2019Youth Leadership Forum for Students with Disabilities (YLF)

Information Security and Confidentiality Agreement

What is confidential information?

Personal Information - includes any information that is maintained by YLF that identifies or describes an individual.

Medical Insurance information What is confidentiality?Confidentiality refers to:

Limiting information access and disclosure to authorized individuals Preventing access by or disclosure to unauthorized individuals Implementing safeguards for protecting personal and confidential

information

How do you store confidential information during the YLF? Records containing names, contact information (addresses and phone

numbers), medical or disability-related information shall be electronically encrypted prior to transmittal and only downloaded or stored on secure, password-protected devices with up-to-date anti-virus software.

o All electronic copies containing confidential information shall be deleted once YLF planning is over.

Hard copy files must be kept in a locked cabinet and destroyed through a confidential destruct process after use.

What are some security concerns for breaches of confidential information?

Using YLF records for private gain Sharing confidential information to unauthorized individuals

What should I do if I know confidentiality has been breached?

Immediately report any actual or suspected violations of security or confidentiality to the management of the California Committee on Employment of People with Disabilities.

Youth Leadership Forum • Department of Rehabilitation • 721 Capitol Mall • Sacramento, CA 95814

(855) 894-3436 (Voice) • for relay services please call 711 • email ylf@dor.ca.govwww.dor.ca.gov/home/ylf

Please read the statements below and sign.

I will safeguard all confidential information entrusted to me, by adhering to the guidelines stated in the YLF Information Security and Confidentiality Training PowerPoint and that are referenced above.

I acknowledge my reading and understanding of the material included in the YLF Information Security and Confidentiality Training PowerPoint and the consequences of any breach that should occur during the production of the YLF.

I understand that the implications of any breach of confidentiality are a legal and ethical responsibility and may include legal prosecution if applicable.

Name (please print): _____________________________________

Signature: _____________________________________________

Organization: ___________________________________________

Date: ____________________

Please contact the California Committee on Employment of People with Disabilities if you have any questions on this policy or acknowledgement form.

Phone: (855) 894-3436Email: ylf@dor.ca.gov

Please scan and email this form to ylf@dor.ca.gov by May 3, 2019 .

Please save a copy for your records.

Youth Leadership Forum • Department of Rehabilitation • 721 Capitol Mall • Sacramento, CA 95814

(855) 894-3436 (Voice) • for relay services please call 711 • email ylf@dor.ca.govwww.dor.ca.gov/home/ylf