Privacy Act Notice
PS Form 3601-A, May 1996
Federal Agency Code/Cost Code (For US official penalty indicia license)
The collection of this information is authorized by 39 USC 401 and 404. This information will be used to administer postage meter activities. As a routine use, the information may be disclosed to an appropriate government agency, domestic or foreign, for law enforcement purposes; where pertinent, in a legal proceeding to which the US Postal Service is a party or has an interest; to a government agency in order to obtain information relevant to a Postal Service decision concerning employment, security clearances, contracts, licenses, grants, permits, or other benefits; to a government agency upon its request when relevant to its decision concerning employment, security clearances, security or suitability investigations, contracts, licenses, grants, or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the Postal Service to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of Postal Service finances; to a labor organization as required by the National Labor Relations Act; and to disclose to any member of the public the identity and address of user and identity of agent. Completion of this form is voluntary; however, if this information is not provided, you may not receive meter services.
I hereby certify by submitting this form that all information furnished on this form is accurate and truthful.