ࡱ> g *bjbjVV 7r<r<" 66666JJJ8n$J2(46f$h2j2j2j2j2j2j2$4G7*26U66UU266H2Q Q Q U|66h2Q Uh2Q Q 6,|- *$\v,T2202,q7Gq7$--q76@.Q  S22|2UUUUq7 :  Report InformationAgency Name:[Insert legal agency name]Agency Number:[Insert agency code]Processing Period:[Insert processing period (refer to Pub1075 Section 7.4.8)]Date Submitted:[Insert date of SAR submission]IRS Reviewer:[Leave blank]IRS Reference Number and Date Received:[Leave blank] IRS Comments:[Leave blank] Agency Instructions:The following guidance is provided to aid agencies with completing this report. Report Guidance Provide a response for all sections of this report unless instructed otherwise in individual section(s) by the IRS Office of Safeguards. Recommended and required attachments to accompany this report are indicated in each section, if applicable. Please include attachments as separate files. Submission Guidance Agencies shall submit their SAR on the template developed by the IRS Office of Safeguards. The most current template may be downloaded from IRS.GOV, keyword Safeguards or requested by emailing HYPERLINK "mailto:SafeguardReports@irs.gov"SafeguardReports@irs.gov. The SAR should be accompanied by a letter on the agencys letterhead signed and dated by the head of the agency or delegate. obs must be sent encrypted via IRS approved encryption techniques using the standard Safeguards password. The password may be requested by contacting HYPERLINK "mailto:SafeguardReports@IRS.gov"SafeguardReports@IRS.gov. Upon receipt of your report submission, you should receive a confirmation of receipt. If an automated confirmation is not sent back to you, there was an error in your submission. If this occurs, please send an e-mail back to the IRS Office of Safeguards mailbox without attachments and request assistance. Please note that the IRS Office of Safeguards does not accept hard copy submissions.  #Publication 1075 Requirement Reference pages 40-42, Section 7.4 Annual Safeguard Activity ReportAgency SAR ContentAdditional Information Needed to be Submitted by Agency Additional information requested in red must be submitted within 30 days, Information in blue must be submitted with next SARChanges to Information or Procedures Previously Reported7.4.1A. Responsible Officers Even if information has not changed since the last SAR, provide the agency Director or Commissioner; Information Technology Security Officer or equivalent; and the Primary IRS contact (Disclosure Officer) information. Include the name, title, mailing address, phone number and e-mail address for each individual.[Insert Director/Commissioner Information] [Insert IT Security Officer Information] [Insert Primary IRS Contact Information] 7.4.1B. Functional Organizations Accessing the Data Even if information has not changed since the last SAR, provide an organizational chart or narrative description of the receiving agency, which includes all functions within the agency where FTI will be received, processed, stored and/or maintained. The description should account for off-site storage, consolidated data centers, disaster recovery organizations, and contractor functions. Attachments: Organization chart (recommended)7.4.1C. Computer Facilities or Equipment and System Security Hardware or Software Changes or Enhancements Describe changes or enhancements to information or procedures previously reported impacting hardware, software, IT organizational operations (movement to state run data center), or system security.7.4.1D. Physical Security (space moves; new locations) Describe changes or enhancements to information or procedures previously reported impacting physical layout (new location or enhancements to current location) and changes to two-barrier protection standard.7.4.1E. Retention or Disposal Policy or Methods Describe changes or enhancements to currently approved retention and disposal policy or methods (e.g. outsourced disposal to shredding company, change in shredding equipment, off-site storage procedures and changes in retention period). If changes have occurred, identify the retention period policy and/or method(s) of destruction.Current Annual Period Safeguard Activities7.4.2A. Agency Disclosure Awareness Program Describe the efforts to inform all employees having access to FTI of the following: Confidentiality requirements of the IRC Agency security requirements Sanctions imposed (IRC Sections 7213, 7213A and 7431) for unauthorized inspection or disclosure of return information Agency incident response policy and procedures The description should account for off-site storage, consolidated data centers, disaster recovery organizations, and contractor functions. Attachments: Sample Training Material and Certification Statement (recommended) 7.4.2 B. Reports of Internal Inspections Copies of a representative sampling of the Inspection Reports and a narrative of the corrective actions taken (or planned) to correct any deficiencies, should be included with the annual SAR. (See Publication 1075 Section 6.4). In addition, the agency should submit the internal inspection plan required by Section 6.3. Attachments: Internal Inspections Plan and a Sample of a completed Internal Inspection reports (required)7.4.2C. Disposal of FTI Describe the amount and method of destruction of FTI (paper and/or electronic, including backup tapes) disposed during the processing period. The description may be a summary from logs which track FTI from receipt through destruction. Copies of logs should not be submitted; a copy of the log template would suffice. Note: Including taxpayer information in the submitted disposal logs is not necessary and should be avoided. Attachments: Destruction log template (required)7.4.2D. Other Information to support the protection of FTI, in accordance with IRC 6103(p)(4) requirements. Agencies authorized to re-disclose FTI to other agencies must provide the name(s) of the agency to whom they provided FTI and the number of records provided. Note: Generally, agencies required to report additional information in this section will receive instructions from the Office of Safeguards on items to report here.Actions on Safeguard Review Recommendations7.4.3Corrective Action Plan The agency must attach a Corrective Action Plan (CAP) to report all corrective actions taken or planned to address findings arising from the last on-site safeguard review until all findings are closed. Attachments: CAP (required)[Notate the attachment number of the CAP.] Planned Actions Affecting Safeguard Procedures7.4.4Planned Actions Any planned agency action that would create a major change to current procedures or safeguard considerations should be reported. Such major changes would include, but are not limited to, new computer equipment, facilities, or systems, or organizational changes.Agency Use of Contractors (Non Agency Employees)7.4.5Agency Use of Contractors The agency must identify all contractors with access to FTI and the purpose for which access was granted. The agency must provide the name and address of the contractor. For each contractor, specify: Name of each Contractor Contractor Work Location (Address) Support contractor provides for the agency Identify the FTI the contractor has access to (data files, data elements, systems, applications) Has the contractor's employees completed required disclosure awareness training and signed confidentiality agreements? If no, explain Does the legal contract between the agency and the contractor include the Publication 1075, Exhibit 7 language? If no, explain Is any FTI provided to contractors or contractor information systems off-shore? If yes, explain. If IT support is provided by a state run data center, is there an SLA in place between the agency and the data center operations? If no, explain7.4.6 FTI Data Received The agency must summarize the FTI received both paper and electronic, during the reporting period, including source, name of file or extract, and volume. A summary of the record keeping logs required in Publication 1075 Section 3 for electronic and paper data would meet this requirement. Attachments: Summary of the record keeping logs (recommended)7.4.7Update of Tax Modeling Activities State tax agencies using FTI to conduct statistical analysis, tax modeling or revenue projections must provide updated information regarding their modeling activities which include FTI. 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