Form FDA 3398.pdf
PDF 460 KB Posted
- Solicitation number
- 75F40125Q00337
About this file
The document is a Commitment to Protect Non-Public Information Employee Agreement (Form FDA 3398) related to the Transfusion-Transmissible Infections Monitoring System (TTIMS) contract solicitation. The form requires an employee to agree not to release, publish, or disclose non-public information from the Food and Drug Administration (FDA) files, with acknowledgment of potential criminal penalties for violations under specific U.S. Code sections (21 U.S.C. 331(j), 21 U.S.C. 360j(c), 18 U.S.C. 1905). The form is part of a confidentiality agreement for a contract (Solicitation Number 75F40125Q00337) between the FDA and the employee's employer, ensuring protection of sensitive information during the performance of official duties.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_QR_75F40125Q00337_Responses.pdf | ||
| Sol_Doc_75F40125Q00337.pdf | ||
| HHS Subcontracting Plan.pdf | ||
| Past Performanc Evaluation Questionnaire.docx | DOCX document |
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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: Solicitation Number: 75F40125Q00337 |
| Attachment Number: Form FDA 3398 |
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