Attachment E-1 Trained Contractor Privacy Agreement 10 16

OMB Control No.: 0584-0523

Expiration Date: xx/xx/xxxx

ATTACHMENT E-1: TRAINED CONTRACTOR PRIVACY AGREEMENT

PRIVACY AGREEMENT

(name of contractor performing service) hereby agrees to keep private and secure all information collected from the participants during the screener and messaging survey conducted on behalf of the USDA, Center for Nutrition Policy and Promotion.

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Signature of Authorized Personnel Date

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Name of Authorized Personnel