Attachment (a) - PED Form.pdf

Authorization Request for Operation of Non-DoD Portable Electronic Devices (PEDs) at Naval Surface Warfare Center, Carderock Division (NSWCCD)

Part I. Non-DoD/Non-NSWCCD PED Registration (To be completed by requestor)

Purpose: To gather user and computer details for the purpose of granting temporary approval for use of outside PEDs at NSWCCD.

This form, once fully completed and approved, must be attached to the equipment while at NSWCCD.

Scope: This form will be used to grant approval for PEDs that are not covered by a NSWCCD or NMCI accreditation.

This form is not required for NMCI or permanent NSWCCD equipment. NMCI equipment may connect to NMCI networks.

Part II. NSWCCD Point of Contact Information (To be completed by NSWCCD POC)

PED Owner Information

Name (Last, First, Middle Initial) Phone

Email Address

Command / Company

PED Details

PED Type

Data Sensitivity/Special Handling:

Purpose of Usage

Laptop PDA Other (specify):

Unclassified Confidential NNPISecret

Manufacturer Model Serial Number

Requested Date(s) for authorization to operate Non-DoD PEDs at NSWCCD: From: To:

User Agreement

I understand that it is my responsibility to comply with all security measures necessary to prevent any unauthorized access, disclosure, modification, or destruction of DoD information, and to abide by the information assurance requirements of PEDs as per Carderock Division Instruction 5239.6B, Use of PEDs at NSWCCD. I understand that the unauthorized use of PEDs may result in the device being confiscated for forensic analysis and/or destruction.

Requestor's Signature Date

Computer Name MAC Address Wireless MAC

Code 34 Tracking #

NSWCCD POC Information Name (Last, First, Middle Initial) Phone Code

Area(s) of Use

Bldg Room Bldg BldgBldgRoom Room Room

Comments

NSWCCD POC Certification:

I certify the requestor information and areas of use; and I have ensured the requestor has been informed of the information assurance requirements detailed in Carderock Division Instruction 5239.6B, Use of PEDs at NSWCCD.

NSWCCD POC Signature Date

Part III. Operation Approval (To be completed by the Local IA Authority - CO/CIO/IAM)

Beginning Date Authorized for use at NSWCCD: Authorization Expires:

Local IA Authority (CO/CIO/IAM) Signature Date

CARDEROCKDIV Form 5239/9 (7-10)

Handling Government Information

Requires RDT&E System/Network Connection

Usage Requirements:

PII

PED will be using a cellular air card (user must sign Section VI - User Agreement)

Cellular Carrier

(PEDs) at Naval Surface Warfare Center, Carderock Division (NSWCCD)

Part IV. Non-DoD PEDs Request to Handle Government Data (To be completed by Department Information Assurance Officer - IAO)

Requirements:

Non-DoD PEDs are prohibited from handling Controlled Unclassified Information (CUI) except where specifically authorized in official contract documents.

Non-DoD PEDs shall be configured with the appropriate security settings prior to handling any Government data. Appropriate security settings shall include IAVA and STIG compliance, and updated Anti-virus operating on the device.

Contract Document Requiring the Non-DoD PED

Information Assurance Officer (IAO) Certification

As the IAO for the Code/RDT&E Lab, I am certifying that the PED listed above has been scanned to ensure the device has the appropriate security settings/configurations that include the following:

RDT&E Lab Name RDT&E Lab #

IAVA Compliance

STIG Compliance

Updated Anti-virus

Virus Scan

Encryption Software

Exceptions/concerns about security compliance:

I understand the DoD requires the removal of CUI from all Non-DoD PEDs and storage media prior to the expiration of the authorization period and before Non-DoD PEDs are released from government control. I shall ensure the NSWCCD procedures and/or guidance for the clean up and/or sanitization of the PED shall be enforced.

I understand that any Non-DoD PED attempting to connect to any NSWCCD system/network shall be part of an approved accreditation package prior to connection.

