Fillable Printable Form DPR-104 - Drinking Driver Program Service Agreement - New York

Form DPR-104 - Drinking Driver Program Service Agreement - New York

DRINKING DRIVER PROGRAM SERVICE AGREEMENT

Driver Regulation - Drinking Driver Program

www.dmv.ny.gov

DPR-104 (3/15)

INSTRUCTIONS

Program applicants must complete, sign, and mail this Service Agreement to the New York State Department of Motor

Vehicles (DMV) in any of the following situations:

After this agreement is completed and signed, the original must be mailed with a completed Drinking Driver

Program Application (form DPR-103) and its required attachments to:

Driver Regulation - Drinking Driver Program

New York State Department of Motor Vehicles

6 Empire State Plaza

Albany, NY 12228

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Business ID Number for Program

OFFICE USE ONLY

Enter the name of the Drinking Driver Program in the box below.

When submitting an application to establish a Drinking Driver Program (DDP) under Article 21 and Article 31

of the New York State Vehicle and Traffic Law, prior to the DDP commencing operations.

When submitting a DDP name change to DMV.

When submitting a sponsoring agency name change to DMV.

When notifying DMV of a newly appointed DDP director.

Upon DMV request.

Purpose: This agreement is made between the New York State Department of Motor Vehicles (DMV) and the Drinking

Driver Program (DDP) provider who signed below to establish the DDP’s responsibility to the motorist and to the DMV.

As used in this agreement, the term “Department of Motor Vehicles” shall refer to the Department of Motor Vehicles

(DMV) or to any successor agency.

As used in this agreement, the term “Commissioner” shall mean the Commissioner of the Department of Motor Vehicles.

By signing this agreement, the DDP agrees to adhere to the terms of both this agreement and the New York State Drinking

Driver Program Director’s Guide (DPR-175) which is incorporated herein by reference.

This agreement shall become effective upon execution by both parties.

Paragraph Headings: Paragraph headings contained in this agreement are for convenience only and shall not be

considered for any purpose in governing, limiting, modifying, construing or affecting the provisions of this agreement

and shall not otherwise be given any legal effect.

The Parties hereto agree as follows:

I DDP’s Responsibility to Motorist:

1. Motorists who are unable to pay the DDP fee will not be denied participation in the DDP if the motorist has been

certified as “indigent” by a court of competent jurisdiction.

*DPR-104*

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2. Motorists are permitted to transfer into and out of DDPs. The director of the DDP from which the motorist is being

transferred must promptly transfer records to the DDP to which the motorist is transferring within 5 business days

from receipt of notification of the pending transfer. In the event that, prior to the first class, a motorist notifies the

DDP of his/her wish to transfer to a different program, the director releasing the motorist must provide written

documentation to the motorist and to the program the motorist wishes to transfer to confirming the transfer from

one program to another.

3. Any fees collected by the DDP must be fully refunded to the motorist in the event that the DDP is unable to provide

the entire course, as prescribed by the Commissioner.

4. The DDP must not steer motorists to a particular clinical provider. In the event the DDP refers a motorist for

evaluation, the DDP must either (a) direct the motorist to the Office of Alcohol and Substance Abuse Services

(OASAS) website for a list of OASAS-approved Impaired Driver Clinical Screening and Assessment Providers, or

(b) provide the motorist with a current list.

5. DDP staff must screen motorists for alcohol and/or drug abuse, using the RIASI Screening Matrix developed by

DMV in cooperation with the Research Institute of Addictions, or by any other method approved by the

Commissioner.

6. The DDP may not charge motorists any fees that exceed amounts provided for in DMV’s regulations (15 NYCRR

134) or that are not provided for in such regulations.

7. Classrooms, and the buildings in which they are located, must comply with all applicable life/safety codes. The

program must be accessible to individuals with a disability, and must comply with the requirements of the Americans

with Disabilities Act. NOTE: Handicapped accessibility is not required for every classroom if another accessible

classroom where a DDP course is conducted is available and is within reasonable proximity of the non-accessible

classroom. DDP classes must only be conducted in DMV-approved classrooms. DMV’s written approval of each

classroom location is required before any class can be scheduled for that classroom.

8. Interpreters for hearing-impaired program participants must be provided, as specified in the New York State

Drinking Driver Program Director’s Guide.

