Transcription of Form 4678 - Request for DPPA Security Access Code
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Form 4678 - Request for DPPA Security Access Code
Form4678 Missouri Department of RevenueRequest for DPPA Security Access CodeForm 4678 (Revised 01-2018)Office Use OnlySecurity Code Assigned _____This form must be fully completed and approved before a Requester can obtain Access to restricted information. Only Requesters who meet the criteria outlined in the Purpose of Request section below are eligible to obtain restricted information and a Security Access code. Incomplete forms will be returned for more information. Appropriate documentation must be submitted with this form to verify your eligibility to receive information under the provisions of the federal Driver s Privacy Protection Act (DPPA) and Missouri law, including but not limited to, business license, insurance license, bar card, or personal credentials.
(U.S.C., Title 18, Sections 2721, 2722, 2724, and 2725 ) or of any provision set forth herein, whether by omission or commission, shall be grounds for action by the Department and may result in termination of the security access code. 2. Requester shall ensure compliance with all security provisions set forth herein.
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