Office of AIDS
Community Planning Group - Information Practices Act
Notice as required by Information Practices Act (IPA)
Civil Code section 1798.17
1798.17. Each agency shall provide on or with any form used to collect personal information from individuals the notice specified in this section. When contact with the individual is of a regularly recurring nature, an initial notice followed by a periodic notice of not more than one-year intervals shall satisfy this requirement. This requirement is also satisfied by notification to individuals of the availability of the notice in annual tax-related pamphlets or booklets provided for them. The notice shall include all of the following:
(a) The name of the agency and the division within the agency that is requesting the information.
(b) The title, business address, and telephone number of the agency official who is responsible for the system of records and who shall, upon request, inform an individual regarding the location of his or her records and the categories of any persons who use the information in those records.
(c) The authority, whether granted by statute, regulation, or executive order which authorizes the maintenance of the information.
(d) With respect to each item of information, whether submission of such information is mandatory or voluntary.
(e) The consequences, if any, of not providing all or any part of the requested information.
(f) The principal purpose or purposes within the agency for which the information is to be used.
(g) Any known or foreseeable disclosures which may be made of the information pursuant to subdivision (e) or (f) of Section 1798.24.
(h) The individual's right of access to records containing personal information which are maintained by the agency.
This section does not apply to any enforcement document issued by an employee of a law enforcement agency in the performance of his or her duties wherein the violator is provided an exact copy of the document, or to accident reports whereby the parties of interest may obtain a copy of the report pursuant to Section 20012 of the Vehicle Code.
The notice required by this section does not apply to agency requirements for an individual to provide his or her name, identifying number, photograph, address, or similar identifying information, if this information is used only for the purpose of identification and communication with the individual by the agency, except that requirements for an individual's social security number shall conform with the provisions of the Federal Privacy Act of 1974 (Public Law 93-579).