Department Of Homeland Security Non-Disclosure Agreement

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DEPARTMENT OF HOMELAND SECURITY
NON-DISCLOSURE AGREEMENT
I, _______________________________________, an individual official, employee, consultant, or subcontractor of or to
_____________________ (the Authorized Entity), intending to be legally bound, hereby consent to the terms in this
Agreement in consideration of my being granted conditional access to certain information, specified below, that is owned
by, produced by, or in the possession of the United States Government.
(Signer will acknowledge the category or categories of information that he or she may have access to, and the signer’s willingness to comply with
the standards for protection by placing his or her initials in front of the applicable category or categories.)
Initials:
Protected Critical Infrastructure Information (PCII)
I attest that I am familiar with, and I will comply with all requirements of the PCII program set out in the Critical
Infrastructure Information Act of 2002 (CII Act) (Title II, Subtitle B, of the Homeland Security Act of 2002, Public Law
107-296, 196 Stat. 2135, 6 USC 101 et seq.), as amended, the implementing regulations thereto (6 CFR Part 29), as
amended, and the applicable PCII Procedures Manual, as amended, and with any such requirements that may be
officially communicated to me by the PCII Program Manager or the PCII Program Manager’s designee.
Initials:
Sensitive Security Information (SSI)
I attest that I am familiar with, and I will comply with the standards for access, dissemination, handling, and
safeguarding of SSI information as cited in this Agreement and in accordance with 49 CFR Part 1520, “Protection of
Sensitive Security Information,” “Policies and Procedures for Safeguarding and Control of SSI,” as amended, and any
supplementary guidance issued by an authorized official of the Department of Homeland Security.
Initials:
Other Sensitive but Unclassified (SBU)
As used in this Agreement, sensitive but unclassified information is an over-arching term that covers any information,
not otherwise indicated above, which the loss of, misuse of, or unauthorized access to or modification of could adversely
affect the national interest or the conduct of Federal programs, or the privacy to which individuals are entitled under
Section 552a of Title 5, as amended, but which has not been specifically authorized under criteria established by an
Executive Order or an Act of Congress to be kept secret in the interest of national defense or foreign policy. This
includes information categorized by DHS or other government agencies as: For Official Use Only (FOUO); Official Use
Only (OUO); Sensitive Homeland Security Information (SHSI); Limited Official Use (LOU); Law Enforcement
Sensitive (LES); Safeguarding Information (SGI); Unclassified Controlled Nuclear Information (UCNI); and any
other identifier used by other government agencies to categorize information as sensitive but unclassified.
I attest that I am familiar with, and I will comply with the standards for access, dissemination, handling, and
safeguarding of the information to which I am granted access as cited in this Agreement and in accordance with the
guidance provided to me relative to the specific category of information.
I understand and agree to the following terms and conditions of my access to the information indicated above:
1. I hereby acknowledge that I have received a security indoctrination concerning the nature and protection of information to which I
have been provided conditional access, including the procedures to be followed in ascertaining whether other persons to whom I
contemplate disclosing this information have been approved for access to it, and that I understand these procedures.
2. By being granted conditional access to the information indicated above, the United States Government has placed special
confidence and trust in me and I am obligated to protect this information from unauthorized disclosure, in accordance with the
terms of this Agreement and the laws, regulations, and directives applicable to the specifi c categories of information to which I am
granted access.
3. I attest that I understand my responsibilities and that I am familiar with and will comply with the standards for protecting such
information that I may have access to in accordance with the terms of this Agreement and the laws, regulations, and/or directives
applicable to the specifi c categories of information to which I am granted access. I understand that the United States Government
may conduct inspections, at any time or place, for the purpose of ensuring compliance with the conditions for access, dissemination,
handling and safeguarding information under this Agreement.
DHS Form 11000-6 (08-04)
Page 1

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