Attachment_4_form_3398._non-disclosure_form.pdf
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- Attached to
- Tobacco Retailer Inspections
- Solicitation number
- 75F40119R00065
About this file
This notice provides details for multiple Indefinite Delivery Indefinite Quantity contracts to conduct tobacco retailer inspections regionally on behalf of the Food and Drug Administration. The contracts aim to assist in inspecting retail establishments that sell cigarettes and smokeless tobacco products across five regions. Services include inspections and surveillance of entities under the Tobacco Control Act. The requirement is set aside for small businesses in NAICS code 541990. All offerors must employ commissionable inspectors authorized to perform inspections in the relevant states. Inspections will cover Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin, Alabama, Arkansas, District of Columbia, Georgia, Florida, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, US Virgin Islands, Virginia, West Virginia, Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, Oregon, New Mexico, Utah, Washington, Wyoming, and Puerto Rico. The solicitation is expected to be available on or around June 17, 2019 via the Federal Business Opportunities website.
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Text version
COMMITMENT TO PROTECT NON-PUBLIC INFORMATION
EMPLOYEE AGREEMENT
Whereas access to non-public information from the files of the Food and Drug Administration (FDA) is required in the performance of my official duties, under Contract Number between FDA and my employer
I, on this day of , 20 hereby agree that I shall not further release, publish or disclose such information and that I shall protect such information in accordance with the provisions of 21 U.S.C. 331(j), 21 U.S.C. 360j(c), 18 U.S.C. 1905 and other pertinent laws and regulations governing the confidentiality of non-public information.
I understand the provisions of 21 U.S.C. 331(j), 21 U.S.C. 360j(c), 18 U.S.C. 1905 and that I am subject to criminal penalties prescribed by law for any violation(s) thereof.
Signature: Date:
Type or Print Name:
Witnessed by: Date:
Type or Print Name:
DESCRIPTION OF INFORMATION RELEASED:
FORM FDA 3398 (10/10)
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOOD AND DRUG ADMINISTRATION
PSC Graphics (301) 443-1090 EF
COMMITMENT TO PROTECT NON-PUBLIC INFORMATION
EMPLOYEE AGREEMENT
Whereas access to non-public information from the files of the Food and Drug Administration (FDA) is required in the performance of my official duties, under Contract Number between FDA and my employer I, on this day of , 20 hereby agree that I shall not further release, publish or disclose such information and that I shall protect such information in accordance with the provisions of 21 U.S.C. 331(j), 21 U.S.C. 360j(c), 18 U.S.C. 1905 and other pertinent laws and regulations governing the confidentiality of non-public information.
I understand the provisions of 21 U.S.C. 331(j), 21 U.S.C. 360j(c), 18 U.S.C. 1905 and that I am subject to criminal penalties prescribed by law for any violation(s) thereof.
Signature:
Date:
Type or Print Name:
Witnessed by:
Date:
Type or Print Name:
DESCRIPTION OF INFORMATION RELEASED:
FORM FDA 3398 (10/10)
DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOOD AND DRUG ADMINISTRATION
PSC Graphics (301) 443-1090
EF
Department of Health and Human Services Food and Drug Administration Commitment to Protect Non-Public Information Employee Agreement
FDA-3398
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