IAO Signature Date

Part V. Government Information Clean Up (To be completed by IAO)

IAO shall submit a signed copy to the IAM and CIO.

Prior to government loss of control the above PED has been :

Verified that all DoD related information has been removed

Performed BCWipe utilizing DoD configuration on storage media free space

Ensured DoD network settings and configuration have been removed

Other Information Clean Up

IAO Signature Date Completed

IAO shall submit an updated signed copy to the IAM and CIO upon clean up of government information from Non-DoD PED.

(PEDs) at Naval Surface Warfare Center, Carderock Division (NSWCCD)

Part VI. User Agreement for using Non-DoD Mobile Computer Devices with Air Cards (Cellular Service)

WARNING: Non- DoD information technology (IT) devices that are introduced into a DoD facility are subject to the current IT security practices utilized by the Command to ensure the security of DoD data. All IT equipment within DoD facilities, including DoD owned and Non-DoD owned, is subject to monitoring and forfeiture, if necessary, to protect DoD information and information systems (IS). Failure to provide the requested information will result in denial to operate Non-DoD PEDs within a DoD facility.

User Agreement:

By signing this document, I acknowledge and consent that when I utilize Non-DoD IT devices within a DoD facility:

- I shall not process DoD data or connect to any DoD asset

- I shall not insert DoD removable storage media into my computer containing DoD data that is marked any higher then Public Release

- I shall not test, strain, or otherwise interact with DoD security suites

- I shall disable all non-essential networking services (802.11, Bluetooth, etc)

- I consent to the following conditions:

- The U.S. Government (USG) routinely intercepts and monitors electronic communications originating within its facilities for purposes including, but not limited to, communications security (COMSEC) monitoring, network operations and defense, law enforcement (LE), and counterintelligence (CI) investigations.

- At anytime the U.S. Government may inspect and/or seize IT devices for the review of data stored on the information system.

- Notwithstanding the above, using a Non-DoD IT device within a DoD facility does not constitute consent to law enforcement or counterintelligence investigative searching or monitoring of the content of privileged communications or data that are related to personal representation or services by attorneys, psychotherapists, or clergy, and their assistants. Under these circumstances, such communications are private and confidential.

By signing this user agreement, I am acknowledging that I accept and will abide by all the terms and conditions described above.

Furthermore, I understand that any violation of these terms and conditions will result in the forfeiture of my IT device to the DoD for analysis and that the return of my IT device is at the sole discretion of the Commanding Officer of the DoD facility in which the violation was detected.

Signature Date

Authorization Request for Operation of Non-DoD Portable Electronic Devices (PEDs) at Naval Surface Warfare Center, Carderock Division (NSWCCD) Part I. Non-DoD/Non-NSWCCD PED Registration (To be completed by requestor) Purpose: To gather user and computer details for the purpose of granting temporary approval for use of outside PEDs at NSWCCD.

This form, once fully completed and approved, must be attached to the equipment while at NSWCCD.

Scope: This form will be used to grant approval for PEDs that are not covered by a NSWCCD or NMCI accreditation.

This form is not required for NMCI or permanent NSWCCD equipment. NMCI equipment may connect to NMCI networks.

Part II. NSWCCD Point of Contact Information (To be completed by NSWCCD POC) PED Owner Information Name (Last, First, Middle Initial) Phone Email Address Command / Company PED Details PED Type Data Sensitivity/Special Handling:

Purpose of Usage User Agreement I understand that it is my responsibility to comply with all security measures necessary to prevent any unauthorized access, disclosure, modification, or destruction of DoD information, and to abide by the information assurance requirements of PEDs as per Carderock Division Instruction 5239.6B, Use of PEDs at NSWCCD. I understand that the unauthorized use of PEDs may result in the device being confiscated for forensic analysis and/or destruction.

Code 34 Tracking # NSWCCD POC Information Name (Last, First, Middle Initial) Phone Code Area(s) of Use NSWCCD POC Certification:

I certify the requestor information and areas of use; and I have ensured the requestor has been informed of the information assurance requirements detailed in Carderock Division Instruction 5239.6B, Use of PEDs at NSWCCD.

