Role of PAS in the Privacy Act

Size: px
Start display at page:

Download "Role of PAS in the Privacy Act"

Transcription

1 Writing and Using Privacy Act Statements (PAS) Arlington, VA May 12, 2014 Presented by: Sarah English, Department of Defense Role of PAS in the Privacy Act To establish a Code of Fair Information Practices which requires agencies to comply with statutory norms for collection, maintenance, and dissemination of records. Mandates Addressed by PAS Inform people at the time of collection: why the information is being collected; how it will be used. Publish a notice in the Federal Register of new, altered, amended, or deleted systems of records. Ensure that information is accurate, relevant, timely, and complete before disclosing to others. 1

2 Collecting Personal Information The goal of the Privacy Act is to directly solicit information from the individual. Why? Accuracy! When directly soliciting personal information from an individual, they must be provided a Privacy Act Statement (PAS) Privacy Act Statements (PAS) No generic statements since we rely on the specific Privacy Act systems of records notices to shed light on what and why we are collecting. The PAS should provided at the point of collection and address the following four areas: Authority Purpose Routine Uses Disclosure When Does One Need a Privacy Act Statement? When an individual is asked to provide personal information (name, date of birth, Social Security Number (SSN), etc.) that will be stored in a system of records, regardless of the method used to collect the information (i.e., forms, in person or telephone interview, etc.) Note: If the information requested will not be included in a system of records, a PAS is not required (unless collecting an SSN). 2

3 Writing a Privacy Act Statement AUTHORITY reflects the Federal law or Executive Order that authorizes the collection of the information. It should reflect the information in the Authority for Maintenance section of the SORN (e.g., 5 U.S.C. 301, PL or Executive Order 9397 (SSN), Departmental Regulations). PURPOSE provides information about how the Agency will use the PII, by whom and how this serves the agency s objectives. It should reflect the information that t is contained in the Purpose section of the SORN. ROUTINE USES provides information about inter-governmental sharing of an individual s PII. Applies to the information collected on the form itself. May include all (or a specific) routine uses identified in the SORN covering the collection. Blanket Routine Uses that may apply must be cited. 3

4 DISCLOSURE reflects whether or not the disclosure of information is "Voluntary" or "Mandatory. It is only appropriate to cite "Mandatory" when a Federal Law or E.O. specifically imposes a requirement to furnish the information and provides a penalty for failure to do so. If furnishing information is a condition for granting a benefit or privilege voluntarily sought by the individual, it is voluntary for the individual to provide the information. The DISCLOSURE section in most PAS s reads: DISCLOSURE: Voluntary. However, failure to provide the requested information may result in (i.e., you not being considered for the position; not being notified in case of emergency; etc.) Enhanced PAS OMB requests additional information if collection is subject to the Paperwork Reduction Act: Purpose: Include link to applicable SORN. Routine Use: Must include all applicable routine uses and link to Agency blanket routine uses. Disclosure: Must include specific use of SSN (if collected). 4

5 Does the PAS have to appear on the form? Yes, or on a separate form that can be retained by the individual collecting the information. If the information is collected by means other than a form completed by the individual (i.e., solicited over the telephone), a PAS should be read to the individual and if requested by the individual, a copy sent to him/her. Where should the PAS be Placed? The preferred locations for PASs are: Immediately below the title of the form. Elsewhere on the front page of the form (clearly indicating it is the PAS). On the back of the form with a notation of its location before the title of the form, or On a separate form which the individual may keep. As a click through for web-based collections. Signing the PAS Does the individual have to sign the PAS? No. 5

6 Now you know how to write a PAS! Questions? 6

Privacy Act of 1974: A Basic Overview. Purpose of the Act. Congress goals. ASAP Conference: Arlington, VA Monday, July 27, 2015, 9:30-10:45am

Privacy Act of 1974: A Basic Overview. Purpose of the Act. Congress goals. ASAP Conference: Arlington, VA Monday, July 27, 2015, 9:30-10:45am Privacy Act of 1974: A Basic Overview 1 ASAP Conference: Arlington, VA Monday, July 27, 2015, 9:30-10:45am Presented by: Jonathan Cantor, Deputy CPO, Dep t of Homeland Security (DHS) Alex Tang, Attorney,

More information

PRIVACY ACT OVERVIEW The Basic Concepts of the Act

PRIVACY ACT OVERVIEW The Basic Concepts of the Act PRIVACY ACT OVERVIEW The Basic Concepts of the Act FOIA/Privacy Act Training Approved by: Samuel P. Jenkins, Director, Defense Privacy and Civil Liberties Office 1901 South Bell Street, Suite 920 Arlington,

More information

Application for Airport AOA Identification Media

Application for Airport AOA Identification Media Initial Renewal Airport Security Badging Office 700 Catalina Drive, Suite 110 Daytona Beach, Florida 32114 (386)-248-8030 Application for Airport AOA Identification Media Last Name First Name Middle Name

More information

Are There Cases When You Should Not Use This Form? What Information Is Needed to Search for USCIS Records? Verification of Identity in Person.

Are There Cases When You Should Not Use This Form? What Information Is Needed to Search for USCIS Records? Verification of Identity in Person. Department of Homeland Security U.S. Citizenship and Immigration Services OMB No. 1653-0030; Expires 08/31/05 G-639, Freedom of Information/ Privacy Act Request Instructions NOTE: Please read all Instructions

More information

MANHATTAN SCHOOL DISTRICT NO. 3 Application for Classified / Coaching / Activities / Substitute Teaching Employment

MANHATTAN SCHOOL DISTRICT NO. 3 Application for Classified / Coaching / Activities / Substitute Teaching Employment District Use Only Date Completed Application Received: SS Card Driver s license TB Test W-4 I-9 Other Background Check: Form received Date requested Date received Hiring personnel review record. Please

More information

A Basic Overview of The Privacy Act of 1974

A Basic Overview of The Privacy Act of 1974 A Basic Overview of The Privacy Act of 1974 Denver, CO June 17, 2015 Presented by: Michael E. Reheuser Department of Defense What are today s goals? Gain a basic understanding of: The Privacy Act Compliance

More information

*The following steps must be completed BEFORE a badging application will be accepted.

