Request For Confidentiality Of Information Form

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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.

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