Appendix 1M

Model Agreement between the Defense Manpower Data Center, Department of Defense (DoD); Administration for Children and Families, Department of Health and Human Services (HHS); and individual State Public Assistance Agencies (SPAAs)

The signatory to this Model Agreement Renewal authorizes the SPAA named below to renew for not more than one additional year the entity’s participation in the Public Assistance Reporting Information System (PARIS) project activities described herein.  The pertinent PARIS project activities, which will be conducted without change, will match public assistance data from the U.S. Department of Defense (DoD).  The matching activities to be carried out are those described in the computer matching agreement initially approved by the DoD Data Integrity Board on December 10, 2010 and published in the Federal Register on January 10, 2011 at 76 Fed. Reg. 1410.  This additional 12 month renewal extends the PARIS Federal match through August 14, 2013.

The signatory asserts that the SPAA named below has complied with the terms and conditions of the foregoing computer matching agreement; acknowledges that the SPAA’s continued compliance with those terms and conditions is required to participate in the PARIS project; and, accordingly, agrees herewith to abide by those terms and conditions.

By executing this document, the signatory to this Model Agreement Renewal also affirms that he or she is authorized to enter into this agreement on behalf of the entity named below.

_______________________________________________________
(Type in State's Name)

(Type in Department or Agency name, e.g., Human Services)

 

_________________________________________
(Type in Name & Title)

____________________________________
(Signature)

___________________________________

___________________________________

___________________________________
(Type in Address and Phone number)

_________________
(Type in Date)

 

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