*The following steps must be completed BEFORE a badging application will be accepted. *The following steps must be completed BEFORE a badging application will be accepted. 1. You must know what type of badge you are applying for; SIDA, NON-SIDA, or STERILE. 2. Access control media applications

More information

1. You could not reasonably have been expected to know of the discriminatory act within the 180-day period;

1. You could not reasonably have been expected to know of the discriminatory act within the 180-day period; AD-3027 (1/19/12) OMB Control Number 0508-0002 UNITED STATES DEPARTMENT OF AGRICULTURE (USDA) Office of the Assistant Secretary for Civil Rights USDA Program Discrimination Complaint Form Instructions

More information

DEPARTMENT OF DEFENSE BILLING CODE Defense Contract Audit Agency (DCAA) Privacy Act Program

DEPARTMENT OF DEFENSE BILLING CODE Defense Contract Audit Agency (DCAA) Privacy Act Program This document is scheduled to be published in the Federal Register on 02/06/2014 and available online at http://federalregister.gov/a/2014-01882, and on FDsys.gov DEPARTMENT OF DEFENSE BILLING CODE 5001-06

More information

GAPS REGISTRATION PROCESS FOR WHITFIELD COUNTY SCHOOLS

GAPS REGISTRATION PROCESS FOR WHITFIELD COUNTY SCHOOLS GAPS REGISTRATION PROCESS FOR WHITFIELD COUNTY SCHOOLS 1. Access the GAPS website at https://www.aps.gemalto.com/ga/index.htm 2. Click on Applicant Registration 3. Select EDUCATION AGENCIES (EA) 4. Select

More information

proposes to add a new system of records in its inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C.

proposes to add a new system of records in its inventory of record systems subject to the Privacy Act of 1974 (5 U.S.C. 1 This document is scheduled to be published in the Federal Register on 09/13/2012 and available online at http://federalregister.gov/a/2012-22549, and on FDsys.gov Billing Code: 5001-06 DEPARTMENT OF

More information

The Privacy Act. Disclaimers. Paul Klingenberg 6/14/2017 PRIVACY ACT AND SYSTEMS OF RECORDS 1

The Privacy Act. Disclaimers. Paul Klingenberg 6/14/2017 PRIVACY ACT AND SYSTEMS OF RECORDS 1 Session 15 Federal Workers Compensation Conference 2017 June 28, 2017 Ashkea Herron McAllister United States Department of Labor Disclaimers This is NOT a comprehensive Privacy Act presentation it is specific

More information

WASHINGTON COUNTY GUIDELINES AND PROCEDURES FOR MINNESOTA GOVERNMENT DATA PRACTICES ACT

WASHINGTON COUNTY GUIDELINES AND PROCEDURES FOR MINNESOTA GOVERNMENT DATA PRACTICES ACT General Administration Policy #1300 - Manual WASHINGTON COUNTY GUIDELINES AND PROCEDURES FOR MINNESOTA GOVERNMENT DATA PRACTICES ACT Manual #1300 Adopted by the Washington County Board of Commissioners

More information

DEPARTMENT OF DEFENSE BILLING CODE

DEPARTMENT OF DEFENSE BILLING CODE This document is scheduled to be published in the Federal Register on 03/10/2015 and available online at http://federalregister.gov/a/2015-05374, and on FDsys.gov DEPARTMENT OF DEFENSE BILLING CODE 5001-06

More information

University of Wollongong

University of Wollongong University of Wollongong Privacy Management Plan September 2004 EXTERNAL USE Management_Plan September 2004 TABLE OF CONTENTS 1. INTRODUCTION...1 1.1 Definitions...1 1.2 Our Commitment to Privacy...1 2.

More information

DEPARTMENT OF DEFENSE Defense Commissary Agency Fort Lee, VA DIRECTIVE

DEPARTMENT OF DEFENSE Defense Commissary Agency Fort Lee, VA DIRECTIVE DEPARTMENT OF DEFENSE Defense Commissary Agency Fort Lee, VA 23801-1800 DIRECTIVE Publications and Forms Program DeCAD 5-1 Corporate Operations Group OPR: HQ DeCA/COG References: See Enclosure 1 1. PURPOSE.

More information

MEEKER COUNTY GUIDELINES AND PROCEDURES FOR MINNESOTA GOVERNMENT DATA PRACTICES ACT

MEEKER COUNTY GUIDELINES AND PROCEDURES FOR MINNESOTA GOVERNMENT DATA PRACTICES ACT MEEKER COUNTY GUIDELINES AND PROCEDURES FOR MINNESOTA GOVERNMENT DATA PRACTICES ACT Adopted by the Meeker County Board of Commissioners November 2010 Implemented: November 2010 MINNESOTA GOVERNMENT DATA

More information

REDMOND MUNICIPAL AIRPORT INITIAL ID APPLICATION AOA ID

REDMOND MUNICIPAL AIRPORT INITIAL ID APPLICATION AOA ID REDMOND MUNICIPAL AIRPORT INITIAL ID APPLICATION AOA ID AIRPORT USE - DATE RECEIVED NAME: LAST NAME LEGAL FIRST NAME MIDDLE NAME ALL - NICK NAMES / FORMER NAMES / ALIAS: ID PIN = LAST - 4 OF SSN OR PHONE

More information

BADGE APPLICATION FORM KALAMAZOO / BATTLE CREEK INTERNATIONAL AIRPORT

BADGE APPLICATION FORM KALAMAZOO / BATTLE CREEK INTERNATIONAL AIRPORT BADGE APPLICATION FORM KALAMAZOO / BATTLE CREEK INTERNATIONAL AIRPORT APPLICATION PAPERWORK MUST BE SUBMITTED BY THE APPLICANT IN PERSON, ALONG WITH ORIGINAL FORMS OF IDENTIFICATION AS DESCRIBED HEREIN.

