ATTACHMENT 5 NON DISCLOSURE STATEMENT.doc

ATTACHMENT 5

NON DISCLOSURE STATEMENT

DEPARTMENT OF HEALTH AND HUMAN SERVICES

FOOD AND DRUG ADMINISTRATION

COMMITMENT TO PROTECT PRIVLIEGED 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 the FDA and my employer________________________________________________________________

I, on this ______________________day of ______________, 2010 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. 360(j), 18 USC. 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. 360(j), 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 (7/03)