Client Other

THE PRIVACY ACT OF 1974
5 U.S.C. ' 552a
As Amended
' 552a. Records maintained on individuals

(a) Definitions
For purposes of this section-(1) the term "agency" means agency as defined in section 552(f) of this title;
(2) the term "individual" means a citizen of the United States or an alien lawfully admitted
for permanent residence;
(3) the term "maintain" includes maintain, collect, use or disseminate;
(4) the term "record" means any item, collection, or grouping of information about an
individual that is maintained by an agency, including, but not limited to, his education,
financial transactions, medical history, and criminal or employment history and that contains
his name, or the identifying number, symbol, or other identifying particular assigned to the
individual, such as a finger or voice print or a photograph;
(5) the term "system of records" means a group of any records under the control of any
agency from which information is retrieved by the name of the individual or by some
identifying number, symbol, or other identifying particular assigned to the individual;
(6) the term "statistical record" means a record in a system of records maintained for
statistical research or reporting purposes only and not used in whole or in part in making
any determination about an identifiable individual, except as provided by section 8 of Title
13;
(7) the term "routine use" means, with respect to the disclosure of a record, the use of
such record for a purpose which is compatible with the purpose for which it was collected;
(8) the term "matching program"-(A) means any computerized comparison of-(i) two or more automated systems of records or a system of records with
non-Federal records for the purpose of-(I) establishing or verifying the eligibility of, or continuing
compliance with statutory and regulatory requirements by,
applicants for, recipients or beneficiaries of, participants in, or
providers of services with respect to, cash or in-kind assistance or
payments under Federal benefit programs, or
(II) recouping payments or delinquent debts under such Federal
benefit programs, or
(ii) two or more automated Federal personnel or payroll systems of
records or a system of Federal personnel or payroll records with nonFederal records,

(B) but does not include-(i) matches performed to produce aggregate statistical data without any
personal identifiers;
(ii) matches performed to support any research or statistical project, the
specific data of which may not be used to make decisions concerning the
rights, benefits, or privileges of specific individuals;
(iii) matches performed, by an agency (or component thereof) which
performs as its principal function any activity pertaining to the enforcement
of criminal laws, subsequent to the initiation of a specific criminal or civil
law enforcement investigation of a named person or persons for the
purpose of gathering evidence against such person or persons;
(iv) matches of tax information (I) pursuant to section 6103(d) of the
Internal Revenue Code of 1986, (II) for purposes of tax administration as
defined in section 6103(b)(4) of such Code, (III) for the purpose of
intercepting a tax refund due an individual under authority granted by
section 404(e), 464, or 1137 of the Social Security Act; or (IV) for the
purpose of intercepting a tax refund due an individual under any other tax
refund intercept program authorized by statute which has been determined
by the Director of the Office of Management and Budget to contain
verification, notice, and hearing requirements that are substantially similar
to the procedures in section 1137 of the Social Security Act;
(v) matches-(I) using records predominantly relating to Federal personnel, that
are performed for routine administrative purposes (subject to
guidance provided by the Director of the Office of Management and
Budget pursuant to subsection (v)); or
(II) conducted by an agency using only records from systems of
records maintained by that agency;
if the purpose of the match is not to take any adverse financial, personnel,
disciplinary, or other adverse action against Federal personnel; or
(vi) matches performed for foreign counterintelligence purposes or to
produce background checks for security clearances of Federal personnel or
Federal contractor personnel; or
(vii) matches performed incident to a levy described in section 6103(k)(8)
of the Internal Revenue Code of 1986;
(9) the term "recipient agency" means any agency, or contractor thereof,
receiving records contained in a system of records from a source agency for use in
a matching program;
(10) the term "non-Federal agency" means any State or local government, or
agency thereof, which receives records contained in a system of records from a
source agency for use in a matching program;
(11) the term "source agency" means any agency which discloses records
contained in a system of records to be used in a matching program, or any State or
local government, or agency thereof, which discloses records to be used in a

matching program;
(12) the term "Federal benefit program" means any program administered or
funded by the Federal Government, or by any agent or State on behalf of the
Federal Government, providing cash or in-kind assistance in the form of payments,
grants, loans, or loan guarantees to individuals; and
(13) the term "Federal personnel" means officers and employees of the
Government of the United States, members of the uniformed services (including
members of the Reserve Components), individuals entitled to receive immediate or
deferred retirement benefits under any retirement program of the Government of
the United States (including survivor benefits).
(b) Conditions of disclosure
No agency shall disclose any record which is contained in a system of records by any means
of communication to any person, or to another agency, except pursuant to a written request
by, or with the prior written consent of, the individual to whom the record pertains, unless
disclosure of the record would be-(1) to those officers and employees of the agency which maintains the record who
have a need for the record in the performance of their duties;
(2) required under section 552 of this title;
(3) for a routine use as defined in subsection (a)(7) of this section and described
under subsection (e)(4)(D) of this section;
(4) to the Bureau of the Census for purposes of planning or carrying out a census
or survey or related activity pursuant to the provisions of Title 13;
(5) to a recipient who has provided the agency with advance adequate written
assurance that the record will be used solely as a statistical research or reporting
record, and the record is to be transferred in a form that is not individually
identifiable;
(6) to the National Archives and Records Administration as a record which has
sufficient historical or other value to warrant its continued preservation by the
United States Government, or for evaluation by the Archivist of the United States or
the designee of the Archivist to determine whether the record has such value;
(7) to another agency or to an instrumentality of any governmental jurisdiction
within or under the control of the United States for a civil or criminal law
enforcement activity if the activity is authorized by law, and if the head of the
agency or instrumentality has made a written request to the agency which
maintains the record specifying the particular portion desired and the law
enforcement activity for which the record is sought;
(8) to a person pursuant to a showing of compelling circumstances affecting the
health or safety of an individual if upon such disclosure notification is transmitted to
the last known address of such individual;
(9) to either House of Congress, or, to the extent of matter within its jurisdiction,
any committee or subcommittee thereof, any joint committee of Congress or
subcommittee of any such joint committee;
(10) to the Comptroller General, or any of his authorized representatives, in the
course of the performance of the duties of the General Accounting Office;