More information

Alias - Last Name Alias - First Name Alias - Middle Name. Alias - Last Name Alias - First Name Alias - Middle Name

Alias - Last Name Alias - First Name Alias - Middle Name. Alias - Last Name Alias - First Name Alias - Middle Name Savannah / Hilton Head International Airport Identification Badge Request / CHRC /S.I.D.A. &/or AOA Driver s Record / Parking Request Work 912-964-7501 ext 4424 or 4425 Fax 912-662-7113 pjones@savannahairport.com

More information

GENERAL AVIATION ACCESS APPLICATION

GENERAL AVIATION ACCESS APPLICATION GENERAL AVIATION ACCESS APPLICATION Updated November 2018 DRIVERS LICENSE COMPANY: No L NM M FOR OFFICIAL USE ONLY Accounting Form Received & Reviewed Received/ Reviewed Application Appropriate Forms of

More information

AIRPORT SECURITY IDENTIFICATION BADGE APPLICATION

AIRPORT SECURITY IDENTIFICATION BADGE APPLICATION AIRPORT SECURITY IDENTIFICATION BADGE APPLICATION PRINT all information in the box below before returning this form to the Airport Operations Control Center. NAME (LAST, FIRST, MIDDLE) G ALIAS(ES) SOCIAL

More information

ID ACCESS BADGE APPLICATION FOR AOA and NON-SIDA

ID ACCESS BADGE APPLICATION FOR AOA and NON-SIDA ID ACCESS BADGE APPLICATION FOR AOA and NON-SIDA 3880 NE 39 th Avenue, Suite A Airport Operations Dept. Gainesville, Fl 32609 Phone: 352-373-0249 Fax: 352-374-8368 AIRPORT OFFICE USE ONLY BADGE TYPE BADGE

More information

U.S. Victims of State Sponsored Terrorism Fund Application Form OMB No Expires 1/31/2017

U.S. Victims of State Sponsored Terrorism Fund Application Form OMB No Expires 1/31/2017 Instructions: Please complete the questions included in this Application (the ) as your submission for compensation from the United States Victims of State Sponsored Terrorism Fund (the Fund ). If you

More information

Codified at 5 U.S.C. 552a. Passed in 1974, became effective September 27, Act passed in haste as an outgrowth of Watergate reforms and the

Codified at 5 U.S.C. 552a. Passed in 1974, became effective September 27, Act passed in haste as an outgrowth of Watergate reforms and the INTERFACE: Freedom of Information Act & Privacy Act Ramona Branch Oliver U.S. Department of Labor ASAP 7 th Annual National Training Conference May 12-14, 14, 2014 The Statutes Codified at 5 U.S.C. 552.

More information

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION St. Cloud Regional Airport 1550 45 th Avenue Southeast, Suite #1 NEW St. Cloud, MN 56304-9535 (320) 255-7292 RENEWAL www.stcloudairport.com SECTION 1 - APPLICANT INFORMATION (Full Legal Name) BADGE # ST.

More information

DEPARTMENT OF HOMELAND SECURITY. U.S. Customs and Border Protection [ ] NAFTA Regulations and Certificate of Origin

DEPARTMENT OF HOMELAND SECURITY. U.S. Customs and Border Protection [ ] NAFTA Regulations and Certificate of Origin This document is scheduled to be published in the Federal Register on 05/16/2014 and available online at http://federalregister.gov/a/2014-11290, and on FDsys.gov [9111-14] DEPARTMENT OF HOMELAND SECURITY

More information

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION St. Cloud Regional Airport 1550 45 th Avenue Southeast, Suite #1 NEW St. Cloud, MN 56304-9535 (320) 255-7292 RENEWAL www.stcloudairport.com SECTION 1 - APPLICANT INFORMATION (Full Legal Name) BADGE # ST.

More information

TRICARE Operations Manual M, April 1, 2015 Administration. Chapter 1 Section 5

TRICARE Operations Manual M, April 1, 2015 Administration. Chapter 1 Section 5 Administration Chapter 1 Section 5 Revision: 1.0 GENERAL 1.1 Contractors shall comply with all federal laws which apply to the administration of TRICARE health plans. In many situations where federal law

More information

Instructions for Record of Abandonment of Lawful Permanent Resident Status

Instructions for Record of Abandonment of Lawful Permanent Resident Status Instructions for Record of Abandonment of Lawful Permanent Resident Status Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-407 OMB No. 1615-0130 Expires 02/28/2017

More information

ORLANDO SANFORD INTERNATIONAL AIRPORT AIRPORT ID BADGE APPLICATION

ORLANDO SANFORD INTERNATIONAL AIRPORT AIRPORT ID BADGE APPLICATION ORLANDO SANFORD INTERNATIONAL AIRPORT AIRPORT ID BADGE APPLICATION PAGE 1 A COPY OF REQUIRED DOCUMENTATION FOR IDENTIFICATION AND WORK AUTHORIZATION MUST BE ATTACHED TO THIS DOCUMENT COMPANY/T-HANGAR NAME:

More information

MUST BE PRINTED IN COLOR

MUST BE PRINTED IN COLOR MUST BE PRINTED IN COLOR LAREDO INTERNATIONAL AIRPORT ACCESS MEDIA APPLICATION INSTRUCTIONS STEP 1-- STEP 2-- STEP 3-- STEP 5-- FILL OUT THE ACCESS MEDIA APPLICATION ENTIRELY. MAKE SURE TO USE BLUE INK.