9. The DDP director must provide a motorist with a minimum of ten (10) days’ written notice prior to dropping such

motorist from the program. Such notice must specify the reason(s) why the motorist is being dropped.

10. In the event that a class is rescheduled, the DDP must notify the motorist and DMV at least 3 days prior to the

regularly scheduled class time, except in the case of an emergency.

11. Status Updates: The DDP must submit all status updates, including motorist transfers, re-entries, drops, class

rescheduling, and course completions in the method prescribed by DMV (e.g., electronically and/or on a document

approved by DMV) within 72 hours following such change of status.

12. The DDP must ensure that course participants are not subjected by the DDP or DDP course providers to sexual

harassment, demeaning or offensive behavior, or unlawful discrimination on the basis of race, creed, color, national

origin, sex, sexual orientation, age or disability.

13. The DDP must not attempt to contact a motorist or solicit such motorist’s enrollment in its DDP prior to receiving

notification from DMV that the motorist has enrolled in its DDP. The DDP is prohibited from contacting or

soliciting participants enrolled in other DDPs.

14. Prior to a motorist’s enrollment in a DDP, the DDP is prohibited from soliciting or obtaining information from any

source (including a court or District Attorney’s office) concerning the motorist’s charge or conviction for an

alcohol-related offense.

DPR-104 (3/15)

15. In the event a motorist misses a class session for any reason, the DDP must reschedule the motorist for a class that

will facilitate attendance at all sessions required for the motorist to receive delivery of the entire curriculum in the

prescribed sequence.

II DDP’s Responsibility to DMV:

1. The DDP must at all times adhere to the provisions of Article 21 and Section 1196 of the New York State Vehicle

and Traffic Law, DMV’s regulations (15 NYCRR 134), the terms of the New York State Drinking Driver Program

Director’s Guide (DPR-175), and any amendments, unless otherwise approved by DMV in writing.

Any request to deviate from the requirements set forth therein must be submitted to DMV in writing, and must

describe the purpose of such request.

2. The DDP must adhere to the provisions of the New York State Drinking Driver Program Director’s Guide (DPR-

175) and Part 134.10 of DMV’s regulations when addressing a motorist’s appeal of any adverse decision made by

treatment providers or program personnel concerning the motorist’s participation in treatment or program services.

3. New DDP applicants who wish to provide services as a DDP must provide a completed “Fiscal Feasibility

Worksheet” with the application, documenting proof of the applicant’s financial viability for successful DDP

operation.

4. The DDP must submit applications of prospective DDP directors and course instructors to DMV for approval, with

all supporting documentation required. DMV will notify applicants and directors upon its preliminary approval of

the application.

DMV’s final approval of course instructors is subject to the instructor meeting the basic requirements for the

position, and obtaining verification that the instructor has successfully completed the required training. The DDP

must not permit untrained instructors (i.e., those who fail to complete any training required or fail to acquire and

maintain the necessary certification) to teach DDP courses.

5. In order to avoid any conflict of interest, or the appearance of impropriety, the DDP must not have a financial

interest, or employ anyone who has a financial interest, in any alcoholism and substance abuse evaluation/treatment

service or employ any person who is employed by a provider of alcoholism and substance abuse

evaluation/treatment service to which the DDP’s participants are referred or treated.

6. The DDP must ensure that DDP staff members, including all course instructors, refrain from directly or indirectly

sharing any fee or other remuneration with any third party.

7. DDP directors are responsible for administrative and supervisory oversight of all approved instructors, and are

responsible for ensuring that the instructors adhere to the provisions of this Service Agreement.

8. Directors must promptly report any actions that are not in accordance with this agreement to DMV.

9. DMV reserves the right to suspend or revoke the certification of any instructor if DMV finds that the instructor:

• Has engaged in fraudulent activity.

• Subjects the participant to sexual harassment, demeaning or offensive behavior, or unlawful discrimination on the

basis of race, creed, color, national origin, sex, sexual orientation, age or disability.

• Is not participating in continuing education requirements.

• Fails to conduct himself or herself in a professional manner.

• Fails to deliver the curriculum as prescribed by the Commissioner.

• Has been convicted of a felony, or of any crime involving violence, dishonesty, deceit, indecency, degeneracy or

moral turpitude.

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DPR-104 (3/15)

• Has a driver license that is suspended or revoked, or if such license is in conditional or restricted status.

