Privacy act statement form

• [PDF File]Privacy Act Statement - DD Form 2653

  https://info.5y1.org/privacy-act-statement-form_1_5b9921.html

  ROUTINE USES: This form is subject to the proper and necessary routine uses identified in the system of records notice(s) specified in the purpose statement above. Information provided will further be disclosed to the DFAS to initiate the involuntary allotment from the member of the Uniformed Service for indebtedness.

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• [PDF File]PRIVACY ACT STATEMENT - HEALTH CARE RECORDS - Centers for Medicare ...

  https://info.5y1.org/privacy-act-statement-form_1_021024.html

  This statement is not a consent form. It will not be used to release or to use your health care information. I. Authority for collection of your information, including your social security ... PRIVACY ACT STATEMENT - HEALTH CARE RECORDS Author: HCFA Software Control

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• [PDF File]FBI Privacy Act Statement

  https://info.5y1.org/privacy-act-statement-form_1_230089.html

  FBI Privacy Act Statement Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and associated information is

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• [PDF File]PRIVACY ACT STATEMENT: Authority: Purpose: Disclosure: INSTRUCTIONS FOR ...

  https://info.5y1.org/privacy-act-statement-form_1_83997d.html

  PRIVACY ACT STATEMENT: Authority: 5 CFR 362.204 requires all Presidential Management Fellows to maintain an Individual Development Plan during their two year appointment. Purpose: The form is used to set forth the specific developmental activities designed to impart the competencies of the occupation or functional discipline in

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• [PDF File]ccfm133-R - United States Army

  https://info.5y1.org/privacy-act-statement-form_1_99ae47.html

  Title: ccfm133-R.pdf Author: U.S. Army Subject: Privacy Act Statement Army Senior ROTC Disenrollment Proceedings Pam 145-4 Keywords: Privacy Act, Statement, Form, 133 ...

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• [PDF File]FBI Privacy Act Statement

  https://info.5y1.org/privacy-act-statement-form_1_5cc97e.html

  Noncriminal Justice Applicant’s Privacy Rights. As an applicant who is the subject of a national fingerprint-based criminal history record check for a noncriminal ...

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• [PDF File]PRIVACY ACT STATEMENT - Navy

  https://info.5y1.org/privacy-act-statement-form_1_63c064.html

  PRIVACY ACT STATEMENT . DATA REQUIRED BY THE PRIVACY ACT OF 1974 _____ PRIVACY ACT STATEMENT . For Personal Information Taken During . Inspector General Interviews _____ AUTHORITY: Title 10, U.S. Code, Sections 5014 and 5020 . PURPOSE: To determine the facts and circumstances surrounding allegations or complaints against ...

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• [PDF File]PRIVACY ACT STATEMENT/E(3) NOTICE GUIDANCE AND TEMPLAT E - DHS

  https://info.5y1.org/privacy-act-statement-form_1_cc2379.html

  Privacy Act Statements should only be used for information collections that will be stored in a Privacy Act System of Records. To include a “Privacy Act Statement ...

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• [PDF File]PRIVACY ACT STATEMENT - Federal Aviation Administration

  https://info.5y1.org/privacy-act-statement-form_1_4bc1a3.html

  (n)Other possible routine uses published in the Federal Register (see Prefatory Statement of General Routine Uses for additional uses (65 F.R. 19477-78) For example, a record from this system of records may be disclosed to the United States Coast Guard (Coast Guard) and to the Transportation Security Administration (TSA) if information from ...

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• [PDF File]DHS Privacy Act Statement

  https://info.5y1.org/privacy-act-statement-form_1_1dc872.html

  REQUIREMENT PRIVACY ACT STATEMENT ... DHS is authorized to collect the information requested on this form pursuant to: Sections 501, 503, 504, and 508 of the Rehabilitation Act of 1973, 29 U.S.C. § 791, as amended, and 29 CFR § 1614.203; Section 202(d) of the E-Government Act of 2002,

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• [PDF File]Privacy Act Statement Enterprise Agency Template

  https://info.5y1.org/privacy-act-statement-form_1_d56b47.html

  This privacy act statement is located on the back of the FD-258 fingerprint card. Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 28 U.S.C. 534. Depending on the nature of your

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• [PDF File]MEDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE PRIVACY ACT ... - GSA

  https://info.5y1.org/privacy-act-statement-form_1_7c4275.html

  symptoms, diagnosis, treatment, treating organization (sign each entry) standard form 600 (rev. 11/2010) back

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• [PDF File]INFORMATION FOR APPLICANT I -----1 Privacy Act Statement

  https://info.5y1.org/privacy-act-statement-form_1_6543b6.html

  Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a

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• [PDF File]Privacy Act Statement - United States Army

  https://info.5y1.org/privacy-act-statement-form_1_d8cc4e.html

  Penalty: The penalty for willfully making a false claim/statement is a maximum of $10,000 or maximum imprisonment of five years, or both (U.S. Code, Title 18, Section 287). If I am separated prior to my ETS, I consent to withholding from current pay, final pay, or any other money due me to satisfy this indebtedness. I

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• [PDF File]PRIVACY ACT STATEMENT AUTHORITY: PRINCIPAL PURPOSE(S ... - DigitalVA

  https://info.5y1.org/privacy-act-statement-form_1_653ed3.html

  PRIVACY ACT STATEMENT AUTHORITY: Public Law 111-292, Telework Enhancement Act of 2010, and VA Handbook 5011, Part II, Chapter 4. ... The employee's official duty station is documented on the most recent Standard Form (SF) 50, Notification of Personnel Action, for such purposes as determining special salary rates, locality pay adjustments, and ...

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• DATA REQUIRED BY THE PRVACY ACT OF 1974 - United States Marine Corps

  I have read and understand this statement, I understand that I may have the opportunity to review published systems notices and current Marine Corps directives which pertain to forms which I am asked to complete. Date Signature of the Individual Social Security No. PRIVACY ACT STATEMENT FOR MARINE CORPS PERSONNEL AND PAY RECORDS

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• [PDF File]Authorization for the Release of Information/ Privacy Act Notice

  https://info.5y1.org/privacy-act-statement-form_1_7910de.html

  Assistance Amendments Act of€1988, as amended by Section 903 of the Housing and Community Development Act of 1992 and Section€3003 of the Omnibus Budget Reconciliation Act of 1993. This law is found at 42 U.S.C. 3544. This law requires that you sign a consent form authorizing: (1) HUD and the Housing Agency/Authority (HA) to request verifi-

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• [PDF File]APPLICANT NOTIFICATION AND ACKNOWLEDGEMENT NYDFS Privacy Act Statement

  https://info.5y1.org/privacy-act-statement-form_1_38486a.html

  As an applicant who is the subject of a national fingerprint-based criminal history record check for a noncriminal justice purpose (such as an application for employment or a license, an immigration or naturalization matter,

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• PRIVACY ACT STATEMENT - FedIdCard

  PRIVACY ACT STATEMENT AUTHORITY: E.O. 9397. PRINCIPAL PURPOSE(S): To collect social security number and other personal identifiers during the certification registration process, to ensure positive identification of the subscriber who signs this form. ROUTINE USES: Information is used in the PIV registration process.

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