Appendix 2M
Model Agreement between the Department of Veterans Affairs and individual State Public Assistance Agencies (SPAAs)
The signatory to this Model Agreement authorizes the SPAA named below to participate in the Public Assistance Reporting Information System (PARIS) project activities facilitated by the U.S. Department of Health and Human Services, Administration for Children and Families. The PARIS project will match public assistance data against data from the U.S. Department of Veterans Affairs (VA) as described in the Computer Matching Agreement executed by the VA Data Integrity Board on January 19, 2012 and published in the Federal Register on April 13, 2012 at 77 Fed. Reg. 22326. This Model Agreement is valid through October 14, 2013.
The signatory asserts that the SPAA named below acknowledges its understanding of the terms and conditions of said 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 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)
