Skilled Nursing Facility Hero Awards
Program Privacy Notice on Collection of Personal Information
The Office of Statewide Health Planning and Development (the Office) is requesting personal information in the following application for the Skilled Nursing Facility Hero Awards Program.
The authority to collect Name, address, and Social Security Number is established in 26 U.S. Code § 6109.
The principal purpose of collecting this personal information is to verify your eligibility for the award and to deliver the award to you.
- Name, Professional License Number, Name of employer(s), work address(s), and Date of Birth will be used to verify your eligibility.
- Name and personal address will be used to deliver your award.
- Name, personal address, and Social Security Number or Taxpayer Identification Number will be used to prepare an Informational Tax Return (1099) if needed.
Where required by law we share the relevant personal information with California and Federal Tax authorities and the California State Controllers office. When there is indication of fraud or other illegal activity this information may be shared with law enforcement. This information may also be shared with our oversight agencies to ensure that we are performing our duties to distribute these funds appropriately.
We may disclose the information to third parties for anti-fraud services and as needed to third party service providers (such as payment services providers; shipping companies; etc.)
This form contains areas where you may enter unrestricted content. Please provide only the information requested. You should not provide any personal information that is not requested in those areas.
Name, Professional License Number, Name of employer(s), work address(s), Date of Birth, personal address, Social Security Number or Taxpayer Identification Number are all required.
We can not process your request without validating your eligibility, having a name and address to send the award to, and federal and state laws require us collect information on how we distribute money to be able to file an information return when required.
The Office of Statewide Health Planning and Development’s Chief Data Officer is responsible for maintaining the records collected. Requests from applicants regarding the location of their records or the categories of any persons who use the information in those records may be submitted to:
Chief Data Officer
2020 West El Camino Avenue, Suite 1100
Sacramento, California, 95833