(5) (In any other case: "Disclosure is voluntary, and if you do not provide the requested information, any determinations or evaluations made as a result of this investigation will be made on the basis of the evidence that is contained in the investigative record.")] b. [In the unusual situation where a specific statute, regulation, or lawful order of competent authority mandatorily directs an individual to disclose particular information for the Government's benefit in furtherance of a Government interest, policy, or objective, the following statement should be used: "Disclosure of (specify the particular relevant information required) is mandatory under (cite the statutue, regulation, or order), and refusal to disclose that information will subject you to possible disciplinary or criminal proceedings. Disclosure of any other information requested is voluntary, (and there will be no adverse effects if you elect not to disclose it) (but election not to disclose the information could. . .)."] A-3-a (4) RECORD OF DISCLOSURE THE ATTACHED RECORD CONTAINS PERSONAL INFORMATION CONCERNING AN INDIVIDUAL. USE AND DISCLOSURE THEREOF IS GOVERNED BY SECNAVINST 5211.5. UNAUTHORIZED DISCLOSURE OF PERSONAL INFORMATION FROM THIS RECORD COULD SUBJECT THE DISCLOSER TO CRIMINAL PENALTIES. INSTRUCTIONS: THIS SHEET IS TO REMAIN AFFIXED AS A PERMANENT PART OF THE RECORD DESCRIBED BELOW. AN APPROPRIATE ENTRY MUST BE MADE BELOW EACH TIME THE RECORD OR ANY INFORMATION FROM THE RECORD IS VIEWED BY, OR FURNISHED TO, ANY PERSON OR AGENCY, INCLUDING THE SUBJECT OF THE RECORD, EXCEPT: (1) DISCLOSURES TO DOD PERSONNEL HAVING A NEED TO KNOW IN THE PERFORMANCE OF THEIR OFFICIAL DUTIES AND (2) DISCLOSURE OF ITEMS LISTED IN SUBPARAGRAPH 7 a (3) OF SECNAVINST 5211.5. |