Part III. Operation Approval (To be completed by the Local IA Authority - CO/CIO/IAM) CARDEROCKDIV Form 5239/9 (7-10)

Page of Usage Requirements:

Page of Authorization Request for Operation of Non-DoD Portable Electronic Devices (PEDs) at Naval Surface Warfare Center, Carderock Division (NSWCCD) Part IV. Non-DoD PEDs Request to Handle Government Data (To be completed by Department Information Assurance Officer - IAO) Requirements:

Non-DoD PEDs are prohibited from handling Controlled Unclassified Information (CUI) except where specifically authorized in official contract documents.

Non-DoD PEDs shall be configured with the appropriate security settings prior to handling any Government data. Appropriate security settings shall include IAVA and STIG compliance, and updated Anti-virus operating on the device.

Information Assurance Officer (IAO) Certification As the IAO for the Code/RDT&E Lab, I am certifying that the PED listed above has been scanned to ensure the device has the appropriate security settings/configurations that include the following:

Exceptions/concerns about security compliance:

I understand the DoD requires the removal of CUI from all Non-DoD PEDs and storage media prior to the expiration of the authorization period and before Non-DoD PEDs are released from government control. I shall ensure the NSWCCD procedures and/or guidance for the clean up and/or sanitization of the PED shall be enforced.

I understand that any Non-DoD PED attempting to connect to any NSWCCD system/network shall be part of an approved accreditation package prior to connection.

Part V. Government Information Clean Up (To be completed by IAO) IAO shall submit a signed copy to the IAM and CIO.

Prior to government loss of control the above PED has been :

IAO shall submit an updated signed copy to the IAM and CIO upon clean up of government information from Non-DoD PED.

CARDEROCKDIV Form 5239/9 (7-10)

CARDEROCKDIV Form 5239/9 (7-10)

Page of Authorization Request for Operation of Non-DoD Portable Electronic Devices (PEDs) at Naval Surface Warfare Center, Carderock Division (NSWCCD) Part VI. User Agreement for using Non-DoD Mobile Computer Devices with Air Cards (Cellular Service) WARNING: Non- DoD information technology (IT) devices that are introduced into a DoD facility are subject to the current IT security practices utilized by the Command to ensure the security of DoD data. All IT equipment within DoD facilities, including DoD owned and Non-DoD owned, is subject to monitoring and forfeiture, if necessary, to protect DoD information and information systems (IS). Failure to provide the requested information will result in denial to operate Non-DoD PEDs within a DoD facility.

User Agreement:

By signing this document, I acknowledge and consent that when I utilize Non-DoD IT devices within a DoD facility:

- I shall not process DoD data or connect to any DoD asset

- I shall not insert DoD removable storage media into my computer containing DoD data that is marked any higher then Public Release

- I shall not test, strain, or otherwise interact with DoD security suites

- I shall disable all non-essential networking services (802.11, Bluetooth, etc)

- I consent to the following conditions:

- The U.S. Government (USG) routinely intercepts and monitors electronic communications originating within its facilities for purposes including, but not limited to, communications security (COMSEC) monitoring, network operations and defense, law enforcement (LE), and counterintelligence (CI) investigations.

- At anytime the U.S. Government may inspect and/or seize IT devices for the review of data stored on the information system.

- Notwithstanding the above, using a Non-DoD IT device within a DoD facility does not constitute consent to law enforcement or counterintelligence investigative searching or monitoring of the content of privileged communications or data that are related to personal representation or services by attorneys, psychotherapists, or clergy, and their assistants. Under these circumstances, such communications are private and confidential.

By signing this user agreement, I am acknowledging that I accept and will abide by all the terms and conditions described above. Furthermore, I understand that any violation of these terms and conditions will result in the forfeiture of my IT device to the DoD for analysis and that the return of my IT device is at the sole discretion of the Commanding Officer of the DoD facility in which the violation was detected.