Appendix F—Format for New or Altered System Report

(See paragraph (c) of §310.33)

The report on a new or altered system shall consist of a transmittal letter, a narrative statement, and include supporting documentation.

A. Transmittal Letter

The transmittal letter shall be prepared by the Defense Privacy Office and shall contain assurances that the new or altered system does not duplicate any existing Component systems, DoD-wide systems or government-wide systems. The narrative statement, and the system notice, shall be attached thereto.

B. Narrative Statement

The statement shall include information on the following:

  1. System name and number;
  2. Purpose of (establishing/modifying) the system;
  3. Specific authority for maintenance of the system;
  4. Evaluation on the probable or potential effect on the privacy of individuals;
  5. Routine use compatibility;
  6. OMB information collection requirements;
  7. Name of IT system (state NONE if paper records only); and 
  8. Is the system, in whole or in part, being (maintained, collected, used, or disseminated) by a contractor?

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DEPARTMENT OF DEFENSE
[Component Name]
Narrative Statement on a [New/Modified] System of Records
Under the Privacy Act of 1974

1.         System name and number:  This caption sets forth the identification and name of the system (see subparagraphs (b)(c) of §310.32).

2.         Purpose of (establishing/modifying) the system:  Describe the purpose of the new system or how an existing system is being changed.

3.          Specific authority for maintenance of the system: See paragraph (g) of §310.32.

4.          Evaluation on the probable or potential effect on the privacy of individuals:   What effect, if any, will the new or altered system impact the personal privacy of the affected individuals.

5.          Routine use compatibility:   The routine uses are consistent with the purposes for which the information was collected and have been determined to be either necessary and proper or functionally equivalent uses.

Routine use (A) is compatible with the purpose of the collection because it would permit necessary and proper uses by enabling disclosures of information to contractors to perform agency functions related to this system of records.

 

Routine uses (B) is compatible with the purpose of this collection because it would permit necessary and proper uses by enabling disclosures in furtherance of authorized law enforcement functions.

 

Routine uses (C) and (D) are compatible with the purpose of this collection because they would permit necessary and proper uses by enabling disclosures of relevant and necessary information in pending or potential litigation or proceedings.

 

Routine use (E) is compatible with the purpose of this collection because it would permit necessary and proper uses of allowing the inspection of agency records by the National Archives and Records Administration, in accordance with applicable legal requirements.

 

Routine use (F) is compatible with the purpose of this collection because it would permit necessary and proper uses by enabling disclosures to Members of Congress and congressional staff when acting on behalf of the individual in addressing constituent matters, in accordance with past Office of Management and Budget (OMB) guidance.

 

Routine uses (G) and (H) are necessary and proper uses included in response to the Office of Management and Budget (OMB) requirement in OMB Memorandum M-17-12 to respond appropriately to a breach of personally identifiable information in this system or records or, as appropriate, to assist another Federal agency or entity in its response to a breach.

 

Routine Use (I) is compatible with the purpose of this collection because it would permit necessary and proper uses by enabling Inspectors General to conduct their duties in accordance with the Inspector General Act of 1978.

 

Routine use (J) is compatible with the purpose of this collection because it would permit necessary and proper uses by enabling disclosures under such circumstances and procedures as are mandated by Federal statute or treaty.

 

Provide assurances that any records contained in the system that are disclosed outside the DoD shall be for a use that is compatible with the purpose for which the record was collected. Advise whether or not the blanket routine uses apply to this system. Please note, routine uses A through J is standard language.

 

6.         OMB information collection requirements:

            OMB collection required:  

            OMB Control Number (if approved):  

            Title of Collection:  

            Date Submitted to OMB if Pending:  

            Expiration Date (if approved):

OMB collection requirements: If information is to be collected from members of the public, the requirements of reference ( ) apply and OMB must be advised.

 

Provide titles of any information collection requests (e.g. forms and number, surveys, interviews scripts, etc.) contained in the system of records: 

If collecting on members of the public and no OMB approval is required, state the applicable exception(s):  

Information Required by PCLD:  (Not required by OMB)

7.         Name of IT system (state NONE if paper records only):  

8.         Is the system, in whole or in part, being (maintained, collected, used, or disseminated) by a contractor?   If yes, Components shall ensure that the contract has incorporated the Federal Acquisition privacy clause (see paragraph (a)(1) of §310.12).

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