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safeguards to ensure data confidentiality, integrity, and availability to prevent unauthorized or <br />inappropriate access, use, or disclosure. <br /> <br />COMPLETE AND ACCURATE INFORMATION: <br /> <br />WIC 18999.8 requires that Participating Agencies take reasonable steps to ensure information <br />provided is complete, accurate, and up to date to the extent necessary for the agency’s intended <br />purposes and that the information has not been altered or destroyed in an unauthorized manner. <br /> <br />ACKNOWLEDGEMENT AND AGREEMENT: <br /> <br />By your signature below, you are certifying: <br /> <br />• Your department or agency will be a Participating Agency; <br />• Your department or agency will abide by all the requirements set forth above and in <br />the attached AB 210 MDT Protocol; <br />• Your department or agency will ensure that all employees participating in <br />information-sharing under AB 210 have signed the required AB 210 Employee <br />Participation and Confidentiality Agreement; and <br /> <br />• Your department or agency will create and abide by its own supplemental policies <br />and procedures, as needed. <br /> <br /> <br />Department/Agency Name: <br /> <br />Name, Title, and Contact Information of Individual Signing on Department/Agency’s behalf: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Signature: <br /> <br />Date: <br /> <br /> <br />Please email the completed document to: HSA Center on Homelessness, <br />HSA_Homeless_Programs@smcgov.org <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Docusign Envelope ID: 5ED92C3C-6B86-455C-A143-F96E1752BA85