Attachment 0007 Clearance of Technical Information for Public Release.pdf

CLEARANCE REQUEST FOR PUBLIC RELEASE OF DEPARTMENT OF DEFENSE INFORMATION

(See Instructions on back.)

(This form is to be used in requesting review and clearance of DoD information proposed for public release in accordance with DoDD 5230.09.)

TO: (See Note) Chief, Office of Security Review, 1155 Defense Pentagon, Washington, DC 20301-1155

1. DOCUMENT DESCRIPTION

a. TYPE b. TITLE

c. PAGE COUNT d. SUBJECT AREA

2. AUTHOR/SPEAKER

a. NAME (Last, First, Middle Initial) c. TITLE

d. OFFICE e. AGENCY

b. RANK

3. PRESENTATION/PUBLICATION DATA (Date, Place, Event)

4. POINT OF CONTACT

a. NAME (Last, First, Middle Initial) b. TELEPHONE NO. (Include Area Code)

5. PRIOR COORDINATION

a. NAME (Last, First, Middle Initial) c. TELEPHONE NO. (Include Area Code)b. OFFICE/AGENCY

6. REMARKS

7. RECOMMENDATION OF SUBMITTING OFFICE/AGENCY

a. THE ATTACHED MATERIAL HAS DEPARTMENT/OFFICE/AGENCY APPROVAL FOR PUBLIC RELEASE (qualifications, if any, are indicated in Remarks section) AND CLEARANCE FOR OPEN PUBLICATION IS RECOMMENDED UNDER PROVISIONS OF DODD 5230.09. I AM

AUTHORIZED TO MAKE THIS RECOMMENDATION FOR RELEASE ON BEHALF OF:

b. CLEARANCE IS REQUESTED BY (YYYYMMDD).

c. NAME (Last, First, Middle Initial) d. TITLE

e. OFFICE f. AGENCY

g. SIGNATURE h. DATE SIGNED (YYYYMMDD)

DD FORM 1910, JAN 2006 PREVIOUS EDITION MAY BE USED.

Note: Regular mail address shown above. For drop-off/next day delivery, use:

Room 12047, 1777 North Kent Street, Rosslyn, VA 22209-2133

Adobe Professional 8.0

INSTRUCTIONS

DD FORM 1910 (BACK), JAN 2006

GENERAL NOTE FOR PERSONNEL PROCESSING

THIS REPORT: Items marked with an asterisk (*) have been registered in the DoD Data Element Program.

1. DOCUMENT DESCRIPTION.

a. Type - Record nature of material submitted; e.g., speech, article, manuscript, study/thesis, brochure, news release, advertisement, radio/television script, etc.

b. Title - Record the exact caption, headline, name or label of the material.

c. Page Count - Enter the number of pages of the document submitted.

d. Subject Area - Record major topic or theme, whenever possible.

Examples: "Go-Between Circuits III - Total Force in Action," and "Communications."

2. AUTHOR/SPEAKER.

*a. Name - Self explanatory.

*b. Rank - Self explanatory.

c. Title - Self explanatory.

d. Office - Self explanatory.

e. Agency - Self explanatory.

3. PRESENTATION/PUBLICATION DATA. Record the forum of open presentation or publication.

4. POINT OF CONTACT

*a. Name - Self explanatory.

b. Telephone Number - Enter the office phone number of the point of contact.

5. PRIOR COORDINATION. Self explanatory.

6. REMARKS. Enter any additional pertinent information.

7. RECOMMENDATION OF SUBMITTING

OFFICE/AGENCY. It is of paramount importance to components, as large and complex as those which comprise the Department of Defense, that coordinated and consistent security and policy determinations are made; therefore, Item

7 must be completed by an individual who possesses the authority to communicate a particular component's policies and recommendation.

a. Enter title of Component/Agency Head or title of other individual ultimately responsible for the substantive issues addressed.

Examples: Secretary of the Army;

Chairman of the Joint Chiefs of Staff; President, National Defense University; etc.

*b. Clearance is requested by - Self explanatory.

*c. Name - Entry must be typed or printed and coincide with signatory official.

d. Title - Self explanatory.

e. Office - Self explanatory.

f. Agency - Self explanatory.

g. Signature - Mandatory.

*h. Date - Self explanatory.