11.3.39  Computer Matching and Privacy Protection Act

Manual Transmittal

September 17, 2013

Purpose

(1) This manual, IRM 11.3.39, Disclosure of Official Information, Computer Matching and Privacy Protection Act, was reviewed on September 4, 2013, and determined to be technically accurate. It is being reissued as a non-procedural update and includes web link updates and links to citation references.

Material Changes

(1) Editorial changes were made throughout to update IRM/statute/organizational references and terms. Web and citation references were added/updated throughout to make the text easier to research in electronic media.

(2) Section 11.3.39.3 changed to clarify functional roles and responsibilities for preparing and reviewing notices and reports. A new IRM 11.3.39.3(2) paragraph was added and subsequent paragraphs renumbered.

Effect on Other Documents

This material supersedes IRM 11.3.39, Disclosure of Official Information, Computer Matching and Privacy Protection Act dated June 24, 2008.

Audience

All Operating Divisions and Functions.

Effective Date

(09-17-2013)

Related Resources

The Governmental Liaison and Disclosure intranet home page can be found at:
http://discl.web.irs.gov/GLD.asp


Gregory T. Ricketts
Acting Director, Governmental Liaison and Disclosure

11.3.39.1  (09-17-2013)
Background

  1. One of the forces driving the Privacy Act of 1974 into existence was Congressional concern about the governments' use of computers in which to keep records about individuals. The Act's preamble points out the possibility of automated recordkeeping greatly magnifying the potential harm to record subjects.

  2. Due to the steady automation of government programs, automated records play a significant and pervasive role in Federal recordkeeping. P.L. 100-503, The Computer Matching and Privacy Protection Act of 1988 (hereafter referred to as the Computer Matching Act (CMA)), is the first amendment to the Privacy Act to attempt to deal with the issue of automated records and their use.

11.3.39.2  (09-17-2013)
Purpose

  1. The CMA amends the Privacy Act of 1974. It adds certain protections for the subjects of Privacy Act records whose records are used in automated matching programs. These protections have been mandated to ensure:

    • Procedural uniformity in carrying out matching programs

    • Due process for subjects in order to protect their rights

    • Oversight of matching programs through the establishment of Data Integrity Boards at each agency engaging in matching to monitor the agency's matching activity

  2. Guidelines on the computer matching act provisions are contained in this Section.

11.3.39.3  (09-17-2013)
Responsibilities

  1. The Director, Governmental Liaison and Disclosure (GLD), will be responsible for oversight of the computer matching provisions of the Privacy Act.

  2. The IRS business owner of the records is responsible for preparing all notices and reports for the CMA package that are required or appropriate.

  3. All activities associated with initiating and continuing matching programs subject to the computer matching provisions of the CMA within the IRS shall be coordinated through the GLD Office of Data Services.

  4. The GLD Office of Disclosure shall provide guidance and technical assistance in determining if matching programs are subject to the computer matching provisions, and if so, provide guidance in the technical review of required documents, notices and reports. See IRM 11.3.39.8 below for details. The IRS business unit owner in conjunction with the agency conducting the match are both responsible for drafting the matching agreement and are to also obtain the agreement of each of the respective agency Data Integrity Board's approval for matching agreements at the Federal level.

  5. Before September 30, 1997, computer matching programs (inter- and intra-agency) subject to the CMA have all been programs under the Director, GLD. Currently, the GLD Data Services is responsible for oversight of the CMA program.

  6. There are additional matches involving internal records (personnel) that are subject to the CMA that also have Data Services oversight.

  7. With the increase in the number of record systems being developed locally, and the IRS's move toward more cooperative activities with State and local agencies, the potential has increased that matches with non Federal agencies at the area and territory levels may also be subject to the CMA provisions.

    Note:

    It is incumbent on field Disclosure personnel to become familiar with the provisions of the CMA so that they can advise and assist with achieving compliance with the Act when a covered match is identified.

  8. GLD Field Disclosure personnel will:

    • Serve as a technical advisor to the business functions/offices

    • Be responsible for monitoring proposed exchanges of both tax and personnel/payroll records for conformance to and compliance with the computer matching provisions of the Act

  9. GLD will also provide guidance and technical assistance to the business unit owner of the records in the development of:

    • Matching agreements

    • Matching notices

    • Reports

    Note:

    Questions about the CMA process should be directed to Data Services.

