The subscription rate is $2,000 per year.)
026-50 (The subscription rate is $3,500 per year.)
❑Specify other quantity
Please confirm that the number of Users given access is and
will be limited to the minimum number necessary to
accomplish the Limited Purpose(s). ® Yes ❑ No
Online Access for Over 25 User Accounts:
*If the request is for more than 25 user accounts, please
indicate the reason the volume of access accounts is
necessary (check all that apply): There is/are:
❑ a high volume of daily/weekly inquiries require the
requested volume of use accounts
❑ other reason(s) for the volume of access accounts:
❑ Offline access:
Offline Method of Transfer and Frequency:
(Check applicable options)
❑ Ongoing: Scheduled computer matching against file of SSNs
or tax account numbers submitted by Requestor periodically.
Frequency of ongoing scheduled requests:
[]Nightly []Weekly ❑ Bi-Weekly ❑ Monthly
❑Quarterly [:]Annually ❑Other —specify:
Texas Workforce Commission I Nov 2022
[] Non-scheduled - Upon Request: Ad hoc request for non-
scheduled matches or data files.
❑ One-time request for large quantity of records.
❑ One-time request for one or a few records (less than 100
matches of SSNS or <5 TWC Employer ID or FEIN).
Submit request to open.records@twc.texas.gov or fax
request to 512-463-2990 or the open records portal at
httos://twc.xovaa.us/WEBAPP/ rs/(Slraibfua2yv4rbj2wrzlu
c3se))/su porthome.as x.
Specify the particular data elements for the information
requested in question 11. E.g., name, address, wage benefit
amount, employer name, telephone number, etc.
1. If other specific data elements are requested, provide a
data format.
Offllne Data Elements Requested:
Data elements to be submitted to TWC for the resulting
matched data:
❑ SSN — Social Security Number
Data available from TWC available for SSN matches
from the UI Wane Records:
Name: last, first, middle initial
NAILS
Quarter Wages were earned
Quarterly Wages
Employer Name
Employer Address
Employer Zip
Employer contract
Employer Telephone
Employer Tax Account Number
Instructions for submitting SSN-Ul Wage Record Match
Requests:
Filename and format will be provided by and
coordinated with the TWC developer upon receipt
of Attachment E. REQUEST FOR TEXAS
WORKFORCE COMMISSION RECORDS
File transmission shall be protected using TWC
Secure FTP and encrypted using at least 256-bit
encryption.
❑ TWC Employer ID Number (EIN)
Texas Workforce Commission I Nov 2022
13
Data available from TWC available for EIN matches
from the Employer Tax Master File:
Name: last, first, middle initial
Social Security Number
Quarterly Wages
Employer Name
Employer Address
Employer Zip
Employer contact
Employer Telephone
Employer Tax Account Number
Instructions for submitting Texas EIDs or FEINs:
(follow the same pattern as for SSNs):
Format sample: 123456789
Send seed file via secure file transfer to
Agency's secure portal, currently GoAnywhere —
https://mft.twc.state.tx.us/webcllent/Lo in.xhtmi
(prior account establishment required)
❑ Federal Employer ID Number (FEIN)
Same as Texas Employer ID information
Volume/quantity of offline records requested per submission
and associated rates:
Estimated number of individuals in which sensitive personally
identifiable information requested at any one time:
❑ 1-999: $250
❑ 1,000— 14,999:$300
❑ 15,000—19,999: $375
❑ 20,000 — 24,999: $500
❑ 25,000 -Above: $1,000
Hourly rate for programming of a new request or
modification of an existing job: $48.81.
De -identification: If submitting SSNs to TWC, also include a
unique identifier. For enhanced security, the return file will not
include SSNs but instead will include only the unique identifier
where feasible.
How will data be viewed? 1) W We will ONLY view screen information. w ��
Select one of the three options. (Respond to #14-19, check "N/A" to #20 and #21.)
2) ❑ We will use electronic copies of screen prints (PDF), or
❑ We will transfer data into an electronic record.
(Respond to #14-20, check "N/A" to #21.)
Texas Workforce Commission I Nov 2022
T
14 Will non -employees be provided access
to the data?
Express written contract language
authorizing data exchange with non -
employees is required for re-
distribution of information accessed.
