Privacy Act Statement Template for Federal Agencies

VDP Privacy Act Statement Template.docx

Vulnerability Discovery Program

Privacy Act Statement Template for Federal Agencies

OMB: 1601-0028

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Authority: [Agency] is authorized to collect this Personally Identifiable Information (PII) by and through the following authority: 5 U.S.C. 301; 44 U.S.C. 3101; [other applicable agency authorities].
Purpose: The PII requested is being collected solely to conduct feedback and dialogue functions with submitters, as necessary.
Sharing Your Information: The information that you provide will be used by and disclosed to Federal Government personnel and contractors for the above-mentioned purpose. This includes using the information as necessary and authorized by the routine uses published in [applicable agency System of Records Notice (SORN)]. Do not provide personal information beyond what is explicitly asked for in any of the provided data fields.
Disclosure: The disclosure of your PII is voluntary. However, a failure to provide your email information will inhibit our ability to provide feedback regarding the reported matter.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHuff, Tyrone
File Modified0000-00-00
File Created2021-03-05

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