Attachment 6 - DD2875 System Authorization Access Request.pdf

PDF 56 KB Posted

Attached to
DDRV Vertical Lift Module Preventative/Corrective Maintenance Federal contract opportunity
Solicitation number
SP330025Q0030
Issued by
Defense Logistics Agency Distribution

About this file

Written by GovTribe AI ·

This appears to be a placeholder PDF file that indicates the viewer needs to upgrade Adobe Reader to properly display the document. The file name suggests it is meant to be DD Form 2875 (System Authorization Access Request), which is typically used to request access to DoD information systems.

This file is related to solicitation SP330025Q0030 for DDRV Vertical Lift Module Preventative/Corrective Maintenance, being issued by the Defense Logistics Agency Distribution as an unrestricted procurement under NAICS 811310 ($12.5M size standard). The solicitation aims to establish a hybrid Firm-Fixed-Price and Time and Materials purchase order, though the actual form content is not accessible in this placeholder document.

View the file

Other files for this federal contract opportunity

Other files attached to DDRV Vertical Lift Module Preventative/Corrective Maintenance, newest first.
File Type Posted
Amendment 0002.pdf PDF
Amendment 0001.pdf PDF
Attachment 4 - Levels of Maintenance.pdf PDF
Attachment 9 - DL1818 Visitor Notification Form.pdf PDF
Attachment 14 - QASP_ DDRV.docx DOCX document
Attachment 8 - DL1591 Supervisor Mishap Report.pdf PDF
Attachment 10 - TE 1.1 Contractor Personnel Sec.pdf PDF
Attachment 11 - TE_1.2_CAC_Procedures.pdf PDF
Attachment 12 - QASP - CAP - VLM Maint.pdf PDF
Attachment 13 - QASP - COSR - VLM Maint.pdf PDF
CSS.pdf PDF
Attachment 1 - Schedule of Services.xlsx XLSX spreadsheet
Attachment 3 - Equipment List.pdf PDF
Attachment 7 - DL0584 Visitor Register Form.pdf PDF
Attachment 2 - PWS.pdf PDF
Attachment 5 - Wage Determination No 2015-4331 Rev 29 dtd 12.23.2024.pdf PDF
Show all 16

On GovTribe

Work with this file on GovTribe

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Please wait...

If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other countries.

PREVIOUS EDITION IS OBSOLETE.

DD FORM 2875, MAY 2022

PREVIOUS EDITION IS OBSOLETE.

DD FORM 2875, MAY 2022

INSTRUCTIONS

The prescribing document is as issued by using DoD Component.

PREVIOUS EDITION IS OBSOLETE.

DD FORM 2875, MAY 2022

Page of

SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)

OMB No. 0704-0630 OMB approval expires:

20250531 The public reporting burden for this collection of information, 0704-0630, is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.

PRIVACY ACT STATEMENT

AUTHORITY: Public Law 99-474, the Computer Fraud and Abuse Act PRINCIPAL PURPOSE(S): To record names, signatures, and other identifiers for the purpose of validating the trustworthiness of individuals requesting access to Department of Defense (DoD) systems and information. NOTE: Records may be maintained in both electronic and/or paper form ROUTINE USE(S): None.

DISCLOSURE: Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or prevent further processing of this request.

USER ID

PART I (To be completed by Requester)

8. CITIZENSHIP

9. DESIGNATION OF PERSON

10. IA TRAINING AND AWARENESS CERTIFICATION REQUIREMENTS (Complete as required for user or functional level access.)

PART II ENDORSEMENT OF ACCESS BY INFORMATION OWNER, USER SUPERVISOR OR GOVERNMENT SPONSOR (If individual is a contractor - provide company name, contract number, and date of contract expiration in Block 16.)

14. TYPE OF ACCESS REQUESTED

15. USER REQUIRES ACCESS TO:

16. VERIFICATION OF NEED TO KNOW

SUPERVISOR

9.0.0.2.20120627.2.874785 DD Form 2875, "SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)" whs.mc-alex.esd.mbx.formswebmaster@mail.mil

WHS

PART III - SECURITY MANAGER VALIDATES THE BACKGROUND INVESTIGATION OR CLEARANCE INFORMATION

PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION

A. PART I: The following information is provided by the user when establishing or modifying their USER ID.

(1) Name. The last name, first name, and middle initial of the user.

