Non-Disclosure Agreement

ATTACHMENT F2

FTE NONDISCLOSURE AGREEMENT

(308(d) Assurance of Confidentiality for CDC Employees)

The success of CDC’s operations depends upon the voluntary cooperation of states, of establishments, and of individuals who provide the information required by CDC programs under an assurance that such information will be kept confidential and be used only for epidemiological or statistical purposes.

When confidentiality is authorized, CDC operates under the restrictions of Section 308(d) of the Public Health Service Act which provides in summary that no information obtained in the course of its activities may be used for any purpose other than the purpose for which it was supplied, and that such information may not be published or released in a manner in which the establishment or person supplying the information or described in it is identifiable unless such establishment or person has consented.

“I am aware that unauthorized disclosure of confidential information is punishable under Title 18, Section 1905 of the U.S. Code, which reads:

‘Whoever, being an officer or employee of the United States or of any department or agency thereof, publishes, divulges, discloses, or makes known in any manner or to any extent not authorized by law any information coming to him in the course of his employment or official duties or by reason of any examination or investigation made by, or return, report or record made to or filed with, such department or agency or officer or employee thereof, which information concerns or relates to the trade secrets, processes, operations, style of work, or apparatus, or to the identity, confidential statistical data, amount or source of any income, profits, losses, or expenditures of any person, firm, partnership, corporation, or association; or permits any income return or copy thereof or any book containing any abstract or particulars thereof to be seen or examined by any person except as provided by law; shall be fined not more than $1,000, or imprisoned not more than one year, or both; and shall be removed from office or employment.’

“I understand that unauthorized disclosure of confidential information is also punishable under the Privacy Act of 1974, Subsection 552a (i) (1), which reads:

‘Any officer or employee of any agency, who by virtue of his employment or official position, has possession of, or access to, agency records which contain individually identifiable information the disclosure of which is prohibited by this section or by rules or regulations established thereunder, and who knowing that disclosure of the specific material is so prohibited, willfully discloses the material in any manner to any person or agency not entitled to receive it, shall be guilty of a misdemeanor and fined not more than $5,000.’

“My signature below indicates that I have read, understood, and agreed to comply with the above statements.”

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Typed/Printed Name Signature Date

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National Center/Institute/Office/Branch

Rev. February 2013, based on CDC 0.979 (E) 10/2012