CLASSIFIED INFORMATION NONDISCLOSURE AGREEMENT

AN AGREEMENT BETWEEN AND THE UNITED STATES

(Name of Individual - Printed or typed)

1. Intending to be legally bound, I hereby accept the obligations contained in this Agreement in consideration of my being granted

access to classified information. As used in this Agreement, classified information is marked or unmarked classified information,

including oral communications, that is classified under the standards of Executive Order 13526, or under any other Executive order or

statute that prohibits the unauthorized disclosure of information in the interest of national security; and unclassified information that

meets the standards for classification and is in the process of a classification determination as provided in sections 1.1, 1.2, 1.3 and

1.4(e) of Executive Order 13526, or under any other Executive order or statute that requires protection for such information in the

interest of national security. I understand and accept that by being granted access to classified information, special confidence and

trust shall be placed in me by the United States Government.

2. I hereby acknowledge that I have received a security indoctrination concerning the nature and protection of classified information,

including the procedures to be followed in ascertaining whether other persons to whom I contemplate disclosing this information have

been approved for access to it, and that I understand these procedures.

3. I have been advised that the unauthorized disclosure, unauthorized retention, or negligent handling of classified information by me

could cause damage or irreparable injury to the United States or could be used to advantage by a foreign nation. I hereby agree that I

will never divulge classified information to anyone unless: (a) I have officially verified that the recipient has been properly authorized by

the United States Government to receive it; or (b) I have been given prior written notice of authorization from the United States

Government Department or Agency (hereinafter Department or Agency) responsible for the classification of information or last granting

me a security clearance that such disclosure is permitted. I understand that if I am uncertain about the classification status of

information, I am required to confirm from an authorized official that the information is unclassified before I may disclose it, except to a

person as provided in (a) or (b), above. I further understand that I am obligated to comply with laws and regulations that prohibit the

unauthorized disclosure of classified information.

4. I have been advised that any breach of this Agreement may result in the termination of any security clearances I hold; removal from

any position of special confidence and trust requiring such clearances; or termination of my employment or other relationships with the

Departments or Agencies that granted my security clearance or clearances. In addition, I have been advised that any unauthorized

disclosure of classified information by me may constitute a violation, or violations, of United States criminal laws, including the

provisions of sections 641, 793, 794, 798, *952 and 1924, title 18, United States Code; *the provisions of section 783(b}, title 50,

United States Code; and the provisions of the Intelligence Identities Protection Act of 1982. I recognize that nothing in this Agreement

constitutes a waiver by the United States of the right to prosecute me for any statutory violation.

5. I hereby assign to the United States Government all royalties, remunerations, and emoluments that have resulted, will result or may

result from any disclosure, publication, or revelation of classified information not consistent with the terms of thisAgreement.

6. I understand that the United States Government may seek any remedy available to it to enforce this Agreement including, but not

limited to, application for a court order prohibiting disclosure of information in breach of thisAgreement.

7. I understand that all classified information to which I have access or may obtain access by signing this Agreement is now and will

remain the property of, or under the control of the United States Government unless and until otherwise determined by an authorized

official or final ruling of a court of law. I agree that I shall return all classified materials which have, or may come into my possession or

for which I am responsible because of such access: (a) upon demand by an authorized representative of the United States

Government; (b) upon the conclusion of my employment or other relationship with the Department or Agency that last granted me a

security clearance or that provided me access to classified information; or (c) upon the conclusion of my employment or other

relationship that requires access to classified information. If I do not return such materials upon request, I understand that this may be

a violation of sections 793 and/or 1924, title 18, United States Code, a United States criminal law.

8. Unless and until I am released in writing by an authorized representative of the United States Government, I understand that all

conditions and obligations imposed upon me by this Agreement apply during the time I am granted access to classified information,

and at all times thereafter.

9. Each provision of this Agreement is severable. If a court should find any provision of this Agreement to be unenforceable, all other

provisions of this Agreement shall remain in full force and effect.

10. These provisions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or

liabilities created by existing statute or Executive order relating to (1) classified information, (2) communications to Congress, (3) the

reporting to an Inspector General of a violation of any law, rule, or regulation, or mismanagement, a gross waste of funds, an abuse of

authority, or a substantial and specific danger to public health or safety, or (4) any other whistleblower protection. The definitions,

requirements, obligations, rights, sanctions, and liabilities created by controlling Executive orders and statutory provisions are

incorporated into this agreement and are controlling.

