2014-2017 NSDUH PrivacyActclearance

Privacy Act Certification

DATE: 12/21/2011

FROM: Michael Jones

Project Officer, NSDUH

SUBJECT: Privacy Act Applicability to Contract

Contract Title:

RFC or Contract Number:

TO: James Whitt

Contracting Officer, OFR, SAMHSA

This memorandum certifies that I have reviewed the above referenced document and find that the work to be performed by the contractor is:

__X__ subject to the Privacy Act. (Systems of Record Notice: 09-30-0036 and 09-30-0049)

___ _ not subject to the Privacy Act because:

( ) a. no information on individuals is to be maintained under the contract. The contract provides for________________________________________

_________________________________________________ and no work under the contract will involve the collection of information about individuals.

( ) b. The gathering of data on individuals is incidental to performance of the contract; however, no information on individuals will be maintained by or retrieved by personal identifier. The Privacy Act clauses prescribed by FAR 52.224-1, 52.224-2, and HHSAR 352.224-70 is ( ), is not ( ), required to be inserted in the contract.

( ) c. The contract provides for the performance of work which will require the contractor to collect, maintain, or use information on individuals. However, for the following reason(s) the records do not constitute a system of records subject to the Privacy Act:

Inclusion of the Privacy Act Clauses (FAR 52.224-1, 52.224-2, and HHSAR 352.224-70) will provide sufficient protection of privacy interests.

________________________ 12/21/2011

Project Officer Date

________________________ (concur) ________ .

Privacy Act Officer (non-concur) Date

James Walters