Privacy Act Statement

Federal agencies are required to provide what is commonly referred to as a “Privacy Act Statement” to all persons asked to provide personal information about themselves, which will go into a system of records (i.e., the information will be stored and retrieved using the individual’s name or other personal identifier such as a Social Security number).

The Privacy Act of 1974, 5 U.S.C. 552a, provides protection to individuals by ensuring that personal information collected by federal agencies is limited to that which is legally authorized and necessary, and is maintained in a manner which precludes unwarranted intrusions upon individual privacy.

Posted here is a sample Privacy Act Statement template you may use for reference.