  10. Each IRS function/office is responsible for periodically reviewing its existing and proposed matching programs to determine if they are subject to CMA. If so, the office coordinating and/or managing the matching program shall complete the requirements for covered matching programs as cited in 5 USC § 552a(o), (p) and (r), including preparing any required package for approval. The owner of the records is ultimately responsible for preparing the package.

11.3.39.4  (06-17-2005)
Scope

  1. The Computer Matching Act is codified as part of the Privacy Act.

  2. The Computer Matching Act:

    • Applies primarily to all Federal agencies subject to the Privacy Act of 1974

    • Brings non-Federal agencies within the ambit of the Privacy Act when they are engaging in certain types of matching activities in conjunction with a Federal agency that is subject to the Privacy Act; and a Federal system of records is involved in the match

  3. The computer matching provisions of the Privacy Act apply to a broad range of Federal agency computer matching activities when the objective is to affect an individual's rights, benefits and/or privileges.

  4. The Act is not intended to prevent the match of any computerized data for which there exists legal authority and which is deemed the most appropriate method of achieving a desired objective. The administrative controls established are intended to ensure privacy, integrity, and verification of data disclosed for computer matching.

    Note:

    The CMA does not extend Privacy Act coverage to those not originally included.

11.3.39.5  (06-17-2005)
Definitions

  1. Matching Agreement - written agreement between the source agency and the recipient agency (or non-Federal agency) specifying the terms of the matching program. There are three categories of matching agreement: new, extension and renewal.

    1. New Agreement - A new agreement is used the first time a matching agreement is developed for a matching program. The matching program itself may have been in existence prior to P.L. 100–503. The agreement may exist for up to 18 months and may be extended 12 additional months. A new agreement must be reviewed by the Data Integrity Board (DIB) and requires development of a cost/benefit analysis.

    2. Extension Agreement - An extension agreement allows the continuation of an existing agreement (new or renewal) for an additional 12 months, without additional review by the DIB, provided certain conditions are met. The participating agencies must certify to the Chairperson of the DIB that the matching program will be continued in full compliance with the existing agreement and requested within the last 90 days of the existing agreement. Notices and reports are not required.

    3. Renewal Agreement - When the initial matching agreement (including any extension) has expired, a renewal agreement permits the matching program to continue and may exist for up to 18 months. This agreement must be approved by the DIB within the last 90 days of the existing agreement. Requires the same review, reports and notices as a new agreement.

  2. The CMA requires that a cost/benefit analysis be a part of an agency decision to conduct or participate in a matching program. It must be included in matching agreements as justification of the proposed matching program and include a "specific estimate of any savings." The analysis is also used by the DIB in review process.

  3. The Data Integrity Board (DIB) is located at the departmental level. It consists of senior agency officials and is responsible for review and approval (or disapproval) of matching agreements and proposed matching programs.

  4. A matching program is the computerized comparison of two or more automated systems of records, or of a system of records with non-Federal records. The records must exist in automated form or be converted to automated form to perform the match.

  5. A non-Federal agency is a State or local governmental agency that receives records contained in a system of records from a Federal agency.

  6. The recipient agency is the Federal agency (or its contractor) that receives records from a Privacy Act system of records of another Federal agency or from State and/or local government to be used in a matching program.

  7. The source agency is the Federal agency that discloses records from a system of records to another Federal agency or to a State or local governmental agency to be used in a matching program. It can also be a non Federal agency that discloses records to a Federal agency to be used in a matching program.

11.3.39.6  (08-19-1998)
Categories of Subjects Covered by CMA

  1. Applicants for Federal benefit programs (individuals initially applying for benefits).

    Note:

    The Congress intends that Federal employees be treated as beneficiaries of a Federal benefit program because of their employment by the Government.

  2. Federal program beneficiaries (individuals who are actually receiving benefits).

  3. Providers of services to assistance programs (those who are not the primary beneficiaries of Federal benefits programs, but may derive income from them, e.g., health care providers).

  4. Federal employees in danger of adverse and/or disciplinary action.

11.3.39.7  (09-17-2013)
Matching Programs Covered by CMA

  1. Only Federal benefit programs providing cash or in-kind assistance to individuals are covered.

    Caution:

    Federal programs not involving cash or in-kind assistance are not covered. Child support enforcement, while having related benefit programs, does not itself involve "assistance." Therefore, child support enforcement tape matches conducted under IRC §6103(l)(6) are not covered matches because the intent of the matching is to locate delinquent obligors and their assets and any recoupment of benefits is peripheral. However, Temporary Assistance for Needy Families matching ( IRC § 6103(l)(7)) and other exchanges for benefits determinations at a State's Department of Human Service agency involve benefits so that matching is covered by the CMA.

