View original document

The full text on this page is automatically extracted from the file linked above and may contain errors and inconsistencies.

Instructions for using the Privacy Notice Online Form Builder
1. Select your form, based on (1) whether you provide an opt out , (2) whether you include affiliate
marketing, and (3) whether you use a mail-back form:
If you provide an opt out and you want to include affiliate marketing, use Form 1.
If you provide an opt out and you do not want to include affiliate marketing, use Form 2.
If you do not provide an opt out and you want to include affiliate marketing, use Form 3.
If you do not provide an opt out and you do not want to include affiliate marketing, use Form 4.
If you provide an opt out, you want to include affiliate marketing, and you have a mail-back form,
use Form 5.
If you provide an opt out, you do not want to include affiliate marketing, and you have a mail-back
form, use Form 6.
2. The PDF forms have fillable areas, indicated by the shaded boxes outlined in red. Place your cursor in
the box and fill in the appropriate text.
The mail-back forms also include shaded boxes for optional text. These forms are designed to be printed on
8½ x 14 inch paper. To create the square for the opt-out provisions in the mail back form, use the square
bracket and underline keys, followed by the text as provided in the rule. For example:
[_] Do not share my personal information with nonaffiliates to market their products and services
to me.
To learn more about the required text for each section, see the final rule notice published in the
Federal Register on December 1, 2009 (pp. 62890–62994). The notice is available in PDF format at
www.ftc.gov/privacy/privacyinitiatives/PrivacyModelForm_FR.pdf or in HTML format at
www.gpo.gov/fdsys/pkg/FR-2009-12-01/html/E9-27882.htm.
For institutions supervised by the following agencies, information required to fill in the forms is
detailed beginning on the Federal Register page number specified below:
Supervising Agency
Office of the Comptroller of the Currency
Federal Reserve System
Federal Deposit Insurance Corporation
Office of Thrift Supervision
National Credit Union Administration
Federal Trade Commission
Commodity Futures Trading Commission
Securities and Exchange Commission

Page
62916
62925
62935
62945
62955
62965
62974
62984

3. If you have questions about the forms or any of the information required to fill in the designated areas,
contact your federal regulator listed on p. 62890 of the Federal Register Notice.

4. If you have technical problems accessing these forms, please use the Contact Us link at the bottom of the
page. Please provide a phone number where we can reach you.
http://www.federalreserve.gov/bankinforeg/privacy_notice_instructions.pdf

September 3, 2010