STATEMENT OF CONSENT (LAWRENCE J. RICKARD)

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150055-3
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 55
• Publication Date: March 23, 1981
• Content Type: CONT

Approved For Release 2001/03/07 :CIA-RDP96-007 9~t~10~5~l-3
DArE~,~~~ -,...._..~
I, ~/~lN't~'~i~/Gla ~ /1 'c~'~~J ~as a p~~rticipant in the INSCOh1
GRILL F~LAh1E Project ~IGFi' do hereby give my consent IAW AR 381-17 to the
tape recording, monitoring and transcribirtg.of all session interviews conducted
as an integral part of tf~e IGFP. I understand that all of my session
interviews are tape recorded. I further understand that these tape recordings
are subject to being monitored and/or transcribed by third parties not otherwise
involved in the session interviews.
In conjunction with my consent to the above, I also waive any claim or right of
ownership to all tape recordings, and transcripts made, or .which have been
made, in conjunction with IGFP. I understand that these tape recordings and
transcripts are the property of the United States Government.
I execute th~.s written consent to foraralize my previous verbal consent to the
above; having giver? my verbal consent to the above ~uhen I became a participant
in the IG~`~P .
DATA RE[~UIRED E3Y THE PRIVACY ACT OF 1974
(5 U.S.C. S52a)
1. Authority: National Records Act, 44 U.S.C. 31U'L; E.O. 9397, Numbering
System for Federal Accounts Relating to Individual Persons, No member 22, 1943.
2. Principal Purpose: To maintain a record of those individuals who have
consented to the recording, monitoring or transcribing IGFP session interviews.
3. Routine Uses: The Social Security Number is to be used to identify the
individual, and .the information is to be retained strictly within the Program.
4. Mandatory or Voluntary Disclosure: Information is disclosed on a volurrot.ary
basis, but withholding information wi11 render it impossible to grant an
individual access to or participation in the Program.
~~~
Name, Rank/Grade
Social Security Number ?~..__..~._
G1.S~//vJ`5 Cc~
Unit/Organization
~/e
Posatio
SGFOIA3 SIGNED:
SGFOIA3
~ocaal 5e;curz ty ~vumtier
Unit Organization ~ _._
Approved For Release 2001/03/07 :CIA-RDP96-007898002100150055-3