  2. The match must have as its purpose one or more of the following:

    • Establishing or verifying initial or continuing eligibility for Federal benefit programs

    • Verifying compliance with the requirements, either statutory or regulatory, of Federal benefit programs

    • Recouping payments or delinquent debts under Federal benefit programs

  3. The Federal benefit program or Federal system of records need not be the sole source of data for a matching program to be covered by the CMA provisions.

  4. Federal personnel or payroll record matches conducted for the purpose of, or with an intended consequence of, taking adverse financial, personnel, or disciplinary or other adverse action against Federal personnel or any individual, are subject to the CMA. This is the case even though these matches often take place within a single agency.

  5. Programs using records about subjects who are not individuals as defined by section (a)(2) of the Privacy Act are not covered.

  6. The four elements must all be present before a matching program is covered under the provisions of the CMA. The provisions are:

    • Computerized comparison

    • Categories of subjects

    • Federal benefit program

    • Matching purpose

11.3.39.7.1  (06-17-2005)
Exempt Matching Programs

  1. Certain matching programs are exempt from the requirements of CMA. For disclosure purposes the most pertinent exemptions are those which exclude matches done for the purposes of:

    • Tax refund offset

    • Tax administration

    • IRC §6103(d)

  2. Although CMA exempts matches performed for tax administration purposes, OMB notes that the intent of the law was to cover the tax system and not "management of the IRS workforce."

  3. Matches conducted within the agency are exempt only if adverse action against Federal personnel is not proposed.

  4. See 5 USC § 552a(a)(8)(B) for the complete list of exempt matches.

11.3.39.8  (06-17-2005)
Requirements for Covered Computer Matching Programs

  1. Prior to the implementation of a covered matching program, the office planning to initiate the matching program must:

    • Develop, execute and obtain approval of a written agreement, prepared in conformance with 5 USC § 552a(o), with the other agency or the other IRS function

    • Provide notice of the matching program to record subjects

    • Prepare a report to Congress on the new matching program

    • Prepare any Federal Register notice and report required (unless prepared by the recipient agency)

    Caution:

    No system of records may be included in a matching program unless the matching activity is provided for in the system's routine uses. The system notice may have to be revised to enable the matching activity.

11.3.39.8.1  (09-17-2013)
Written Agreements

  1. Pursuant to 5 USC § 552a(o), no record which is contained in a system of records may be disclosed for use in a computer matching program except pursuant to a written agreement between the agencies.

  2. See Exhibit 11.3.39-1 for a sample matching agreement. The type of matching agreement (new, extension or renewal) shall be determined in accordance with IRM 11.3.39.5 above.

  3. While IRS frequently conducts the same matching program for several different agencies, the match for each agency is considered a single matching program, thus requiring a matching agreement with each agency.

  4. The Director, GLD and Data Services, shall provide guidance and technical assistance to the responsible function or coordinating office in the development of the matching agreement.

  5. Once the responsible function or office has obtained concurrence by affected agency functions, the final agreement shall be forwarded to the Director, GLD, at least 120 days prior to scheduled implementation of the matching program.

  6. Data Services will prepare a transmittal and forward the matching agreement to the Treasury's Data Integrity Board for review. See Exhibit 11.3.39-3 for a sample transmittal.

  7. The DIB will review the matching agreement. Questions and/or comments shall be channeled through Data Services.

  8. Once approval of the matching agreement is obtained from the DIB, Data Services shall forward copies of the agreement to Congress and OMB and the original agreement package will be returned to the originating office or function.

  9. When preparing the matching agreement, consideration must be given to the systems of records to be used in the matching program. The routine use cited in the existing system notice must encompass the proposed matching program. If not, the system notice must be republished to revise the routine use statement prior to submitting the matching agreement for review by the DIB.

  10. In addition, consideration must also be given to the data resulting from the matching program. If the match data result in a new system of records, then a new system notice must also be published.

  11. The initial matching agreement may remain in effect for a period not to exceed 18 months. During the last 90 days of the existing matching agreement, the parties to the agreement may approve a one-time extension. The extension may not exceed 12 months. ( See Exhibit 11.3.39-2 which provides a sample extension agreement.) The extension agreement does not require notice and reports.

