Common use of Privacy Act Notification Clause in Contracts

Privacy Act Notification. This information is provided pursuant to the Privacy Act of 1974 (Public Law No. 94-579), as amended, for individuals supplying information for inclusion in a system of records. The authority for the collection of this information is 34 U.S.C. §10671. The purpose of the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Loan Repayment for Prosecutors and Public Defenders statute is to encourage qualified individuals to enter and continue employment as prosecutors and public defenders. This Agreement and related data are made part of the file to be used within the Department of Justice for record-keeping and management while participating in the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Student Loan Repayment program. The information also may be disclosed outside the Department, as permitted by the Privacy Act and Freedom of Information Act, to the Congress, the Internal Revenue Service, and pursuant to court order. You are asked to provide your Social Security Number. Please note that if you do not provide the information, and you are selected to participate in the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Student Loan Repayment program, your Social Security Number will be required later to enable the Department to verify your eligibility status. Failure to submit this information will render this Agreement incomplete and you be considered ineligible to participate in the program. I, , agree to the terms of this Service Agreement. The following form should be used only in cases where a current JRJ beneficiary has not yet fulfilled his/her initial 3-year service obligation, but remains eligible for JRJ benefits. Appendix D: JRJ Beneficiary Service Agreement (Acknowledgment of Benefit)‌ Note to JRJ State Administering Agencies: the following form should be used only in cases where a current JRJ beneficiary has not yet fulfilled his/her initial 3-year service obligation, but remains eligible for JRJ benefits. Upon fulfilling his/her initial 3-year service obligation, the JRJ beneficiary may exit the program or, if selected to receive additional JRJ benefits, should execute the JRJSLRP – Secondary Term of Service document (see Appendix D above). I, , hereby acknowledge the following: NAME

Privacy Act Notification. This information is provided pursuant to the Privacy Act of 1974 (Public Law No. 94-579), as amended, for individuals supplying information for inclusion in a system of records. The authority for the collection of this information is 34 42 U.S.C. §106713797cc-21. The purpose of the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Loan Repayment for Prosecutors and Public Defenders statute is to encourage qualified individuals to enter and continue employment as prosecutors and public defenders. This Agreement and related data are made part of the file to be used within the Department of Justice for record-record- keeping and management while participating in the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Student Loan Repayment program. The information also may be disclosed outside the Department, as permitted by the Privacy Act and Freedom of Information Act, to the Congress, the Internal Revenue Service, and pursuant to court order. You are asked to provide your Social Security Number. Please note that if you do not provide the information, and you are selected to participate in the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Student Loan Repayment program, your Social Security Number will be required later to enable the Department to verify your eligibility status. Failure to submit this information will render this Agreement incomplete and you be considered ineligible to participate in the program. I, , agree to the terms of this the Service Agreement. The following form should SIGNATURE (must be used only in cases where a current JRJ beneficiary has not yet fulfilled his/her initial 3ink) DATE NAME: Last four #’s of SSN: xxx-year service obligation, but remains eligible for JRJ benefits. Appendix D: JRJ Beneficiary Service Agreement (Acknowledgment of Benefit)‌ Note to JRJ State Administering Agencies: the following form should be used only in cases where a current JRJ beneficiary has not yet fulfilled his/her initial 3-year service obligation, but remains eligible for JRJ benefits. Upon fulfilling his/her initial 3-year service obligation, the JRJ beneficiary may exit the program or, if selected to receive additional JRJ benefits, should execute the JRJSLRP – Secondary Term of Service document (see Appendix D above). xx- I, , hereby acknowledge the following: NAME 1. I have personally executed a JRJSLRP Service Agreement and the term of obligated public service thereunder (as designated in said Service Agreement) has not yet expired as of the date of execution hereunder. 2. Additional JRJSLRP benefit payments have been made on my behalf during the fiscal year in which this document is executed. 3. I remain bound by the terms of my JRJSLRP Service Agreement. 4. At the expiration of my term of obligated public service (as designated in the JRJSLRP Service Agreement to which I am currently subject), I may enter into a separate agreement that will govern the terms and conditions of the receipt of any additional JRJSLRP benefits received on my behalf outside the terms and conditions of the JRJSLRP Service Agreement to which I am now subject.

Privacy Act Notification. This information is provided pursuant to the Privacy Act of 1974 (Public Law No. 94-579), as amended, for individuals supplying information for inclusion in a system of records. The authority for the collection of this information is 34 U.S.C. §1067110671cc-21. The purpose of the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Loan Repayment for Prosecutors and Public Defenders statute is to encourage qualified individuals to enter and continue employment as prosecutors and public defenders. This Agreement and related data are made part of the file to be used within the Department of Justice for record-record- keeping and management while participating in the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Student Loan Repayment program. The information also may be disclosed outside the Department, as permitted by the Privacy Act and Freedom of Information Act, to the Congress, the Internal Revenue Service, and pursuant to court order. You are asked to provide your Social Security Number. Please note that if you do not provide the information, and you are selected to participate in the ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ Student Loan Repayment program, your Social Security Number will be required later to enable the Department to verify your eligibility status. Failure to submit this information will render this Agreement incomplete and you be considered ineligible to participate in the program. I, , agree to the terms of this the Service Agreement. The following form should SIGNATURE (must be used only in cases where a current JRJ beneficiary has not yet fulfilled his/her initial 3ink) DATE NAME: Last four #’s of SSN: xxx-year service obligation, but remains eligible for JRJ benefits. Appendix D: JRJ Beneficiary Service Agreement (Acknowledgment of Benefit)‌ Note to JRJ State Administering Agencies: the following form should be used only in cases where a current JRJ beneficiary has not yet fulfilled his/her initial 3-year service obligation, but remains eligible for JRJ benefits. Upon fulfilling his/her initial 3-year service obligation, the JRJ beneficiary may exit the program or, if selected to receive additional JRJ benefits, should execute the JRJSLRP – Secondary Term of Service document (see Appendix D above). xx- I, , hereby acknowledge the following: NAME 1. I have personally executed a JRJSLRP Service Agreement and the term of obligated public service thereunder (as designated in said Service Agreement) has not yet expired as of the date of execution hereunder. 2. Additional JRJSLRP benefit payments have been made on my behalf during the fiscal year in which this document is executed. 3. I remain bound by the terms of my JRJSLRP Service Agreement. 4. At the expiration of my term of obligated public service (as designated in the JRJSLRP Service Agreement to which I am currently subject), I may enter into a separate agreement that will govern the terms and conditions of the receipt of any additional JRJSLRP benefits received on my behalf outside the terms and conditions of the JRJSLRP Service Agreement to which I am now subject.