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Privacy Notice on Collection

This notice is provided pursuant to the Information Practices Act of 1977.

The State Personnel Board (SPB), Appeals Division, is requesting the information specified on this form pursuant to the California Code of Regulations, title 2, section 52.4.

The information collected will be used for processing your appeal or complaint and will be disclosed to other State Agencies involved in the appeals process.

Individuals should not provide personal information that is not requested or required.

The submission of all information requested is mandatory unless otherwise noted. If you fail to provide the information requested, SPB will not be able to approve your appeal/complaint.

Department Privacy Policy

The information collected by SPB is subject to the limitations in the Information Practices Act of 1977 and state policy. For more information on how we care for your personal information, please read our Privacy Policy.

Access to Your Information

The SPB Privacy Officer is responsible for maintaining collected records. You have a right to access records containing your personal information we maintain. To request access, contact:

State Personnel Board
Attn: Privacy Officer
Office of the Chief Counsel, MS 53
801 Capitol Mall
Sacramento, CA 95814

Revision Date: 6/2016

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