(11) pursuant to the order of a court of competent jurisdiction; or
(12) to a consumer reporting agency in accordance with section 3711(e) of Title
31.
(c) Accounting of Certain Disclosures
Each agency, with respect to each system of records under its control, shall-(1) except for disclosures made under subsections (b)(1) or (b)(2) of this section,
keep an accurate accounting of-(A) the date, nature, and purpose of each disclosure of a record to any
person or to another agency made under subsection (b) of this section;
and
(B) the name and address of the person or agency to whom the disclosure
is made;
(2) retain the accounting made under paragraph (1) of this subsection for at least
five years or the life of the record, whichever is longer, after the disclosure for
which the accounting is made;
(3) except for disclosures made under subsection (b)(7) of this section, make the
accounting made under paragraph (1) of this subsection available to the individual
named in the record at his request; and
(4) inform any person or other agency about any correction or notation of dispute
made by the agency in accordance with subsection (d) of this section of any record
that has been disclosed to the person or agency if an accounting of the disclosure
was made.
(d) Access to records
Each agency that maintains a system of records shall-(1) upon request by any individual to gain access to his record or to any
information pertaining to him which is contained in the system, permit him and
upon his request, a person of his own choosing to accompany him, to review the
record and have a copy made of all or any portion thereof in a form
comprehensible to him, except that the agency may require the individual to furnish
a written statement authorizing discussion of that individual's record in the
accompanying person's presence;
(2) permit the individual to request amendment of a record pertaining to him and-(A) not later than 10 days (excluding Saturdays, Sundays, and legal public
holidays) after the date of receipt of such request, acknowledge in writing
such receipt; and
(B) promptly, either-(i) make any correction of any portion thereof which the individual
believes is not accurate, relevant, timely, or complete; or
(ii) inform the individual of its refusal to amend the record in
accordance with his request, the reason for the refusal, the
procedures established by the agency for the individual to request
a review of that refusal by the head of the agency or an officer

designated by the head of the agency, and the name and business
address of that official;
(3) permit the individual who disagrees with the refusal of the agency to amend his
record to request a review of such refusal, and not later than 30 days (excluding
Saturdays, Sundays, and legal public holidays) from the date on which the
individual requests such review, complete such review and make a final
determination unless, for good cause shown, the head of the agency extends such
30-day period; and if, after his review, the reviewing official also refuses to amend
the record in accordance with the request, permit the individual to file with the
agency a concise statement setting forth the reasons for his disagreement with the
refusal of the agency, and notify the individual of the provisions for judicial review
of the reviewing official's determination under subsection (g)(1)(A) of this section;
(4) in any disclosure, containing information about which the individual has filed a
statement of disagreement, occurring after the filing of the statement under
paragraph (3) of this subsection, clearly note any portion of the record which is
disputed and provide copies of the statement and, if the agency deems it
appropriate, copies of a concise statement of the reasons of the agency for not
making the amendments requested, to persons or other agencies to whom the
disputed record has been disclosed; and
(5) nothing in this section shall allow an individual access to any information
compiled in reasonable anticipation of a civil action or proceeding.
(e) Agency requirements
Each agency that maintains a system of records shall-(1) maintain in its records only such information about an individual as is relevant
and necessary to accomplish a purpose of the agency required to be accomplished
by statute or by Executive order of the President;
(2) collect information to the greatest extent practicable directly from the subject
individual when the information may result in adverse determinations about an
individual's rights, benefits, and privileges under Federal programs;
(3) inform each individual whom it asks to supply information, on the form which it
uses to collect the information or on a separate form that can be retained by the
individual-(A) the authority (whether granted by statute, or by Executive order of the
President) which authorizes the solicitation of the information and whether
disclosure of such information is mandatory or voluntary;
(B) the principal purpose or purposes for which the information is intended
to be used;
(C) the routine uses which may be made of the information, as published
pursuant to paragraph (4)(D) of this subsection; and
(D) the effects on him, if any, of not providing all or any part of the
requested information;
(4) subject to the provisions of paragraph (11) of this subsection, publish in the
Federal Register upon establishment or revision a notice of the existence and
character of the system of records, which notice shall include--

(A) the name and location of the system;
(B) the categories of individuals on whom records are maintained in the
system;
(C) the categories of records maintained in the system;
(D) each routine use of the records contained in the system, including the
categories of users and the purpose of such use;
(E) the policies and practices of the agency regarding storage,
retrievability, access controls, retention, and disposal of the records;
(F) the title and business address of the agency official who is responsible
for the system of records;
(G) the agency procedures whereby an individual can be notified at his
request if the system of records contains a record pertaining to him;
(H) the agency procedures whereby an individual can be notified at his
request how he can gain access to any record pertaining to him contained
in the system of records, and how he can contest its content; and
(I) the categories of sources of records in the system;
(5) maintain all records which are used by the agency in making any determination
about any individual with such accuracy, relevance, timeliness, and completeness
as is reasonably necessary to assure fairness to the individual in the determination;
(6) prior to disseminating any record about an individual to any person other than
an agency, unless the dissemination is made pursuant to subsection (b)(2) of this
section, make reasonable efforts to assure that such records are accurate,
complete, timely, and relevant for agency purposes;
(7) maintain no record describing how any individual exercises rights guaranteed
by the First Amendment unless expressly authorized by statute or by the individual
about whom the record is maintained or unless pertinent to and within the scope of
an authorized law enforcement activity;
(8) make reasonable efforts to serve notice on an individual when any record on
such individual is made available to any person under compulsory legal process
when such process becomes a matter of public record;
(9) establish rules of conduct for persons involved in the design, development,
operation, or maintenance of any system of records, or in maintaining any record,
and instruct each such person with respect to such rules and the requirements of
this section, including any other rules and procedures adopted pursuant to this
section and the penalties for noncompliance;
(10) establish appropriate administrative, technical and physical safeguards to
insure the security and confidentiality of records and to protect against any
anticipated threats or hazards to their security or integrity which could result in
substantial harm, embarrassment, inconvenience, or unfairness to any individual on
whom information is maintained;
(11) at least 30 days prior to publication of information under paragraph (4)(D) of
this subsection, publish in the Federal Register notice of any new use or intended
use of the information in the system, and provide an opportunity for interested

