[Iowa DOT] 431200: Certified Motor Vehicle Record Request Form

CERTIFIED MOTOR VEHICLE RECORD REQUEST FORM

FOR USE BY COUNTY ATTORNEY’S OFFICES AND LAW ENFORCEMENT AGENCIES

Requestor

Seeking certified record of

Must also complete requestor section if seeking vehicle information

Notice to Requestor: The certified record you are requesting and receiving contains “personal information” and “highly restricted personal information” under the Driver’s Privacy Protection Act of 1994 (DPPA), 18 U.S.C. 2721-2725, and Iowa Code 321.11. These federal and state laws regulate access to and restricted the use and redisclosure of information contained in motor vehicle records.

By requesting and reviewing any certified motor vehicle record, you are certifying that you are engaging in a “permissible use” under the laws. If you provide the certified record to anyone else, it must be for a permissible use. Permissible uses include:

Use by any government agency, including any court or law enforcement agency, in carrying out its functions, or any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions, and

Use in connection with any civil, criminal, administrative, or arbitral proceeding in any federal, state, or local court or agency or before any self-regulatory body, including the service of process, investigation in anticipation of litigation, and the execution or enforcement of judgments and orders, or pursuant to an order of a federal, state, or local court.

18 U.S.C. 2721(b)(1) and (b)(4). The DPPA provides for 12 other permissible uses. See 18 U.S.C. 2721(b). “Highly restricted personal information,” which is defined as “an individual’s photograph or image, Social Security number, [and] medical or disability information,” may only be redisclosed for four permissible uses, including the two specified above. 18 U.S.C. 2725(4); 18 U.S.C. 2721(a)(2).

When you provide the motor vehicle record to anyone else, you must keep a record of that redisclosure for a period of five years. Your record must satisfy the requirements of 18 U.S.C. 2721(c), which means that the record must (1) identify each person or entity that receives information; and (2) identify the permitted purpose for which the information will be used. Additionally, your records of redisclosure must be made available to the Iowa Department of Transportation upon request. Individuals who violate these privacy laws are subject to criminal and civil penalties.

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