RRB11R004 Attachment D.doc

Information Privacy Certification by Contractor I understand that while performing work for the Railroad Retirement Board – Office of Inspector General (RRB-OIG) I may encounter federally owned, personally identifiable, information protected by the Privacy Act of 1974 as amended, the Railroad Retirement Act, and the Railroad Unemployment Insurance Act.

I agree:

· Any information made available by the RRB-OIG in any format shall be used only for the purpose of carrying out the provisions of this contract. Information contained in such material will be treated as confidential and will not be divulged or make known in any manner to any person other than those persons with a need to know such information in carrying out their responsibilities under this contract. Disclosure to anyone other than an officer of employee of the RRB-OIG is prohibited, except where such disclosure is required by law.

· All information provided by the RRB-OIG will be properly secured and safeguarded before, during and after processing. In addition, all related output will be given the same level of protection as required for the source material.

· All the data processed, captured, printed or stored in any media format during the performance of this contract will be completely purged from any non-RRB-OIG system and no output retained after the work is no longer needed or the contract is completed, whichever comes first.

· I will provide a certificate stating that all data provided by RRB-OIG was purged, when it was purged, and how it was purged to the Inspector General prior to final completion of the contract.

· I will follow the appropriate purge techniques as directed in the National Institute of Standards and Technology (NIST), Special Publications 800-88, Guidelines for Media Sanitization. http://csrc.nist.gov/publications/nistpubs/800-88/NISTSP800-88_rev1.pdf I will contact the Assistant Inspector General for Investigations at 312 751-3344 immediately if there is a potential or actual loss of Sensitive Business Information (SBI) or Personally Identifiable Information (PII) in any RRB-OIG information that is entrusted to my care.

· I have read the following Privacy Act information on the RRB-OIG Web site and understand the importance of preserving the privacy of individuals:

· Introduction http://www.rrb.gov/bis/privacy_act/introduction.asp

· Overview http://www.rrb.gov/bis/privacy_act/overview.asp The Privacy Act and the RRB, Information On Individuals in the Railroad Industry, http://www.rrb.gov/bis/privacy_act/information_rrb_maintains.asp.

· I am aware and understand the purpose of the following:

· The RRB’s Privacy Systems of Records concerning Medicare Part B Claims, identified as “RRB-3 Medicare: Part B (Supplementary Medical Insurance Payment System--Contracted to Palmetto Government Benefits Administrators)” at http://www.rrb.gov/bis/privacy_act/SORNList.asp.

Signature:

Date:

Name (print)

For RRB-OIG Use Only

Accepted by

(Name & Signature):

Title and Date:

Return completed form to:

Inspector General

U.S. Railroad Retirement Board

844 North Rush Street, 4th FL Chicago, IL. 60611