Request For Confidentiality Of Information Form printable pdf download

NOTICE

Request for Confidentiality of Information Maintained by the

City of _______________ Utilities Department

Information in your City of ___________ Utilities Department customer account record is generally considered

public information under Texas Government Code, Chapter 552 (Public Information Act). However, the Texas

Utilities Code, Chapter 182 (Rights of Utilities Customers), provides that a government-operated utility may not

disclose personal information, or any information relating to the volume or units of utility usage or the amounts

billed to or collected from a customer for utility usage, if the customer requests that the government-operated

utility keep the information confidential.*

This form enables you to request confidentiality of certain information under Texas Utilities Code, Chapter 182.

If you wish to request confidentiality of your information, please check the boxes below and return this form

with your payment (or in the separate envelope provided for that purpose).

Customer Name:___________________________

Account Number: ___________________________

I request that personal information (address, telephone number, and social security number) in my account

record maintained by the City of ________________ Utilities Department be kept confidential under

Texas Utilities Code, Chapter 182.

I request that any information relating to the volume or units of utility usage or the amounts billed to or

collected from me for utility usage maintained by the City of ________________ Utilities Department be

kept confidential under Texas Utilities Code, Chapter 182.

I understand that the City of ______________ Utilities Department may charge each customer who requests

confidentiality under Chapter 182 a fee not to exceed the administrative cost of complying with the request of

confidentiality. The fee charged by the City of _____________ Utilities Department for this service is

$_____________.

You may rescind your request for confidentiality by providing the City of _________ Utilities Department

written permission to disclose your personal information. A government-operated utility or an officer or

employee of a government-operated utility is immune from civil liability for a violation of Texas Utilities Code,

Subchapter B.

∗

A government-operated utility may disclose information related to the customer’s volume or units of utility

usage or amounts billed to or collected from the customer for utility usage if the primary source of water for

such utility is a sole-source designated aquifer. A request for confidentiality under Chapter 182 does not

prohibit a government-operated utility from disclosing personal information in a customer's account record to:

(1) an official or employee of the state, a political subdivision of the state, or the United States acting in an

official capacity; (2) an employee of a utility acting in connection with the employee's duties; (3) a consumer

reporting agency; (4) a contractor or subcontractor approved by and providing services to the utility, the state, a

political subdivision of the state, or the United States; (5) a person for whom the customer has contractually

waived confidentiality for personal information; or (6) another entity that provides water, wastewater, sewer,

gas, garbage, electricity, or drainage service for compensation.

Request For Confidentiality Of Information Form