Att D - FDA Form 3398.pdf
PDF 287 KB Posted
- Attached to
- Safe Medication Use
- Solicitation number
- 75F40125Q00401
About this file
The document is a FDA Form 3398 (10/10) "Commitment to Protect Non-Public Information Employee Agreement" from the Department of Health and Human Services' Food and Drug Administration. The form requires an employee to agree not to release, publish, or disclose non-public FDA information obtained during their official duties under a specific contract. The employee acknowledges understanding legal provisions including 21 U.S.C. 331(j), 21 U.S.C. 360j(c), and 18 U.S.C. 1905, and recognizes potential criminal penalties for violations of confidentiality. The form provides spaces for the employee's signature, printed name, and a witness, with a section at the bottom for describing any information being released.
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Other files
| File | Type | Posted |
|---|---|---|
| 75F40125Q00401-SafeMedUse-QA.pdf | ||
| Att A - Records management cert.pdf | ||
| Att B - Records management training.pdf | ||
| SOL_RFQ (75F40125Q00401) SafeMedUse.docx | DOCX document | |
| Att C - Pricing Worksheet.xlsx | XLSX spreadsheet | |
| Att F - Data Disclosure Clearance Form.docx | DOCX document | |
| Att E - Data Disclosure Clearance Procedures.docx | DOCX document |
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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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File details come from the government source that posted it. Updated .