Appendix A to Part 389
49:5.1.1.2.32.2.11.16.15 : Appendix A
Appendix A to Part 389 AFFIDAVIT IN SUPPORT OF REQUEST FOR
CONFIDENTIALITY
I, _______, pursuant to the provisions of 49 CFR part 389,
section 389.9, state as follows:
(1) I am [insert official's name, title] and I am authorized by
[insert name of entity] to execute this Affidavit on its
behalf;
(2) I certify that the information contained in the document(s)
attached to this Affidavit is submitted voluntarily, with the claim
that the information is entitled to confidential treatment under 5
U.S.C. 552(b)(4);
(3) I certify that the information contained in the documents
attached to this Affidavit is of a type not customarily disclosed
to the general public by [insert name of entity];
(4) I certify that, to the best of my knowledge, information and
belief, the information contained in the documents attached to this
Affidavit, for which confidential treatment is claimed, has never
been released to the general public or been made available to any
unauthorized person outside [insert name of entity];
(5) I certify that this information satisfies the substantive
criteria set forth in the notice published in the Federal Register
on ___[insert date of rule-specific publication in month/day/year
format] under FMCSA Docket Number [insert docket number].
(6) I make no representations beyond those made in this
Affidavit, and, in particular, I make no representations as to
whether this information may become available outside [insert name
of entity] due to unauthorized or inadvertent disclosure; and
(7) I certify under penalties of perjury that the foregoing
statements are true and correct.
Executed on this __day of __, __.
_________(signature of official)
[80 FR 32865, June 10, 2015]