(2) Organization. The user's current organization (i.e. DISA, SDI, DoD and government agency or commercial firm).

(3) Office Symbol/Department. The office symbol within the current organization (i.e. SDI).

(4) Telephone Number/DSN. The Defense Switching Network (DSN) phone number of the user. If DSN is unavailable, indicate commercial number.

(5) Official E-mail Address. The user's official e-mail address.

(6) Job Title/Grade/Rank. The civilian job title (Example: Systems Analyst, GS-14, Pay Clerk, GS-5)/military rank (COL, United States Army, CMSgt, USAF) or "CTR" if user is a contractor.

(7) Official Mailing Address. The user's official mailing address.

(8) Citizenship (US, Foreign National, or Other).

(9) Designation of Person (Service Member (SM), Government Employee (GOV), Contractor (CTR)) (Military, Civilian, Contractor).

(10) IA Training and Awareness Certification Requirements. User must declare the Annual Cyber Awareness Training and Date.

(11) User's Signature. User must sign the DD Form 2875 with the understanding that they are responsible and accountable for their password and access to the system(s).

(12) Date. The date that the user signs the form.

B. PART II: The information below requires the endorsement from the user's Supervisor or the Government Sponsor.

(13) Justification for Access. A brief statement is required to justify establishment of an initial USER ID. Provide appropriate information if the USER ID or access to the current USER ID is modified.

(14) Type of Access Required: Place an "X" in the appropriate box. (Authorized - Individual with normal access. Privileged - Those with privilege to amend or change system configuration, parameters, or settings.)

(15) User Requires Access To: Place an "X" in the appropriate box. Specify category.

(16) Verification of Need to Know. To verify that the user requires access as requested.

(16a) Expiration Date for Access. The user must specify expiration date if less than 1 year.

(17) Supervisor's Name (Print Name). The supervisor or representative prints their name to indicate that the above information has been verified and that access is required.

(17a) E-mail Address. Supervisor's e-mail address.

(17b) Phone Number. Supervisor's telephone number.

(17c) Supervisor's Organization/Department. Supervisor's organization and department.

(17d) Supervisor's Signature. Supervisor's signature is required by the endorser's representative.

(17e) Date. Date the supervisor signs the form.

(18) Phone Number. Functional appointee telephone number.

(18a) Signature of Information Owner/Office of Primary Responsibility (OPR). Signature of the Information Owner or functional appointee of the office responsible for approving access to the system being requested.

(18b) Date. The date the functional appointee signs the DD Form 2875.

(19) Organization/Department. ISSO’s organization and department.

(19a) Phone Number. ISSO’s telephone number.

(19b) Signature of Information Systems Security Officer (ISSO) or Appointee. Signature of the ISSO or Appointee of the office responsible for approving access to the system being requested.

(19c) Date. The date the ISSO or Appointee signs the DD Form 2875.

(21) Optional Information. This item is intended to add additional information, as required.

C. PART III: Verification of Background or Clearance.

(22) Type of Investigation. The user's last type of background investigation (i.e., Tier 3, Tier 5, etc.).

(22a) Investigation Date. Date of last investigation.

(22b) Continuous Evaluation Enrollment Date. Date of CE enrollment. Leave blank if user is not enrolled in CE.

(22c) Access Level. The access level granted to the user by the sponsoring agency/service (i.e. Secret, Top Secret, etc.). Access level refers to the access determination made on the basis of the user’s individual need for access to classified information to perform official duties; a determination separate from the user’s eligibility determination.

(23) Verified By. The Security Manager or representative prints name to indicate that the above clearance and investigation information has been verified.

(24) Phone Number. Security Manager’s telephone number.

(25) Security Manager Signature. The Security Manager or designated representative indicates that the above clearance and investigation information has been verified.

(26) Verification Date. Date the Security Manager performed the background investigation and clearance information verification.

D. PART IV: This information is site specific and existing blocks can be used to collect account-specific information. This information will specifically identify the access required by the user.

E. DISPOSITION OF FORM:

TRANSMISSION: Form may be electronically transmitted, faxed, or mailed. Adding a password to this form makes it a minimum of CONTROLLED UNCLASSIFIED INFORMATION” and must be protected as such.

