Attachment_18-NEFSC_Statement_of_Non-Disclosure.pdf

Individual Computer/Network/Data Access Agreement Last First Initial

EMPLOYER/SPONSOR EMPLOYMENT STATUS

☐NMFS

☐Other Federal Agency ☐State Agency ☐Fishery Mgt. Council

☐Federal Staff ☐Contractor (Specify Contract #) ☐Commissioned ☐Associate (check type)

☐Other ☐Student/Intern ☐Post-doc ☐Guest ☐Volunteer

NETWORK ACCOUNTS REQUIRED:

☐Oracle Account ☐Network (Unix) Account ☐Network (AD) Account ☐Email Account (LDAP) ☐Data Only; No Account ☐VPN Access For Fisheries Sampling Branch staff: ☐Data Entry ☐Editor For Ecosystems Surveys Branch staff: ☐SVDBS Audit User

DATABASE ACCESS:

☐Ecosystems Survey (svdbs) ☐Commercial Fisheries (cfdbs) ☐Observer Data (obdbs)

Other: _____________________________

Other: _____________________________

LENGTH OF TIME ACCESS IS REQUIRED:

Account Access will NOT be granted if date information is incomplete.

Permanent Staff Only: Start Date:

(mm/dd/yyyy)

To be completed by NEFSC Data Management Systems Staff

Account Type : ☐Admin i s t ra tor ☐End User

ACCOUNT ACCESS GRANTED; RESTRICTIONS IMPOSED; DMS Form 2;

Revised 9/23/2014

Work Organization Information Only:

Organization

Address

Zip Code

Office Phone: E-Mail/Internet Address

Office or Lab Location: ☐ WH ☐ NA ☐ MI ☐ SH ☐OR ☐ Other:

For use with the IMMEDIATE RESPONSE INFORMATION SYSTEM (IRIS) only.

Personal Phone Personal E-Mail Address

Temporary Staff Only (Contractors, Associates, Other nonpermanent)

Start Date:

(mm/dd/yyyy)

End Date:

(mm/dd/yyyy)

Attachment 18

EA133F-17-RP-1824 SECTION J

Individual Statement of Non-Disclosure

This is to certify:

1. It has been determined by: Name of COR/Supervisor/Sponsor:

Title: Org/Contact Number:

that in order for me to carry out my fisheries-related work assignments I require access to NMFS Government computer systems and/or NMFS data files which may contain information declared to be held confidential by NMFS. My affiliation with the NMFS Greater Atlantic Regional Fisheries Office or the Northeast Fisheries Science Center is:

Employee Type: ☐NMFS ☐Associate ☐Commissioned ☐Contractor

Other Federal Government Employee (Agency) Division

State Employee (State) and Division

2. Are you a Foreign National? ☐No ☐Yes Country

3. In using NMFS computers and data I agree to uphold the government's security provisions for preserving the safety and integrity of the systems accessed and protecting against misuse or destruction of the computer systems and data being accessed.

4. I have read NOAA Administrative Order 216-100 (PROTECTION OF CONFIDENTIAL FISHERIES STATISTICS) and/or NOAA Administrative Order 212-13 (NOAA Information Technology Security Policy). http://www.corporateservices.noaa.gov/ames/administrative_orders/chapter_216/216-100.html

5. I am fully aware of the civil and criminal penalties for unauthorized disclosure, misuse, or other violation of the confidentiality of such statistics.

6. I will not knowingly disclose any statistics identified as confidential under this agreement to any person or persons, except as authorized by the NMFS Assistant Administrator for Fisheries, or the Administrator's designee, in accordance with the law, as authorized by the NOAA office of General Counsel.

Name of User Signature Date

Name (Supervisor/Program Mgr) Signature Date

Access Certification Signature of the NEC-ISSO Date

DMS Form 2 Revised 9/23/2014

Attachment 18

EA133F-17-RP-1824 SECTION J