Agenda - 11-03-1999 - 8b - Laserfiche WebLink

Browse Search

X1561 28-00092 cn~~i~~nnnn FORM D-1553 (9-21-99) CONFIDENTIALITY AGREEMENT NEW CONSTRUCTION PROGRAM United States Census 2000 U.S. DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS 1. Name of your Organization 2. Address (Number and Street RR HC, or Post Office Box Number) PO. Box 31$1 3. City, State, ZIP Code 4. Governmental Units Represented by your Organization 5. Name of your New Construction Program Liaison 6. Responsibilities of liaisons participating in New Construction program activities New Construction program liaisons must agree to keep confidential the Census 2000 address information they review or to which they have access. They may use this information solely for suggesting improvements to the Census 2000 address list. All individuals from your organization who will be reviewing Census 2000 addresses need to sign below to indicate they read and understand the Census Bureau's rules on confidential information. These rules are provided in the New Construction Program Confidentialityand Security Guidelines. In addition, liaisons who sign below indicate they have read and understand the penaky for disclosing information obtained by the Census Bureau about addresses or individuals is a fine of not more than 55,000, or imprisonment for not more than five years, or both. Date Liaison's Signature and Printed Name Telephone Number 10~2E,~~g -TT2.4~~z- (Pri ary New truction Program Liaison) CR~I G -BE~NED I CT, PLANN I N DIRECTOR ROSCOE REEilE, Director of Land Records Department You may duplicate this form if you require more signature blocks This. form (Confidentiality Agreement, Participation Registration and Program Materials Request) must be returned by November 1, 1999.