Common use of Display of Notice Clause in Contracts

Display of Notice. Pursuant to the notice published by the Department of Housing and Urban Development (HUD) on July 30, 2004, Participant will prominently display the Notice to Clients of Uses & Disclosures (Privacy Notice to Clients) in its program offices where intake occurs and will take appropriate steps to ensure that all Clients whose information is entered into or accessed from CMIS/HMIS, read and understand the contents of the Notice. The Notice will be substantially in the form of the Notice to Clients of Uses & Disclosures, except that (a) where an Organization’s treatment of information is materially limited by other applicable laws or requirements, the Participant’s Notice must reflect the more stringent requirements, and (b) Participant will update its Notice whenever NWSSC CMIS/HMIS updates and distributes a new form of Notice to Clients of Uses & Disclosures. Participant will provide a written copy of the Participant’s Notice then in effect to any Client who requests it and will provide a copy of such Notice to all Clients who are asked to sign a Client Consent/Release of Information Form. Participant will maintain documentation of compliance with these notice requirements by, among other things, maintaining copies of all Notices it uses and the dates upon which they were first used. ASSURANCE (Participant) assures that the following fully executed documents will be on file and available for review. ▪ The Organization’s Confidentiality Policy. ▪ The Organization’s Grievance Policy, including a procedure for external review. ▪ The Organization’s official Privacy Notice for NWSSC clients. ▪ Executed Client Release of Information forms. ▪ Executed Organization Authorizations for Release of Information as needed. ▪ Certificates of Completion for required training for all NWSSC System Users. ▪ A fully executed User Agreement for all NWSSC System Users. ▪ A current copy of the NWSSC Policy and Procedures. Signature Printed Name Date (mm/dd/YYYY) EXTENT OF AGREEMENT

Display of Notice. Pursuant to the notice published by the Department of Housing and Urban Development (HUD) on July 30, 2004, Participant will prominently display the Notice to Clients of Uses & Disclosures (Privacy Notice to Clients) in its program offices where intake occurs and will take appropriate steps to ensure that all Clients whose information is entered into or accessed from CMIS/HMIS, read and understand the contents of the Notice. The Notice will be substantially in the form of the Notice to Clients of Uses & Disclosures, except that (a) where an Organization’s treatment of information is materially limited by other applicable laws or requirements, the Participant’s Notice must reflect the more stringent requirements, and (b) Participant will update its Notice whenever NWSSC CMIS/HMIS updates and distributes a new form of Notice to Clients of Uses & Disclosures. Participant will provide a written copy of the Participant’s Notice then in effect to any Client who requests it and will provide a copy of such Notice to all Clients who are asked to sign a Client Consent/Release of Information Form. Participant will maintain documentation of compliance with these notice requirements by, among other things, maintaining copies of all Notices it uses and the dates upon which they were first used. ASSURANCE (Participant) assures that the following fully executed documents will be on file and available for review. ▪  The Organization’s Confidentiality Policy. ▪  The Organization’s Grievance Policy, including a procedure for external review. ▪  The Organization’s official Privacy Notice for NWSSC clients. ▪  Executed Client Release of Information forms. ▪  Executed Organization Authorizations for Release of Information as needed. ▪  Certificates of Completion for required training for all NWSSC System Users. ▪  A fully executed User Agreement for all NWSSC System Users. ▪  A current copy of the NWSSC Policy and Procedures. Signature Printed Name Date (mm/dd/YYYY) EXTENT OF AGREEMENT

