APPENDIX 4_Sample Confidentiality Agreement

OMB Control No.: 0584-0523
Expiration Date: xx/xx/xxxx

APPENDIX 9

Sample Confidentiality Agreement
CONFIDENTIALITY AGREEMENT

I hereby agree to keep confidential all information discussed during the Interview/Focus Group
in which I am participating in (location, date, time) being conducted by (name of contractor
performing service) on behalf of the USDA, Center for Nutrition Policy and Promotion.
_________________________________________
Signature of Participant

________________________
Date

_________________________________________
Name of Participant

(name of contractor performing service) hereby agrees to keep confidential all information
discussed during the (Interview/Focus Group) held in (location, date, time) on behalf of the
USDA, Center for Nutrition Policy and Promotion.
_________________________________________
Signature of Authorized Personnel

________________________
Date

_________________________________________
Name of Authorized Personnel

[RESEARCH FACILITY] hereby agrees to keep confidential all information discussed during
the (Interview/Focus Group) held in (location, date, time) on behalf of the USDA, Center for
Nutrition Policy and Promotion.
_________________________________________
Signature of Authorized Personnel
_________________________________________
Name of Authorized Personnel

________________________
Date