More information

FEDERAL CERTIFICATIONS Sponsored Center

FEDERAL CERTIFICATIONS Sponsored Center The undersigned states that: FEDERAL CERTIFICATIONS Sponsored Center 1. He or she is the duly authorized representative of the Contractor named below; 2. He or she is authorized to make, and does hereby

More information

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION St. Cloud Regional Airport 1550 45 th Avenue Southeast, Suite #1 NEW St. Cloud, MN 56304-9535 (320) 255-7292 RENEWAL www.stcloudairport.com BADGE # ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

More information

The Army Privacy Program

The Army Privacy Program Army Regulation 25 22 Information Management The Army Privacy Program UNCLASSIFIED Headquarters Department of the Army Washington, DC 22 December 2016 SUMMARY of CHANGE AR 25 22 The Army Privacy Program

More information

TEMPLATE: DO NOT SEND TO NFA NATIONAL FUTURES ASSOCIATION

TEMPLATE: DO NOT SEND TO NFA NATIONAL FUTURES ASSOCIATION Instructions for Using the Exempt Foreign Firm Application Template This document is not an application form. Do not send this document to NFA. It is a template that you may use to assist in filing the

More information

T. F. GREEN AIRPORT (PVD) - SECURITY BADGE APPLICATION SIGNATORY: (PRINT NAME ONLY APPROVED SIGNATORY ON FILE CAN SIGN APPLICATION)

T. F. GREEN AIRPORT (PVD) - SECURITY BADGE APPLICATION SIGNATORY: (PRINT NAME ONLY APPROVED SIGNATORY ON FILE CAN SIGN APPLICATION) RHODE ISLAND AIRPORT CORPORATION BADGING OFFICE T. F. Green Airport 2000 Post Road Warwick, R.I. 02886 Phone: (401) 691-2000 ext. 270 OR 256 Fax: (401) 691-2569 T. F. GREEN AIRPORT (PVD) - SECURITY BADGE

More information

GUIDELINE FOR PROTECTION OF PERSONAL INFORMATION

GUIDELINE FOR PROTECTION OF PERSONAL INFORMATION GUIDELINE FOR PROTECTION OF PERSONAL INFORMATION (February 9, 2005) (Purpose) Article 1 The purpose of the Guideline for Protection of Personal Information (hereinafter referred to as Guideline ) is to

More information

Teacher Education Programs Background Check Requirements

Teacher Education Programs Background Check Requirements Date Received: Received By: Teacher Education Programs Background Check Requirements Application Instructions Complete and submit this application: You have the obligation to complete, sign, and have notarized

More information

GENERAL AVIATION APPLICATION

GENERAL AVIATION APPLICATION GENERAL AVIATION APPLICATION INSTRUCTION SHEET FOR COMPLETING THE BOISE AIRPORT GA APPLICATION (Revised October 2017) The application must be filled out legibly and completely. If not, the application

More information

INSTRUCTIONS FOR FILLING OUT THE BOISE AIR TERMINAL - APPLICATION FOR NON SIDA AOA ACCESS BADGE. Revised October 19, 2016

INSTRUCTIONS FOR FILLING OUT THE BOISE AIR TERMINAL - APPLICATION FOR NON SIDA AOA ACCESS BADGE. Revised October 19, 2016 AOA INSTRUCTIONS FOR FILLING OUT THE BOISE AIR TERMINAL - APPLICATION FOR NON SIDA AOA ACCESS BADGE Revised October 19, 2016 AOA NOTE: The application must be filled out legibly and completely. If not,

More information

NON SIDA VEHICLE ACCESS BADGE/GA

NON SIDA VEHICLE ACCESS BADGE/GA P INSTRUCTIONS FOR FILLING OUT THE BOISE AIR TERMINAL - APPLICATION FOR NON SIDA VEHICLE ACCESS BADGE/GA Revised October 19, 2016 P NOTE: The application must be filled out legibly and completely. If not,

More information

To schedule an Application Processing Appointment

To schedule an Application Processing Appointment REDMOND MUNICIPAL AIRPORT (RDM) Secured & Sterile Area ID Application THIS PAGE FOR APPLICANT TO KEEP Identification badges issued by Redmond Municipal Airport (RDM) are, and remain, property of the Airport.

More information

Last Name First Name Middle Name. At: (City/Providence/State/Country) 4. Signature: Date:

Last Name First Name Middle Name. At: (City/Providence/State/Country) 4. Signature: Date: Department of Homeland Security U.S. Citizenship and Immigration Services OMB No. 1615-0025 I-508, Waiver of Rights, Privileges, Exemptions and Immunities (Under Section 247(b) of the INA) Type or print

More information

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION St. Cloud Regional Airport 1550 45 th Avenue Southeast, Suite #1 NEW St. Cloud, MN 56304-9535 (320) 255-7292 RENEWAL www.stcloudairport.com BADGE # ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

More information

ETA Form 9089 U.S. Department of Labor

ETA Form 9089 U.S. Department of Labor Please read and review the filing instructions before completing this form. A copy of the instructions can be found at http://workforcesecurity.doleta.gov/foreign/. Employing or continuing to employ an

More information

City of Midland. Freedom of Information Act. (P.A. 442 of 1976, as amended) Administrative Policy

City of Midland. Freedom of Information Act. (P.A. 442 of 1976, as amended) Administrative Policy City of Midland FOIA Policy Page 1 of 4 City of Midland Freedom of Information Act (P.A. 442 of 1976, as amended) Administrative Policy I. Purpose. Public Act 442 of 1976, commonly known as the Freedom