  12. Upon expiration of the initial matching agreement and one-time extension agreement, a renewal agreement must be secured to continue the matching program. The renewal matching agreement must be secured within the last 90 days of the original matching agreement (or extension). The renewal agreement requires the same notice and reporting requirements as the initial matching agreement. The format for the initial matching agreement shall be used for the renewal matching agreement.

11.3.39.8.2  (06-17-2005)
Matching Program Notice

  1. Agencies participating in matching programs that are subject to CMA must publish a notice in the Federal Register describing new or altered matching programs at least 30 days prior the implementation of the matching program.

    Note:

    Agencies wishing to renew a matching program must also publish a notice.

  2. The recipient Federal agency (or the source Federal agency in a match conducted with a non-Federal agency) is responsible for publishing the notice describing the matching program and citing the systems of records involved.

  3. Matching program participants need only publish a notice when there is a change that significantly alters the terms of the agreement covering the matching program. Examples of significant changes are cited in OMB Circular A-130, Appendix I, November 28, 2000.

  4. Publication of the new or altered matching program notice must occur at least 30 days prior to the initiation of any matching activity carried out under such program.

  5. Publication for renewals of programs, must occur at least 30 days prior to the expiration of the existing matching agreement.

    Note:

    A report to OMB and Congress is also required at least 40 days prior to the initiation of a new or altered matching program.

  6. Generally, the recipient Federal agency (or the Federal source agency) is responsible for publishing in the Federal Register. However, in matching programs involving only Federal agencies, the agencies may assign responsibility. In the case of matching programs conducted with a non-Federal agency, the Federal agency is responsible for publishing.

    Note:

    The matching program notice may be published in the Federal Register at the same time the matching program report is forwarded to OMB and Congress. The period for OMB and congressional review and the notice and comment period will then run concurrently.

11.3.39.8.3  (06-17-2005)
Notice to Record Subjects

  1. Federal agencies undertaking a matching program covered by CMA must notify record subjects that their records may be matched prior to the actual conduct of the matching program.

  2. The recipient agency (or Federal agency when the matching program is conducted with a non-Federal agency) shall publish constructive notice in the Federal Register informing record subjects of the proposed matching program.

  3. The notice shall be prepared in accordance with 5 USC § 552a(e) and in the format prescribed by the Office of the Federal Register Document Drafting Handbook.

    Note:

    This notice must be published at least 30 days prior to implementation of the matching program.

  4. The agencies participating in a matching program must ensure that a direct notice of the match is provided to each individual in the match population. This may be accomplished by a statement on an application form or by separate document and will ordinarily be done by the agency that will act on the results of the match. In most instances, amending the Privacy Act statement on an application form will meet CMA requirements.

    Note:

    The notice must be provided prior to the implementation of the matching program and periodically thereafter.

  5. For matching programs designed to detect fraud and/or illegal acts of agency employees, the participating agencies shall ensure that direct notice is provided to each record subject. While the agency's Standards of Conduct universally prohibit fraud or inappropriate actions on the part of its employees, a specific notice to each record subject regarding the matching program shall be provided prior to the implementation of the matching program and, at the least, an annual notice during the period the matching program is authorized. TIGTA prepares the Federal Register Notice for matches it conducts involving IRS employees.

11.3.39.9  (09-17-2013)
Matching Program Reporting Requirements

  1. Each agency/function proposing or participating in a matching program shall include a report describing the new or altered matching programs.

  2. The report must be received by OMB and Congress at least 40 days prior to the initiation of any matching activity.

    Note:

    For renewals of continuing programs, the report must be dated at least 40 days prior to the expiration of any existing matching agreement.

  3. The New or Altered Matching Program Report shall be prepared by the originating office/function in accordance with OMB Circular A-130, Appendix I and forwarded to the Director, GLD, at least 60 days prior to the initiation of the matching program. The letter transmitting the report to OMB and Congress shall be signed by the Director, GLD.

11.3.39.9.1  (09-17-2013)
Biennial Matching Report

  1. CMA covered matching program activity shall be reported in a Biennial Matching Activity Report compiled for the Data Integrity Board of agencies that participated in matches covered by the computer matching provisions.

  2. GLD shall consolidate IRS matching program information and forward to the DIB.

  3. Each office/function conducting a matching program shall prepare a report containing the information required in OMB Circular A-130, Appendix I, 4.a. The report shall be prepared in hard copy and on diskette in Microsoft Word and forwarded to the Director, GLDS by April 30th, for the two previous calendar years.

