Attachment 11 - AFRL Privacy Act for Covered Individuals Fillable.pdf
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- Solicitation number
- FA2394-26-R-B004
About this file
This document is a Privacy Act Statement form required by the Air Force Research Laboratory (AFRL) for covered individuals involved in federal research and development awards under solicitation FA2394-26-R-B004.
The statement establishes the legal authority and purpose for collecting personal information from individuals participating in AFRL-funded grants, cooperative agreements, contracts, and Other Transaction Agreements. Information collected may be used to process, investigate, and maintain records relevant to these awards, with the primary purpose of ensuring that federal benefits are awarded to responsible parties and entities. The statement references multiple authorities including the Government Paperwork Elimination Act, the CHIPS and Science Act, National Defense Authorization Acts, DoD intelligence and personnel security directives, and Executive Orders related to national security for U.S. research and development. Routine uses of collected information include sharing with contractors, grantees, and other entities performing work on federal contracts or grants, as well as disclosure to appropriate law enforcement authorities when records indicate potential violations of law. The form requires acknowledgment of consent through signatures from both the covered individual and the institution's authorized representative, along with printed names, signatures with dates, and the institution name. Notably, while providing information is voluntary, noncompliance with 42 U.S. Code § 6605 disclosure requirements may result in application rejection or other civil or criminal remedies.
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Privacy Act Statement Air Force Research Laboratory
Authority: Government Paperwork Elimination Act (Pub. L. 105-277, 44 U.S.C. 3504); Executive Order 12372, Intergovernmental review of Federal Programs (47 FR 30959); 42 U.S. Code § 6605 – Disclosure of funding sources in applications for Federal research and development awards; Public Law 117-167, CHIPS and Science Act; Public Law 116-92, National Defense Authorization Act for Fiscal Year 2020;
Public Law 116-283, National Defense Authorization Act for Fiscal Year 2021; 5 U.S.C. 9101, Access to Criminal History for National Security and Other Purposes 5 CFR §1320.8, Agency collection of information Responsibility; 18 U.S.C. § 1001, False Statements, Concealment; E.O. 13478, Amendments to Executive Order 9397 Related to Federal Use of social Security Numbers; NSPM-33, National Security Presidential Memorandum 33 on National Security for United States Research and Development; DoD-D 5240.01, DoD Intelligence Activities; DoDI 5200.02, Department of Defense Personnel Security Program; DODI 5205.87 Mitigating Risks Related to Foreign Ownership, Control, or Influence for Covered DOD Contractors and Subcontractors; Air Force Research Laboratory Instruction 61-113, Science and Technology Protection for the Air Force Research Laboratory;
Purpose: The information collected may be used in processing, investigating, and maintaining records relevant to Federal Grants, Cooperative Agreements, Contracts, Other Transaction Agreements or other research related agreements awarded by the Department of the Air Force. Records in these systems will be used to ensure Department of the Air Force sponsored and/or awarded federal grants, cooperative agreements, contracts, Other Transaction Agreements and/or benefits are awarded to responsible parties, entities, and individuals.
Routine Uses: To contractors, grantees, experts, consultants, students, and others performing or working on a contract, grant, cooperative agreement, other transaction or other assignment for the Federal Government when necessary to accomplish an agency function.
To the appropriate Federal, State, local, territorial, tribal, foreign, or international law enforcement authority or other appropriate entity where a record, either alone or in conjunction with other information, indicates a violation or potential violation of law, whether criminal, civil, or regulatory in nature.
DoD Blanket Routine Use (http://dpcld.defense.gov/privacy)
Effect of not providing information: Providing information to the Department of the Air Force is voluntary. However, 42 U.S. Code § 6605, which imposes certain disclosure requirements in connection with Federal research and development awards, provides various enforcement mechanisms for non-compliance to include civil or criminal remedies. One such mechanism, which the Department of the Air Force intends to pursue here, is rejection of such applications.
Proposal Title: ____________________________
Acknowledgment of consent:
Covered individual (Signature): ______________________________ Date: ___________
Covered individual (Name print): ______________________________
Institution’s Authorized Representative (Signature): _______________________ Date: ___________
Institution’s Authorized Representative (Name print): ______________________________
Institution Name: _______________________________
Attachment 11 AFRL Privacy Act for Covered Individuals
FA2394-26-R-B004
http://dpcld.defense.gov/privacy
| Proposal Title: |
| Covered individual Name print: |
| Institutions Authorized Representative Name print: |
| Institution Name: |
| Date: |
| Date2: |
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