Tennessen Warning - EH: Minnesota Department of Health

Tennessen Warning
Explanation of Rights
Well Management Program

For Individuals Applying for Certification

The Commissioner of Health uses the information provided on an application to determine if you meet the requirements for certification. You are not required to provide any of the requested information. However, if the requested information is not provided, your application will be denied. Submitting false information will result in the denial of your application or suspending, revoking, or taking other disciplinary action against your certification.

Minnesota Statutes, section 270C.72, subdivision 4, requires you to submit your social security number to the Commissioner before a certification can be issued to you. The information submitted will not be disclosed outside the Minnesota Department of Health (MDH) during the application process. It may be disclosed to others, including the Attorney General’s Office and persons contacted for purposes of verification or investigation, if required by law. Information on the application, including your social security number, will be provided to the Minnesota Department of Revenue (MDOR) at its request. If the matter of your certifications contested, the information submitted on the application may become public. When you become certified all information in the application becomes public, except your social security number, which remains private.

For Companies Applying for a License

The Commissioner of Health uses the information provided on an application to determine if you meet the requirements for a license. You are not required to provide any of the requested information. However, if the requested information is not provided, your application will be denied. Submitting false information will result in the denial of your application or suspending, revoking, or taking other disciplinary action against your license.

Minnesota Statute, section 270C.72, subdivision 4, requires you to supply your Minnesota business identification number, or your social security number if you are a sole proprietor, before the Commissioner issues a license. Minnesota statutes also requires you to provide the information concerning Workers Compensation Insurance or your permit information to self-insure.

The information submitted will not be disclosed outside MDH during the application process. It may be disclosed to others, including the Attorney General’s Office and persons contacted for purposes of verification or investigation, if required by law. Information on the application, including your social security number, will be provided to MDOR at its request. If the matter of your license is contested, the information submitted on the application may become public. When you become licensed all information in the application becomes public, except your social security number, which remains private.

For Credit Card Use

MDH programs allow for payment of fees with credit cards. Pursuant to Minnesota Statutes, section 16A.626, item (f), all credit card, change card, debit card, or other methods of electronic funds transfer account numbers are nonpublic data not on individuals as defined in Minnesota Statutes, section 13.02, subdivision 9, or private data on individuals as defined in Minnesota Statutes, section 13.02, subdivision 12.

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Questions?
Contact the MDH Well Management Section
651-201-4600 or 800-383-9808
health.wells@state.mn.us

Minnesota Department of Health
Updated Tuesday, June 27, 2017 at 09:01AM