General Purpose Privacy Act Statement (OPNAV FORM 5211/12)

Published, September 13, 2010

When an individual is requested to furnish personally identifiable information for possible inclusion in a system of records, a Privacy Act Statement (PAS) must be provided to the individual, regardless of the method used to collect the information (e.g., forms, personal, telephonic interview, IT system, etc). If the information requested will not be included in a system of records, a PAS is not required.

More detailed PAS guidance regarding the use, required information and format can be found in the SECNAVINST 5211.5 series.

OPNAV FORM 5211/12 (General Purpose Privacy Act Statement) is provided to assist in developing a PAS.

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