NASDA Form

NAS-004
(Rev. 3/07)

NASDA CERTIFICATION OF
CONFIDENTIALITY AND MOTOR VEHICLE INSURANCE
As an Officer, Employee, or Person Acting for or on Behalf of the United States Department of
Agriculture in activities related to data collection and preparation of Reports, I fully recognize my
responsibility for:
a. Safeguarding Confidential as well as Nonconfidential types of data, records, or information from
unauthorized disclosure, destruction, or modification, whether accidental or intentional.
b. Maintaining the minimum motor vehicle insurance coverage required in my State, while driving
an automobile in relation to NASDA business.
The authorized representative of National Association of State Department of Agriculture and National
Agricultural Statistics Service has placed before me the following:
a. NASS Security Expectations Brochure.
b. Title 18, United States Code, Paragraph 1905, "Disclosure of confidential Information Generally."
c. E-Government Act of 2002, (Public Law 107-347), Title V – Confidential Information Protection and
Statistical Efficiency Act (CIPSEA), Section 512, “Limitations on Use and Disclosure of Data and
Information.”
d. E-Government Act of 2002, (Public Law 107-347), Title V – Confidential Information Protection and
Statistical Efficiency Act (CIPSEA), Section 513, “Fines and Penalties.”
e. NASDA motor Vehicle Insurance Regulation. (Required of all NASDA employees being reimbursed
for mileage in connection with NASDA business.)
I certify that I have read the above mentioned material this
will abide by them.

Title:

day of

, 20

Signature:

(Please type or print in ink the following information)
Name:
Street Address:
City, State, & Zip Code:

Witnessed by:

Date:
Representative of National Association of State Departments of
Agriculture or the National Agricultural Statistics Service

, and

NAS-004
(Rev. 3/07)

UNITED STATES CODE
Title 18, Section 1905, Disclosure of Confidential
information generally.
Whoever, being an officer or employee of the United
States or of any department or agency thereof,
publishes, divulges, discloses, or makes known in any
manner or to any extent not authorized by law any
information coming to him in the course of his
employment or official duties or by reason of any
examination or investigation made by, or return, report
or record made to or filed with, such department or
agency or officer or employee thereof, which
information concerns or relates to the trade secrets,
processes, operations, style of work, or apparatus, or to
the identity, confidential statistical data, amount or
source of any income, profit, losses, or expenditures of
any person, firm, partnership, corporation, or
association; or permits any income return or copy
thereof or any book containing any abstract or
particulars thereof to be seen or examined by any
person except as provided by law; shall be fined ..., or
imprisoned ..., or both and shall be removed from
office or employment.
E-Government Act of 2002, (Public Law 107-347),
Title V - Confidential Information Protection and
Statistical Efficiency Act (CIPSEA),
Section 512, Limitations on Use and Disclosure
of Data and Information.
(a) Use of Statistical Data or Information. – Data or
information acquired by an agency under a pledge of
confidentiality and for exclusively statistical purposes
shall be used by officers, employees, or agents of the
agency exclusively for statistical purposes.
(b) Disclosure of Statistical Data or Information. –
(1) Data or information acquired by an agency under
a pledge of confidentiality for exclusively statistical
purposes shall not be disclosed by an agency in
identifiable form, for any use other than an
exclusively statistical purpose, except with the
informed consent of the respondent.
(2) A disclosure pursuant to paragraph (1) is
authorized only when the head of the agency
approves such disclosure and the disclosure is not
prohibited by any other law.
(3) This section does not restrict or diminish any
confidentiality protections in law that otherwise
apply to data or information acquired by an agency
under a pledge of confidentiality for exclusively
statistical purposes.

(c) Rule for Use of Data or Information for
Nonstatistical Purposes. – A statistical agency or unit
shall clearly distinguish any data or information it
collects for nonstatistical purposes (as authorized by
law) and provide notice to the public, before the data or
information is collected, that the data or information
could be used for nonstatistical purposes.
(d) Designation of Agents. – A statistical agency or
unit may designate agents, by contract or by entering
into a special agreement containing the provisions
required under section 502(2) for treatment as an agent
under that section, who may perform exclusively
statistical activities, subject to the limitations and
penalties described in this title.

Section 513, Fines and Penalties.
Whoever, being an officer, employee, or agent of an
agency acquiring information for exclusively statistical
purposes, having taken and subscribed the oath of
office, or having sworn to observe the limitations
imposed by Section 512 (above), comes into
possession of such information by reason of his or her
being an officer, employee, or agent and, knowing that
the disclosure of the specific information is prohibited
under the provisions of this title, willfully discloses the
information in any manner to a person or agency not
entitled to receive it, shall be guilty of a class E felony
and imprisoned for not more than 5 years, or fined not
more than $250,000, or both.

NASDA MOTOR VEHICLE INSURANCE
REGULATION
As an employee of NASDA, you are not covered under
the Federal Tort Claims Act. You must have motor
vehicle liability insurance which meets the minimum
requirement for your State. You should contact your
insurance company to determine if additional coverage
is needed. Survey work qualifies as a non-farm
business. Insurance companies generally require a
higher rate for cars and trucks used in a non-farm
business in comparison with vehicles used solely for
farm work. NASDA does have comprehensive
liability insurance covering their liability in excess of
insurance carried by Enumerators. Should you fail to
inform you insurance company that you are engaged in
a non-farm business with you motor vehicle, you could
face possible cancellation of the policy if you are
involved in an accident.