Pursuant to Title 28 of the Code of Federal Regulations, Part 22, project staff have an obligation to those we interview to protect their identities and the information they provide to the ______________ project. The identity of persons interviewed and the related data are to remain confidential. Removal of names or disclosure of identities and related information is strictly forbidden. Contents of interviews are not to be discussed with anyone except project staff, and only as it is necessary to complete the assigned work. Additionally, sensitive interview information should not be discussed anywhere it could be overheard by persons who are not authorized to know this information.
As a member of the site personnel, contractor, or subcontractor staff of the _______________project, I, _____________________________, agree that I will protect the confidentiality of all information identifiable to a private person that is collected in the conduct of my work for the __________________ project.
I agree that I shall not discuss any identifiable information that I may learn of during the course of my employment as part of the site personnel, contractor, or subcontractor staff with anyone other than project staff members who have a need to know this information.
I agree to follow the procedures established by the ___________________ project to prevent unauthorized access to information identifiable to a private person.
I certify that I have been informed that the ________________ project, which is being funded in whole or in part by the National Institute of Justice, is governed by the Department of Justice Regulations in 28 CFR Part 22 & Part 46, which govern the use and revelation of research and statistical information identifiable to a private person, and that I, as a member of the _____________ project's site personnel, contractor, or subcontractor staff am governed by these regulations as well.
I certify that I have been given copies of the regulations at 28 CFR Part 22 & Part 46 and that I understand the obligations imposed by them.
I understand that my signing this agreement is a condition of my employment as part of the_________________ project's site personnel, contractor, or subcontractor staff.
By signing this statement, I am acknowledging that I understand the rules surrounding the protection of confidential information and, if I am found to be in violation of these provisions, I can be fined not to exceed $10,000 in addition to any other penalty imposed by law.
Full Legal Name (please print): ___________________________________