FILING: Original SAAR, with original signatures in Parts I, II, and III, must be maintained on file for one year after termination of user's account. File may be maintained by the DoD or by the Customer’s ISSO. Recommend file be maintained by ISSO adding the user to the system.

DesignationIndicator:
Select Classification from drop-down list.: 1
Click this button to save this form.:
Click this button to print this form.:
Click this Reset button to erase data from all fields.:
DI:
CurrentPage:
PageCount:
Enter system name (Platform or Applications).:
User ID:
typeReqDate:
Enter location (Physical Location of System).:
Enter name (Last, First, Middle Initial- this field is auto-filled with the value of item 1.:
Enter organization.:
Enter office symbol/department.:
Enter phone number (DSN or Commercial).:
Enter office email address.:
Enter job title and grade/rank.:
Enter official mailing address.:
8. CITIZENSHIP - Select for "United States": 0
8. CITIZENSHIP - Select for "foreign national.": 0
15. USER REQUIRES ACCESS TO: - Select for "user requires access to other.": 0
15. USER REQUIRES ACCESS TO: - Select for "user requires access to other.": 0
9. DESIGNATION OF PERSON - Select for "military.": 0
9. DESIGNATION OF PERSON - Select for "civilian.": 0
9. DESIGNATION OF PERSON - Select for "contractor.": 0
10. IA TRAINING AND AWARENESS CERTIFICATION REQUIREMENTS (Complete as required for user or functional level access.) - Select for "I have completed the Annual Cyber Awareness Training.": 0
10. IA TRAINING AND AWARENESS CERTIFICATION REQUIREMENTS - Enter date in format YYYYMMDD.:
Enter user signature.:
Date of signature in format YYYYMMDD.:
PART II ENDORSEMENT OF ACCESS BY INFORMATION OWNER, USER SUPERVISOR OR GOVERNMENT SPONSOR

(If individual is a contractor - provide company name, contract number, and date of contract expiration in Block 16.) - 13. JUSTIFICATION FOR ACCESS:

14. TYPE OF ACCESS REQUESTED - Select for "authorized.": 0
14. TYPE OF ACCESS REQUESTED - Select for "privileged.": 0
15. USER REQUIRES ACCESS TO: - Select for "user requires access to unclassified.": 0
15. USER REQUIRES ACCESS TO: - Select for "user requires access to classified.: 0
15. USER REQUIRES ACCESS TO: Specify classified category.:
15. USER REQUIRES ACCESS TO: enter specification for "Other":
16. VERIFICATION OF NEED TO KNOW - Select for "I certify that this user requires access as requested.": 0
Enter access expiration date (Contractors must specify Company Name, Contract Number, Expiration Date. Use Block 27 if needed.):
Enter supervisor's printed name.:
Enter supervisor's email address.:
Enter security manager telephone number.:
Enter supervisor's organization/department.:
Enter security manager signature.:
Enter information owner/OPR phone number.:
Enter ISSO organization/department.:
Enter optional information.:
PART III - SECURITY MANAGER VALIDATES THE BACKGROUND INVESTIGATION OR CLEARANCE INFORMATION - 22. TYPE OF INVESTIGATION:
Enter date in format YYYYMMDD.:
Enter date in format YYYYMMDD.:
Enter access level:
Enter the printed name of the verifier.:
PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION - Enter title, line 1.:
Enter system for line 1.:
Enter account code, line 1.:
PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION - Enter title, line 2.:
Enter domain for line 2.:
Enter account code, line 2.:
PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION - Enter title, line 3.:
Enter server for line 3.:
Enter account code, line 3.:
PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION - Enter title, line 4.:
Enter application for line 4.:
Enter account code, line 4.:
PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION - Enter title, line 5.:
Enter files for line 5.:
Enter account code, line 5.:
PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION - Enter title, line 6.:
Enter datasets for line 6.:
Enter account code, line 6.:
Date processed in format YYYYMMDD.:
Print name of who processed account information.:
Signature of who processed account information.:
Date revalidated in format YYYYMMDD.:
Print name of who o revalidated account information.:
Signature of who revalidated account information.:

File details come from the government source that posted it. Updated .