MN Legislature

Menu

Revisor of Statutes Menu

Authenticate

Pdf

Minnesota Administrative Rules

1205.2000 ADVISORY FORMS.

Subpart 1.

Advisory form A:

resolution appointing a county responsible authority.

State of Minnesota

County of (name of county) _________________

WHEREAS, Minnesota Statutes, section 13.02, subdivision 16, requires that (name of county) _______________ County appoint one person as the Responsible Authority to administer the requirements for collection, storage, use and dissemination of data on individuals within the county and,

WHEREAS, the (name of county) _______________ County Board of Commissioners shares the concern expressed by the legislature on the responsible use of all County data and wishes to satisfy this concern by immediately appointing an administratively and technically qualified Responsible Authority as required under the statute.

BE IT RESOLVED, the County Board of Commissioners appoints (name of individual) _______________ as the Responsible Authority for the purpose of meeting all requirements of Minnesota Statutes, chapter 13, as amended, and with rules as lawfully promulgated by the Commissioner of Administration as published in the State Register on (insert appropriate date) __________.

ADOPTED BY (name of county) __________ COUNTY COMMISSIONERS ON (date) _______.

ATTESTED TO: _____________________________________
(signature of appropriate official)
_____________________________________
(title of appropriate official)

Subp. 2.

Advisory form B:

resolution appointing a city responsible authority.

State of Minnesota

City of (insert name of city) ___________________

Resolution Title: Appointment of Responsible Authority

WHEREAS, Minnesota Statutes, section 13.02, Subdivision 16, as amended, requires that the City of (insert name of city) _______________ appoint one person as the Responsible Authority to administer the requirements for collection, storage, use and dissemination of data on individuals, within the City and,

WHEREAS, the (insert name of city) _______________ City Council shares concern expressed by the legislature on the responsible use of all City data and wishes to satisfy this concern by immediately appointing an administratively qualified Responsible Authority as required under the statute.

BE IT RESOLVED, the City Council of (insert name of city) ____________ appoints (name of individual appointed) _______________ as the Responsible Authority for the purposes of meeting all requirements of Minnesota Statutes, chapter 13, as amended, and with rules as lawfully promulgated by the Commissioner of Administration as published in the State Register on (insert appropriate date) _______________.

ADOPTED BY (insert name of city) _______________ CITY COUNCIL ON (date) _______________.

ATTESTED TO BY THE:

____________________________ ____________________
(Signature of Mayor) on (date)
____________________________ ____________________
(Signature of City Clerk) (date)

Subp. 3.

Advisory form C:

resolution appointing a school district responsible authority.

State of Minnesota

(name of district) _______________ School District

School District Number ____

Pursuant to the provisions of Minnesota Statutes, section 13.02, subdivision 16, as amended, (insert name of individual) ____________________, is hereby appointed Responsible Authority for the (insert name of district) _______________ School District Number ____.

(insert name of individual appointed) ____________________ is hereby authorized to take all actions necessary to assure that all programs, administrative procedures and forms used within School District (insert number) ____ are administered in compliance with the provisions of Minnesota Statutes, chapter 13, as amended, and with rules as lawfully promulgated by the Commissioner of Administration as published in the State Register on (insert appropriate date) __________.

Subp. 4.

Advisory form D:

resolution appointing a responsible authority for state or local boards or commissions.

State of Minnesota

(insert name of board or commission) ___________________

Under the provisions of Minnesota Statutes, section 13.02, Subdivision 16, as amended, (name of individual) ____________________ is hereby appointed Responsible Authority for (insert name of board or commission) ____________________.

(insert name of individual appointed) _________________________ is hereby authorized to take all actions necessary to assure that all programs, administrative procedures and forms used by the (insert name of board or commission) _________________________ are administered in compliance with the provisions of Minnesota Statutes, chapter 13, as amended, and with rules as lawfully promulgated by the Commissioner of Administration and published in the State Register on (insert date) ____.

Subp. 5.

Advisory form E:

public document as required by Minnesota Statutes, section 13.05.

GOVERNMENTAL ENTITY: (Name of Entity) RESPONSIBLE AUTHORITY: (Name)
_ _
(Address) (Title)
_ _
(Address)
_ _
_ _
NAME OF RECORD, FILE, SYSTEM OR PROCESS DESCRIPTION OF RECORD, FILE, SYSTEM OR PROCESS CLASSIFI- CATION CITATION OF STATUTE OR FEDERAL LAW THAT CLASSIFIES THE DATA NAME, TITLE AND ADDRESS OF DESIGNEE, IF ANY FOR FILE. ETC.
(Insert a name sufficient to identify.) (Describe in terms understandable by the general public.) (Insert private or confidential.) (Insert citation to state or federal statute, federal rule, case law) (Insert name, etc. of person appointed to be in charge of this file)
.
.
.
.
.
.
.
.
.
.

Statutory Authority:

MS s 13.07

Published Electronically:

July 13, 2007

700 State Office Building, 100 Rev. Dr. Martin Luther King Jr. Blvd., St. Paul, MN 55155 ♦ Phone: (651) 296-2868 ♦ TTY: 1-800-627-3529 ♦ Fax: (651) 296-0569