S02 - Attachment 06 - NDNUS - IV Buffer Support - 19AUG2026.pdf

VA/VHA Nondisclosure/Non-Use Statement

Solicitation/Contract Number: RFQ 36C24C26Q0027

Task Order Number [if applicable]: TBD

Requirement/Project Title: Insurance Entry and Verification Buffer Support Services

VA Organization/Facility: [Insert VISN, VHA program office, and/or VA medical center]

Contractor/Subcontractor: [Insert legal entity name]

Individual’s Name: [Insert full name]

Position/Role: [Insert title]

1. Purpose

In performing duties under the above-referenced contract or Task Order, I may receive, create, access, use, maintain, transmit, store, or otherwise handle Department of Veterans Affairs [VA] information. This may include VA sensitive information; personally identifiable information [PII]; sensitive personal information [SPI]; protected health information [PHI]; Federal Tax Information [FTI], if applicable;

proprietary information; procurement-sensitive information; Controlled Unclassified Information [CUI], if applicable; information-system information; and other nonpublic information.

I acknowledge that access to such information is granted solely to enable performance of my official duties under the contract or Task Order.

2. Nondisclosure and Non-Use Commitment

I agree to the following:

1. I will access, use, disclose, copy, reproduce, transmit, download, store, or maintain VA information only to the extent authorized and necessary to perform my assigned duties under the contract or Task Order.

2. I will not use VA information for my own benefit, the benefit of my employer or any other person or entity, commercial purposes, marketing, research, publication, litigation, or any purpose not expressly authorized in writing by the VA Contracting Officer.

3. I will not disclose VA information to any person or entity unless that person or entity has a legitimate need to know, has been authorized to receive the information, and the disclosure is permitted by the contract, applicable law, VA policy, and written direction from VA.

4. I will not disclose VA information to the media, post it to social-media platforms, or otherwise make it publicly available. I will direct all external requests, including requests under the

Freedom of Information Act, subpoenas, court orders, media inquiries, and other requests for VA information, to the Contracting Officer for VA response.

5. I will protect VA information from unauthorized access, use, modification, loss, theft, destruction, disclosure, or release. I will use only VA-authorized systems, accounts, devices, applications, storage locations, communication methods, and access mechanisms when handling

VA information, unless otherwise expressly authorized in writing by VA.

6. I will not remove VA information from VA-controlled facilities, systems, or approved work locations except as expressly authorized under the contract or by the Contracting Officer. I will not store VA information on personal devices, personal email accounts, removable media, or unapproved cloud-storage services.

7. I will safeguard credentials, multifactor-authentication devices, passwords, Personal Identity

Verification credentials, tokens, keys, and other access mechanisms. I will not share them or permit another individual to use my account or credentials.

8. I will complete all required VA privacy, security, records-management, HIPAA, and role-based training before accessing VA information or VA information systems, and I will comply with all applicable VA rules, procedures, and security controls.

9. I will immediately report any actual or suspected loss, theft, improper access, unauthorized disclosure, security incident, privacy incident, phishing event, malware event, or other compromise involving VA information or VA information systems. I will make the report to [insert required reporting contact[s]] and follow the incident-reporting procedures in the contract and applicable VA policy.

10. Upon completion of my duties, reassignment, separation from employment, or direction from

VA or my employer, I will promptly stop accessing VA information and return or securely dispose of VA information, records, equipment, credentials, and media in accordance with contract requirements and VA direction. I will not retain copies in any form.

3. Continuing Obligation

My obligations to protect against unauthorized use and disclosure of VA information continue after the end of my assignment, employment, subcontract, Task Order, or contract. This statement does not authorize access to VA information and does not supersede any applicable statute, regulation, contract clause, VA policy, or other legally binding agreement.

4. Acknowledgment

I understand that unauthorized use or disclosure of VA information may result in removal from the contract or Task Order, loss of system or facility access, adverse employment action, contractual remedies, civil liability, criminal penalties, and any other remedies available to VA or the Government.

I certify that I have read, understand, and agree to comply with this VA/VHA Nondisclosure/Non-Use

Statement.

Individual certification

Printed name [Insert]

Signature [Insert]

Date [Insert]

Employer [Insert Contractor/subcontractor name]

Supervisor/Contractor representative name [Insert]

Supervisor/Contractor representative signature [Insert]

Date [Insert]