PT-05(02) Privacy Act Statements

Include Privacy Act statements on forms that collect information that will be maintained in a Privacy Act system of records, or provide Privacy Act statements on separate forms that can be retained by individuals.



If a federal agency asks individuals to supply information that will become part of a system of records, the agency is required to provide a [PRIVACT](#18e71fec-c6fd-475a-925a-5d8495cf8455) statement on the form used to collect the information or on a separate form that can be retained by the individual. The agency provides a [PRIVACT](#18e71fec-c6fd-475a-925a-5d8495cf8455) statement in such circumstances regardless of whether the information will be collected on a paper or electronic form, on a website, on a mobile application, over the telephone, or through some other medium. This requirement ensures that the individual is provided with sufficient information about the request for information to make an informed decision on whether or not to respond.

[PRIVACT](#18e71fec-c6fd-475a-925a-5d8495cf8455) statements provide formal notice to individuals of the authority that authorizes the solicitation of the information; whether providing the information is mandatory or voluntary; the principal purpose(s) for which the information is to be used; the published routine uses to which the information is subject; the effects on the individual, if any, of not providing all or any part of the information requested; and an appropriate citation and link to the relevant system of records notice. Federal agency personnel consult with the senior agency official for privacy and legal counsel regarding the notice provisions of the [PRIVACT](#18e71fec-c6fd-475a-925a-5d8495cf8455).

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