Privacy - Model Form
Margaret A. Maddux, of the West End Bank, S.B. is sharing one of the tools with us that she uses to make instant compliance a little easier. This is for those times you need to print a Privacy Notice. Note that there are two verions for those with and without an opt-out provision. (PDF versions are also available for reference.)
Last Dec. 1, 2009 the regulatory agencies released 202 pages explaining the model privacy forms. Margaret copied the forms with the actual verbiage from Appendix A to Part 216 B into the sample forms from Appendix A to Part 216 A.
Those who are users of Word 2007, can use the ".docx" version which automates forms completion with drop down menus. Where the form has "[choose]" you can click to activate a drop down menu and select "Yes" or "No" to populate the field. Older versions of Word can use the ".doc" version or download and install the Microsoft Compatibility Pack for Office 2007 from Microsoft. (Some of the form's features may be lost when using the older version of Word.)
To use the tool, simply edit the verbiage in magenta to suit the requirement of your institution (where possible, Margaret listed the choices offered in §248 Appendix A Form S-P B). In addition, there are a few sections your institution is permitted to omit; and you may remove them as needed (for instance, if the notice is not being provided jointly with other institutions the section titled "Who we are" may be removed). Margaret advises using this tool in conjunction with the directions outlined in Appendix A to Part 216 B to ensure compliance.
Please note that on March 3, 2010 page two of each form was updated to change the first section header line from "What we do" to "Who we are." We apologize for any inconvenience.
Model Privacy Form - w/Opt-out (docx format(1). Right click to save.)
Model Privacy Form - w/Opt-out (doc format. Right click to save.)
Model Privacy Form - w/Opt-out (PDF format. Click to view, right click to save.)
Model Privacy Form - w/no Opt-out (docx format(1). Right click to save.)
Model Privacy Form - w/no Opt-out (doc format. Right click to save.)
Model Privacy Form - w/no Opt-out (PDF format. Click to view, right click to save.)
(1) Users of Internet Explorer may get a ".zip" file. A ".docx" file is a collection of ".xml" files zipped together. You can save the file to your desktop and change the extension from ".zip" to ".docx" or change the extension after selecting Save so it downloads/saves as a ".docx" file.
Pub 02/05/10, updated 03/03/10
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