Form Not Applicable Not Applicable Letter for Final Job Offer

Human Resources Specialist
@ftc.gov
(202) 326-

Privacy Act Statement (to be sent with final offer letter)

Authority: We are authorized to collect the information requested pursuant to Executive Order 14043,
Requiring Coronavirus Disease 2019 Vaccination for Federal Employees (Sept. 9, 2021).

Purpose: This information is being collected and maintained to promote the safety of Federal buildings
and the Federal workforce consistent with the above-referenced authority, the COVID-19 Workplace
Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force, and
guidance from Centers for Disease Control and Prevention and the Occupational Safety and Health
Administration.

Routine Uses: This information may be disclosed to any source from which additional information is
requested when necessary to obtain information relevant to an agency decision concerning hiring or
retaining an employee, issuing a security clearance, conducting a security or suitability investigation of
an individual, classifying positions, letting a contract, or issuing a license, grant or other benefit. A
complete list of the routine uses can be found in the Privacy Act systems for Employment ApplicationRelated Records (FTC-II-4) and for Recruiting, Examining, and Placement Records (OPM/GOVT-5).

Consequence of Failure to Provide Information: Providing this information is voluntary. However, if you
fail to provide this information, you will be treated as not fully vaccinated for purposes of considering
your application for employment with the federal government and in implementing safety measures,
including with respect to mask wearing, physical distancing, testing, travel, and quarantine.