NCSES License Application Affidavit Form

Last Modified: April 2022

APPENDIX E

NSF/NCSES AFFIDAVIT OF NONDISCLOSURE FORM
(Attachment #4 to the License Agreement)

August 2018

48

Last Modified: April 2022

NSF/NCSES AFFIDAVIT OF NONDISCLOSURE
I,
, do solemnly swear (or affirm) that I have read and understand the content of the
NSF/NCSES LICENSE FOR RESTRICTED-USE DATA are protected under the Confidential
Information Protection and Statistical Efficiency Act of 2002, 44 U.S.C. 3501 et. sec.; section
14(i) of the National Science Foundation Act of 1950, as amended, 42 U.S.C. 1873(i); and/or the
Privacy Act of 1974 as amended, 5 U.S.C. 552a and when given access to the restricted use data
(hereinafter referred to as the subject file) from the Survey of Doctorate Recipients, the Survey
of Earned Doctorates, the National Survey of Recent College Graduates and/or the SESTAT
Integrated Database:
•

I will not use the data in the subject file for any purpose other than statistical reporting and analysis.
Information from the file will be released only in statistical summaries that do not disclose
information about any individual.

•

I will not release the subject file or any part of it to any other person or organization.

•

I will not use the subject file to attempt to learn the identity of, or to gain information concerning, any
person included in the data set; unless such identification is directly related to survey

administrative tasks or quality control, arising from a comparison with NIH administrative
data.

If the identity of any individual in the file should be discovered inadvertently, then a) I will make no use
of this knowledge, (b) I will advise the Director, NCSES, of the incident, (c) the information about the
individual will be safeguarded, and (d) no one else will be told of the information discovered.

Signature of Collaborating Researcher
Typed/Printed Name of Collaborating Researcher
Date signed by Collaborating Researcher

Signature of Principal Researcher

Notary Public/Seal/Date

Typed/Printed Name of Principal Researcher
Date signed by Principal Researcher

VIOLATION OF THIS AGREEMENT IS PUNISHABLE UNDER THE PRIVACY ACT OF
1974 AND OTHER LAWS NAMED ABOVE, AND MAY RESULT IN THE RESEARCHER
AND THE RESEARCHER’S INSTITUTION BEING INELIGIBLE FOR FEDERAL
GRANTS.

August 3, 2011

49

Last Modified: April 2022

NSF/NCSES LICENSE FOR RESTRICTED-USE DATA
AMENDMENT TO ADD COLLABORATING RESEARCHER
This is an amendment to add a Collaborating Researcher to the License agreement between the
National Science Foundation (NSF), National Center for Science and Engineering Statistics
(NCSES),
, and
Principal Researcher
.
Parent Institution of the Principal Researcher
Approval is granted for
(Collaborating Researcher)
under the direction of the Principal Researcher, to be added to the above-mentioned License
agreement for access to the restricted use data file specified in the License agreement. All
security requirements as stated in the previous License Agreement signed,
remain in effect.
Date
The Collaborating Researcher confirms that he/she has read and understood the terms of the
original License and will abide by such terms for the full term of the original and any subsequent
extensions.

Signature of Principal Researcher

Date

Signature of Collaborating Researcher

Date

Signature of Senior Official from Parent Institution

Date

Signature of Director, NSF/NCSES

Date

Signature of Chief Statistician, NSF/NCSES

Date

August 3, 2011

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