U.S. DEPARTMENT OF JUSTICE carga. tom, Cfien. (n eccortunce with Se At ‘uberission of ans MANDATORY, cer dents | VOLUNTARY busts for the scfaty and conentance Dyo persons protaons of tho Privacy. Let medias ts gusta rhe = “ee PRIVACY ACT STATEMENT: SOCIAL SECURITY NUMBER-1: AUTHORITY: Exncutve Onder 0397 cated November 22, 182 2 PURPOSE AND USE The Sock Senaty Numbor (S6N) bs usod os a urtque Iddartior for matching locator rocards to records hi parsornel und payrad faa. Uso of fo BEN ansures corroct iden®iceton of records for exptoyoss with Pe sume camo 3 EFFECTS OF NCN-CISCLOSURE Cisconuro of tio SEN Is MANDATORY. Fedire © Gsdieso tho SSN on aocesson wil resi in your payrod chack not been procossed, Fetce to Gsciose he SEN win reporting changes wo rest hn ho PRIVACY ACT STATEMENT: RESIDENCE ADORESS-1. AUTHORITY: § S.C. Sacton 8310, 6817 and SE2t 28 U.S.C. Sectors 6001 awd 108 2 PURPOSE AND USE: Tomect fo reporting rogiremerss of Federal, Suto end Loo tx wittoking progu=a 3 EFFECTS OF NON-DISCLOSURE: Dtuctosize of azrant Resitonce Address Is MAXOATORY . Feture t ciactose (w cururt Residence PRIVACY ACT STATEMENT: RESIDENCE ADDRESS AND TELEPHONE NUMBER-1, AUTHORITY: 5 U.S.C. Section S01. 2 PURPOSE ANDUSE: To contact expioyees at Set residence on meters of ao Micha methiso rotating to trar enpioynert with the Ouparcnont af ust. Acooss to tis information is Omited to the ermpioyests superdsor(s) OR bcividusts eertzad by the sparvisoris). 3 EFFECTS OF NON-OISCLOSURE: Submission c! thts Gzta ts VOLUNTARY. if tve Gata to not exbrrited, supervisory personnel cnay havo etboudy iocoing eployess to indorm then af enorguncy werk emuasiora. PRIVACY ACT STATEMENT: 1. AUTHORITY: Thera ls no stututary uutorty tor tho use of ts torreon to ened Departnont ef Juste empioyons ih tho Commuter Ch Tho Cammmuter Cab is sponsarad ad (Gpartiad by the iteropoian Wastington Gourd of Trade. Leena haan ora ener nett etbrno eo 2. PURPOSE AND USE To supply pate ae ig een vy ¢ the Commenter CLS wil rent th to errpiqos's rama, hore ecktess, exnpioyar (agency). office | Loustor ters 4, 7, @ 0, 10, 11, 12, 23, SY, 38 40 41, 42 43, 47, end 48) being cont to Se Commuter Cat's acomaind employe name, expioyer (agency), and cfice teieyhone manber (Form OO}253 Employee Locstor tems 4, 38 47, end 45) 3. EFFECTS.OF NON. . Faire discteso wi rasua h ernpioyes not becoring @ mamber of te Commuter ub ert hayutra, no amployes Formation wi be sort pho 18. WASKINGTON, DC METROPOLITAN AREA EMPLOYEES ONLY Y | © Yes, -1wtat to ptr te Comematior Cast N Romeve end pornoral irformation tom tre Comma’ Cab (if you are not Interested In the Commutor Club, skip this question). R peeing ion-anmereynsineieronh ol 41. COUNTY OR FORBIGN COUNTRY ewe ie me Live Lm [7 SEVEN DiOTT NUMBER [= SxTENSIONTEN NUMBER” | Cove onemen Sd PERSON TO BE NOTIFIED INEVENT OF EMERGENCY [62 BUILDINGCODE EFTA00122410