Affirmation of Non-Disclosure
This statement should be signed by employees whose positions are created by the Committee on
House Administration under the House Employees Position Classification Act that have
access to electronic communications services. This statement should also be signed by
personnel contracted to provide electronic communication or consulting services with or to the
House at large. This affirmation must be signed prior to commencement of work by such House
or contractor employees. Copies of the executed oath shall be retained by the employing
authority as part of the records of the House.
I do solemnly swear (or affirm) that I will not disclose any information
relating to private or privileged electronic/verbal/written communications received in the
course of my service with or to the U.S. House of Representatives, except as
authorized by the Committee on House Administration or in accordance with
the Rules of the House of Representatives.
___________________________ _________________________
Contractor Personnel Name Title
___________________________ ________________
Signature Date
Company Name:______________________________________________________
Contract Number:_____________________________________________________
Contractor Program Manager:___________________________________________
Place two copies of the acknowledged forms in a sealed envelope with the following words marked on the
outside of an envelope: Affirmation of Non-Disclosure Forms and mail to the Contracting Officer’s
Representative. In addition, ensure that the front of the envelope contains the following information:
DATE, CONTRACT NUMBER, COMPANY NAME, and COMPANY POINT OF CONTACT NAME
