36C24919R0190-003.docx

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Board Certified/Board Eligible Psychiatrist
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36C24919R0190
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36C24919R0190 ATTACHMENT 3 VHA STATEMENT OF COMMITMENT AND UNDERSTANDING.docx

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COMBINED SYNOPSIS 36C24919R0190

ATTACHMENT 3 – VHA STATEMENT OF COMMITMENT AND UNDERSTANDING

STATEMENT OF COMMITMENT AND UNDERSTANDING FOR VA CONTRACTORS WHO POSSESS, HANDLE, OR COME INTO CONTACT WITH VA SENSITIVE INFORMATION OR PERSONAL DATA

As a contractor of the Department of Veterans Affairs (VA), I am committed to safeguarding the personal information that veterans and their families have entrusted to the Department. I am also committed to safeguarding the personal information which VA employees and applicants have provided.

To ensure that I understand my obligations and responsibilities in handling the personal information of veterans and their families, I have completed both the annual General Privacy Awareness Training (or VHA Privacy Training, as applicable) and the annual VA Cyber Security Training.

I know that I should contact the Contracting Officer whom will then get in touch with the Information Security Officer or Regional or General Counsel, when I am unsure whether or how I may gather or create, maintain, use, disclose or dispose of information about veterans and their families, and VA employees and applicants.

I further understand that if I fail to comply with applicable confidentiality statutes and regulations, I may be subject to civil and criminal penalties, including fines and imprisonment. I also recognize that VA may impose sanctions, up to and including termination of contract for violation of applicable confidentiality and security statutes, regulations and policies.

I certify that I have completed the training outlined above and am committed to safeguarding personal information about veterans and their families, and VA employees and applicants.

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[Print or type Contractor name]Signature
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Position TitleDate

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