OS - SECURITY BRIEFING ACKNOWLEDGMENT - HUGHES, GERALD K., JR.

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0005382825
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 1
• Document Creation Date: June 23, 2015
• Document Release Date: June 10, 2010
• Case Number: F-2009-00344
• Publication Date: September 11, 1984

,; I make this
SIGNATURE
as a prior condition of access
DATE
as witnessed by the undersigned who accepted it on behalf of the United States Government
GERALD K. HW
Printed or Typed Name
'al Access Program(s):
Having been reminded?vf?my continuing obligation to comply with the terms of this Agreement, I hereby acknowledge that I was de-
briefed on The following SCI Speaah,l~ccess Program(s):
Social Securi}y Number (See Notice Below) Organization (Name add ;Address)
I certify that the debriefing presented b me on the above date was in accordance with relevant Sit rocedures.
APPROVED FOR RELEASEDDATE: 17-Mar-2010
~b)~3)
(b)(6)
NOTICE: The Privacy Act, 5 U.S.C. 522a, 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 Account Number (SSN) is Executive Order 9397. Your SSN will be used to identify i j )
you precisely when it is necessary to I) certify that you have access to the information indicated above, 2) determine that your access to [he information I ` I
indicated has terminated, or 3) certify that you have witnessed a briefing or debriefing. Although disclosure of your SSN is not mandatory, your failure ~ 1
to do so may impede such certifications or determinations. \~