Contractor Non-Disclosure Agreement (Nda) Form Page 2
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2COMMITMENT TO PROTECT NON-PUBLIC INFORMATION
Contractor Agreement
Access to non-public information may be required in the performance of my official duties,
while working under the following contract or subcontract with the National Institutes of
Health (NIH): Contract Number _________________________________ between
________________________________ and my employer ______________________________.
(NIH I/C Name or Component)
(Contractor’s Company)
Should I have access to non-public information, I agree that I shall not release, publish, or
disclose such information to unauthorized persons. I shall protect such information and will
employ all reasonable efforts to maintain the confidentiality of such information. These
efforts shall be no less than the degree of care employed by NIH to preserve and safeguard
sensitive information.
I agree that I shall immediately notify the NIH IT Service Desk of any suspected or confirmed
unauthorized disclosure and/or misuse of sensitive information.
[ 301-496-4357 (local), 866-319-4357 (toll free), 301-496-8294 (TTY) or
I understand that there are laws and regulations which provide for criminal and/or civil
penalties for improper disclosure, including but not limited to:
a) 18 U.S.C. 641 (Public Money, Property or Records)
b) 18 U.S.C. 1832 (Trade Secrets)
c) 18 U.S.C. 1905 (Disclosure of Confidential Information)
d) 5 U.S.C. 552a (Privacy Act)
I have read and understand the requirements stated above and agree to adhere to them for
the duration of time I work under a contract or subcontract with NIH. I understand that
violation of the agreement may subject me to criminal and civil penalties.
Select one of the two options for signing this form:
1) Digital Signature
2) Manual Signatures (requires Witness)
Insert Digital Signature
Type or Print Your Name: _____________________________
Signature: _________________________________________
Date: ___________________
Type or Print Witness Name: __________________________
Signature: _________________________________________
Date: ___________________
Copies are to be retained by:
3) Contractor’s Company (Division of Contract
1) NIH IC Project Officer
Management) System
2) Individual Contractor
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