Attachment 8 - AFRL Privacy Act for Covered Individuals.pdf
PDF 107 KB Posted
- Attached to
- Combat Identification Automated Target Recognition Technology (CATCH) Call 02 Federal contract opportunity
- Solicitation number
- FA237725RB008
About this file
This document is a Privacy Act Statement form from the Air Force Research Laboratory (AFRL) for use in federal research and development agreements. The form outlines the legal authorities under which personal information may be collected, including various public laws and executive orders related to government research, national security, and personnel security.
The purpose of the document is to inform individuals that their information may be used in processing and maintaining records for federal grants, cooperative agreements, contracts, and other research-related agreements. While providing information is voluntary, failure to do so may result in application rejection. The form requires signatures from a covered individual and an institution's authorized representative, with provisions for sharing information with contractors, law enforcement, and other government entities as necessary to accomplish agency functions or investigate potential legal violations.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| CATCH Call 02 Solicitation.pdf | ||
| CATCH Call 02 - Questions and Answers.xlsx | XLSX spreadsheet | |
| CATCH Call 02 Solicitation.pdf | ||
| Attachment 3 - Contract Data Requirements List (CDRLs).pdf | ||
| Attachment 1- Placeholder Statement of Objectives (SOO).pdf | ||
| Attachment 10 - Model Contract.pdf | ||
| Attachment 2 - SOO Supplemental Requirements.pdf | ||
| Attachment 4 - Placeholder DD254.pdf | ||
| Attachment 7 - Research and Related Senior and Key Person Profile Worksheet.pdf | ||
| Attachment 9 - Security Risk Review.pdf | ||
| Attachment 11 - Placeholder for Government Furnished Information (GFI).pdf | ||
| Attachment 5 - Section K (Reps and Certs).pdf | ||
| Attachment 6 - Security Program Questionnaire.pdf |
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Text version
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: _______________________________ http://dpcld.defense.gov/privacy
| Proposal Title: |
| Covered individual Name print: |
| Institutions Authorized Representative Name print: |
| Institution Name: |
| Date: |
| Date2: |
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