More information

THE PRIVACY ACT OF 1974 (As Amended) Public Law , as codified at 5 U.S.C. 552a

THE PRIVACY ACT OF 1974 (As Amended) Public Law , as codified at 5 U.S.C. 552a THE PRIVACY ACT OF 1974 (As Amended) Public Law 93-579, as codified at 5 U.S.C. 552a Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, that

More information

OSHA-7 Form ( Notice of Alleged Safety and Health Hazard ); Extension of. the Office of Management and Budget s Approval of Information Collection

OSHA-7 Form ( Notice of Alleged Safety and Health Hazard ); Extension of. the Office of Management and Budget s Approval of Information Collection This document is scheduled to be published in the Federal Register on 01/24/2014 and available online at http://federalregister.gov/a/2014-01357, and on FDsys.gov DEPARTMENT OF LABOR Occupational Safety

More information

ROSWELL POLICE DEPARTMENT INTERNSHIP APPLICATION 1854

ROSWELL POLICE DEPARTMENT INTERNSHIP APPLICATION 1854 ROSWELL POLICE DEPARTMENT INTERNSHIP APPLICATION 1854 Applicant s Name: (Last) (First) (MI) Applicant s Address: City: State: Zip Code: Cell Phone Number: Email Address: Date of Birth: SSN: OLN: Are you

More information

Privacy Act of 1974, as Amended; Computer Matching Program (Social Security

Privacy Act of 1974, as Amended; Computer Matching Program (Social Security This document is scheduled to be published in the Federal Register on 07/06/2015 and available online at http://federalregister.gov/a/2015-16433, and on FDsys.gov 4191-02U SOCIAL SECURITY ADMINISTRATION

More information

Occupational License Application

Occupational License Application West Virginia Lottery Commission 900 Pennsylvania Avenue, Charleston, WV 25302 Occupational License Application INSTRUCTIONS This form is authorized under Article 22C of the 2007 West Virginia Lottery

More information

United States Patent and Trademark Office. Substantive Submissions Made During Prosecution of the

United States Patent and Trademark Office. Substantive Submissions Made During Prosecution of the This document is scheduled to be published in the Federal Register on 06/23/2014 and available online at http://federalregister.gov/a/2014-14511, and on FDsys.gov 3510-16-P DEPARTMENT OF COMMERCE United

More information

Federal Criminal Background Check

Federal Criminal Background Check Federal Criminal Background Check The College of Education at Montana State University Billings (MSUB) requires that a national criminal history background check, including fingerprinting, to be completed

More information

Instructions for Applying to be Reinstated After 5 Years

Instructions for Applying to be Reinstated After 5 Years Instructions for Applying to be Reinstated After 5 Years If you have been inactive for more than five consecutive years as a real estate salesperson or broker you must complete this application. If your

More information

THE MEDICAL COUNCIL OF HONG KONG

THE MEDICAL COUNCIL OF HONG KONG THE MEDICAL COUNCIL OF HONG KONG GUIDANCE NOTES TO APPLICANTS FOR LIMITED REGISTRATION UNDER PROMULGATION NO. 10 Employment by a firm of solicitors registered by the Law Society of Hong Kong to carry out

More information

GRAND RONDE GAMING COMMISSION

GRAND RONDE GAMING COMMISSION GRAND RONDE GAMING COMMISSION Gaming License Last Name First Name Middle Name Aliases ( Please list name and indicate whether name is nickname, maiden name, other name change(s) - whether legal or otherwise.)

More information

Section 5310 (Formerly Section 16)/ Community Transportation NON-VEHICLE 8/20/2009

Section 5310 (Formerly Section 16)/ Community Transportation NON-VEHICLE 8/20/2009 D. BID FORMS Section 5310 (Formerly Section 16)/ Community Transportation NON-VEHICLE 8/20/2009 D.1 BID PROPOSAL FORM D.2 BUY AMERICA CERTIFICATION D.3 PENNSYLVANIA STEEL PRODUCTS PROCUREMENT ACT CERTIFICATION

More information

ID ACCESS BADGE APPLICATION FOR SECURED AREA/SECURITY IDENTIFICATION DISPLAY AREA (SIDA) / STERILE AREA

ID ACCESS BADGE APPLICATION FOR SECURED AREA/SECURITY IDENTIFICATION DISPLAY AREA (SIDA) / STERILE AREA ID ACCESS BADGE APPLICATION FOR SECURED AREA/SECURITY IDENTIFICATION DISPLAY AREA (SIDA) / STERILE AREA SECTION 1 TODAY S DATE: PROVIDE FULL LEGAL NAME 3880 NE 39 th Avenue, Suite A Airport Operations

More information

ROCHESTER INTERNATIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

ROCHESTER INTERNATIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION ROCHESTER INTERNATIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION BADGE # NEW AIRPORT BADGE BADGE RENEWAL ACCESS TYPE SECTION 1 APPLICANT INFORMATION Present this application along with two (2) forms

More information

NEW YORK CITY TRANSIT AUTHORITY. Division of Materiel. Schedule F

NEW YORK CITY TRANSIT AUTHORITY. Division of Materiel. Schedule F NEW YORK CITY TRANSIT AUTHORITY Schedule F FEDERAL CERTIFICATION, DISCLOSURE, DISADVANTAGED BUSINESS ENTERPRISE AND EQUAL EMPLOYMENT OPPORTUNITY FORMS Page No. Certification Regarding Debarment, Suspension,

More information

Application for Airport SIDA Identification Media. / / Company Name Company Phone Job Title

