Privacy Act Notification. This information is provided pursuant to the Privacy Act of 1974 (Public Law 94-579), as amended, for individuals supplying information for inclusion in a system of records. The authority for the collection of this information is 42 U.S.C. §3797cc-21. The purpose of the Xxxx X. Xxxxxxx Loan Repayment for Prosecutors and Public Defenders statute is to encourage qualified individuals to enter and continue employment as prosecutors and public defenders. This Agreement and related data are made part of the file to be used within the Department of Justice for record-keeping and management while participating in the Xxxx X. Xxxxxxx Loan Repayment program. The information also may be disclosed outside the Department, as permitted by the Privacy Act and Freedom of Information Act, to the Congress, the Internal Revenue Service, and pursuant to court order. You are asked to provide your Social Security Number. Please note that if you do not provide this information, and you are selected to participate in the Xxxx X. Xxxxxxx Loan Repayment program, your Social Security Number will be required later to enable the Department to verify your eligibility status. Failure to submit this information will render this Agreement incomplete and you will be considered ineligible to participate in the program. I, , agree to the terms of this Service Agreement.
Privacy Act Notification. The CNA will be subject to the Privacy Act of 1974 (5 U.S.C. § 552a) and applicable Commission regulations, when conducting AbilityOne Program qualified NPA site visits and/or in the event the CNA has reason to inspect personally identifiable information maintained for AbilityOne Program purposes. Violation of the Act may involve the imposition of criminal penalties.
Privacy Act Notification. This information is provided pursuant to the Privacy Act of 1974 (Public Law No. 94-579), as amended, for individuals supplying information for inclusion in a system of records. The authority for the collection of this information is 34 U.S.C. §10671. The purpose of the Xxxx X. Xxxxxxx Loan Repayment for Prosecutors and Public Defenders statute is to encourage qualified individuals to enter and continue employment as prosecutors and public defenders. This Agreement and related data are made part of the file to be used within the Department of Justice for record-keeping and management while participating in the Xxxx X. Xxxxxxx Student Loan Repayment program. The information also may be disclosed outside the Department, as permitted by the Privacy Act and Freedom of Information Act, to the Congress, the Internal Revenue Service, and pursuant to court order. You are asked to provide your Social Security Number. Please note that if you do not provide the information, and you are selected to participate in the Xxxx X. Xxxxxxx Student Loan Repayment program, your Social Security Number will be required later to enable the Department to verify your eligibility status. Failure to submit this information will render this Agreement incomplete and you be considered ineligible to participate in the program. I, , agree to the terms of this Service Agreement. SIGNATURE DATE Service Agreement Appendix D The following form should be used only in cases where a current JRJ beneficiary has not yet fulfilled his/her initial 3-year service obligation, but remains eligible for JRJ benefits. Appendix D: JRJ Beneficiary Service Agreement (Acknowledgment of Benefit) Note to JRJ State Administering Agencies: the following form should be used only in cases where a current JRJ beneficiary has not yet fulfilled his/her initial 3-year service obligation, but remains eligible for JRJ benefits. Upon fulfilling his/her initial 3-year service obligation, the JRJ beneficiary may exit the program or, if selected to receive additional JRJ benefits, should execute the JRJSLRP – Secondary Term of Service document (see Appendix D above). Xxxx X. Xxxxxxx Student Loan Repayment Program (JRJSLRP) Service Agreement Acknowledgment of Benefit I, , hereby acknowledge the following: NAME
Privacy Act Notification. Submitter agrees that information collected by the NIH from the Submitter, as part of the DSA, may be made public in part or in whole for tracking and reporting purposes. This Privacy Act Notification is provided pursuant to Public Law 93-579, Privacy Act of 1974, 5 U.S.C. Section 552a. Authority for the collection of the information requested below from the Submitter comes from the authorities regarding the establishment of the National Institutes of Health, its general authority to conduct and fund research and to provide training assistance, and its general authority to maintain records in connection with these and its other functions (42 U.S.C. 203, 241, 289l-1 and 44 U.S.C. 3101), and Sections 301 and 493 of the Public Health Service Act. These records will be maintained in accordance with the Privacy Act System of Record Notice 09-25-0156 (https://xxx.xx.xxx.xxx/forms/Privacy%20Documents/Documents/Privacy%20Act%20Systems%20of%2 0Records%20Notices%20(SORNs)%205-1-15.pdf)) covering “Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD.” The primary uses of this information are to document, track, monitor, and evaluate the submission of data from clinical, basic, and population-based research activities and to notify Submitters in the event a potential error in the dataset is identified, or in the event of updates or other changes to the database. The Federal Privacy Act protects the confidentiality of some NIH records. The NIH will use the information collected for the purposes described above. In addition, the Act allows the release of some information in the Submitter’s records without the Submitter’s permission; for example, if it is requested by members of Congress or other authorized individuals. The information requested in the DSA is voluntary, but necessary for submitting data to the NIMH Data Archive.
