Form Bc 300 – Fill Out and Use This PDF

The Form BC-300 serves a critical role in maintaining privacy and ensuring accurate identification for requests made to the U.S. Census Bureau under the Privacy Act of 1974. It is a Certification of Identity form, designed by the U.S. Department of Commerce, that helps prevent the wrongful disclosure of individual records stored within U.S. Census Bureau systems. By providing detailed personal information and a declaration under penalty of perjury, individuals can request access to their own records or authorize the release of information to a designated recipient, making it a crucial document for upholding the Privacy Act's provisions. Ready to safeguard your privacy with the U.S. Census Bureau? Click the button below to start filling out your Form BC-300.

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Form Bc 300 PDF Details

The BC-300 form, utilized by the U.S. Department of Commerce under the Economics and Statistics Administration of the U.S. Census Bureau, plays a pivotal role in safeguarding individual privacy while adhering to the Privacy Act of 1974. This form is integral for individuals requesting personal records, ensuring that their identification is thoroughly verified to prevent the wrongful disclosure of personal information. It underscores the importance of providing accurate identification details, including full name, place and date of birth, current address, and particularly the nature of the request. The form delineates clear guidelines for requesters, whether they are acting on their behalf, as guardians, or as parents of minors, emphasizing the voluntary nature of providing information albeit highlighting the inability to proceed with requests if information is withheld. Furthermore, the document stresses the legal implications of providing false information, referencing potential penalties under 18 U.S.C. Section 1001 and 5 U.S.C. Section 552a(i)(3) which include significant fines and imprisonment. Additionally, it incorporates provisions for authorizing the release of information to third parties, ensuring that the requester’s consent is explicitly obtained and documented. This form exemplifies a meticulous approach to data privacy, embodying the legal and ethical standards enforced by the U.S. Census Bureau in handling individual records requests.

Question	Answer
Form Name	Form Bc 300
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	requester census search, census bc pdf, bc 300, form bc 300

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FORM BC-300 (2-4-2016)

U.S. DEPARTMENT OF COMMERCE

Economics and Statistics Administration

U.S. CENSUS BUREAU

CERTIFICATION OF IDENTITY

PRIVACY ACT STATEMENT

In accordance with 15 CFR Section 4.24(d), the U.S. Census Bureau requires you provide us with sufficient information

to identify you when you submit requests by mail or otherwise not in person under the Privacy Act of 1974, 5 U.S.C. Section 552a. We take this step to ensure that we do not wrongfully disclose the records of individuals who are the subject of U.S. Census Bureau systems of records. Providing this information is voluntary, however, if you do not provide it we will be unable to take action on your request. If you provide false information on this statement you may be subject to criminal penalties under 18 U.S.C. Section 1001 and/or 5 U.S.C. Section 552a(i)(3).

REQUESTER INFORMATION

Full name of requester/

Last – Please print or type

First – Please print or type

Middle – Please print or type

Subject of record(s) sought

Place of Birth – Please print or type

Date of Birth (mm/dd/yyyy)

Current address

Address – Number and street – Please print or type

City – Please print or type

State

ZIP Code

Email Address – Please print or type

Requester status

Self

Mark (X) appropriate box.

Guardian of individual whose record(s) is sought – Enclose copy of

appointing document,

Parent of minor child whose record(s) is sought

Information being

Please print or type

requested – Please

describe in as much

detail as possible.

Declaration

I declare under penalty of perjury under the laws of the United States of America that the foregoing

is true and correct, and that I am the person named above, and I understand that any falsification

of this statement is punishable under the provisions of 18 U.S.C. Section 1001 by a fine of not

more than $10,000 or by imprisonment of not more than five years or both, and that requesting or

obtaining any record(s) under false pretenses is punishable under the provisions of 5 U.S.C.

552a(i)(3) by a fine of not more than $5,000.

Original Signature of Requester

Date

Authorization to

a. If you are authorizing information relating to yourself to be released to another person –

release information to

Please fill in the information below.

another person.

Name of authorized recipient – Please print or type

	Office Use Only	b. Further pursuant to 5 U.S.C. Section 552a(b), I authorize the U.S. Census Bureau to release
	Office Use Only	the above-described information relating to me.
		the above-described information relating to me.

PA/FOIA Control #

Original Signature of Requester	Date

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Step 1: First of all, access the pdf editor by clicking the "Get Form Button" at the top of this site.

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Be mindful while filling out this form. Make sure that all necessary areas are filled in properly.

1. Fill out the bc300 with a group of necessary blank fields. Collect all the information you need and ensure nothing is omitted!

2. Your next stage is usually to fill in all of the following blanks: Requester status, Mark X appropriate box, Information being, requested Please describe in as, Declaration, Self Guardian of individual whose, Please print or type, I declare under penalty of perjury, Original Signature of Requester, Date, Authorization to, release information to another, a If you are authorizing, Please fill in the information, and Name of authorized recipient.

3. Within this part, check out Office Use Only PAFOIA Control, the abovedescribed information, Original Signature of Requester, and Date. Each of these will need to be filled out with utmost accuracy.

It is easy to make errors when filling out the Original Signature of Requester, so make sure to reread it before you'll submit it.

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Form Bc 300 – Fill Out and Use This PDF

Form Bc 300 PDF Details

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