Application for Airport SIDA Identification Media. / / Company Name Company Phone Job Title Initial Renewal Airport Security Badging Office 700 Catalina Drive, Suite 110 Daytona Beach, Florida 32114 (386)-248-8030 Application for Airport SIDA Identification Media Last Name First Name Middle Name

More information

CHARLESTON COUNTY AVIATION AUTHORITY APPLICATION FOR AIRPORT AOA/PUBLIC AREA BADGE

CHARLESTON COUNTY AVIATION AUTHORITY APPLICATION FOR AIRPORT AOA/PUBLIC AREA BADGE STA APPROVAL CHARLESTON COUNTY AVIATION AUTHORITY APPLICATION FOR AIRPORT AOA/PUBLIC AREA BADGE Print or Type all Information SECTION I -- APPLICANT SSN: NAME (Last, First, Middle): HOME ADDRESS (Street,

More information

Cherokee County Fire & Emergency Services

Cherokee County Fire & Emergency Services Cherokee County Fire & Emergency Services Application for the Position of: VOLUNTEER SERVICE REV.9/2010 CHEROKEE COUNTY FIRE & EMERGENCY SERVICES 150 Chattin Drive, Canton, GA 30115 678-493-4000 (phone)

More information

803 CMR: DEPARTMENT OF CRIMINAL JUSTICE INFORMATION SERVICES 803 CMR 11.00: CONSUMER REPORTING AGENCY (CRA) Section

803 CMR: DEPARTMENT OF CRIMINAL JUSTICE INFORMATION SERVICES 803 CMR 11.00: CONSUMER REPORTING AGENCY (CRA) Section 803 CMR 11.00: CONSUMER REPORTING AGENCY (CRA) Section 11.01: Purpose and Scope 11.02: Definitions 11.03: icori Registration 11.04: Access to CORI by a CRA to Evaluate a Subject 11.05: Procedures for Requesting

More information

ASSEMBLY, No STATE OF NEW JERSEY. 218th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 2018 SESSION

ASSEMBLY, No STATE OF NEW JERSEY. 218th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 2018 SESSION ASSEMBLY, No. 0 STATE OF NEW JERSEY th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 0 SESSION Sponsored by: Assemblyman JAMES J. KENNEDY District (Middlesex, Somerset and Union) Assemblyman KEVIN J. ROONEY

More information

Name {Last, First, Middle} Social Security Number: Check ( )Yes / ( ) No To submit to TSA Clearinghouse Print your Social Security Number Below

Name {Last, First, Middle} Social Security Number: Check ( )Yes / ( ) No To submit to TSA Clearinghouse Print your Social Security Number Below Savannah / Hilton Head International Airport Identification Badge Request / CHRC /S.I.D.A. &/or AOA Driver s Record / Parking Request Work 912-964-7501 ext 4424 or 4425 Fax 912-965-2727 pjones@savannahairport.com

More information

CHARLESTON COUNTY AVIATION AUTHORITY APPLICATION FOR AIRPORT AOA/PUBLIC AREA BADGE

CHARLESTON COUNTY AVIATION AUTHORITY APPLICATION FOR AIRPORT AOA/PUBLIC AREA BADGE SECURITY DEPARTMENT USE ONLY: FP STA CHARLESTON COUNTY AVIATION AUTHORITY APPLICATION FOR AIRPORT AOA/PUBLIC AREA BADGE Print or Type all Information SECTION I -- APPLICANT SSN: NAME (Last, First, Middle):

More information

APPLICATION FOR A SUPPORT STAFF POSITION 505 West Burkhart St Malden, MO 63863

APPLICATION FOR A SUPPORT STAFF POSITION 505 West Burkhart St Malden, MO 63863 APPLICATION FOR A SUPPORT STAFF POSITION 505 West Burkhart St Malden, MO 63863 The Malden R-1 School District Board of Education does not discriminate on basis of race, color, religion, sex, national origin,

More information

Documents Required With Application. Sky Dancer Casino & Resort

Documents Required With Application. Sky Dancer Casino & Resort 3965 Sky Dancer Way N.E. PO Box 1449 Belcourt ND 58316 www.skydancercasino.com Documents Required With Application Resume should be attached with the following 1. Two forms of Identification 2. High School

More information

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF GEORGIA ATLANTA DIVISION

IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF GEORGIA ATLANTA DIVISION IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF GEORGIA ATLANTA DIVISION JAMES CAMP, ) ) Plaintiff, ) CIVIL ACTION FILE NO. ) v. ) ) BETTY B. CASON in her official) capacity as Probate

More information

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION St. Cloud Regional Airport 1550 45 th Avenue Southeast, Suite #1 NEW St. Cloud, MN 56304-9535 (320) 255-7292 RENEWAL www.stcloudairport.com BADGE # ST. CLOUD REGIONAL AIRPORT FINGERPRINTING AND BADGE APPLICATION

More information

Agency Information Collection Activities; Submission for OMB Review; Comment

Agency Information Collection Activities; Submission for OMB Review; Comment This document is scheduled to be published in the Federal Register on 05/06/2016 and available online at http://federalregister.gov/a/2016-10680, and on FDsys.gov BILLING CODE: 4510-26-P DEPARTMENT OF

More information

(Please print legibly) SECTION A PERSONAL INFORMATION SECTION B - CRIMINAL CONVICTIONS. NO Skip Section B

(Please print legibly) SECTION A PERSONAL INFORMATION SECTION B - CRIMINAL CONVICTIONS. NO Skip Section B Bureau of Emergency Medical Services Emergency Medical Services Vehicle Operator (EMSVO) Application (Please print legibly) SECTION A PERSONAL INFORMATION Last Name (include Maiden Name, if applicable)

