Approved For Release 2001/04/02 : CIA-RDP96-00788RO 0120001 DATE '7 GRILL FLAME SECURITY AGREEMENT understand that the highly sensitive and classified information I have, or aM, about to receive as part of the GRILL FLAIU!', Program belongs to the United States Government. I understand that 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 provi .sions of -this agreement will rerain '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. Authority: National Records Act, 44 U.S.C. 31102; E.O. 9397, Numbering System for Federal Accounts Relating to Individual Persons, November 22, 1943. 2. Principal Purpose: To maintain a record of -those individuals who have or have had access to GRILL FLAME information through the use of their name and./or Social- Securit-y 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. I[. Mandatory or Voluntary Disclosure: Information is disclosed on a voluntary basis, but withholding infornation will rerder it impossible to grant an individual access -to or participation in the Program. Approved For Release 2001/04/02 : CIA-RDP96-00788ROO1200010089-2 Approved For Release 2001/04/02 : CIA-RDP96-00788ROO1200010089-2 GRILL 'FLAME SE, CURITY AGREEMENT CONTMATION PAGE DATE .9-0 9 WITNESS, SIGE 0@ @4-@x 846 ICS4 r@-h - , @R,@Irv @ @ DE NA., RANK/GRADE. A"bc,5 1) PS - 441"7) @` 1* UNIT/5R-GANIZATION 'r ,A1 9 6-0)--k POSITION psh a, 14#x(olow UNIT/ORGANIZATION 47C POSITION Approved For Release 2001/04/02: CIA-RDP96-00788ROO1200010089-2