persons to submit written data, views, or arguments to the agency; and
(12) if such agency is a recipient agency or a source agency in a matching
program with a non-Federal agency, with respect to any establishment or revision
of a matching program, at least 30 days prior to conducting such program, publish
in the Federal Register notice of such establishment or revision.
(f) Agency rules
In order to carry out the provisions of this section, each agency that maintains a system of
records shall promulgate rules, in accordance with the requirements (including general
notice) of section 553 of this title, which shall-(1) establish procedures whereby an individual can be notified in response to his
request if any system of records named by the individual contains a record
pertaining to him;
(2) define reasonable times, places, and requirements for identifying an individual
who requests his record or information pertaining to him before the agency shall
make the record or information available to the individual;
(3) establish procedures for the disclosure to an individual upon his request of his
record or information pertaining to him, including special procedure, if deemed
necessary, for the disclosure to an individual of medical records, including
psychological records, pertaining to him;
(4) establish procedures for reviewing a request from an individual concerning the
amendment of any record or information pertaining to the individual, for making a
determination on the request, for an appeal within the agency of an initial adverse
agency determination, and for whatever additional means may be necessary for
each individual to be able to exercise fully his rights under this section; and
(5) establish fees to be charged, if any, to any individual for making copies of his
record, excluding the cost of any search for and review of the record.
The Office of the Federal Register shall biennially compile and publish the rules promulgated
under this subsection and agency notices published under subsection (e)(4) of this section in
a form available to the public at low cost.
(g) (1) Civil remedies
Whenever any agency
(A) makes a determination under subsection (d)(3) of this section not to
amend an individual's record in accordance with his request, or fails to
make such review in conformity with that subsection;
(B) refuses to comply with an individual request under subsection (d)(1) of
this section;
(C) fails to maintain any record concerning any individual with such
accuracy, relevance, timeliness, and completeness as is necessary to
assure fairness in any determination relating to the qualifications,
character, rights, or opportunities of, or benefits to the individual that may
be made on the basis of such record, and consequently a determination is
made which is adverse to the individual; or
(D) fails to comply with any other provision of this section, or any rule

promulgated thereunder, in such a way as to have an adverse effect on an
individual, the individual may bring a civil action against the agency, and
the district courts of the United States shall have jurisdiction in the matters
under the provisions of this subsection.
(2)(A) In any suit brought under the provisions of subsection (g)(1)(A) of this
section, the court may order the agency to amend the individual's record in
accordance with his request or in such other way as the court may direct. In such a
case the court shall determine the matter de novo.
(B) The court may assess against the United States reasonable attorney
fees and other litigation costs reasonably incurred in any case under this
paragraph in which the complainant has substantially prevailed.
(3)(A) In any suit brought under the provisions of subsection (g)(1)(B) of this
section, the court may enjoin the agency from withholding the records and order
the production to the complainant of any agency records improperly withheld from
him. In such a case the court shall determine the matter de novo, and may examine
the contents of any agency records in camera to determine whether the records or
any portion thereof may be withheld under any of the exemptions set forth in
subsection (k) of this section, and the burden is on the agency to sustain its action.
(B) The court may assess against the United States reasonable attorney
fees and other litigation costs reasonably incurred in any case under this
paragraph in which the complainant has substantially prevailed.
(4) In any suit brought under the provisions of subsection (g)(1)(C) or (D) of this
section in which the court determines that the agency acted in a manner which was
intentional or willful, the United States shall be liable to the individual in an amount
equal to the sum of-(A) actual damages sustained by the individual as a result of the refusal or
failure, but in no case shall a person entitled to recovery receive less than
the sum of $1,000; and
(B) the costs of the action together with reasonable attorney fees as
determined by the court.
(5) An action to enforce any liability created under this section may be brought in
the district court of the United States in the district in which the complainant
resides, or has his principal place of business, or in which the agency records are
situated, or in the District of Columbia, without regard to the amount in controversy,
within two years from the date on which the cause of action arises, except that
where an agency has materially and willfully misrepresented any information
required under this section to be disclosed to an individual and the information so
misrepresented is material to establishment of the liability of the agency to the
individual under this section, the action may be brought at any time within two
years after discovery by the individual of the misrepresentation. Nothing in this
section shall be construed to authorize any civil action by reason of any injury
sustained as the result of a disclosure of a record prior to September 27, 1975.
(h) Rights of legal guardians
For the purposes of this section, the parent of any minor, or the legal guardian of any
individual who has been declared to be incompetent due to physical or mental incapacity or
age by a court of competent jurisdiction, may act on behalf of the individual.

(i) (1) Criminal penalties
Any officer or employee of an agency, who by virtue of his employment or official position,
has possession of, or access to, agency records which contain individually identifiable
information the disclosure of which is prohibited by this section or by rules or regulations
established thereunder, and who knowing that disclosure of the specific material is so
prohibited, willfully discloses the material in any manner to any person or agency not
entitled to receive it, shall be guilty of a misdemeanor and fined not more than $5,000.
(2) Any officer or employee of any agency who willfully maintains a system of
records without meeting the notice requirements of subsection (e)(4) of this section
shall be guilty of a misdemeanor and fined not more than $5,000.
(3) Any person who knowingly and willfully requests or obtains any record
concerning an individual from an agency under false pretenses shall be guilty of a
misdemeanor and fined not more than $5,000.
(j) General exemptions
The head of any agency may promulgate rules, in accordance with the requirements
(including general notice) of sections 553(b)(1), (2), and (3), (c), and (e) of this title, to
exempt any system of records within the agency from any part of this section except
subsections (b), (c)(1) and (2), (e)(4)(A) through (F), (e)(6), (7), (9), (10), and (11), and
(i) if the system of records is-(1) maintained by the Central Intelligence Agency; or
(2) maintained by an agency or component thereof which performs as its principal
function any activity pertaining to the enforcement of criminal laws, including police
efforts to prevent, control, or reduce crime or to apprehend criminals, and the
activities of prosecutors, courts, correctional, probation, pardon, or parole
authorities, and which consists of (A) information compiled for the purpose of
identifying individual criminal offenders and alleged offenders and consisting only of
identifying data and notations of arrests, the nature and disposition of criminal
charges, sentencing, confinement, release, and parole and probation status; (B)
information compiled for the purpose of a criminal investigation, including reports of
informants and investigators, and associated with an identifiable individual; or (C)
reports identifiable to an individual compiled at any stage of the process of
enforcement of the criminal laws from arrest or indictment through release from
supervision.
At the time rules are adopted under this subsection, the agency shall include in the
statement required under section 553(c) of this title, the reasons why the system of records
is to be exempted from a provision of this section.
(k) Specific exemptions
The head of any agency may promulgate rules, in accordance with the requirements
(including general notice) of sections 553(b)(1), (2), and (3), (c), and (e) of this title, to
exempt any system of records within the agency from subsections (c)(3), (d), (e)(1),
(e)(4)(G), (H), and (I) and (f) of this section if the system of records is-(1) subject to the provisions of section 552(b)(1) of this title;
(2) investigatory material compiled for law enforcement purposes, other than
material within the scope of subsection (j)(2) of this section: Provided, however,
That if any individual is denied any right, privilege, or benefit that he would