More information

NEW YORK CITY TRANSIT AUTHORITY. Division of Materiel. Schedule W. Compliance with NYS State Finance Law Sections 139-j and 139-k ( Lobbying Law )

NEW YORK CITY TRANSIT AUTHORITY. Division of Materiel. Schedule W. Compliance with NYS State Finance Law Sections 139-j and 139-k ( Lobbying Law ) NEW YORK CITY TRANSIT AUTHORITY Division of Materiel Schedule W Compliance with NYS State Finance Law Sections 139-j and 139-k ( Lobbying Law ) Solicitation No.: 9/06 NEW YORK CITY TRANSIT AUTHORITY COMPLIANCE

More information

THIS SECTION SHOULD BE FILLED OUT BY LAFAYETTE AIRPORT BADGING OFFICE (FILL OUT IN INK) LFT ID Badge No. Expiration Date: Vehicle Tag/s:

THIS SECTION SHOULD BE FILLED OUT BY LAFAYETTE AIRPORT BADGING OFFICE (FILL OUT IN INK) LFT ID Badge No. Expiration Date: Vehicle Tag/s: Lafayette Regional Airport (LFT Category III) ID Badge Renewal / Replacement Form (Rev. July 2015) 222 Jet Ranger X Drive, Lafayette, LA 70508 337-266-4401 - Fax 337-266-4410 email airport@lftairport.com

More information

DEPARTMENT OF HOMELAND SECURITY. U.S. Customs and Border Protection [ ] Agency Information Collection Activities:

DEPARTMENT OF HOMELAND SECURITY. U.S. Customs and Border Protection [ ] Agency Information Collection Activities: This document is scheduled to be published in the Federal Register on 05/26/2016 and available online at http://federalregister.gov/a/2016-12439, and on FDsys.gov [9111-14] DEPARTMENT OF HOMELAND SECURITY

More information

DEPARTMENT OF HOMELAND SECURITY. U.S. Customs and Border Protection [ ] Agency Information Collection Activities:

DEPARTMENT OF HOMELAND SECURITY. U.S. Customs and Border Protection [ ] Agency Information Collection Activities: This document is scheduled to be published in the Federal Register on 02/21/2017 and available online at https://federalregister.gov/d/2017-03343, and on FDsys.gov DEPARTMENT OF HOMELAND SECURITY U.S.

More information

U.S. Army Garrison Fort A.P. Hill Instructions for Request for Unescorted Installation Access

U.S. Army Garrison Fort A.P. Hill Instructions for Request for Unescorted Installation Access U.S. Army Garrison Fort A.P. Hill Instructions for Request for Unescorted Installation Access This form is used to request unescorted access to U.S. Army Garrison, Fort A.P. Hill by U.S. citizens and Permanent

More information

DISCLOSURE CONTROLS AND PROCEDURES OF CLARCOR INC. These Disclosure Controls and Procedures have been designed with the objective of ensuring that:

DISCLOSURE CONTROLS AND PROCEDURES OF CLARCOR INC. These Disclosure Controls and Procedures have been designed with the objective of ensuring that: DISCLOSURE CONTROLS AND PROCEDURES OF CLARCOR INC. Objectives These Disclosure Controls and Procedures have been designed with the objective of ensuring that: corporate disclosure is accurate in all material

More information

VOLUNTARY DISCLOSURE AGREEMENT. The State of Florida Department of Financial Services, Division of Unclaimed Property, 200

VOLUNTARY DISCLOSURE AGREEMENT. The State of Florida Department of Financial Services, Division of Unclaimed Property, 200 DEPARTMENT OF FINANCIAL SERVICES Division of Unclaimed Property In Re: Case No. (Print Name of Holder) Respondent/Holder. / VOLUNTARY DISCLOSURE AGREEMENT The State of Florida Department of Financial Services,

More information

PUBLIC RECORDS INSPECTION AND DUPLICATION POLICY

PUBLIC RECORDS INSPECTION AND DUPLICATION POLICY BOROUGH OF MANHEIM PUBLIC RECORDS INSPECTION AND DUPLICATION POLICY In accordance with the Pennsylvania Right-to-Know Law, Act of February 14, 2008, P.L., No. 3, hereinafter referred to as the Law, the

More information

FOIA Exemptions 6 & 7C Personal Privacy Exemptions

FOIA Exemptions 6 & 7C Personal Privacy Exemptions FOIA Exemptions 6 & 7C Personal Privacy Exemptions Denver, Colorado June 17-18, 2015 Instructor Fred Sadler Consultant, FOI & Privacy Statutes Former FOI & Privacy Officer, FDA/HHS, Retired FOIA Exemptions

More information

FOIA Exemptions 6 & 7C Personal Privacy Exemptions

FOIA Exemptions 6 & 7C Personal Privacy Exemptions FOIA Exemptions 6 & 7C Personal Privacy Exemptions Chicago, Illinois September 4, 2014 FOIA Exemptions 6 & 7(C) Personal privacy interests are protected by 2 provisions of the FOIA Each exemption covers

More information

APPLICATION FOR AN ADMINISTRATIVE POSITION Malden R-I School District 505 West Burkhart Street Malden, MO 63863

APPLICATION FOR AN ADMINISTRATIVE POSITION Malden R-I School District 505 West Burkhart Street Malden, MO 63863 APPLICATION FOR AN ADMINISTRATIVE POSITION Malden R-I School District 505 West Burkhart Street Malden, MO 63863 The Malden R-1 School District Board of Education does not discriminate on basis of race,

More information

60-Day Notice of Proposed Information Collection: Application for Nonimmigrant

60-Day Notice of Proposed Information Collection: Application for Nonimmigrant This document is scheduled to be published in the Federal Register on 03/30/2018 and available online at https://federalregister.gov/d/2018-06496, and on FDsys.gov DEPARTMENT OF STATE [Public Notice 10260]

