CIA-RDP96-00789R002100150055-3

Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150055-3
DATE 23/Tarch/18
STATEMENT OF CONSENT
I,
LAWRENCE J. RICKARD
as a participant in the INSCOM
GRILL FLAME Project (IGFP) do hereby give my consent IAW AR 381-17 to the
tape recording, monitoring and transcribing of all session interviews conducted
as an integral part of the IGFP. I understand that all of my session
interviews are tape recorded. I further understand that these tape recordings
are subject to being monitored and/or transcribed by third parties not otherwise
involved in the session interviews.
In conjunction with my consent to the above, I also waive any claim or right of
ownership to all tape recordings, and transcripts made, or which have been
made, in conjunction with IGFP. I understand that these tape recordings and
transcripts are the property of the United States Government.
I execute this written consent to formalize my previous verbal consent to the
above; having given my verbal consent to the above when I became a participant
in the IGFP.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
(5 U.S.C. 552a)
1.
Authority:
National Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering
System for Federal Accounts Relating to Individual Persons, No mber 22, 1943.
2.
Principal Purpose: To maintain a record of those individuals who have
consented to the recording, monitoring or transcribing IGFP session interviews.
3.
Routine Uses:
The Social Security Number is to be used to identify the
individual, and the information is to be retained strictly within the Program.
4.
Mandatory or Voluntary Disclosure:
Information is disclosed on a voluntary
basis, but withholding information will render it impossible to grant an
individual access to or participation in the Program.
WITNESS:
Frederick A. atwater, CPT
SGFOIA3
SIGNED:
Jamrencent Rickand SFC E-7
Name, Rank/Grade
Name, Rard«/Grade
SGFOIA3
Social Security Number
USAINTS.COM
Unit/Organization
Training / Concepts
Position
Social Security Number
COD USAINSCOM CONUS MIGP
Unit/Organization
Analyst
Position
Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150055-3