Display of Notice. Pursuant to the notice published by the Department of Housing and Urban Development (HUD) on July 30, 2004, Participant will prominently display the Notice to Clients of Uses & Disclosures (Privacy Notice to Clients) in its program offices where intake occurs and will take appropriate steps to ensure that all Clients whose information is entered into or accessed from CMIS/HMIS, read and understand the contents of the Notice. The Notice will be substantially in the form of the Notice to Clients of Uses & Disclosures, except that (a) where an Organization’s treatment of information is materially limited by other applicable laws or requirements, the Participant’s Notice must reflect the more stringent requirements, and (b) Participant will update its Notice whenever NWSSC ROCC CMIS/HMIS updates and distributes a new form of Notice to Clients of Uses & Disclosures. Participant will provide a written copy of the Participant’s Notice then in effect to any Client who requests it and will provide a copy of such Notice to all Clients who are asked to sign a Client Consent/Release of Information Form. Participant will maintain documentation of compliance with these notice requirements by, among other things, maintaining copies of all Notices it uses and the dates upon which they were first used. ASSURANCE (Participant) assures that the following fully executed documents will be on file and available for review. ▪  The Organization’s Confidentiality Policy. ▪  The Organization’s Grievance Policy, including a procedure for external review. ▪  The Organization’s official Privacy Notice for NWSSC ROCC clients. ▪  Executed Client Release of Information forms. ▪  Executed Organization Authorizations for Release of Information as needed. ▪  Certificates of Completion for required training for all NWSSC ROCC System Users. ▪  A fully executed User Agreement for all NWSSC ROCC System Users. ▪  A current copy of the NWSSC ROCC Policy and Procedures. _ Signature _ Printed Name _ Date (mm/dd/YYYY) EXTENT OF AGREEMENTAGREEMENT This document represents the entire agreement between the parties and supercedes all prior representations, negotiations, or agreements, whether written or oral. PARTICIPANT City of Portland, Portland Housing Bureau _ _ 000 XX 0xx Xxxxxx, Xxxxx 000 _ _ Xxxxxxxx, Xxxxxx 00000 _ _ _ _ Signature Signature Xxxxx Xxxxxxx _ _ Printed Name Printed Name Director _ _ Title Title _ _ Date (mm/dd/YYYY) Date (mm/dd/YYYY) Rural Oregon Continuum of Care (ROCC) Participation Agreement ROCC CMIS/HMIS Page 6 of 6 Legal Review 12/28/2010

Display of Notice. Pursuant to the notice published by the Department of Housing and Urban Development (HUD) on July 30, 2004, Participant will prominently display the Notice to Clients of Uses & Disclosures (Privacy Notice to Clients) in its program offices where intake occurs and will take appropriate steps to ensure that all Clients whose information is entered into or accessed from CMIS/HMIS, read and understand the contents of the Notice. The Notice will be substantially in the form of the Notice to Clients of Uses & Disclosures, except that (a) where an Organization’s treatment of information is materially limited by other applicable laws or requirements, the Participant’s Notice must reflect the more stringent requirements, and (b) Participant will update its Notice whenever NWSSC CMIS/HMIS updates and distributes a new form of Notice to Clients of Uses & Disclosures. Participant will provide a written copy of the Participant’s Notice then in effect to any Client who requests it and will provide a copy of such Notice to all Clients who are asked to sign a Client Consent/Release of Information Form. Participant will maintain documentation of compliance with these notice requirements by, among other things, maintaining copies of all Notices it uses and the dates upon which they were first used. ASSURANCE (Participant) assures that the following fully executed documents will be on file and available for review. ▪  The Organization’s Confidentiality Policy. ▪  The Organization’s Grievance Policy, including a procedure for external review. ▪  The Organization’s official Privacy Notice for NWSSC clients. ▪  Executed Client Release of Information forms. ▪  Executed Organization Authorizations for Release of Information as needed. ▪  Certificates of Completion for required training for all NWSSC System Users. ▪  A fully executed User Agreement for all NWSSC System Users. ▪  A current copy of the NWSSC Policy and Procedures. Signature Printed Name Date (mm/dd/YYYY) EXTENT OF AGREEMENTAGREEMENT This document represents the entire agreement between the parties and supercedes all prior representations, negotiations or agreements, whether written or oral. PARTICIPANT City of Portland, Portland Housing Bureau _ _ 000 XX 0xx Xxxxxx, Xxxxx 000 _ _ Xxxxxxxx, Xxxxxx 00000 _ _ _ _ Signature Signature T raci Xxxxxxx _ _ Printed Name Printed Name D irector _ _ Title Title _ _