NSN 7540-01-280-5499

Previous edition not usable.

(Continue on reverse.)

STANDARD FORM 312 (Rev. 7-2013)

Prescribed by ODNI

32 CFR PART 2001.80 E.O. 13526
11. These restrictions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or

liabilities created by Executive Order No. 13526 (75 Fed. Reg. 707), or any successor thereto section 7211 of title 5, United States

Code (governing disclosures to Congress); section 1034 of title 10, United States Code, as amended by the Military Whistleblower

Protection Act (governing disclosure to Congress by members of the military); section 2302(b) (8) of title 5, United States Code, as

amended by the Whistleblower Protection Act of 1989 (governing disclosures of illegality, waste, fraud , abuse or public health or

safety threats); the Intelligence Identities Protection Act of 1982 (50 U.S.C. 421 et seq.) (governing disclosures that could expose

confidential Government agents); sections 7(c) and 8H of the Inspector General Act of 1978 (5 U.S.C. App.) (relating to disclosures to

an inspector general, the inspectors general of the Intelligence Community. and Congress); section 103H(g)(3) of the National Security

Act of 1947 (50 U.S.C. 403-3h(g)(3) (relating to disclosures to the inspector general of the Intelligence Community); sections 17(d)(5)

and 17(e)(3) of the Central Intelligence Agency Act of 1949 (50 U.S.C. 403g(d)(5) and 403q(e)(3)) (relating to disclosures to the

Inspector General of the Central Intelligence Agency and Congress); and the statutes which protect against disclosure that may

compromise the national security, including sections 641, 793, 794, 798, *952 and 1924 of title 18, United States Code, and *section 4

(b) of the Subversive Activities Control Act of 1950 (50 U.S.C. section 783(b)). The definitions, requirements, obligations, rights,

sanctions, and liabilities created by said Executive Order and listed statutes are incorporated into this agreement and are controlling.

12. I have read this Agreement carefully and my questions, if any, have been answered. I acknowledge that the briefing officer has

made available to me the Executive Order and statutes referenced in this agreement and its implementing regulation (32 CFR Part

2001 , section 2001 .80(d)(2) ) so that I may read them at this time, if I so choose.

* NOT APPLICABLE TO NON-GOVERNMENT PERSONNEL SIGNING THIS AGREEMENT.

SIGNATURE DATE SOCIAL SECURITY NUMBER (See Notice below)

ORGANIZATION (IF CONTRACTOR, LICENSEE, GRANTEE OR AGENT, PROVIDE: NAME, ADDRESS, AND, IF APPLICABLE, FEDERAL SUPPLY CODE

NUMBER) (Type or print)

WITNESS ACCEPTANCE

THE EXECUTION OF THIS AGREEMENT WAS WITNESSED 

BY THE UNDERSIGNED.

THE UNDERSIGNED ACCEPTED THIS AGREEMENT 

ON BEHALF OF THE UNITED STATES GOVERNMENT.

SIGNATURE DATE SIGNATURE DATE

NAME AND ADDRESS (Type or print) NAME AND ADDRESS (Type or print)

SECURITY DEBRIEFING ACKNOWLEDGEMENT

I reaffirm that the provisions of the espionage laws, other federal criminal laws and executive orders applicable to the safeguarding of classified 

information have been made available to me; that I have returned all classified information in my custody; that I will not communicate or transmit 

classified information to any unauthorized person or organization; that I will promptly report to the Federal Bureau of Investigation any attempt by an 

unauthorized person to solicit classified information, and that I (have) (have not) (strike out inappropriate word or words) received a security debriefing.

SIGNATURE OF EMPLOYEE DATE

NAME OF WITNESS (Type or print) SIGNATURE OF WITNESS

NOTICE: The Privacy Act, 5 U.S.C. 552a, requires that federal agencies inform individuals, at the time information is solicited from them, whether the 

disclosure is mandatory or voluntary, by what authority such information is solicited, and what uses will be made of the information. You are hereby 

advised that authority for soliciting your Social Security Number (SSN) is Public Law 104-134 (April 26, 1996). Your SSN will be used to identify you 

precisely when it is necessary to certify that you have access to the information indicated above or to determine that your access to the information 

indicated has been terminated. Furnishing your Social Security Number, as well as other data, is voluntary, but failure to do so may delay or prevent you 

being granted access to classified information.

STANDARD FORM 312 BACK (Rev. 7-2013)