Privacy Act Examples

For Storage of EO Records

These drawers and cabinets may contain sensitive information pertaining to the office of Equal Opportunity, which is protected from mandatory disclosure under the Freedom of Information Act (FOIA), 5 USC Section 552.

Access to this information is limited to the 1st Operations Brigade Equal Opportunity Advisor and the Brigade Commander.


1. AUTHORITY: Title 50, Appendix, U.S.C., Title 10, U.S.C., Public Law 96-357 96th Congress, September 24 1980 (Amendment to Title 10, U.S.C. 2107).

2. PRINCIPAL PURPOSE(s): To Maintain a Record of administrative data, common tasks, skill qualification assessments, and specific collective tasks which support the unit METL. Also to maintain a record of personal information that affects soldiers' training performance geared toward meeting the soldiers' personal training needs.

3. ROUTINE USE(S): Tracking and evaluations of soldiers' tasks. Provide administrative input to the chain of command on proficiency of the organization. Conduct and track performance and developmental counseling.

4. MANDATORY AND VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL PROVIDING INFORMATION: Disclosure of information requested in this leader's book is Voluntary. However, the information must be furnished for the soldier (s) to ensure that they are receiving the best possible and most current training and to receive proper and timely counseling.


When soliciting personal information such as a SSN or home address for inclusion in a system of records, the following information must be presented to the person:

AUTHORITY: The specific federal statute or executive order that authorizes collection of the requested information.

PRINCIPAL PURPOSE(S): The purpose or purposes for which the information is to be used.

ROUTINE USE(S): How the information is going to be used outside the Department of Defense.

MANDATORY OR VOLUNTARY: If the statute or executive order provides a penalty for not providing the information, than it is mandatory.

Example of Privacy Act statement for Counseling

AUTHORITY: 10 U.S.C. 3013, Secretary of the Army; ATP 6-22.1 Army Leadership, The Counseling Process.

PURPOSE: To record this counseling session and receive any comments you desire to submit (on a voluntary basis) for consideration concerning this action.

ROUTINE USES: This document and any comments and documents submitted become part of the record. These records will normally be maintained at unit level unless requested by a competent authority to support disciplinary action.

DISCLOSURE: Your written acknowledgment of receipt and signature are mandatory. Any other document you provide is voluntary.

Example of Privacy Act statement for EO Complaint

AUTHORITY: 10 U.S.C. Section 3013, Secretary of the Army; AR 600-20, Army Command Policy and E.O. 9397 (SSN).

PRINCIPAL PURPOSE(s): To provide a means for filing a complaint based on discrimination due to race, color religion, gender, or national origin.

ROUTINE USE(S): None. The "Blanket Routine Uses" set forth at the beginning of the Army's Compilation of Systems of Record Notices also applies to this system.

DISCLOSURE: Voluntary. However, failure to provide all the requested information could lead to rejection of complaint for inadequate data.

Image of Page Divider Line

To contribute examples, enter them below and click Submit.