More information

European Data Protection Supervisor Transparency in the EU administration: Your right to access documents

European Data Protection Supervisor Transparency in the EU administration: Your right to access documents European Data Protection Supervisor Transparency in the EU administration: Your right to access documents EDPS factsheet 2 The European institutions and bodies make decisions and adopt legislation that

More information

What Happens After I Get Out? A Guide for Immigrants Seeking Release From Prolonged Detention at a Bond Hearing Under Rodriguez v. Robbins March 2016

What Happens After I Get Out? A Guide for Immigrants Seeking Release From Prolonged Detention at a Bond Hearing Under Rodriguez v. Robbins March 2016 LEGAL DEPARTMENT IMMIGRANTS RIGHTS PROJECT What Happens After I Get Out? A Guide for Immigrants Seeking Release From Prolonged Detention at a Bond Hearing Under Rodriguez v. Robbins March 2016 This guide

More information

STATE OF NEW JERSEY. SENATE, No th LEGISLATURE

STATE OF NEW JERSEY. SENATE, No th LEGISLATURE SENATE, No. STATE OF NEW JERSEY th LEGISLATURE INTRODUCED APRIL, 0 Sponsored by: Senator BRIAN P. STACK District (Hudson) Senator SANDRA B. CUNNINGHAM District (Hudson) SYNOPSIS Requires Secretary of State

More information

NEW YORK CITY TRANSIT AUTHORITY. Division of Materiel. Schedule W. Compliance with NYS State Finance Law Sections 139-j and 139-k ( Lobbying Law )

NEW YORK CITY TRANSIT AUTHORITY. Division of Materiel. Schedule W. Compliance with NYS State Finance Law Sections 139-j and 139-k ( Lobbying Law ) NEW YORK CITY TRANSIT AUTHORITY Division of Materiel Schedule W Compliance with NYS State Finance Law Sections 139-j and 139-k ( Lobbying Law ) Solicitation No.: 1/13 NEW YORK CITY TRANSIT AUTHORITY COMPLIANCE

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES. Administration for Children and Families

DEPARTMENT OF HEALTH AND HUMAN SERVICES. Administration for Children and Families This document is scheduled to be published in the Federal Register on 06/15/2015 and available online at http://federalregister.gov/a/2015-14465, and on FDsys.gov 4184-01 DEPARTMENT OF HEALTH AND HUMAN

More information

Interstate Commission for Adult Offender Supervision

Interstate Commission for Adult Offender Supervision Interstate Commission for Adult Offender Supervision Privacy Policy Interstate Compact Offender Tracking System Version 3.0 Approved 04/23/2009 Revised on 4/18/2017 1.0 Statement of Purpose The goal of

More information

Policy To Protect Personal Information

Policy To Protect Personal Information Policy To Protect Personal Information 1. Accountability 1.1. Melody Deeley is hereby appointed as the Personal Information Compliance Officer (the Officer ) for Summit Pacific College ( SPC ). 1.2. All

More information

AIRPORT IDENTIFICATION BADGE APPLICATION

AIRPORT IDENTIFICATION BADGE APPLICATION Airport Badge Types INSTRUCTIONS AOA Badge All individuals who require regular and routine access to the Airport Operations Area (AOA), which includes all areas of the airport inside the perimeter fencing

More information

STATE BOARD FOR TECHNICAL AND COMPREHENSIVE EDUCATION PROCEDURE FREEDOM OF INFORMATION

STATE BOARD FOR TECHNICAL AND COMPREHENSIVE EDUCATION PROCEDURE FREEDOM OF INFORMATION PAGE: 1 of 5 TITLE: FREEDOM OF INFORMATION POLICY REFERENCE NUMBER: 8-0-107 DIVISION OF RESPONSIBILITY: Human Resource Services DATE OF LAST REVISION: June 15, 2018 DISCLAIMER PURSUANT TO SECTION 41-1-110

More information

Instructions for Notice of Entry of Appearance as Attorney or Accredited Representative

Instructions for Notice of Entry of Appearance as Attorney or Accredited Representative Instructions for Notice of Entry of Appearance as Attorney or Accredited Representative Department of Homeland Security DHS Form G-28 OMB No. 1615-0105 Expires 05/31/2021 What Is the Purpose of Form G-28?

More information

Proposed Information Collection; Comment Request; Redistricting Data Program

Proposed Information Collection; Comment Request; Redistricting Data Program This document is scheduled to be published in the Federal Register on 07/14/2015 and available online at http://federalregister.gov/a/2015-17073, and on FDsys.gov DEPARTMENT OF COMMERCE U.S. Census Bureau

More information

UNDCP MODEL WITNESS PROTECTION BILL, 2000

UNDCP MODEL WITNESS PROTECTION BILL, 2000 UNDCP MODEL WITNESS PROTECTION BILL, 2000 1. The aim of the Model Witness Protection Bill is to ensure that the investigation and prosecution of serious criminal offences is not prejudiced because witnesses

More information

STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 Blair Stone Road Tallahassee, FL

STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 Blair Stone Road Tallahassee, FL DBPR EL-4512 Historical Sketch STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 2601 Blair Stone Road Tallahassee, FL 32399-0783 Rule 61G7-5.0012, Florida Administrative Code requires

More information

APPLICATION FOR HOUSING WAIT LIST

APPLICATION FOR HOUSING WAIT LIST PROVIDENCE STAFF USE ONLY Date/Time Received: Staff Initials: Vincent House 1423 First Avenue, Seattle WA 98101 Phone: 206-682-9307 Fax: 206-682-0548 TTY: 800-833-6388 WA Relay: 711 APPLICATION FOR HOUSING

More information