11.3.39.10  (09-17-2013)
Existing Matching Programs

  1. Data Services maintains matching agreements with approximately 75 Federal and State agencies. The matching agreements were developed at the dawn of the CMA for existing extract (matching) programs and have been renewed timely to ensure uninterrupted service to our customers.

  2. The matching agreements maintained by Data Services cover various matching programs. Both matching programs provide return information for use in Federal benefit programs. One matching program provides address information to enable Federal agencies to locate individuals to recoup monies while the other provides income information for use in determining eligibility for Federal benefit programs.

  3. The DIFSLA matching program was developed pursuant to IRC § 6103(l)(7) and includes Federal and State agencies authorized to participate in the program. While all agencies are not currently active, acknowledgment of their authorization enables resumption in the program with minimal effort. IRS provides these agencies with income information for use in determining benefit program eligibility.

  4. The TAR matching program provides Federal agencies with address information pursuant to IRC § 6103(m)(2), (4) and (5). The return information is used in locating individuals to recoup monies owed.

  5. TIGTA maintains a matching agreement that covers the numerous computer matches conducted to detect and deter fraud, waste and abuse in IRS programs and operations. While TIGTA is carrying out its administrative responsibility, the matches are developed to detect employees who are violating laws, rules or regulations relating to their employment.

  6. IRS participates in a computer matching program with the Department of Health and Human Services under IRC § 6103(l)(19) . IRC § 6103(l)(19) authorizes the IRS to disclose specified return information of applicants for transitional assistance to officers, employees and contractors of Health and Human Services (HHS) upon written request from the Secretary of HHS. The IRS will participate in a matching program with the Social Security Administration pursuant to IRC § 6103(l)(20). IRC § 6103(l)(20) provides for disclosure of certain limited return information upon written request from the Commissioner of Social Security about a taxpayer whose Social Security, Part B premium (according to the records of the Secretary) may be subject to adjustment under section 1839(i) of the Social Security Act.

Exhibit 11.3.39-1 
Model Matching Agreement (New and/or Renewal)

MATCHING AGREEMENT
between
DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE
OFFICE OF (NAME)
and
(FEDERAL AGENCY NAME)
(OR STATE AGENCY NAME)
for
(MATCHING PROGRAM NAME)
      Effective Date: __________
      Expiration Date: __________
         
I. PURPOSE AND LEGAL AUTHORITY
         
  A. Purpose of the Matching Program
         
    1. This matching agreement is executed pursuant to 5 USC 552a(o), the Privacy Act of 1974 as amended and sets forth the terms under which the (agency name or function) agrees to disclose return information relating to (type of data) to the (name of agency or function).
         
    2. The purpose of the disclosure is to provide (agency name) with information which may be useful in verifying eligibility for, and the correct amount of, benefits provided under (program name).
         
  B. Legal Authority
         
    (Statute and/or regulation) authorizes the disclosure of return information with respect to (type of data) to (name or type of agency) for the purpose of determining eligibility for, or the correct amount of, benefits.
         
II. JUSTIFICATION AND ANTICIPATED RESULTS
         
  A. Justification
         
    The volume of requests for return information, the volume of requesters and the method in which information documents are maintained make computer matching the most feasible method of access.
         
  B. Expected Results
         
    1. [Statement regarding IRS' anticipated results and savings. A cost/benefit analysis shall support the statement and become part of the matching agreement as an attachment.]
         
    2. [Statement regarding the other agency's anticipated results and savings. A cost/benefit analysis shall support the statement and become part of the matching agreement as an attachment.]
         
III. RECORDS DESCRIPTION
         
  A. System of Records
         
    1. (agency name) will provide the IRS with identifying information with respect to (match population) from the (system name). A copy of the system notice shall become part of the matching agreement as an attachment. [Also cite the specific office responsible for the providing the data.]
         
    2. IRS will extract return information with respect to (type of data) from (system name). [State the name of the matching program if applicable.] A copy of the system notice shall become part of the matching agreement as an attachment. [Also cite the specific office responsible for the providing the data.]
         
    3. Information obtained from the matching program will be maintained in the (system name).
         
  B. Specified Data Elements
         
    1. For each individual for whom (type of data) is being requested, (agency name) will furnish the IRS with the: (list the specific data elements to be used).
         