Instructors must possess a valid driver license, and must not have had such license suspended or revoked within

five years prior to the instructor’s application for certification, except for a suspension which may be

terminated by an act of the licensee. The instructor may, in DMV’s sole discretion, be eligible for re-approval

on a case-by-case basis

10. It is the responsibility of the DDP to ensure that an out-of-state driver license held by an instructor is valid, is not

in conditional or restricted status, and has not been suspended or revoked for the five years prior to the a

application date, except for a suspension which may be terminated by an act of the licensee. Out- of- State

applicants must submit supporting documentation with their instructor’s application, which includes a certified

copy of the applicant’s Abstract of Driving Record. The DDP must annually submit to DMV an updated Abstract

of Driving Record for each approved out-of-state instructor.

11. DDP staff must participate in any mandatory DMV-approved activities designed to enhance course presentation

or the administration of the DDP.

DDP staff must attend a minimum of 18 hours of continuing education every 3 years. DMV-approved continuing

education is required for DDP staff to remain current in addiction prevention, treatment and recovery, traffic

safety, and changes in the law or regulations.

The following link provides the Office of Alcoholism and Substance Abuse Services (OASAS) list of free

learning and development opportunities: http://www.oasas.ny.gov/workforce/training/FreeLDO.cfm

The OASAS’ Training Catalog provides individuals with information concerning upcoming training in their area.

Use this link to access the catalog: http://www.oasas.ny.gov/training/search.cfm

12. The DDP director must monitor classroom presentations and the actions of course providers and DDP personnel

to maintain standards of quality and consistency in the delivery of the program curriculum.

13. Approved DDP instructors must apply to be fully certified after curriculum training and the delivery of a full

cycle of the curriculum. In the event the instructor is not fully certified within one year from the initial

curriculum training, the instructor’s approval will be suspended.

In order to remain approved to teach a DDP course, instructors must attend additional training whenever the

course curriculum is updated.

14. Classes must meet the required minimum and maximum number of students, as specified in the New York State

Drinking Driver Program Director’s Guide (DPR-175), and as provided in DMV’s notice of approval for each

DDP class location. Two course instructors are required for classes having 14 or more participants; two

instructors are recommended

for all classes.

15. The DDP must submit a Drinking Driver Program Classroom Site Inspection Report (form DPR-125) with any

request for a change to, or addition of, existing classroom locations. Refer to the New York State Drinking Driver

Program Director’s Guide (DPR-175) for more information. New classroom site requests must be accompanied

by justification for adding a new classroom. Justification is to support both the need for a new classroom as well

as client enrollment sustainability. The DDP may begin scheduling classes at such locations only after receiving

notice of approval from DMV.

16. DDP’s Obligation of Indemnification and Liability:

DDP’s obligations to indemnify and hold harmless specified hereunder shall survive the expiration of the

Contract by termination or otherwise.

DDP shall be solely responsible and answerable in damages for any and all accidents and/or injuries (including

death) to persons or property arising out of or related to the services to be rendered by the Contractor or its

subcontractors pursuant to this agreement. The DDP shall indemnify and hold harmless the State and its officers

and employees from claims, suits, actions, damages and costs of every nature arising out of the provision of

services pursuant to this agreement.

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DPR-104 (3/15)

DDP is an independent contractor and may neither hold itself out nor claim to be an officer, employee or

subdivision of the State nor make any claim, demand or application to or for any right based upon any different

status.

Driver’s Privacy Protection Act (DPPA) & New York State Information Security Breach and Notification Act

(ISBNA): DDP acknowledges that all DMV records containing personal information, as well as DMV-related

processing information, are confidential and are the property of the Department and the State of New York. In the

event that such information is improperly used, accessed, or becomes compromised, the DDP may be held liable

for violating the federal DPPA (18 U.S.C. §2721, et seq.) and the New York State ISBNA (General Business Law,

§899-aa; State Technology Law, §208), and may be required to indemnify DMV for any such violation.

DDP must report suspected or confirmed violations of the DPPA or ISBNA to DMV within one (1) business day

of discovering any such violation. Violations must be reported to:

Audit Services

New York State Department of Motor Vehicles

6 Empire State Plaza

Albany, NY 12228

Tele: (518) 474-0881

Fax: (518) 474-8358

DPPA: A person who knowingly violates the DPPA shall be subject to criminal fines and liability for civil

remedies. DDP shall indemnify and hold harmless New York State, its employees and agents, from and against

any claims, demands, loss, damage or expense related solely to a knowing violation of the DPPA committed by

DDP, its employees, officers, agents or subcontractors. DDP shall indemnify the Department and the State of New

York even if DDP did not have knowledge of such violation of the DPPA by its officers, employees, agents, or

subcontractors at the time such violation occurred.

