Every department, board, commission, division, authority, or other agency of this state that issues or renews a license or other authority to conduct a profession, trade, or business shall annually, ninety (90) days prior to the renewal date of any license or on June 30 if such licenses are issued intermittently, furnish to the tax administrator, in such form as the tax administrator may determine, a list containing the following information for all licensees:

(a)  Name;

(b)  Address;

(c)  Federal identification number and/or social security number;

(d)  Type of license issued;

(e)  Effective date of initial license;

(f)  Expiration date of license; and

(g)  Status of license (active/inactive).

Unless otherwise required by law, no department, board, commission, authority, or other agency shall maintain, use, or disclose, for any other purpose, the social security information obtained pursuant to this section.