Display of Notice. Pursuant to the notice published by the Department of Housing and Urban Development (HUD) on July 30, 2004), Participant will prominently display the Notice to Clients of Uses & Disclosures (Privacy Notice to Clients) in its program offices where intake occurs and will take appropriate steps to ensure that all Clients whose information is entered into or accessed from CMIS/HMIS, read and understand the contents of the Notice. The Notice will be substantially in the form of the Notice to Clients of Uses & Disclosures, except that (a) where an Organization’s treatment of information is materially limited by other applicable laws or requirements, the Participant’s Notice must reflect the more stringent requirements, and (b) Participant will update its Notice whenever NWSSC CMIS/HMIS updates and distributes a new form of Notice to Clients of Uses & Disclosures. Participant will provide a written copy of the Participant’s Notice then in effect to any Client who requests it and will provide a copy of such Notice to all Clients who are asked to sign a Client Consent/Consent to Release of Information Formfor Data Sharing in Washington County and other agency Release Of Information forms. Participant will maintain documentation of compliance with these notice requirements by, among other things, maintaining copies of all Notices it uses and the dates upon which they were first used. ASSURANCE (Participant) assures that the following fully executed documents will be on file and available for review. ▪ The Organization’s Confidentiality Policy. ▪ The Organization’s Grievance Policy, including a procedure for external review. ▪ The Organization’s official Notice to Clients of Uses & Disclosures, Privacy Notice for NWSSC clientsto Clients. ▪ Executed Client Consent to Release of Information formsfor Data Sharing in Washington County, Oregon form. ▪ Executed Inter-Agency Data Sharing Agreement for Agencies in Washington County, Oregon. ▪ Executed Organization Authorizations for Release of Information Information, as needed. ▪ Certificates of Completion for required training for all NWSSC System HMIS Users. ▪ A fully executed User Agreement for all NWSSC System HMIS Users. ▪ A current copy of the NWSSC WC-DHS HMIS Policy and Procedures. Signature Printed Name Date (mm/dd/YYYY) EXTENT OF AGREEMENTInter-Agency Data Sharing Agreement for Agencies in Washington County, Oregon Agency Name/Participant: Definition: The Agency entering into this Agreement is the “Participant”; Any individual receiving services is “Client”.

Display of Notice. Pursuant to the notice published by the Department of Housing and Urban Development (HUD) on July 30, 2004), Participant will prominently display the Notice to Clients of Uses & Disclosures (Privacy Notice to Clients) in its program offices where intake occurs and will take appropriate steps to ensure that all Clients whose information is entered into or accessed from CMIS/HMIS, read and understand the contents of the Notice. The Notice will be substantially in the form of the Notice to Clients of Uses & Disclosures, except that (a) where an Organization’s treatment of information is materially limited by other applicable laws or requirements, the Participant’s Notice must reflect the more stringent requirements, and (b) Participant will update its Notice whenever NWSSC CMIS/HMIS updates and distributes a new form of Notice to Clients of Uses & Disclosures. Participant will provide a written copy of the Participant’s Notice then in effect to any Client who requests it and will provide a copy of such Notice to all Clients who are asked to sign a Client Consent/Consent to Release of Information Formfor Data Sharing in Washington County and other agency Release Of Information forms. Participant will maintain documentation of compliance with these notice requirements by, among other things, maintaining copies of all Notices it uses and the dates upon which they were first used. ASSURANCE (Participant) assures that the following fully executed documents will be on file and available for review. ▪  The Organization’s Confidentiality Policy. ▪  The Organization’s Grievance Policy, including a procedure for external review. ▪  The Organization’s official Notice to Clients of Uses & Disclosures, Privacy Notice for NWSSC clientsto Clients. ▪  Executed Client Consent to Release of Information formsfor Data Sharing in Washington County, Oregon form. ▪  Executed Inter-Agency Data Sharing Agreement for Agencies in Washington County, Oregon.  Executed Organization Authorizations for Release of Information Information, as needed. ▪  Certificates of Completion for required training for all NWSSC System HMIS Users. ▪  A fully executed User Agreement for all NWSSC System HMIS Users. ▪  A current copy of the NWSSC WC-DHS HMIS Policy and Procedures. Signature Printed Name Date (mm/dd/YYYY) EXTENT OF AGREEMENTInter-Agency Data Sharing Agreement for Agencies in Washington County, Oregon Agency Name/Participant: Definition: The Agency entering into this Agreement is the “Participant”; Any individual receiving services is “Client”.