DHS Form CG-5211A Privacy Act Data Cover Sheet

Form CG-5211A or the "Privacy Act Data Cover Sheet" is a form issued by the U.S. Department of Homeland Security.

The form was last revised in April 1, 2014 and is available for digital filing. Download an up-to-date fillable Form CG-5211A in PDF-format down below or look it up on the U.S. Department of Homeland Security Forms website.

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DEPARTMENT OF HOMELAND SECURITY
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U.S. Coast Guard
PRIVACY ACT DATA COVER SHEET
PRIVACY ACT DATA COVER SHEET
To be used on all
documents containing
Personally Identifiable
Information
(PII).
DOCUMENTS ENCLOSED ARE SUBJECT TO THE PRIVACY ACT OF 1974
Contents shall be protected at all times and not disclosed, discussed, or
shared with individuals unless they have a legitimate need-to-know in the
performance of their official duties. Only deliver this/(these) document(s)
directly to the intended recipient.
DO NOT
drop off with a third-party.
Deliver to:
The enclosed document(s) may contain personal or privileged information and should be treated
as “For Official Use Only.” Unauthorized disclosure of this information may result in
CIVIL
and
CRIMINAL
penalties. If you are not the intended recipient or believe that you have received this
document(s) in error, do not copy, disseminate or otherwise use the information and contact the
owner/creator or your Privacy Act officer regarding the document(s).
PRIVACY ACT DATA COVER SHEET
CG-5211A (04/14)
DEPARTMENT OF HOMELAND SECURITY
Reset Form
Print Form
U.S. Coast Guard
PRIVACY ACT DATA COVER SHEET
PRIVACY ACT DATA COVER SHEET
To be used on all
documents containing
Personally Identifiable
Information
(PII).
DOCUMENTS ENCLOSED ARE SUBJECT TO THE PRIVACY ACT OF 1974
Contents shall be protected at all times and not disclosed, discussed, or
shared with individuals unless they have a legitimate need-to-know in the
performance of their official duties. Only deliver this/(these) document(s)
directly to the intended recipient.
DO NOT
drop off with a third-party.
Deliver to:
The enclosed document(s) may contain personal or privileged information and should be treated
as “For Official Use Only.” Unauthorized disclosure of this information may result in
CIVIL
and
CRIMINAL
penalties. If you are not the intended recipient or believe that you have received this
document(s) in error, do not copy, disseminate or otherwise use the information and contact the
owner/creator or your Privacy Act officer regarding the document(s).
PRIVACY ACT DATA COVER SHEET
CG-5211A (04/14)

Download DHS Form CG-5211A Privacy Act Data Cover Sheet

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