15. Will the data you are requesting be
disclosed to any other entity?
Express written contract language
authorizing data exchange with non -
employees is required for re-
distribution of information accessed.
16. What access control methods will you
use for access to the TWC information?
17. How does your organization assess
your security posture? How frequently
are these assessments conducted?
18.0 it Are background checks performed on
18.1
19
20.
employees who will access
information?
When are background checks
performed?
How will you have an auditable trail?
How will you encrypt the data at rest.)
(Ex: Once transferred to a database or
other electronic system)
When will data destruction occur?
3)_0We will use paper copies of screen prints, or
❑ We will transfer information into paper records format.
(Respond to ##14-19 and f#21, check "N/A" to ##20)
Only direct employees will be provided access.
❑ Persons who are not employees may/will be provided
access. Please specify those that apply:
❑ Data Center Operators
❑ Other Governmental Contractors: Please specify:
Yes - Specify:
-0
Texas State Requirements under Title 1, Part 10, TAC Sec.
202, or comparable standards
❑ National Institute of Secure Technology (NIST) or
comparable standards
❑ IRS Publication 1075 or comparable standards
Vulnerability testing Frequency:
❑ Penetration testing Frequency:
® Audits testing Frequency: Weekly C ber Hygiene
Assessment by CISA and we complete the GIS Audit and stay in
compliance with those standards.
❑ Other — Please specify: Frequency:
Yes, background checks are performed (go to 18.1).
❑ No, background checks are not performed
If No background checks are performed, state what type of
records checks are being performed:
Pre -employment
❑ Periodic checks during employment
❑ N/A
I will keep a worksheet that includes at a minimum, the
person making the inquiry, the reason for the inquiry,
identifying information regarding the case or claim for which
the inquiry was made, and the date the inquiry was made.
rl Other, If Other specify: _
Lj Please specify:
® N/A — We do not keep data at rest.
[Consistent with Texas State Libraries and Archives
Commission (state records retention laws)
❑ Consistent with other standards: Please specify:
® N/A - We do not retain data.
Texas Workforce Commission E Nov 2022
22.7P21
of Contact Name
daily mattes)
Rick White
23.of
Contact Title
Plannin Manager
512-218-SS24
24.of
Contact Phone
25.
of Contact E-mail
rwhite@roundrocktexas.v
2701 N Mays St, Round Rock TX 78665
26.
1 Point of Contact Address
27.
Alternate Point of Contact Name and
Title
If different from Point of Contact
Laurie Hadley 4
City Manager
512-218-5400
1hAdlekgRroundrocktexas.goy
221 E Main, Ste 221, Round Rock, TX 78664
28.
Alternate Point of Contact Phone
29.
Alternate Point of Contact E-mail
30.
Alternate Point of Contact Address
31.
Signatory Name
32.
Signatory Title
33.
Signatory Phone Number
34.
Signatory E-mail
35.
Signatory Address
36.
Data Technology Contact Name
Megan Tschoerner _
512-218-5451
mtschoerner@roundrocktexas.gov
37.
Data Technology Contact Phone
38.
Data Technology Contact E-mail
39.
Invoice Recipient Name
Rick White
512-218-SS24
40.
Invoice Recipient Phone Number
41.
Invoice Recipient Title
Plannin Manager
r roundr ktexas. ov
42,
Invoice Recipient E-mail
43.
Invoice Recipient Address
If different from Point of Contact — Same Address
All statements and information on this form and associated correspondence relating to the Request and
Safeguard Plan are incorporated by reference into the data exchange Contract with TWC as Exhibit 1. The
original Exhibit 1 and contract must be signed by the Contract Signatory.
The person signing is authorized by Recipient to bind their organization to the terms of the contract.
signation For Subsequent Submissions:
By checking here, the contract signatory approves the Recipient Point of Contact as their designee for
s bmission of subsequent updates to the Request for Safeguard Plan and requests for renewals for purposes
of extending the duration and associated amount.
I'el 7. 26-z3
Contract Signatory or desi ee Date
Laurie Hadley/City Manager
Printed Name/Title
For questions on how to complete this request form, contact DEContracts@twc.texas.com
Texas Workforce Commission I Nov 2022