System of Records Notice (SORN) Guide 4/22/2010
Default Wording
“In addition, the requester must provide a notarized statement or an unsworn declaration
made in accordance with 28 U.S.C. 1746, in the following format:
If executed outside the United States: ‘I declare (or certify, verify, or state) under penalty
of perjury under the laws of the United States of America that the foregoing is true and
correct. Executed on [date]. [Signature].’
If executed within the United States, its territories, possessions, or commonwealths: ‘I
declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and
correct. Executed on [date]. [Signature].’”
Contesting record procedures:
Describe how an individual may contest information pertaining to him or her in the system of
records. Similar to “Record Access Procedures,” this section may be the same as “Notification
Procedure.” As such, the program office may state, “See Notification Procedure above.”
Record source categories:
This section includes where the agency received the records (e.g., from the individual, other
system of records, etc.). List all sources of the information you are maintaining. Sources can be
within OPM or outside of OPM. Do you get data from other Federal entities? What about
private entities? What about State or local agencies? Keep in mind that the Privacy Act requires
that data be collected from the record subject whenever the possibility of adverse action is
present. As a general practice, rely on the individual to supply the data whenever possible.
Exemptions claimed for the system:
Often the response here is “None,” because many systems do not meet the requirements to claim
exemptions to the Privacy Act. If you believe an exemption applies to the system of records,
please review the text of general exemptions (j) and specific exemptions (k) printed below. After
reviewing the Privacy Act text, determine which exemption is appropriate and consult with the
OPM Privacy Act Officer and OPM Office of General Counsel to draft a notice of proposed
rulemaking (NPRM).
Text of General Exemption (j) of the Privacy Act:
The head of any agency may promulgate rules, in accordance with the requirements (including
general notice) of sections 553(b)(1), (2), and (3), (c), and (e) of this title, to exempt any system
of records within the agency from any part of this section except subsections (b), (c)(1) and (2),
(e)(4)(A) through (F), (e)(6), (7), (9), (10), and (11), and (i) if the system of records is:
(1) maintained by the Central Intelligence Agency; or
(2) maintained by an agency or component thereof which performs as its principal function any
activity pertaining to the enforcement of criminal laws, including police efforts to prevent,
control, or reduce crime or to apprehend criminals, and the activities of prosecutors, courts,
correctional, probation, pardon, or parole authorities, and which consists of (A) information
compiled for the purpose of identifying individual criminal offenders and alleged offenders and
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