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ISSUE DATE: 09/2008

When you ask people to provide private or confidential data about themselves, you must tell them:

The purpose and intended use of the requested data.

Whether they may refuse or if the law requires them to supply the data.

The consequences of supplying or refusing to supply the data.

The identity of other people or entities authorized to receive the data.

The Combined Application Form (CAF) (DHS-5223) (PDF) contains some of this information. More information is on the form Notice of Privacy Practices (DHS-3979) (PDF).

Include a signed copy of the Combined Application Form (CAF) in the case file to document that you gave the client a Notice of Privacy Practices. Also see 0005.09 (Combined Application Form (CAF)).

For other questions related to data practices, write to the Data Practices Attorney:

DHS Data Practices Attorney
P.O. Box 64998
St. Paul, Minnesota 55164

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