    2. IRS will disclose, when there is a match of individual identifier, the:
         
      (list specific data elements)
         
  C. Accuracy Assessments
         
    1. [Statement regarding each agency's assessment of the accuracy of their data.]
         
    2. [Statement regarding each agency's procedure(s) for ensuring only desired population is included in the matching program.]
         
  D. Number of Records
         
    1. (agency name) will be submitting approximately (number) records during the life of this matching agreement.
         
    2. IRS will provide a response for each individual identified, if appropriate, by (agency name).
         
  E. Starting and Completion Dates
         
    [The expected duration of the matching program. The frequency of the matching program should also be stated, e.g., the program will be run on a weekly, monthly or bi-monthly basis.]
         
IV. NOTICE PROCEDURES
         
  A. IRS has published constructive notice in the Federal Register, Vol. NN, No. NNN, page NNNNN dated [June 3, 200N,] that the matching program will be conducted, provided as attachment to this agreement.
         
  B. (agency name) has published constructive notice in the Federal Register, Vol. NN, No. NNN, page NNNNN dated [June 3, 200N,] that the matching program will be conducted, provided as attachment to this agreement.
         
  C. (agency name) will provide direct notice, in writing, that the match is being conducted to all applicants at the time of application, and to all current recipients periodically that their records will be matched against those of other agencies to verify their eligibility or payment amount. The notice will conform to standards set by the Office of Management and Budget (OMB) and (other functions/offices, if appropriate).
         
V. VERIFICATION AND OPPORTUNITY TO PROTEST
         
  A. Verification of Match Information
         
    1. The source agency shall provide a detailed description of their procedures for verifying the match information.
         
    2. The recipient agency shall provide a detailed description of their procedures for verifying the match information.
         
  B. Notice and Opportunity to Contest
         
    [Describe briefly the procedures used by the agency that will act on the match results to provide beneficiaries notice of a potential denial or loss of benefits and the beneficiaries' opportunity to contest that decision.]
         
VI. DISPOSITION OF MATCHED ITEMS
         
  A. [Each agency shall provide a detailed description of their procedures for maintaining and disposing of data created in the matching program.]
         
  B. [The procedures shall include retention time frames.]
VII. SAFEGUARD AND SECURITY PROCEDURES
         
  A. [Each agency shall detail safeguards and security procedures or cite reference if procedures exist. IRS data is protected in accordance with the Privacy Act, therefore, the reference shall be included in the matching agreement.]
         
  B. [Requirements for reports shall be specified if appropriate.]
  C. [Each agency shall include comments of compliance with last safeguard review report, if applicable.]
VIII. RECORDS USAGE, DUPLICATION AND REDISCLOSURE RESTRICTIONS
         
  [Procedures and prohibitions governing the use, duplication and redisclosure of records used and/or created in the matching program shall be detailed. Information used in matching programs with IRS are usually subject to IRC § 6103(p)(4), Federal Safeguards.]
         
IX. RECORDS ACCURACY ASSESSMENT
         
  [A description of the quality of the records used in the computer matching program and whether the records meet the standard imposed by the Privacy Act for insuring the accuracy of the records.]
         
X. ACCESS BY THE COMPTROLLER GENERAL
         
  Consistent with IRC Section 6103, the Government Accountability Office (Comptroller General) may have access to all IRS and (agency name) records as necessary in order to verify compliance with this agreement.
         
XI. REIMBURSEMENT
         
  [If the matching program is being conducted on a cost basis, the details regarding fees for services shall be detailed.]
         
XII. PERSONS TO CONTACT
         
  A. [List specific IRS contact person(s) in reference to the matching program. There may be a different contact for various phases of the matching program, e.g., matching agreement, systems operations, program management, etc.]
         
  B. [List specific contacts person(s) in reference to the matching program from the other agency.]
         
XIII. AUTHORIZED OFFICIALS
         
  The agency official with authority to request information under this agreement on behalf of (agency name) is:
         
    (name), (title)
    (agency name)
XIV. LIMITATION OF LIABILITY
         
  [If applicable, each agency shall state the limit of their responsibility pursuant to the use of any data furnished pursuant to this agreement.]
         
XV. SIGNATURES
         
  Each party executing this agreement is authorized to enter into agreements of this nature on behalf of their agency.
         
