Attach I Affidavit of Nondisclosure_draft_09 13 06

ATTACHMENT I

Affidavit of Nondisclosure

(This document will be signed by all Battelle employees who work on the study)

In accordance with Subsection (m) of the Privacy Act of 1974 (5 U.S.C. 552a), Battelle is required to comply with the applicable provisions of the Privacy Act and to undertake other safeguards for individuals and establishments against invasions of privacy.

To provide these safeguards in performance of the contract, Battelle staff shall be bound to the following:

1. Ensure that confidentiality is protected by Battelle employees and to provide for the physical security of the records:

a. To preclude observation of confidential information by persons not employed on the project, Battelle shall maintain all confidential records that identify individuals or establishments or from which individuals or establishments could be identified under lock and key.

Specifically, at each site where these items are processed or maintained, all confidential records that will permit identification of individuals or establishments are to be kept in locked containers when not in use by Battelle employees. The keys or means of access to these containers are to be held by a limited number of Battelle staff. When confidential records are being used in a room, admittance to the room is to be restricted to employees pledged to confidentiality and employed on this project. If at any time the project employees are absent from the room, it is to be locked.

b. Battelle staff will take steps to insure that the intent of the statement of understanding is enforced at all times through appropriate qualifications standards for all personnel working on this project and through adequate training and periodic follow up procedures

2. Information contained on the survey which would permit identification of any individual or establishment has been collected with a guarantee that it will be held in strict confidence by Battelle and CDC, will be used only for purposes stated in this study, and will not be disclosed or released to anyone other than authorized staff of CDC without the consent of the individual or the establishment in accordance with the Public Health Service Act.

The survey form or cover letter will inform each potential respondent

a. That the collection of the information by CDC and Battelle is authorized by Section 46 of the Public Health Service Act;

b. Of the purpose or purposes for which the information is intended to be used, clearly stating that the records will be used solely for statistical research and reporting purposes;

c. That participation is voluntary and there are no penalties for declining to participate in whole or in part; and

d. That no information collected under the authority of the Public Health Service Act may be used for any purpose other than the purpose for which it was supplied, and such information may not be published or released in other form if the particular individual or establishment supplying the information or described in it is identifiable to anyone other than authorized staff of CDC, unless the individual or establishment has consented to such release.

3. Release no information from the data obtained or used under this contract to any person except authorized staff of CDC.

4. By a specified date, which may be no later than the date of completion of the contract, provide all study data to CDC, as specified by the contract.

___________________________

(Typed/Printed Name)

___________________________

(Signature)

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(Date)