ISBNA: DDP shall be responsible for complying with the provisions of the ISBNA with respect to any private

information (as defined in the ISBNA) received by DDP, its officers, employees, agents, or subcontractors. In the

event of a breach of security, DDP shall immediately commence an investigation, in cooperation with DMV, to

determine the scope of the breach, and DDP shall assist DMV in restoring the security of the related system in

order to prevent any further breaches. DDP shall notify DMV of any breach of security immediately following

discovery of such breach.

Under the ISBNA, DMV is required to notify any individuals whose records have been accessed for unauthorized

purposes from a system maintained by DMV.

In furtherance of the investigation of any breach of the ISBNA, the DDP must receive written authorization from

DMV prior to providing notice of such breach to any other entity. DDP shall be responsible for all costs associated

with providing notices required under the ISBNA. The DDP shall not impair the authority of the New York State

Office of the Attorney General to bring an action against DDP to enforce the provisions of the ISBNA, or limit

DDP’s liability for any violations of the ISBNA. Additional information concerning the ISBNA and the

notification process is available at: http://www.cscic.state.ny.us/security/securitybreach

By signing this agreement, the authorized signatory attests that he/she has read the DPPA and the ISBNA,

understands their provisions, and agrees to abide by their terms and conditions.

17. The DDP must not request or view a motorist’s electronic or paper Abstract of Driving Record prior to the

participant’s official enrollment in the DDP by DMV, including the entry of the participant’s name on the class

roster and the participant’s execution of the DMV-approved consent form.

In addition, the DDP is prohibited from requesting or viewing a motorist’s Abstract of Driving Record after

the

motorist has completed, transferred from, or has been dropped from the DDP.

18. The DDP must fully cooperate with DMV in any audit of DDP records required to monitor and evaluate DDP

administrative procedures, operations, and the delivery of the course curriculum.

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DPR-104 (3/15)

19. DMV reserves the right, in its sole discretion, to rescind its approval for any DDP to operate as a DDP, in the

event DMV determines that the DDP has violated the conditions of such approval, or has unsatisfactorily

conducted services.

In the event that DMV determines that a DDP has performed unsatisfactorily or has breached any term hereof,

DMV will notify the DDP director of such deficiency. DMV reserves the right, in its sole discretion, to permit

the DDP to correct any such deficiency within a period of time prescribed by DMV. Failure to rectify deficiencies

within the time frame specified in the notification may result in revocation, suspension or a partial rescission of

DMV’s approval of the DDP to operate as a DDP.

A partial rescission of approval will permit the DDP to continue to provide limited services, subject to conditions

imposed by DMV.

20. This agreement will remain in effect unless superseded by a subsequent agreement, or terminated by DMV as

provided herein, or upon the DDP’s cessation of operations. The DDP must provide DMV with 90 days advanced

written notice of its intention to cease operations as a DDP.

Notwithstanding the termination of this agreement, DDP staff having access to personal identifying information

of DDP participants shall have a continuing obligation to refrain from any unauthorized use, access, or

dissemination of such information.

21. The DDP must promptly cooperate with DMV to ensure the transfer of students and the transfer of participants

in referral status, upon termination of this agreement for any reason; and this continuing obligation will survive

the termination of this agreement.

22. This agreement may only be amended in writing by the mutual consent of the Parties.

In Witness Whereof, the Parties have executed this agreement by their duly authorized officer or representative.

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Drinking Driver Program Provider

By,

_____________________________________________________________________________________________

(Please Sign Here)

_____________________________________________________________________________________________

(Please Print Name Here)

_____________________________________________________________________________________________

(Title)

Date: ________/________/________

(mm/dd/yyyy)

NYS Department of Motor Vehicles

By,

_____________________________________________________________________________________________

(Please Sign Here)

_____________________________________________________________________________________________

(Please Print Name Here)

_____________________________________________________________________________________________

(Title)

Date: ________/________/________

(mm/dd/yyyy)

DPR-104 (3/15)

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