otherwise be entitled by Federal law, or for which he would otherwise be eligible,
as a result of the maintenance of such material, such material shall be provided to
such individual, except to the extent that the disclosure of such material would
reveal the identity of a source who furnished information to the Government under
an express promise that the identity of the source would be held in confidence, or,
prior to the effective date of this section, under an implied promise that the identity
of the source would be held in confidence;
(3) maintained in connection with providing protective services to the President of
the United States or other individuals pursuant to section 3056 of Title 18;
(4) required by statute to be maintained and used solely as statistical records;
(5) investigatory material compiled solely for the purpose of determining suitability,
eligibility, or qualifications for Federal civilian employment, military service, Federal
contracts, or access to classified information, but only to the extent that the
disclosure of such material would reveal the identity of a source who furnished
information to the Government under an express promise that the identity of the
source would be held in confidence, or, prior to the effective date of this section,
under an implied promise that the identity of the source would be held in
confidence;
(6) testing or examination material used solely to determine individual
qualifications for appointment or promotion in the Federal service the disclosure of
which would compromise the objectivity or fairness of the testing or examination
process; or
(7) evaluation material used to determine potential for promotion in the armed
services, but only to the extent that the disclosure of such material would reveal the
identity of a source who furnished information to the Government under an express
promise that the identity of the source would be held in confidence, or, prior to the
effective date of this section, under an implied promise that the identity of the
source would be held in confidence.
At the time rules are adopted under this subsection, the agency shall include in the
statement required under section 553(c) of this title, the reasons why the system of records
is to be exempted from a provision of this section.
(1) Archival records
(1) Each agency record which is accepted by the Archivist of the United States for
storage, processing, and servicing in accordance with section 3103 of Title 44 shall,
for the purposes of this section, be considered to be maintained by the agency
which deposited the record and shall be subject to the provisions of this section.
The Archivist of the United States shall not disclose the record except to the agency
which maintains the record, or under rules established by that agency which are
not inconsistent with the provisions of this section.
(2) Each agency record pertaining to an identifiable individual which was
transferred to the National Archives of the United States as a record which has
sufficient historical or other value to warrant its continued preservation by the
United States Government, prior to the effective date of this section, shall, for the
purposes of this section, be considered to be maintained by the National Archives
and shall not be subject to the provisions of this section, except that a statement
generally describing such records (modeled after the requirements relating to
records subject to subsections (e)(4)(A) through (G) of this section) shall be

published in the Federal Register.
(3) Each agency record pertaining to an identifiable individual which is transferred
to the National Archives of the United States as a record which has sufficient
historical or other value to warrant its continued preservation by the United States
Government, on or after the effective date of this section, shall, for the purposes of
this section, be considered to be maintained by the National Archives and shall be
exempt from the requirements of this section except subsections (e)(4)(A) through
(G) and (e)(9) of this section.
(m) Government contractors
(1) When an agency provides by a contract for the operation by or on behalf of the
agency of a system of records to accomplish an agency function, the agency shall,
consistent with its authority, cause the requirements of this section to be applied to
such system. For purposes of subsection (i) of this section any such contractor and
any employee of such contractor, if such contract is agreed to on or after the
effective date of this section, shall be considered to be an employee of an agency.
(2) A consumer reporting agency to which a record is disclosed under section
3711(e) of Title 31 shall not be considered a contractor for the purposes of this
section.
(n) Mailing lists
An individual's name and address may not be sold or rented by an agency unless such
action is specifically authorized by law. This provision shall not be construed to require the
withholding of names and addresses otherwise permitted to be made public.
(o) Matching agreements-- (1) No record which is contained in a system of records may
be disclosed to a recipient agency or non-Federal agency for use in a computer matching
program except pursuant to a written agreement between the source agency and the
recipient agency or non-Federal agency specifying-(A) the purpose and legal authority for conducting the program;
(B) the justification for the program and the anticipated results, including a
specific estimate of any savings;
(C) a description of the records that will be matched, including each data
element that will be used, the approximate number of records that will be
matched, and the projected starting and completion dates of the matching
program;
(D) procedures for providing individualized notice at the time of
application, and notice periodically thereafter as directed by the Data
Integrity Board of such agency (subject to guidance provided by the
Director of the Office of Management and Budget pursuant to subsection
(v)), to-(i) applicants for and recipients of financial assistance or payments
under Federal benefit programs, and
(ii) applicants for and holders of positions as Federal personnel,
that any information provided by such applicants, recipients,
holders, and individuals may be subject to verification through
matching programs;

(E) procedures for verifying information produced in such matching
program as required by subsection (p);
(F) procedures for the retention and timely destruction of identifiable
records created by a recipient agency or non-Federal agency in such
matching program;
(G) procedures for ensuring the administrative, technical, and physical
security of the records matched and the results of such programs;
(H) prohibitions on duplication and redisclosure of records provided by the
source agency within or outside the recipient agency or the non-Federal
agency, except where required by law or essential to the conduct of the
matching program;
(I) procedures governing the use by a recipient agency or non-Federal
agency of records provided in a matching program by a source agency,
including procedures governing return of the records to the source agency
or destruction of records used in such program;
(J) information on assessments that have been made on the accuracy of
the records that will be used in such matching program; and
(K) that the Comptroller General may have access to all records of a
recipient agency or a non-Federal agency that the Comptroller General
deems necessary in order to monitor or verify compliance with the
agreement.
(2)(A) A copy of each agreement entered into pursuant to paragraph (1) shall-(i) be transmitted to the Committee on Governmental Affairs of the
Senate and the Committee on Government Operations of the
House of Representatives; and
(ii) be available upon request to the public.
(B) No such agreement shall be effective until 30 days after the date on
which such a copy is transmitted pursuant to subparagraph (A)(i).
(C) Such an agreement shall remain in effect only for such period, not to
exceed 18 months, as the Data Integrity Board of the agency determines is
appropriate in light of the purposes, and length of time necessary for the
conduct, of the matching program.
(D) Within 3 months prior to the expiration of such an agreement pursuant
to subparagraph (C), the Data Integrity Board of the agency may, without
additional review, renew the matching agreement for a current, ongoing
matching program for not more than one additional year if-(i) such program will be conducted without any change; and
(ii) each party to the agreement certifies to the Board in writing
that the program has been conducted in compliance with the
agreement.
(p) Verification and Opportunity to Contest Findings
(1) In order to protect any individual whose records are used in a matching

