Attachment 8 - AFRL Privacy Act for Covered Individuals.pdf
PDF 107 KB Posted
- Attached to
- Combat Identification Automated Target Recognition Technology (CATCH) Call 06 Federal contract opportunity
- Solicitation number
- FA237726RB005
About this file
This is a Privacy Act Statement template issued by the Air Force Research Laboratory for use in federal research and development award applications and agreements.
The statement establishes the legal authority for information collection under multiple federal statutes and directives, including the Government Paperwork Elimination Act, CHIPS and Science Act, National Defense Authorization Acts, and various DoD instructions addressing personnel security and foreign ownership control. The stated purpose is to process, investigate, and maintain records related to federal grants, cooperative agreements, contracts, and Other Transaction Agreements awarded by the Department of the Air Force to ensure awards are granted to responsible parties and entities. Information collected may be shared with contractors, grantees, experts, consultants, and others performing work on federal contracts or grants, as well as with appropriate law enforcement authorities when records indicate potential violations of law. The statement clarifies that providing information is voluntary; however, non-compliance with 42 U.S. Code § 6605 disclosure requirements may result in rejection of applications or civil or criminal remedies. The template includes signature blocks for a covered individual (with printed name and date) and the institution's authorized representative (with printed name and date), along with a field for the institution name and proposal title.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Solicitation Questions and Answers.xlsx | XLSX spreadsheet | |
| Attachment 10 - Model Contract.pdf | ||
| Attachment 2 - SOO Supplemental Requirements.pdf | ||
| Attachment 11 - Placeholder for Government Furnished Information (GFI).pdf | ||
| CATCH Call 06 Solicitation.pdf | ||
| Attachment 7 - Research and Related Senior and Key Person Profile Worksheet.pdf | ||
| Attachment 4 - Placeholder DD254.pdf | ||
| Attachment 1- Placeholder Statement of Objectives (SOO).pdf | ||
| Attachment 3 - Contract Data Requirements List (CDRLs).pdf | ||
| Attachment 9 - Security Risk Review.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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