PRIVACY NOTIFICATION

Pursuant to the Federal Privacy Act of 1974, you are hereby notified that disclosure of your social security number is mandatory. This record-keeping system was established prior to January 1, 1975 pursuant to the authority of The Regents of the University of California under Article IX, Section 9 of the California Constitution. The social security number is used to verify your identity.

The State of California Information Practices Act of 1977 requires the University to provide the following notification to individuals who are asked to supply information:

The principal purpose for requesting the information on this form is to provide a record of a request for a duplicate W2, an updated address, and telephone number(s). University policy and Federal and State statutes authorize maintenance of this information.

Furnishing all information requested on this form is mandatory - failure to provide such information will delay, or may even prevent, completion of the action for which the form is being filled out. Information furnished on this form may be used by various University departments for payroll and personnel administration, and will be transmitted to state and federal governments as required by law.

Individuals have the right to review their own records in accordance with University Personnel Policy and collective bargaining agreements. Information on applicable policies and agreements may be obtained from Staff and Academic Personnel Offices at the campuses or the Office of the President.

The official responsible for maintaining the information contained on this form is the Campus Accounting Officer.