program, no recipient agency, non-Federal agency, or source agency may suspend,
terminate, reduce, or make a final denial of any financial assistance or payment
under a Federal benefit program to such individual, or take other adverse action
against such individual, as a result of information produced by such matching
program, until-(A)(i) the agency has independently verified the information; or
(ii) the Data Integrity Board of the agency, or in the case of a nonFederal agency the Data Integrity Board of the source agency,
determines in accordance with guidance issued by the Director of
the Office of Management and Budget that-(I) the information is limited to identification and amount
of benefits paid by the source agency under a Federal
benefit program; and
(II) there is a high degree of confidence that the
information provided to the recipient agency is accurate;
(B) the individual receives a notice from the agency containing a statement
of its findings and informing the individual of the opportunity to contest
such findings; and
(C)(i) the expiration of any time period established for the program by
statute or regulation for the individual to respond to that notice; or
(ii) in the case of a program for which no such period is
established, the end of the 30-day period beginning on the date on
which notice under subparagraph (B) is mailed or otherwise
provided to the individual.
(2) Independent verification referred to in paragraph (1) requires investigation and
confirmation of specific information relating to an individual that is used as a basis
for an adverse action against the individual, including where applicable investigation
and confirmation of-(A) the amount of any asset or income involved;
(B) whether such individual actually has or had access to such asset or
income for such individual's own use; and
(C) the period or periods when the individual actually had such asset or
income.
(3) Notwithstanding paragraph (1), an agency may take any appropriate action
otherwise prohibited by such paragraph if the agency determines that the public
health or public safety may be adversely affected or significantly threatened during
any notice period required by such paragraph.
(q) Sanctions
(1) Notwithstanding any other provision of law, no source agency may disclose any
record which is contained in a system of records to a recipient agency or nonFederal agency for a matching program if such source agency has reason to believe
that the requirements of subsection (p), or any matching agreement entered into
pursuant to subsection (o), or both, are not being met by such recipient agency.

(2) No source agency may renew a matching agreement unless-(A) the recipient agency or non-Federal agency has certified that it has
complied with the provisions of that agreement; and
(B) the source agency has no reason to believe that the certification is
inaccurate.
(r) Report on new systems and matching programs
Each agency that proposes to establish or make a significant change in a system of records
or a matching program shall provide adequate advance notice of any such proposal (in
duplicate) to the Committee on Government Operations of the House of Representatives, the
Committee on Governmental Affairs of the Senate, and the Office of Management and
Budget in order to permit an evaluation of the probable or potential effect of such proposal
on the privacy or other rights of individuals.
(s) Biennial report
The President shall biennially submit to the Speaker of the House of Representatives and
the President pro tempore of the Senate a report-(1) describing the actions of the Director of the Office of Management and Budget
pursuant to section 6 of the Privacy Act of 1974 during the preceding two years;
(2) describing the exercise of individual rights of access and amendment under this
section during such years;
(3) identifying changes in or additions to systems of records;
(4) containing such other information concerning administration of this section as
may be necessary or useful to the Congress in reviewing the effectiveness of this
section in carrying out the purposes of the Privacy Act of 1974.
(t) Effect of other laws
(1) No agency shall rely on any exemption contained in section 552 of this title to
withhold from an individual any record which is otherwise accessible to such
individual under the provisions of this section.
(2) No agency shall rely on any exemption in this section to withhold from an
individual any record which is otherwise accessible to such individual under the
provisions of section 552 of this title.
(u) Data Integrity Boards
(1) Every agency conducting or participating in a matching program shall establish
a Data Integrity Board to oversee and coordinate among the various components of
such agency the agency's implementation of this section.
(2) Each Data Integrity Board shall consist of senior officials designated by the head
of the agency, and shall include any senior official designated by the head of the
agency as responsible for implementation of this section, and the inspector general
of the agency, if any. The inspector general shall not serve as chairman of the Data
Integrity Board.
(3) Each Data Integrity Board-(A) shall review, approve, and maintain all written agreements for receipt

or disclosure of agency records for matching programs to ensure
compliance with subsection (o), and all relevant statutes, regulations, and
guidelines;
(B) shall review all matching programs in which the agency has
participated during the year, either as a source agency or recipient agency,
determine compliance with applicable laws, regulations, guidelines, and
agency agreements, and assess the costs and benefits of such programs;
(C) shall review all recurring matching programs in which the agency has
participated during the year, either as a source agency or recipient agency,
for continued justification for such disclosures;
(D) shall compile an annual report, which shall be submitted to the head of
the agency and the Office of Management and Budget and made available
to the public on request, describing the matching activities of the agency,
including-(i) matching programs in which the agency has participated as a
source agency or recipient agency;
(ii) matching agreements proposed under subsection (o) that were
disapproved by the Board;
(iii) any changes in membership or structure of the Board in the
preceding year;
(iv) the reasons for any waiver of the requirement in paragraph
(4) of this section for completion and submission of a cost-benefit
analysis prior to the approval of a matching program;
(v) any violations of matching agreements that have been alleged
or identified and any corrective action taken; and
(vi) any other information required by the Director of the Office of
Management and Budget to be included in such report;
(E) shall serve as a clearinghouse for receiving and providing information
on the accuracy, completeness, and reliability of records used in matching
programs;
(F) shall provide interpretation and guidance to agency components and
personnel on the requirements of this section for matching programs;
(G) shall review agency recordkeeping and disposal policies and practices
for matching programs to assure compliance with this section; and
(H) may review and report on any agency matching activities that are not
matching programs.
(4)(A) Except as provided in subparagraphs (B) and (C), a Data Integrity Board
shall not approve any written agreement for a matching program unless the agency
has completed and submitted to such Board a cost-benefit analysis of the proposed
program and such analysis demonstrates that the program is likely to be cost
effective.
(B) The Board may waive the requirements of subparagraph (A) of this
paragraph if it determines in writing, in accordance with guidelines

prescribed by the Director of the Office of Management and Budget, that a
cost-benefit analysis is not required.
(C) A cost-benefit analysis shall not be required under subparagraph (A)
prior to the initial approval of a written agreement for a matching program
that is specifically required by statute. Any subsequent written agreement
for such a program shall not be approved by the Data Integrity Board
unless the agency has submitted a cost-benefit analysis of the program as
conducted under the preceding approval of such agreement.
(5)(A) If a matching agreement is disapproved by a Data Integrity Board, any party
to such agreement may appeal the disapproval to the Director of the Office of
Management and Budget. Timely notice of the filing of such an appeal shall be
provided by the Director of the Office of Management and Budget to the Committee
on Governmental Affairs of the Senate and the Committee on Government
Operations of the House of Representatives.
(B) The Director of the Office of Management and Budget may approve a
matching agreement notwithstanding the disapproval of a Data Integrity
Board if the Director determines that-(i) the matching program will be consistent with all applicable
legal, regulatory, and policy requirements;
(ii) there is adequate evidence that the matching agreement will
be cost- effective; and
(iii) the matching program is in the public interest.
(C) The decision of the Director to approve a matching agreement shall not
take effect until 30 days after it is reported to committees described in
subparagraph (A).
(D) If the Data Integrity Board and the Director of the Office of
Management and Budget disapprove a matching program proposed by the
inspector general of an agency, the inspector general may report the
disapproval to the head of the agency and to the Congress.
(6) The Director of the Office of Management and Budget shall, annually during the
first 3 years after the date of enactment of this subsection and biennially thereafter,
consolidate in a report to the Congress the information contained in the reports
from the various Data Integrity Boards under paragraph (3)(D). Such report shall
include detailed information about costs and benefits of matching programs that are
conducted during the period covered by such consolidated report, and shall identify
each waiver granted by a Data Integrity Board of the requirement for completion
and submission of a cost-benefit analysis and the reasons for granting the waiver.
(7) In the reports required by paragraphs (3)(D) and (6), agency matching
activities that are not matching programs may be reported on an aggregate basis, if
and to the extent necessary to protect ongoing law enforcement or
counterintelligence investigations.
(v) Office of Management and Budget Responsibilities
The Director of the Office of Management and Budget shall-(1) develop and, after notice and opportunity for public comment, prescribe
guidelines and regulations for the use of agencies in implementing the provisions of

this section; and
(2) provide continuing assistance to and oversight of the implementation of this
section by agencies.
The following section was originally part of the Privacy Act but was not codified; it may be
found at ' 552a (note).
Sec. 7 (a)(1) It shall be unlawful for any Federal, State or local government agency to deny to any
individual any right, benefit, or privilege provided by law because of such individual's refusal to
disclose his social security account number.
(2) the provisions of paragraph (1) of this subsection shall not apply with respect to-(A) any disclosure which is required by Federal statute, or
(B) any disclosure of a social security number to any Federal, State, or local agency
maintaining a system of records in existence and operating before January 1, 1975,
if such disclosure was required under statute or regulation adopted prior to such
date to verify the identity of an individual.
(b) Any Federal, State or local government agency which requests an individual to disclose his social
security account number shall inform that individual whether that disclosure is mandatory or
voluntary, by what statutory or other authority such number is solicited, and what uses will be made
of it.
The following sections were originally part of P.L. 100-503, the Computer Matching and Privacy
Protection Act of 1988; they may be found at ' 552a (note).
Sec. 6 Functions of the Director of the Office of Management and Budget.
(b) Implementation Guidance for Amendments-- The Director shall, pursuant to section
552a(v) of Title 5, United States Code, develop guidelines and regulations for the use of
agencies in implementing the amendments made by this Act not later than 8 months after
the date of enactment of this Act.
Sec. 9 Rules of Construction.
Nothing in the amendments made by this Act shall be construed to authorize-(1) the establishment or maintenance by any agency of a national data bank that combines,
merges, or links information on individuals maintained in systems of records by other
Federal agencies;
(2) the direct linking of computerized systems of records maintained by Federal agencies;
(3) the computer matching of records not otherwise authorized by law; or
(4) the disclosure of records for computer matching except to a Federal, State, or local
agency.
Sec. 10 Effective Dates.
(a) In General-- Except as provided in subsection (b), the amendments made by this Act
shall take effect 9 months after the date of enactment of this Act.
(b) Exceptions-- The amendment made by sections 3(b) [Notice of Matching Programs Report to Congress and the Office of Management and Budget], 6 [Functions of the Director
of the Office of Management and Budget], 7 [Compilation of Rules and Notices] and 8

[Annual Report] of this Act shall take effect upon enactment.
Go to: FOIA Home Page //Justice Department Home Page
Updated page November 2, 1999 usdoj/oip/pam

Attachment 2b: Document 2 - Client Focus Group Recruitment Flyer

Have you been involved
with (Insert Program
Name) for at least 14 days?
If yes, we are looking for individuals
to participate in a 1 hour group
discussion about your experience
with ______(Pgm Name TBD by PGM
staff).
To sign up go to room ## or see
(Insert name of staff member)
A $20 Gift Card will be provided in appreciation
of your time and for participation in the group
discusssion.

Attachment 2b: Document 3 - Client Focus Group Sign Up Roster

Client Focus Group Sign Up Roster
(To be completed by Grantee staff member designated to assist with focus group recruitment)
Participant
Initials

Date of
birth

Race

Gender

Serostatus

Time in
treatment
(in weeks)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
*1. Individually approached by staff member
2. Saw flyer and signed up
3. Heard about focus group from another client
4. Heard announcement in a group session or other setting

Type of
treatment
(inpatient or
outpatient)

Number of
times in
treatment

Prison/ Jail
reentry
(yes/no)

How did client
come to
participate in
focus group *

Attachment 2b: Document 4 - Client Consent Form
Form Approved
OMB No. ####-####
Expiration Date: ##/##/####

Consent Form for Participation in the Targeted Capacity Expansion Program for Substance Abuse
Treatment and HIV/AIDS Services (TCE-HIV) Multi-site Evaluation
CLIENT FOCUS GROUP
A.
BACKGROUND AND PURPOSE
JBS International, the Alliance for Quality Education, Battelle Memorial Institute, and the Oregon Health & Science
University (JBS team) have a contract with the Substance Abuse Mental Health Services Administration
(SAMHSA), Center for Substance Abuse Treatment (CSAT) to conduct a multi-site study of the TCE-HIV program.
The JBS Team is not part of CSAT or any other federal agency.
The purpose of this study is to learn more about the effect of substance abuse treatment programs supported by
TCE-HIV funding. The goal of the study is to improve care for racial and ethnic minorities at risk for HIV/AIDS.
Information from your participation will help the JBS team understand how programs can better reduce substance
abuse and HIV risk behaviors. You are being asked to participate in this study because you are a client who receives
services from a TCE-HIV program.
B.
PROCEDURES
If you agree to participate, the following will occur:
• You will take part in a focus group discussion. The focus group will be about your experiences and
opinions about this program.
• The discussion will include questions about drug use and sexual activity.
• The group discussion will take place at a time and location convenient to you.
• You will complete a form providing background information (e.g., your age, gender).
• Total time commitment will be approximately 60 minutes.
• The discussion will be audio taped to ensure accuracy in reporting your statements. No names or identities
will be used in any published reports.
All information you provide is anonymous. Input you provide during the discussion will be combined with
information from other focus groups from across the United States. The combined information will be analyzed.
Only combined results will be presented in reports.
C.
RISKS
There is a small risk of loss of privacy. However, extra measures will be taken to protect each participant’s privacy.
No names or identifiers will be used in any study reports. Also, the JBS team member leading the discussion will
begin by asking the participants to agree to the importance of keeping information discussed in the focus group
private. Only the JBS team will have access to information from the discussion. There is a risk that you may feel
uncomfortable with some of the questions asked. However, you can answer only the questions you choose to
answer.
Notice to Respondents
Public reporting time for this collection is estimated to average 60 minutes, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to SAMHSA OMB Officer, 1
Choke Cherry Road Room 7-1044, Rockville, MD 20850. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is XXXX-XXXX.

1

Attachment 2b: Document 4 - Client Consent Form
D.
PRIVACY
The privacy of the information we collect about you will be very carefully protected. The evaluation staff is trained
on handling sensitive data and the importance of privacy. All of the data will be kept in locked files at JBS
International, and only the official project staff will have access to these files. At the end of the project all data will
be given to CSAT. The data that is given to CSAT will not include names or participant identification. We have
received a Certificate of Confidentiality (CC) issued by Substance Abuse and Mental Health Services
Administration (SAMHSA), which is designed to protect identifiable research information from forced or compelled
exposure. The Certificate of Confidentiality protects the investigators from being forced, even under a court order or
subpoena, to release information that could identify you. However, we may release identifying information in some
circumstances. For example, we may disclose medical information in cases of medical necessity, or take steps
(including notifying authorities) to protect you or someone else from serious harm, including child abuse/neglect.
DHHS may see your information if it audits us. This CC does not imply DHHS approval or disapproval of this
evaluation.

E.
BENEFITS
There is no direct benefit to you for participating in this research project. However, the information you share may
benefit your TCE-HIV program and similar programs targeting persons similar to you.
F.
COMPENSATION
At the end of the focus group discussion, you will be given a $20 gift card for your participation.
G.
RIGHT TO REFUSE OR WITHDRAW
Your participation in this focus group is completely voluntary. You may leave the focus group at any time. You will
not receive the $20 if you leave before the session ends.
H.
PERSONS TO CONTACT
If you have any questions about this study, please contact Dr. Resa Matthew at JBS International.
Resa Matthew, Ph.D.
JBS International
5515 Security Lane, Suite 800
Bethesda, MD 20852
(301) 495-1080
[email protected]
If you have any concerns about your rights in this study or questions about injuries related to the research project,
please contact Dr. Amanda Gmyrek of the JBS International Institutional Review Board.
Amanda Gmyrek, Ph.D.
JBS International
5515 Security Lane, Suite 800
Bethesda, MD 20852
(301) 495-1080
[email protected]

YOUR CONSENT
You have read this consent form. You have been given a chance to ask questions, and feel that all of your questions
have been answered. You know that you are free to participate in the focus group or not. You know that after
choosing to participate in the focus group, you may drop out at any time. You are signing below because you agree
to participate in this focus group. You give permission for your responses to be audio-recorded.

2

Attachment 2b: Document 4 - Client Consent Form

_____________________________________
Participant Name (Print)

__________________
Date

____________________________________
Participant Signature

I acknowledge that I witnessed the participant sign this consent form.
_____________________________________
Witness’ Name (Print)

__________________
Date

_____________________________________
Witness’ Signature

_____________________________________
Researcher Signature

__________________
Date

3

JBS International. Inc. Institutional Review Board
5515 Security Lane, Suite 800
North Bethesda, MD 20852
301-495-1080
May 28, 2010
To:

Resa Matthew, Ph.D.
Principal Investigator
JBS International, Inc.

From: Lisa Kretz, Ph.D.
IRB Member and Designee of the Chair
JBS International, Inc.
Amanda Gmyrek, Ph.D.
IRB Chair
JBS International, Inc.
Re:

JBS IRB #RM10-001
Approved by Expedited Review
Approval Period from May 28, 2010 through May 27, 2011

Dear Dr. Matthew:
Your protocol entitled Targeted Capacity Expansion Program for Substance Abuse Treatment and HIWAIDS (TC'EHIV) Services Multi-Site Evaluation (JBS IRB # RM10-001) has been approved by expedited review by the
Institutional Review Board. This study fulfills the criteria for expedited review under 45 CFR 46.110, category # 7.
The initial period of approval is 05/28/2010 through 05/27/2011. Approval of this protocol will terminate on the
above date unless a progress report and renewal request is submitted, in writing, to the IRB. Your continuation
request should be submitted to the IRB by 04/29/2011.
The IRB Chair will send you an email reminder prior to the end of the protocol; however, it is your responsibility to
assure that project activities are not conducted past the approval termination date. The continuation request must be
submitted to the IRB via expedited review. If you are not planning to collect data from human participants and
have completed basic data analyses (and risk to subjects does not change) a renewal request is not necessary.
A closure report is required.
As the Principal Investigator, you have the ultimate responsibility for the conduct of the study, the ethical
performance of the project, the protection of the rights and welfare of human subjects, and strict adherence to any
stipulations imposed by the IRB. You must abide by the following principles when conducting your research:
1. Perform the project by qualified personnel according to the approved protocol.
2. Do not implement changes in the approved protocol or consent form without prior IRB approval (except in
a life-threatening emergency, if necessary to safeguard the well-being of human subjects). This includes
changes to the research design or procedures that could introduce new or increased risks to human subjects
and thereby change the nature of the research.
3. Promptly report any adverse reactions or unanticipated reactions within five working days of occurrence.
All fatal or life threatening events or events requiring hospitalization must be reported to the IRB in writing
within 48 hours after discovery.
The investigator(s) identified above are required to retain an IRB protocol file, including a record of IRB-related
activity, data summaries and consent forms. This file is to be made available for review for internal procedural
(audit) monitoring.
If you have any questions, please contact me at 240-645-4385 or lkretzAjbsinternational.com .

JBS International. Inc. Institutional Review Board
5515 Security Lane, Suite 800
North Bethesda, MD 20852
301-495-1080
Expedited Review Approved By:

Lisa Kretz, Ph.D.
JBS IRB Member and Designee of the Chair

Amanda Gmyrek, Ph.D.
IRB Chair

DEPARTMENT OF HEALTH & HUMAN SERVICES

Substance Abuse and Mental
Health Services Administration
Center for Mental Health Services
Center for Substance Abuse
Prevention
Center for Substance Abuse
Treatment
Rockville MD 20857

AUG 2 5 2010

Resa Matthew, Ph.D.
Project Director
JBS International, Inc.
5515 Security Lane, Suite 800
Rockville, MD 20852
Dear Dr. Matthew:
It is a pleasure to convey your Confidentiality Certificate to you. Note your expiration
information on the last page of the Certificate. Please also note that SAMHSA policy prohibits
use of SAMHSA Confidentiality Certificates to avoid child abuse reporting. If you revise the
consent forms or protocol for your study so they differ from those in your application for this
Certificate but you want to continue the protection of the Certificate, please contact me before
you use the changed consent forms or protocol. My telephone number is (240) 276-2315 and my
e-mail address is [email protected] .
Sincerely yours,
Ae.7-e,e-62)
Peggy Riccio
SAMHSA CC Coordinator

Enclosure

Office of the Administrator — Office of Applied Studies — Office of Communications — Office of Policy, Planning and Budget — Office of Program Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration

CONFIDENTIALITY CERTIFICATE
issued to
JBS International, Inc.
Conducting the
Targeted Capacity Expansion Program for Substance Abuse Treatment
and HIV/AIDS Services Multi-site Evaluation
In accordance with the provisions of section 301(d) of the Public Health Service Act (42 U.S.C.
section 241(d)) this Certificate is issued in response to the request of the principal investigator,
Resa Matthew, Ph.D., Project Director, JBS International, Inc., 5515 Security Lane, Suite 800,
Rockville, MD 20852; to protect the privacy of evaluation subjects by withholding their
identities from all persons not connected with the project. Dr. Matthew is primarily responsible
for the conduct of this project, which is funded by SAMHSA's Center for Substance Abuse
Treatment under contract #HEISS283-2007-0000311HHS5283-00004T.
Under authority vested in the Secretary of Health & Human Services by that section, all persons who
1.

are employed by JBS International, Inc., and its contractors and cooperating
agencies as indicated in the application and

2.

have, in the course of that employment, access to information that would identify
individuals who are the subjects of the project entitled "Targeted Capacity
Expansion Program for Substance Abuse Treatment and HIV/AIDS Services
Multi-site Evaluation"

are hereby authorized to protect the privacy of the individuals who are the subjects of that project
by withholding their names and other identifying characteristics from all persons not connected
with the conduct of that project.

Project Purpose
The purpose of the project is to learn about the impact the TCE/HIV outreach/pretreatment and
treatment program has on client outcomes and to understand the mechanism by which the
TCE/HW program affects positive change in the reduction of substance abuse and HIV risk
behaviors in racial and ethnic minority communities. Data will be obtained from 40 treatment
grantees and 8 outreach/pretreatment grantees. Focus groups will be conducted at the 40
treatment grantees in Year 2 and Year 4 of the 5-year project. It is expected that 360 clients (9
clients x 40 sites) will participate in the 2 years for a total of 720 client focus group participants.
A process evaluation will be conducted with the 8 outreach/pretreatment grantees. Data will be
collected and key staff will be interviewed.
Project Location
The focus groups will be conducted at 40 grantee sites, across the country. See the requester's
cover letter for street addresses. Data will be gathered and interviews with staff will be conducted
at the 8 outreach/pretreatment grant sites. See requester's cover letter for street addresses. Data
will be housed and analyzed at JBS International, Inc., in Rockville, MD.
As provided in section 301(d) of the Public Health Service Act (42 U.S.C. sec. 241 (d)):
"Persons so authorized to protect the privacy of such individuals may not be
compelled in any Federal, State, or local civil, criminal, administrative,
legislative, or other proceedings to identify such individuals."
This authorization is applicable to all information obtained pursuant to the project entitled,
"Targeted Capacity Expansion Program for Substance Abuse Treatment and HW/AIDS Services
Multi-site Evaluation" funded by SAMHSA's CSAT contract #HHS5283-2007000031/HHS5283-00004T that could identify the individuals who are subjects or respondents in
the evaluation project.
The following conditions apply to the protection provided under this Certificate:
(1)

(2)

This Certificate does not authorize JBS International, Inc., to refuse to reveal identifying
information concerning evaluation subjects if any of the following conditions exist:
(a)

The subject (or, if he or she is legally incompetent, his or her guardian) consents
in writing to disclosure of identifying information.

(b)

If authorized DHHS personnel request identifying information for audit or
program evaluation of a project funded by DHHS or for investigation of DHHS
grantees or contractors.

This Certificate requires that there be no disclosures of identifying characteristics of
evaluation subjects in any Federal, State, or local civil, criminal, administrative,

legislative or other proceedings to compel disclosure of the identifying characteristics of
such subjects, except as provided for in paragraph (1), above.
(3)

This Certificate does not otherwise govern the voluntary disclosure of identifying
characteristics of evaluation subjects.

(4)

All evaluation subjects in the project will be given a fair, clear explanation of the
protection this Certificate affords, and of the limitations and exceptions to the protection.

(5)

This project may also be subject to special rules for confidentiality of alcohol and drug
abuse patient records, under section 543 of the Public Health Service Act (42 U.S.C. sec.
290dd-2), and implementing regulations at 42 CFR Part 2, which restrict voluntary
disclosures of information from covered patient records.

(6)

This Certificate does not constitute an endorsement of the evaluation project.

(7)

The Certificate becomes effective as of the date of issuance or the commencement of the
project, whichever is later, and will expire September 30, 2014, or sooner if the holder is
notified of cancellation in accordance with the procedures set forth in 42 CFR section
2a.8. The protection afforded by this Certificate of Confidentiality is permanent for
persons who participate as subjects in the evaluation during any time the Certificate is in
effect.

Da
ade, .A.
Director, Office of Financial Resources
Substance Abuse and Mental Health Services Administration