Request for Data-Sharing Agreement

The Department of Revenue has an obligation to handle information responsibly and can only provide outside entities access to confidential information under limited circumstances. This form helps confirm whether sharing information is permissible, appropriate, and consistent with the Department of Revenue’s mission.

By submitting your request, you certify that you have the legal authority to receive all requested information and have confirmed that the requested information is the least amount of information necessary to fulfill your intended use. You acknowledge that you may be required to provide proof of appropriate privacy and security controls, sign a data sharing agreement, and/or ensure all individuals with access sign a confidentiality agreement. Completing this form is not an assurance that the requested information will be provided, and your request may be modified or denied after review.

This form is not intended to be used for public records requests under the Public Records Act in chapter 42.56 RCW. Please send public records requests to dorpublicrecords@dor.wa.gov.

Please do not use this form to send confidential information.

Questions about this form may be submitted to dordatasharing@dor.wa.gov Please note, incomplete, vague, or missing information on this form may cause delays in processing your request.

Section A: Requester Information

Entity Information * indicates required field

Contract Manager (if different than listed above)

Contract Signer * indicates required field

Entity Type * indicates required field

Type of entity: *
Section B: Requested Information

What information and/or data elements are you requesting? *

Please provide as much detail as possible, including timeframe and if applicable list the specific data elements you are requesting.

What category is the data? *

See WaTech’s Data Classification Standard

Do you have access to this information now, or have you previously received this information? *

What format do you prefer to receive the information/data?

Select all that apply *

If you are requesting a data extract, what frequency do you need the data? *

Please state the requested duration for the data share agreement. *

Will the records be linked to or commingled with any other records? *

Section C: Purpose

Why do you need this information/data to accomplish your purpose? *

Please provide a detailed explanation.

What will you do with the information/data? *

Explain how the data will be used, and what you will be doing with it.

How long will you keep this information? *

If requesting Category 3 information, what legal authority allows the Department of Revenue to share this information with you? *

For more information refer to RCW 82.32.330, RCW 19.02.115, RCW 84.08.210, RCW 63.30.380 and 26 U.S.C § 6103

Will you be publicly releasing any analysis or derivative data products based on the data? *

Section D: Access

How many people will access this information? *

What are the types of employee duties of those that will access this information? *

List all that apply, including the justification for access:

Will any other entities (such as subcontractors) have access to this information? *

Section E: Privacy and Security Controls

Describe in detail your plan to prevent unauthorized access or redisclosure. How will you comply with OCIO Security Standard 141.10 and any other applicable privacy and security standards? *

Where will the information/data be stored? *

What is your plan for disposing of the information/data? *

Are you subject to external security audit(s) (e.g. SOC 1, SOC 2, SSAE 16, IRS, SSA, etc.)? *