R2007-202 REGARDING PARTICIPATION IN THE 2010 DECENNIAL CENSUS

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4132. . , OMB No. 0607-0795 FORM D-1676 U.S. DEPARTMENT OF COMMERCE ENTITY ID (6-12-2007) Ecortomics and Statistics Administration U,S. CENSUS BUREAU SELF-ASSESSMENT CHECKLIST FOR THE CONFIDENTIALITY AND SECURITY GUIDELINES pL1718823 LOCAL UPDATE OF CENSUS ADDRESSES {LUCA) PROGRAM 20i0 Decennial iCeasus lnstructions � Please review the Confidentrality and Security GuideUnes then check the appropriate resp�nse on this form. If you select LUCA Participatidn Option 1 or Option 2, sign and return this form togeiher with your complet�d 2010 Decennial Census LUCA Registration form, Participation Option/Product Preference form, and signed Confidentiality Agreement form in the encTosed, postage-paid envelope. Each LUCA liaison is responsible #or protecting and safeguarding the confidentiat Census Bureau materials covered by Title 13, United States Code {U.S.C.). This includes any list or fife that shows individua! Census Bureau addresses and any map that shows structure points(Structure points will be displayed on the address list and maps, where applicable, for fhe Feedback phase of the program)for dwellings. The liaison must re5trict access to the Census Bureau's address infiormation to only those individuals who have signed the Confidentiality Agreemen#.All individuals directly invo�ved in reviewing #he materials for the 201 O Decennial Census LUCA Program and anyone with access to Title 13 materials must sign the Confidentiality Agreement making a permanent commitment to protec# #he confidentiality of Title 13 information. You must be at least 18 years af age to sign the Confidentiality Agreement. Protecting Census Bureau Address Information and Maps Keep all Census Bureau address information and maps showing structure iocation points (structure points provided for Feedback phase only)in a locked-room during nonwork hours. During work hours, do not leave a room una#tended where Cerrsus Bureau address information and maps are being reviewed. Addi#ionally, do nat feave Census Bureau address infarmation and maps unattended at your desk. 4perating systems, progr�ms, applications, and data related to the review of Census Bureau addresses must be accessible only to LUCA program liaisons, reviewers and anyone with access to Title 13 materials. The automated cfata processing (ADP) system must restrict#he read, wrife, delete, and execute functions applicable to the Census Bureau's addresses. If Census Bureau address information is placed on a shared computer system, create electronic security profiles to allow access only to LUCA Program [iaisons, reviewers, and anyone with access to Titte 13 materials. Lock all rooms with computers that contain Census Bureau address information and all associated media during nonwork hours. � Mark(X) the appropriate r respanse. 1. Will you store Title 13 materials including the paper address list, CD-ROM/DVD 1 containing the address list, and/or paper or digital maps containing structure points I i� Yes (structure points pravided for Feedback phase only) in a secure location? I 2❑ No 2. If staff members, other than those who signed the Confidentiality Agreement, have � access to the offices, cabinets, etc, where the Census Bureau's address iist and/or � maps with structure points (structure points provided for Feedback phase only) are f stored, will you secure #he Title 13 materials (both paper and electronic) to prevent � � Yes unauthorized staff from accessing these materials? � z❑ No 3. If Census Bureau Title 13 address information is placed on a shared computer 1 system, witl you construct electronic security profiiles to allow only those who I signed the Confidentiality Agreement access to the Census Bureau's address 4 i � Yes information? 7 z❑ No 4. Will you ensure that your ADP system restricts the read, write, delete, and execute functions applicable to the Census Bureau's Title 13 address list file only to those � a IZl Yes who signed fhe Confidentiality Agreement? 2❑ No 5.Will you assign an encrypfed, unique user-1D and password for each LUCA � 7 � Yes Program liaison, reviewer, and anyone with access to Title 13 materials? f 2❑ No 6. Will you keep Title 13 data separa#e firom your other dafa? I � � Yes (Titie 13 data canno# be backed-up, mixed with, or stored with other data.) ! 2❑ No USCENSUSBUREAU