Appendix 2M

Model Agreement Extension between the Department of Veterans Affairs and individual State Public Assistance Agencies (SPAAs)

The signatory to this Model Agreement Extension authorizes the SPAA named below to extend for not more than one additional year the entity's participation in the Public Assistance Reporting Information System (PARIS) project activities described within.  The pertinent PARIS project activities, which will be conducted without change, will match public assistance data against data from the U.S. Department of Veterans Affairs (VA).  The matching activities to be carried out are those described in the computer matching agreement initially approved by the VA Data Integrity Board on January 19, 2012 and described in the Federal Register on April 13, 2012 at 77 Fed. Reg. 22326.  This additional 12 month extension extends the PARIS VA match through October 14, 2014.

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 Extension 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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