Security Awareness
Contractor / Affiliate Personnel Security Certification
Purpose: This form is to be signed by contractor or affiliate personnel to certify that they have received and understand
SSA's Security Awareness Training requirements detailed below.
Background:
I understand that SSA maintains a variety of sensitive information about the agency's operations and
programs (hereinafter "SSA information"), which may be information pertaining to program (e.g., information about SSA's
clients) or non-program (e.g., administrative and personnel records) matters. I understand that SSA may authorize me to
have access to SSA information and that my access to and use of SSA information must be in accordance with the
provisions of the contract under which I am performing work for SSA and/or the terms of any other written agreement that
authorizes me to access SSA information.
I have read, understand, and agree that:
1. I will not inspect, access, or attempt to access any SSA information that SSA has not expressly authorized me
to access.
2. I will not release or disclose any SSA information to any unauthorized person, agency, or entity. I understand
that unauthorized disclosure of SSA information may lead to civil penalties and/or criminal prosecution under
Federal law (i.e., The Privacy Act of 1974, 5 U.S.C. 552a; SSA's regulations at 20 C.F R. Part 401; The Social
Security Act, 42 U.S.C. 1306(a); and 5 U.S.C. Section 552(i)). I further understand that additional privacy and
disclosure protections may apply to certain types of SSA information, including Federal Tax Information (i.e.,
earnings information), which may be subject to additional penalties under sections 6103, 7213, 7213A, and 7431
of the Internal Revenue Service (IRS) Code (Title 26 of the United States Code).
3. I will follow all access, retention, and/or destruction requirements in the contract and/or agreement under which I
am authorized to access SSA information. I understand that such requirements may require me to cease access
to, return, or destroy SSA information upon completion of my work for SSA or termination of my contract or
agreement that authorized my access to SSA information.
4. I will not take SSA information off-site, unless expressly authorized to do so by contract or other written
authorization from SSA. If SSA authorizes me to take SSA information off-site, I agree to safeguard all SSA
information in accordance with agency policy and standards so that no unauthorized person, agency, or entity can
access SSA's information.
5. I will keep confidential any third-party proprietary information that may be entrusted to me as part of the contract,
including safeguarding such information from unauthorized access and not disclosing or releasing such
information unless expressly authorized to do so.
6. I will follow all SSA terms, conditions, and policies in the contract under which I am performing work for SSA
and/or the terms of any other written agreement that authorizes me to access SSA information, including but not
limited to those governing confidential information or personally identifiable information.
7. I will follow all SSA Standards of Conduct, and Rules of Behavior for Users and Managers of SSA's Automated
Information Resources.
8. I understand that the contract and/or agreement terms take precedent over this document.
9. I understand that any questions I may have concerning authorization(s) should be directed to the Contracting
Officer designated in my company's contract.
Contractor Employee Name (Print/Type) Date (MM/DD/YYYY)
Contractor Employee Signature (Sign)
Contract Number Company Name (Print/Type)
Company Point Of Contact (Print/Type) Company Point of Contact Phone Number
Form SSA-222 (10-2016)
Discontinue Previous Editions
Page 1 of 2
Social Security Administration
