D-2006 Self-Assessment Security Checklist

Form D-2006

(XX-XX-XXXX)

OMB Control No. XXXX-XXXX

U.S. DEPARTMENT OF COMMERCE

ECONOMICS AND STATISTICS ADMINSTRATION

U.S. CENSUS BUREAU

SELF-ASSESSMENT CHECKLIST

2020 CENSUS LOCAL UPDATE OF CENSUS ADDRESSES OPERATION (LUCA)

PROTECTING CENSUS BUREAU TITLE 13 MATERIALS		Confidentiality & Security Guidelines Reference	Circle Y, N or NA (Paper Participants Only)
1	Do you understand that the U.S. Census Bureau’s Title 13 data, including addresses and latitude/longitude coordinate data (structure points), cannot be used to create, update, nor modify a tribal, state, or local jurisdiction address database?	3	Y	N
2	Will you store Title 13 materials in a secure location?	4.1, 4.2	Y	N
3	Will you secure Title 13 materials to prevent unauthorized staff from accessing these materials? This includes staff members other than those who signed the Confidentiality Agreement, who have access to the offices, cabinets, or other areas where Title 13 materials are stored.	4.1, 4.2	Y	N
4	Will you construct electronic security profiles to allow only those who signed the Confidentiality Agreement to access the Census Bureau’s Title 13 materials, if the Title 13 information is placed on a shared computer system?	4.1	Y	N	NA
5	Will you ensure that your IT system restricts access to the Census Bureau’s Title 13 materials to only those individuals that signed the Confidentiality Agreement?	4.1	Y	N	NA
6	Will you assign an encrypted, unique user ID and password for each LUCA liaison, reviewer, and anyone with access to digital Title 13 materials?	4.1	Y	N	NA
7	Will you keep Title 13 data separate from your other data? Title 13 data cannot be backed up, mixed with, or stored with other data.	4.1	Y	N	NA

REPORTING AN INCIDENT		Confidentiality & Security Guidelines Reference	Circle Y or N
8	Will you report to the Census Bureau all violations of unauthorized viewing or loss of Title 13 materials within 24 hours of discovery?	4.3	Y	N

ON-SITE VISITS		Confidentiality & Security Guidelines Reference	Circle Y or N
9	Do you understand that the Census Bureau may conduct on-site visits to your office to inspect your security measures regarding the Census Bureau’s Title 13 materials?	4.4	Y	N

DESTRUCTION OR RETURN OF CONFIDENTIAL MATERIALS		Confidentiality & Security Guidelines Reference	Circle Y or N
10	Will you destroy (the preferred method) or return the Title 13 materials according to the approved destruction or return methods outlined in the Confidentiality and Security Guidelines?	4.5, 4.6	Y	N

Designated LUCA Liaison Signature: ________________________________________________________________

Designated LUCA Liaison Name (print): _______________________________________ Date: ______________

Complete this form and return it along with the completed, signed copies of the Registration Form, Confidentiality Agreement, and the Product Preference Form. Use the enclosed postage-paid envelope addressed to ATTN: Geography LUCA Materials 63-E, National Processing Center, 1201 East 10^th St, Jeffersonville IN 47132. Rather than mailing, you may scan your completed forms, including forms with signatures, and email them to [email protected].