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APPENDIXC <br />CERTIFICATION OF DATA DISPOSITION <br />Date of Disposition _____________________ _ <br />0 All copies of any Datasets related to agreement DOH# ___ have been deleted from <br />all data storage systems. These data storage systems continue to be used for the storage <br />of confidential data and are physically and logically secured to prevent any future access <br />to stored information. Before transfer or surplus, all data will be eradicated from these <br />data storage systems to effectively prevent any future access to previously stored <br />information. <br />D All copies of any Datasets related to agreement DOH# ___ have been eradicated from <br />all data storage systems to effectively prevent any future access to the previously stored <br />information. <br />D All materials and computer media containing any data related to agreement DOH <br /># ___ have been physically destroyed to prevent any future use of the materials and <br />media. <br />• All paper copies of the information related to agreement DOH # ___ have been <br />destroyed on-site by cross cut shredding. <br />D All copies of any Datasets related to agreement DOH # ___ that have not been <br />disposed of in a manner described above, have been returned to DOH. <br />D Other <br />The data recipient hereby certifies, by signature below, that the data disposition requirements <br />as provided in agreement DOH# ___ ~ Section C, item B Disposition of Information, have <br />been fulfilled as indicated above. <br />Signature of data recipient <br />Print Name <br />Date <br />Page ZS of 26 <br />09/2017