Pilot IRS_TPMR_Attachment B_NDA.pdf

INSTRUCTIONS FOR NON-DISCLOSURE AGREEMENTS

Beginning on page two of this document is the Non-disclosure agreement.

Treasury/IRS policy requires that ALL contractors who require access to sensitive but unclassified (SBU) data are required to sign an NDA .

When the COR has determined that the contractor will have access to SBU (which requires an NDA), the COR will complete the following steps before giving the Non- Disclosure Agreement to the contract employee to sign:

1. COR modifies all highlighted areas as they pertain to the identified contract. (COR may only modify the agreement by insertion of specific language in blank or parenthetical spaces relative to the contract, contracting Treasury/bureau or project. Other modifications require legal counsel and Office of Security approval.)

2. Contract employee signs and dates the agreement.

3. COR signs and dates agreement for acceptance on behalf of the agency.

4. COR maintains the original signed and dated Non-Disclosure Agreement with the Contract file.

5. COR sends a scanned copy of the agreement via email to CSM at CSM@irs.gov.

6. COR may furnish copy of the agreement to the individual signatory, if requested.

http://irm.web.irs.gov/link.asp?link=10.23.2 mailto:CSM@irs.gov

Third Party Media Research Conditional Access to Sensitive Information

Non-Disclosure Agreement

I, ______________, hereby consent to the terms in this Agreement in consideration of my being granted conditional access to certain United States Government documents or material containing sensitive information.

I understand and agree to the following terms and conditions:

1. By being granted conditional access to sensitive information, the United States Government has placed special confidence and trust in me and I am obligated to protect this information from unauthorized disclosure, in accordance with the terms of this Agreement.

2. As used in the Agreement, sensitive information is any information the loss, misuse, or unauthorized access to or modification of which could adversely affect the national interest or the conduct of Federal programs, or the privacy to which individuals are entitled under Title 5 U.S.C. 522a, but which has not been specifically authorized under criteria established by an Executive Order or an Act of Congress to be kept secret in the interest of national defense or foreign policy.

3. I am being granted conditional access contingent upon my execution of this Agreement for the sole purpose of Third Party Media Research. This approval will permit me conditional access to certain information, (to include but not limited to e.g., documents, memoranda, reports, maps, drawings, schematics, plans, assessments, etc.) and/or to attend meetings in which such information is discussed or otherwise made available to me. This Agreement will not allow me access to materials which the Department of the Treasury (Treasury) has predetermined, in its sole discretion, is inappropriate for disclosure pursuant to this Agreement. This may include sensitive but unclassified information provided to the Treasury by other agencies of the United States Government.

4. I will never divulge any sensitive but unclassified information, which is provided to me pursuant to this Agreement to any person, unless I have been advised in writing by the Department of Treasury, Internal Revenue Service that the individual is authorized to receive it. Unless expressly authorized by the IRS, I will not use any sensitive but unclassified information for any commercial or other purpose other than that for which access to such information is provided under Contract # ______TBD_________. I agree that I must seek and obtain the prior written approval of the Internal Revenue Service for any proposed disclosure or use.

Additionally, I will submit to the Internal Revenue Service for security review, prior to any submission for publication, any book, article, column or other written work for general publication that is based upon any knowledge I obtained during the course of my work on Contract # ______TBD_________ in order for the Internal Revenue Service to ensure that no sensitive but unclassified information is disclosed.

5. I hereby assign to the United States Government all royalties, remunerations, and emoluments that have resulted, will result or may result from any disclosure, publication, or revelation of sensitive information not consistent with the terms of this Agreement.

6. If I am permitted, at the sole discretion of the IRS, to review any official documents containing sensitive but unclassified information, such review will be conducted at a secure facility or under circumstances, which will maintain the security protection of such material. I will not be permitted to and will not make any copies of documents or parts of documents to which conditional access is granted to me. Any notes taken during the course of such access will remain at the IRS to be placed in secure storage unless it is determined by IRS officials that the notes contain no sensitive but unclassified information. If I wish to have the notes released to me, IRS officials will review the notes for purposes of deleting any sensitive but unclassified information to create a redacted copy of the notes. If I do not wish a review of any notes that I make, those notes will remain sealed in secure storage at the IRS.

