Free DEPARTMENT OF HOMELAND SECURITY - Federal

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection
Facilities Management & Engineering Division

SENSITIVE SECURITY INFORMATION (SSI) DOCUMENT RECEIPT
CD 1450-021

Date:

Sensitive Security Information (SSI): As defined in 49 C.F.R. Section 1520.5, information obtained or developed in the conduct of security activities, including research and development, the disclosure of which DHS/TSA has determined would (1) constitute an unwarranted invasion of privacy (including but not limited to, information contained in any personnel, medical, or similar file); (2) reveal trade secrets or privileged or confidential information obtained from any person; or (3) be detrimental to the security of transportation.

Project Name: FROM: Name: Title: Company: U.S. CUSTOMS AND BORDER PROTECTION Address: TO: Name: Title: Company: Address:

Project Number:

Telephone Number(s): E-mail Address:

FAX Number:

Telephone Number(s): E-mail Address:

FAX Number:

Electronic Format

Hard Copy

Description of Information/Document (include document date/version; CD)

Security Statement This document is designated FOR OFFICIAL USE ONLY (FOUO). It contains information that may be exempt from public release under the Freedom of Information Act (5 USC 552). This document is to be controlled, handled, transmitted, distributed, and disposed of in accordance with Department of Homeland Security policy relating to FOUO information, and is not to be released to the public or personnel who do not have a valid "need to know" without prior approval from the CBP Public Information Office. Copying, dissemination, or distribution of these documents or drawings to unauthorized user is prohibited.

Please sign to signify your concurrence and return form to CBP sender listed above: SIGNATURE X Date: CBP Form 306 (06/09)