Appendix D - The Urban Institute Staff Confidentiality Pledge

Appendix D
Urban Institute Staff Confidentiality Pledge

Revised June 2014

CONFIDENTIALITY PLEDGE
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES STUDY (2-PARENT TANF)
Assurance of Confidentiality

The Urban Institute assures all respondents and participating organizations that the information
they release to this study will be held in the strictest confidence possible by the contracting
organizations and that no information obtained in the course of this study will be disclosed in
such a way that individuals or organizations are identifiable. Access to the data in this study is
by consent of the respondents who have been assured confidentiality. This assurance of
confidentiality does not prevent researchers from voluntarily disclosing information as required
by law, without consent. For example, the study team may voluntarily disclose information about
incidents such as child abuse, or intent to hurt oneself or others. In addition, this assurance of
confidentiality does not prevent respondents or members of respondents’ family from voluntarily
releasing information about respondents or their involvement in this research.
In furtherance of our commitment of confidentiality to respondents and participating
organization, you hereby confirm the following:
“I have carefully read and understand this assurance that pertains to the confidential
nature of all information and records to be handled in this study. I have read a copy of
the “Confidential Data at the Urban Institute – Guidelines for Data Security,” which
has been provided for me with this Confidentiality Pledge. I understand that I
must comply with all of data security requirements adapted from those Guidelines
for this project as approved by the Urban Institute Institutional Review Board to
the extent permitted by federal laws, regulations, and directives applicable. As an
employee of The Urban Institute, I understand that I am prohibited from
disclosing any such confidential information which has been obtained under the
terms of this contract to anyone other than authorized contractor staff and agree
to follow the procedures outlined to me during training. Should situations arise
that warrant the disclosure or release of such information, I will do so only under
approved circumstances and in accordance with the laws, regulations, or directives
applicable. I understand that each provision of the Guidelines is severable and if
any provision of the Guidelines is found to be unenforceable, all other provisions
shall remain in full force and effect. I will report any suspected breach of
confidentiality/data security immediately to the Chief Information Officer of
The Urban Institute at the address below. I understand that any willful and
knowing disclosure of information released to this study may subject an
employee of The Urban Institute to disciplinary action, up to and including
termination of employment or contract.”
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Revised June 2014

(Print Your Name)

(Signature)

(Date)

(Witness signature)

(Date)

The Urban Institute
2100 M Street, NW
Washington, DC 20037
(202) 833-7200

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