Any reasonable grounds for belief that a person has violated any provision of Iowa Coded Chapters 235A or 235B shall be grounds for the immediate withdrawal of any authorized access that person or agency might otherwise have to child or dependent adult abuse information. Conditions of Agreement We agree to have every employee who will have access to child and dependent adult abuse electronic information sign a copy of this and keep it in a file at this facility or agency to allow the Non-Redissemination Agreement licensure agency personnel to view this agreement on request The agreement signed by the administrator of the agency or facility will be sent to the Department of Human Services, Central Abuse Registry, 401 SW 7th Street, Suite G, Floor, Des Moines, IA 50319-3574, and a copy will be posted within sight of the electronic information system work area. We understand that this agreement will allow our agency or facility to receive any child or dependent adult abuse information maintained by the DHS as allowed under Chapter 235A and 235B of the Iowa Code. We understand that without a signed agreement on file our agency or facility will not have access to child and dependent adult abuse information. Name of Facility or Agency Administrator (type or print name) Signature of Administrator 470-3767 (Rev. 6/10)
Any reasonable grounds for belief that a person has violated any provision of Iowa Coded Chapters 235A or 235B shall be grounds for the immediate withdrawal of any authorized access that person or agency might otherwise have to child or dependent adult abuse information. Conditions of Agreement We agree to have every employee who will have access to child and dependent adult abuse electronic information sign a copy of this Non-Redissemination Agreement and keep it in a file at this facility or agency to allow the licensure agency personnel to view this agreement on request The agreement signed by the administrator of the agency or facility will be sent to the Department of Human Services, Central Abuse Registry, 401 SW 7th Street, Suite G, Floor, Des Moines, IA 50319-3574, and a copy will be posted within sight of the electronic information system work area. We understand that this agreement will allow our agency or facility to receive any child or dependent adult abuse information maintained by the DHS as allowed under Chapter 235A and 235B of the Iowa Code. We understand that without a signed agreement on file our agency or facility will not have access to child and dependent adult abuse information. Name of Facility or Agency Administrator (type or print name) Signature of Administrator 470-3767 (Rev. 6/10)
sing_id_request3.docx