Attachment 5 - Form 3002.pdf

Review of Government Information for Public Release TITLE: PAO Log #

AUTHOR/PRODUCER (S): ADDRESS (IF APPLICABLE):

OFFICE SYMBOL:

PHONE/BLDG #:

AUTHOR/PRODUCER (S): COMPANY ADDRESS:

CONTRACT NUMBER:

NAME OF PICATINNY SPONSOR:

SPONSOR OFFICE SYMBOL:

SPONSOR PHONE/BLDG#: COMPANY PHONE:

PURPOSE OF RELEASE: Presentation Publication News Release

MEETING TITLE (If presentation,speech or conference paper):

PLACE: DATE(S): No Yes DoD Sponsored:

PUBLICATION (Magazine, journal, newspaper, proceeding):

Abstract

Yes No Solicited

REQUIRED APPROVALS: Signatures with approval below certify the material is approved for unlimited public release (Dist. A): The material was reviewed for technical accuracy, classified and/or protected information, security implications, proprietary information, competition-sensitive information and for compliance with any other relevant policy; the Operations Security (OPSEC) review was conducted in accordance with AR 530-1, Operations Security, paragraph 5-2; that inventions have been previously submitted for patent review, and that the subject matter does not fall under the Militarily Critical Technology List.

CERTIFICATION: I certify that this material has not been copied substantially without written permission from the author/producer and does not contain any sensitive, potentially controversial, FOUO or classified information.

Requestor/Author's/Producer's Signature

SIGNATURE No Date:

SIGNATURE (Patent/Legal) Approve

Recommend Distribution: A

No Date:

SIGNATURE (OPSEC) Approve Yes

Recommend Distribution: A

No Date:

SIGNATURE (Commander/Staff Agency Chief) Approve Yes

Recommend Distribution: A

No Date:

SIGNATURE (Supervisor/Subject Matter Expert) Approve Yes

Recommend Distribution: A

No Date:

(Contracting Officer, if appropriate) Approve Yes

IMPI-PLS Form 3002, 16 Nov 2016 Replaces AMSTA-AR Form 3002 Page 1 of 2

APPROVED

DISTRIBUTION:

CO

N

TR

A

CT

O

R

PI

CA

TI

N N

Y

TYPED NAME:

TYPED NAME:

DISPOSITION: BASED ON RECOMMENDATIONS PROVIDED ABOVE, CLEARANCE IS GRANTED FOR

RELEASE BASED ON THE APPROVED DISTRIBUTION CHECKED BELOW

Picatinny Arsenal Public Affairs Office Date

(Unlimited)A

Print Form

Website

Remarks/See Reverse:

Yes

Yes

Yes

Yes

Remarks/See Reverse:

Remarks/See Reverse:

Remarks/See Reverse:

Remarks/See Reverse:

Other:

Additional Remarks or Written Changes to the Submitted Material

Review of Government Information for Public Release

IF AUTHOR/PRODUCER IS PICATINNY-BASED:

Picatinny-based authors/producers are responsible for initiating the clearance process and ensuring that their material is approved for public release. This is accomplished by attaching one copy of the material (manuscript, photos, videotapes and any other material that requires clearance) to this form and obtaining the necessary signatures. When clearance is granted, the Picatinny Public Affairs Office (the last office in the clearance process) will forward one copy of this form along with the attached material to the Picatinny Information Center for archival purposes and provide another copy of this form to the author/producer. It is the author/producer's responsibility to notify all interested parties of the release approval and to make subsequent distribution. The Author/Producer's Signature;

Supervisor/Subject Matter Expert Signature; and Commander/Staff Agency Chief shall be different people. The purpose of this review is to have Subject Matter Experts, Supervisors, Commanders and Staff Agency Chiefs, confirm there is no sensitive, critical or classified information contained in the request for public release of government information. Particularly, it is critical that the signing Commander(s) or Staff Agency Chief(s) be aware of the information being submitted for public release on their behalf.

IF AUTHOR/PRODUCER IS A CONTRACTOR:

A contractor initiates the clearance process by forwarding the material to a Picatinny sponsor, who in turn begins the clearance process in the same manner as a Picatinny-based request. When clearance is granted, the Picatinny Public Affairs Office (the last office in the clearance process) will forward one copy of this form along with the attached material to the Picatinny Information Center for archival purposes, and provide another copy of this form to the Picatinny sponsor. It is the Picatinny sponsor's responsibility to notify the contractor and any other interested parties of the release approval and to coordinate subsequent distribution with the contractor. Because contractor-submitted videotape material requires clearance at the Defense Department level, recommend that these submissions be made at least 90 days prior to the projected public release date. Only Picatinny-related portions of multi-topic videotapes will be reviewed here.

RECOMMENDED DISTRIBUTION:

Each signatory in the Required Approvals section has indicted their respective recommendations for public release and distribution. The approved distribution is circled at the bottom of the form and will reflect the most stringent distribution category selected by the signatory(ies).

For more information on the clearance process or this form, please contact the Picatinny Arsenal Public Affairs Office; DSN 880-6365; (973) 724-6365.

INSTRUCTIONS

COMMENTS

(Use this space, and additional pages as necessary, to make additional remarks or written changes to the submitted material. If changes are made directly on the material, a note to that effect in the Required Approvals section under "Remarks" is all that's necessary.)

IMPI-PLS Form 3002, 16 Nov 2016 Replaces AMSTA-AR Form 3002 Page 2 of 2