MCD Sponsorship Request Toolkit

  • Guidance is also available in Portable Document Format (PDF)
Guidance: MCD Sponsorship Closeout
How do I closeout my MCD Sponsorship?
  • Upon expiration of DUA/DEAA, Requestor submits the Data Destruction Affidavit form to Security and Privacy Bureau
  • Security and Privacy Bureau provides DUA/DEAA Closure Letter
Do I need to use a specific form or template?
  • Yes, the Data Destruction Affidavit form needs to be completed
How do I obtain the Data Destruction Affidavit form?
  • There are two ways to obtain the Data Destruction Affidavit form:
How do I complete the Data Destruction Affidavit?
  • Section 1: Fill out name
  • Section 2: Fill out your organization and organization´s address
  • Section 3: Enter what type of MCD received from NYSDOH, DUA Identification number, and the purpose of the DUA
  • Section 4: No action needed
  • Section 5: Check if MCD was returned to NYSDOH or destroyed and date of such
  • Section 6: If data was destroyed, enter the name of the entity that destroyed
  • Section 7: No action needed
  • Section 8: Individual who performed the destruction or the Requestor on the DUA needs to sign, date, and have the affidavit notarized
Questions? Contact us!