"IRS Disclosure Awareness Acknowledgement Statement for Third-Party Providers" - North Carolina

IRS Disclosure Awareness Acknowledgement Statement for Third-Party Providers is a legal document that was released by the North Carolina Department of Information Technology - a government authority operating within North Carolina.

Form Details:

  • The latest edition currently provided by the North Carolina Department of Information Technology;
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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the North Carolina Department of Information Technology.

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State of North Carolina
Office of Information Technology Services
Pat McCrory
Chris Estes
Governor
State Chief Information Officer
I RS D
A
A
S
I SCLOSURE
WARENESS
CKNOWLEDGEM ENT
TATEM ENT
F
OR
1
T
-P
P
HIRD
ARTY
ROVIDERS
By signing this statement, I acknowledge that I have viewed and understand the “IRS Disclosure Awareness
Training” video.
As a Third-Party Provider to the North Carolina Office of Information Technology Services, I agree that I will not
access or inspect taxpayer records for any non-business reason. I understand the penalties for not maintaining the
confidentiality of taxpayer records. I will contact my supervisor if I need additional information on the
confidentiality of tax information.
AGREED, this _____ day of _________, 201_. I also acknowledge that I have been provided a copy of this
statement.
__________________________________________
__________________________________________
Third Party Name Printed
Third Party Signature
Division: __________________________________
Company Name: ____________________________
__________________________________________
__________________________________________
Manager/Supervisor Name Printed
Manager/Supervisor Manager Signature
1
Third-party providers are non-state employees, such as vendors, suppliers, individuals, contractors, and consultants, including their employees and agents,
responsible for providing goods or services to the state. In order to perform the requested services, a third party may require access to information
technology assets and access to agency information determined to be valuable to operations and/or classified as confidential by law.
P.O. Box 17209, Raleigh, NC 27619-7209
4101 Mail Service Center, Raleigh NC 27699-4101
Telephone: 919-754-6100
An Equal Opportunity/Affirmative Action Employer
State of North Carolina
Office of Information Technology Services
Pat McCrory
Chris Estes
Governor
State Chief Information Officer
I RS D
A
A
S
I SCLOSURE
WARENESS
CKNOWLEDGEM ENT
TATEM ENT
F
OR
1
T
-P
P
HIRD
ARTY
ROVIDERS
By signing this statement, I acknowledge that I have viewed and understand the “IRS Disclosure Awareness
Training” video.
As a Third-Party Provider to the North Carolina Office of Information Technology Services, I agree that I will not
access or inspect taxpayer records for any non-business reason. I understand the penalties for not maintaining the
confidentiality of taxpayer records. I will contact my supervisor if I need additional information on the
confidentiality of tax information.
AGREED, this _____ day of _________, 201_. I also acknowledge that I have been provided a copy of this
statement.
__________________________________________
__________________________________________
Third Party Name Printed
Third Party Signature
Division: __________________________________
Company Name: ____________________________
__________________________________________
__________________________________________
Manager/Supervisor Name Printed
Manager/Supervisor Manager Signature
1
Third-party providers are non-state employees, such as vendors, suppliers, individuals, contractors, and consultants, including their employees and agents,
responsible for providing goods or services to the state. In order to perform the requested services, a third party may require access to information
technology assets and access to agency information determined to be valuable to operations and/or classified as confidential by law.
P.O. Box 17209, Raleigh, NC 27619-7209
4101 Mail Service Center, Raleigh NC 27699-4101
Telephone: 919-754-6100
An Equal Opportunity/Affirmative Action Employer