D.4 - Statement of Commitment and Understa.pdf
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- Solicitation number
- 36C24925R0004
About this file
This document is a VHA Statement of Commitment and Understanding form for VA contractors who will handle sensitive information or personal data. The form requires contractors to affirm their commitment to safeguarding personal information of veterans, their families, and VA employees by completing mandatory annual privacy and cybersecurity training. Contractors must acknowledge potential civil and criminal penalties for non-compliance, including possible contract termination, and agree to consult with the Contracting Officer or appropriate VA officials if uncertain about information handling procedures. The form includes signature lines for the contractor's name, signature, position title, and date of execution, and is part of RFP #36C24925R0004 for Orthopedic Surgery Services.
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RFP # 36C24925R0004 – Orthopedic Surgery Services
Attachment 4 – 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.
Contractor name [Print or type] Signature
Position Title Date
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