Approved For Release 2000/08/07 : CIA-RDP96-00788ROO1200280038-9 DATE- I 5g~,,b GRILL FLAME SECURITY AGREEMENT if D6 P? j 4 5; f~O_V;I_e understand that the highly sensitive and classified inro-rmation I have, or are about to receive as part of the GRILL FLAME Program belongs to the United States Government. I understand that the disclosure of this information is punishable under Title 18, Section 798,'U.S.C.,, "Disclosure of Classified Information," June 1948, as amended. I do solemnly swear that I will never divulge, publish, or reveal. by word, conduct, or by any other means such classified information or knowledge, except in the performance of my official" duties, and as specifically authorized in writing in each case by the appropriate agency of the United States Government. I-,understand that no change in my assignment or employment will relieve me of my obligation under this agreement and that the provisior~s of this agreement will remain.binding upon me even after the termination of my services with the United States Government. I'take this obligation of.my,.own free will, without any mental. reservation or purpose of evasion. DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C.. 552a) 1. Autborityt National Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering System for Federal Accounts Relating to Ind.ividual Personsl, November 22, 1943. 2. Principal Purpose: To maintain a record of those individ- uals who have or have had access to GRILL FLAME information through the use of their name and/or Social Security Number. 3. Routine Uses: The Social Security Number is to be used to identify the individual, and the information is to be retained strictly within the Program. 4. Mandatory or Voluntary Disclosure: Information is disclosed on a voluntary basis, but withholding information will render it impossible to grant an individual access to or participation in the Program. Approved For Release 2000/O8tOT___C IA-RDP96-00788 ROO 120-028.00-3-"- Approved For Release 2000/08/07 : CIA-RDP96-007-88ROO1200280038-9 GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE' DATE / q FeL k1 I I ZIA S VLftkc nef e-c .WITNESS:. SIGNED: LTC NAME,, RANK GRADE NAXEf RANK/GRADE At~" r - 40VwL0'F - . . fie2 UNIT/-ORGANIZATION UNIT/ORGAN!ZATION POSITION Approved For Release 2000/08/07 CIA-AP96-00788R001200280038-9 POSITION