Web page notices: In context

Personal Information Collection Statement
Example A – Personal Information Collection Statement

Use this sample on your "Contact Us" page, or anywhere that users have the option to submit their personal information.

All personal information created, held or collected by this department is protected under the Privacy Act. This means that you will be informed of the purpose for which it is being collected and how to exercise your right of access to that information. You will be asked for your consent where appropriate.

Public Communications

The personal information you include in an inquiry may be used to prepare a reply. The personal information is collected pursuant to the [appropriate provision in department’s enabling statute]. Such information may be used for statistical, evaluation and reporting purposes. The information is included in the personal information bank [PIB Number - PIB Title]. The information may be shared with programs and activities of [Applied Title of the Department] should your inquiry pertain to a specific program or activity of the department. In such cases, the information is included in the personal information bank of the program or activity.

[Optional: You may include a statement on who will have access to the information; how long the information will be kept and where it will be kept].

The transmission of this information is not secure so sensitive personal information, such as your Social Insurance Number, should not be included in your message.

If after reading this statement, you prefer not to submit your inquiry via the Internet, you may use one of the following methods:

By Telephone:
[telephone number]
By Mail:
[mailing address]
In Person at:
[building address]
Teletypewriter:
[teletypewriter number]

Privacy Inquiry

Any questions, comments, concerns or complaints regarding the administration of the Privacy Act and privacy policies may be directed to the departmental Privacy Coordinator by email to [Privacy Coordinator email], by calling [Privacy Coordinator phone number] or writing to:

[Privacy Coordinator mailing address]

If you are not satisfied with our response to your privacy concern, you may wish to contact the Office of the Privacy Commissioner by e-mail at info@priv.gc.ca or by telephone at 1-800-282-1376.

Third-Party Information Liability Disclaimer

Some of the information on this Web page has been provided by external sources. The Government of Canada is not responsible for the accuracy, reliability or currency of the information supplied by external sources. Users wishing to rely upon this information should consult directly with the source of the information. Content provided by external sources is not subject to official languages, privacy and accessibility requirements.

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