Privacy Act Notification. In order to access the NESARC-III, the Recipient agrees to provide the information requested below. The Recipient agrees that information collected from the Recipient, as part of the Data Access Request, may be made public in part or in whole for tracking and reporting purposes. This Privacy Act Notification is provided pursuant to Public Law 93-579, Privacy Act of 1974, 5 U.S.C. Section 552a. Authority for the collection of the information requested below from the recipient comes from the authorities regarding the establishment of the National Institutes of Health, its general authority to conduct and fund research and to provide training assistance, and its general authority to maintain records in connection with these and its other functions (42 U.S.C. 203, 241, 289l-1 and 44 U.S.C. 3101), and Section 301 and 493 of the Public Health Service Act. These records will be maintained in accordance with the Privacy Act System of Record Notice 00-00-000 covering “Clinical Basic and Population-based Research Studies of the National Institutes of Health (NIH), HHS/NIH/OD”. Primary uses of this information are to document, track, and monitor and evaluate the use of the NIAAA NESARC-III datasets, as well as notify interested recipients of updates, corrections, or other changes to the database.
Privacy Act Notification. This information is provided pursuant to the Privacy Act of 1974 (Public Law 94-579), as amended, for individuals supplying information for inclusion in a system of records. The authority for the collection of this information is 42 U.S.C. §3797-cc-
Privacy Act Notification. The Contractor shall ensure that the following banner is dis- played on all DOS systems that contain Pri- vacy Act information operated by the Con- tractor prior to allowing anyone access to the system: This system contains information pro- tected under the provisions of the Privacy Act of 1974 (Pub. L. 93–579). Any privacy in- formation displayed on the screen or printed shall be protected from unauthorized disclo- sure. Employees who violate privacy safe- guards may be subject to disciplinary ac- tions, a fine of up to $5,000, or both.
Privacy Act Notification. The Recipient Institution agrees that information collected from the Recipient, such as name, contact, funding, and biospecimen use information may be used in part, or in whole, for tracking and reporting purposes. This Privacy Act Notification is provided pursuant to Public Law 93-579, Privacy Act of 1974, 5 U.S.C. Section 552a. The authority for the collection of the information requested from the Recipient comes from the authorities regarding the establishment of the National Institutes of Health (NIH), its general authority to conduct and fund research and to provide training assistance, and its general authority to maintain records in connection with these and its other functions (42 U.S.C. 203, 241, 289l-1 and 44 U.S.C. 3101), and Sections 301 and 493 of the Public Health Service Act. These records will be maintained in accordance with the Privacy Act System of Record Notice 09-25-0156 xxxxx://xxx.xxxxxxx.xxx/content/pkg/FR-2002-09-26/pdf/02-23965.pdf covering “Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service (PHS), HHS/PHS/NIH/OD.” The primary uses of this information are to document, track, monitor, and evaluate the use of Biospecimens requested through NICHD DASH.
Privacy Act Notification. The PI/Submitter agrees that information collected from the PI/Submitter, as part of the SA, may be made public in part or in whole for tracking and reporting purposes. This Privacy Act Notification is provided pursuant to Public Law 93-579, Privacy Act of 1974, 5 U.S.C. Section 552a. Authority for the collection of the information requested below from the PI/Submitter comes from the authorities regarding the establishment of NIH, its general authority to conduct and fund research and to provide training assistance, and its general authority to maintain records in connection with these and its other functions (42 U.S.C. 203, 241, 289l-1 and 44 U.S.C. 3101), and Section 301 and 493 of the Public Health Service Act. These records will be maintained in accordance with the Privacy Act System of Record Notice 09-25-0200 covering “Clinical, Basic and Population-based Research Studies of the NIH, HHS/NIH/OD.” The primary uses of this information are to document, track, monitor and evaluate the submission of data from clinical, basic, and population-based research activities and to notify PI/Submitters if a potential error in the dataset is identified or in the event of updates or other changes to the database. The Federal Privacy Act protects the confidentiality of the PI/Xxxxxxxxx’s NIH records. NIH will use the data collected for the purposes described above. In addition, this Act allows the release of some information in the PI/Submitter’s records without the PI/Xxxxxxxxx’s permission; for example, if it is required by members of Congress or other authorized individuals. The information requested is voluntary, but necessary for submitting data to mapMECFS.
Privacy Act Notification. The California Information Practices Act of 1977 requires the University to provide information to the individual to whom the information pertains. Furnishing information requested in the Vital Statistic sheet is mandatory. Failure to provide such information will delay or may even prevent completion of the action for which the form is being filled out. Information furnished on this form will be transmitted to the state and federal governments if required by law. Civil Code Section 1798.9 et seq. requires each state agency to provide notice to individuals completing this form (VS-11 Certificate of Death and VS 9 Application and Permit for Disposition of Human Remains). The information is being requested by: Department of Health Services, Office of Vital Records, 000 X Xxxxxx, X.X. Box 730241, Sacramento, CA 94244-0241. The information requested on this certificate is authorized as required by Divisions 7 and 102 of the Health and Safety Code, and related provisions with the Civil Code, Code of Civil Procedure, and Government Code. The principal purpose for this record is:
