Appendix E-1 Confidentiality Agreement_may6

OMB Control No.: 0584-0523

Expiration Date: xx/xx/xxxx

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0523. The time to complete this information collection is estimated at 3 minutes including the time for reviewing instructions and completing the information.

APPENDIX E-1 CNPP CONFIDENTIALITY AGREEMENT - ENGLISH

CONFIDENTIALITY AGREEMENT

(name of contractor performing service) hereby agrees to keep confidential all information discussed during the (Interview/Focus Group) held in (location, date, time) on behalf of the USDA, Center for Nutrition Policy and Promotion.

_________________________________________ ________________________

Signature of Authorized Personnel Date

_________________________________________

Name of Authorized Personnel

[RESEARCH FACILITY] hereby agrees to keep confidential all information discussed during the (Interview/Focus Group) held in (location, date, time) on behalf of the USDA, Center for Nutrition Policy and Promotion.

_________________________________________ ________________________

Signature of Authorized Personnel Date

_________________________________________

Name of Authorized Personnel