Study 2: FMCS OMB G1 Westat Confidentiality and Nondisclosure agreement

APPENDIX G1: CONFIDENTIALITY AND NON-DISCLOSURE AGREEMENT

I understand and acknowledge that:

1. I shall respect and maintain the confidentiality of all discussions and all information given to me by respondents both, orally or in writing.

2. It is my legal and ethical responsibility to protect the privacy, confidentiality and security of all information contained in the completed surveys.

3. I shall only access or disseminate information contained in the survey in the performance of my assigned duties and where required by or permitted by law, and in a manner which is consistent with officially adopted Westat policies, or where no officially adopted policy exists, only with the express approval of my supervisor or designee. I shall make no voluntary disclosure of any personal information, except to persons authorized to receive it in the conduct of Task.

4. I agree to discuss confidential information only in the work place and only for job related purposes and to not discuss such information outside of the work place or within hearing of other people who do not have a need to know about the information.

5. My obligation to safeguard data confidentiality continues after my termination of employment with Westat.

I hereby acknowledge that I have read and understand the foregoing information (Confidentiality Agreement) and that my signature below signifies my agreement to comply with the above terms. In the event of a breach or threatened breach of the Confidentiality Agreement, I acknowledge that Westat may, as applicable and as it deems appropriate, pursue disciplinary action up to and including my termination from Westat.

Name: ___________________________________

Signature: ________________________________ Date: _______________