  (Recipient agency or function name)  
         
  BY _________  
   (typed name), (title)  
         
  DATE _______  
         
  (Source agency or function name)  
         
  BY _________  
   (typed name), (title)  
  DATE _______  
         
XVI. DATA INTEGRITY BOARD REVIEW
         
  The respective Data Integrity Boards have reviewed this agreement and find it satisfactory and in compliance with the Privacy Act, as amended, and signify their collective approval thereof.
         
  (Department name) (Department name)
         
  BY _________ BY _________
   (typed name), Chairperson  (typed name), Chairperson
         
  (title) (title)
         
  DATE _______ DATE _______
         

Note:

Only one signature line is required for DIB if internal matching program or matching with non-Federal agency.

Exhibit 11.3.39-2 
Model Extension Agreement

EXTENSION
of
MATCHING AGREEMENT
between
DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE
OFFICE OF (NAME)
and
(FEDERAL AGENCY NAME)
(OR STATE AGENCY NAME)
for
(MATCHING PROGRAM NAME)
         
      Effective Date: __________
      Expiration Date: __________
         
I. PURPOSE AND LEGAL AUTHORITY
         
  A. Purpose of the Matching Program
         
    1. This matching agreement is executed pursuant to 5 USC § 552a(o), the Privacy Act of 1974, as amended, and sets forth the terms under which the (agency name or function) agrees to disclose return information relating to (type of data) to the (name of agency or function).
         
    2. The purpose of the disclosure is to provide (agency name) with information which may be useful in verifying eligibility for, and the correct amount of benefits provided under (program name and).
         
  B. Legal Authority
         
    (Statute and/or regulation) authorizes the disclosure of return information with respect to (type of data) to (name or type of agency) for the purpose of determining eligibility for, or the correct amount of, benefits.
         
II. CERTIFICATION
         
  A. Recipient (or non-Federal) Agency
         
    As a designated representative of (agency or function name), I certify that the subject match has been conducted in accordance with the current agreement and further agree to conduct said matching program without change.
         
    __________ ______
    (name, title) Date
    (agency or function name)  
  B. Source Agency
         
    As the designated representative of (agency or function name), I certify that the subject match has been conducted in accordance with the current agreement and agree to conduct said matching program without change. Furthermore, we have no reason to believe that the above certification is inaccurate.
         
    __________ ______
    (name, title) Date
    (agency or function name)  
         
III. DATA INTEGRITY BOARD REVIEW
         
  The respective Data Integrity Boards have reviewed this extension agreement and find it satisfactory and in compliance with the Privacy Act, as amended, and signify their collective approval thereof.
         
  (Department name) (Department name)
         
  BY _________ BY _________
   (typed name), Chairperson  (typed name), Chairperson
   (title) _________(title)                 
         
  DATE _______ DATE _______
         

Note:

Only one signature line is required for DIB if internal matching program or matching with a non-Federal agency.

Exhibit 11.3.39-3 
DIB Transmittal

Director, Office of Information and Resources Management
Attn.:  : (Name) Senior Program Analyst MT-MII
 
Director, Office of Governmental Liaison and Disclosure
 
Computer Matching Agreement Entered Into Pursuant to (pertinent legal citation) Between the (agency or function name) and (agency or function name)
 
  Pursuant to 5 USC § 552a(o)(2)(C) and revised OMB Circular A-130, the Treasury Data Integrity Board (TDIB) must approve matching agreements that support matching programs subject to the computer matching provisions of the Privacy Act.
 
  We are forwarding a new computer matching agreement for (name of matching program) between the (agency or function name) and (agency or function name) conducted under (statutory or regulatory reference). [State the reason the matching program was developed and its purpose.] Therefore, we are submitting a new (duration) month matching agreement for the period (date) through (date).
 
  In addition to developing the new matching agreement, we have prepared a new Federal Register notice (copy attached) and anticipate publication by (date).
 
  We are requesting your assistance in channeling the attached copies of the matching agreement to the TDIB for their approval. To facilitate the TDIB's review, we are providing seven copies of the agreements, one for each member of the TDIB. We are also requesting that the TDIB authorize us to forward copies of the signed agreements to the Congressional committees of jurisdiction. To ensure the matching program is initiated by the scheduled implementation date, we request a reply by (date).
 
  Should you, or the TDIB, have any questions concerning this matter, please call me at (phone number), or you may call (name), of my staff, at (number).
 
Attachments
  Tab A-Matching Agreement
  Tab B-Federal Register Notice

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