DCF 8-81
(rev. 12/2010)
State of New Jersey
DEPARTMENT OF CHILDREN AND FAMILIES
DCF CONFIDENTIALITY AGREEMENT
(For Contracted Employees)
As a contracted employee of the New Jersey Department of Children and Families (DCF),
providing professional research, case reviewing and/or interviewing services to the agency,
I,____________________________, hereby certify that any confidential, client-specific
information obtained or reviewed in the course of the contracted work assignment:
•
will not be disclosed to any person or organization not directly involved in the
conduct of the research;
•
will be adequately safeguarded (in a secure, locked or otherwise inaccessible
form of storage) during the period in which it is used to conduct research;
•
will be destroyed at the earliest possible time in the conduct of the research; and
•
will not be divulged or referenced in the published or otherwise presented
research finding or report that is ultimately prepared.
Client-specific case data is confidential when it includes or contains information that reveals
the identity of a DCF or Child Protection and Permanency (CP&P) report, referral, or client –
past or present. Such information includes but is not limited to:
•
the client’s name,
•
the client’s case number,
•
the client’s Social Security number,
•
the client’s address and telephone number,
•
a unique identifier employed by another public agency,
•
combinations of indirect descriptions (such as precise date of birth, current
address, employer, etc.) when they can be used in a way which can be
reasonably expected to allow the researcher to identify the client, or
•
other data that would identify a DCF or CP&P client, or other referral or report.
I will comply with the aforementioned rules and regulations and all other applicable Federal,
State and local laws, rules and regulations.
Signature:____________________________
Name:_____________________________
Project:________________________
Title:______________________________
Date:__________________________