Attachment J7 - Form FDA 3398.pdf
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- Solicitation number
- 75F40121R00014
About this file
This document contains an employee agreement form and information about a federal solicitation for roof repair services. The employee agreement form is Form FDA 3398, which requires the signature of any employee who will have access to non-public FDA information under a federal contract. The employee agrees not to further release, publish, or disclose such information and to protect it in accordance with relevant laws.
The related federal solicitation seeks offers for roof replacement and repair services at buildings 15, 53A, 53B, 53C, 53D, and the mechanical room at the National Center for Toxicological Research facility in Jefferson, Arkansas. The solicitation was issued under number 75F40121R00014 by the Department of Health and Human Services Food and Drug Administration Office of Acquisition and Grant Services. No further details are provided about response dates, pricing terms, set-asides, or other solicitation requirements.
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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
| Please type a description of information released here: |
| Please type witness's name here: |
| Please type your name here: |
| Please type date of the witness's signature here in 2 digit month/2 digit day/4 digit year format: |
| Please type the signature date here in 2 digit month/2 digit day/4 digit year format: |
| Please type the employer's name here, first line: |
| Please type the employer's name here, second line: |
| Please type the current day here: |
| Please type the current month here: |
| Please type the current 2 digit year here: 21 |
| Please type the contract number here: |
| Contract Number: 75F40121R00014 |
| Attachment Number: Attachment J6 - Form FDA 3398 |
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