7. If I violate the terms and conditions of this Agreement, I understand that the unauthorized disclosure of sensitive but unclassified information could compromise the mission and the security of the Internal Revenue Service.

8. If I violate the terms and conditions of this Agreement, such violation may result in the cancellation of my conditional access to sensitive but unclassified information. This may serve as a basis for my being denied conditional access to the Internal Revenue Service information, both classified and sensitive but unclassified information in the future. If I violate the terms and conditions of this Agreement, the United States may institute a civil action for damages or any other appropriate relief. The willful disclosure of information to which I have agreed herein not to divulge may constitute a criminal offence.

9. Unless and until I am provided a written release by the Internal Revenue Service from this Agreement or any portions of it, all conditions and obligations contained in this Agreement apply both during my period of conditional access, which shall terminate at the conclusion of my work on Third Party Media Research Contract #TBD, and at all times thereafter.

10. Each provision of this Agreement is severable. If a court should find any provisions of this Agreement unenforceable, all other provisions shall remain in full force and effect.

11. I understand that the United States Government may seek any remedy available to it to enforce this Agreement, including, but not limited to, application for a court order prohibiting disclosure of information in breach of this Agreement.

12. By granting me conditional access to information in this context, the United States Government does not waive any statutory or common law evidentiary privileges or protections that it may assert in any administrative or court proceeding to protect any sensitive information to which I have been given conditional access under the terms of this Agreement.

13. These restrictions are consistent with and do not supersede, conflict with or otherwise alter the employee obligations, rights or liabilities created by Executive Order 13526 or 13556; Section 7211 of Title 5, United States Code (governing disclosures to Congress); Section 1034 of Title 10, United States Code, as amended by the Military Whistleblower Protection Act (governing disclosure to Congress by members of the military); Section 2302(b)(8) of Title 5, United States Code, as amended by the

Whistleblower Protection Act (governing disclosures of illegality, waste, fraud, abuse or public health or safety threats); the Intelligence Identities Protection Act of 1982 (50 USC 421 et seq.)(governing disclosures that could expose confidential Government agents), and the statutes that protect against disclosure that may compromise the national security, including Sections 641, 793, 794, 798, and 952 of Title 128, United States Code, and Section 4(b) of the Subversive Activities Act of 1950 (50 USC Section 783 (b)). The definitions, requirements, obligations, rights, sanctions and liabilities created by said Executive Order and listed statutes are incorporated into this Agreement and are controlling.

14. My execution of this Agreement shall not nullify or effect in any manner any other secrecy or nondisclosure Agreement which I have executed or may execute with the United States Government.

15. I make this Agreement in good faith, without mental reservation or purpose of evasion.

Name Date

Signature

This Agreement was accepted by the undersigned on behalf of the Internal Revenue Service as a prior condition on conditional access to sensitive but unclassified information. Further release to any other third party requires execution of a nondisclosure agreement.

IF APPLICABLE:

When information is shared with the Office of Inspector General or the Treasury Inspector General for Tax Administration or the Special Inspector General for TARP, for official audit/investigative purposes, the following statement must be added below the signature line. “This Agreement was accepted by the undersigned on behalf of the (identify bureau and (the Office of Inspector General or Treasury Inspector General for Tax Administration, Special Inspector General for TARP, as applicable) for conditional access to sensitive information. Further release and dissemination of (identify DO/bureau) sensitive information under this non-disclosure agreement must be in accordance with a written arrangement related to the official audit/investigative functions of the OIG or TIGTA or SIGTARP for that particular matter. Further release to any other third party requires execution of a nondisclosure agreement.”

IRS COR / Date

(OIG or TIGTA or SIGTARP signatory) Date