Industry Liaison Program Vendor Profile Form Page 2

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PRIVACY ACT STATEMENT
AUTHORITY: 6 U.S.C § 796 "Registry of disaster response contractors"
Purpose: DHS/FEMA collects this information to facilitate communication between FEMA and the participants of FEMA's Industry Liaison
Program.
Routine Use(s): This information is used for the principal purpose(s) noted above. The information on this form may be disclosed internally
within DHS as generally permitted under
5 U.S.C. § 552a(b)(1) of the Privacy Act of 1974, as amended, and will not be shared outside of DHS.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or
prevent FEMA's sharing of information related to its Industry Liaison Program.

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