REMIS.docx

REMIS USER ACCESS REQUEST

ALL INFORMATION -- PLEASE TYPE OR COMPLETE IN MICROSOFT WORD

The Reliability and Maintainability Information System (REMIS) User Access Request is the only form accepted by the REMIS Program Management Office (PMO) when requesting REMIS access. Complete all requested information for your user type (government or contractor). Incorrectly completed or incomplete forms will be returned to the requester without processing. This is a DOcument Template form (remis-access.dot) designed to be filled out in Microsoft Word.

PLEASE FILL OUT IN MICROSOFT WORD OR TYPE.

HAND WRITTEN/PRINTED OR FAXED FORMS ARE NO LONGER ACCEPTED.

Illegible forms will be returned without processing.

SECTION 1 - USER INFORMATION: TO BE COMPLETED FOR ALL REQUESTS (GOVERNMENT OR CONTRACTOR).

USER TYPE: Mark one: government or contractor.

REQUEST TYPE: Mark one: initial, update, or delete USER ID: Current REMIS ID, if request type marked is update or delete, leave blank for initial requests LAST NAME: User’s legal last name NO NICKNAMES!!

FIRST NAME: User’s legal first name NO NICKNAMES!!

M.I.: User’s legal middle initial NO NICKNAMES!!

RANK/GRADE: User’s military rank or civilian grade.

COMM. PHONE : Commercial phone number, including area code/country code.

DSN PHONE: DSN phone number.

SS# (LAST 4): Last 4 digits, only, of user’s Social Security Number (used for identification purposes).

U.S. CITIZEN: Must mark one.

ORGANIZATION/COMPANY NAME: User’s government office symbol or company name.

MAILING ADDRESS (STREET): User’s official mailing street address. (Contractors: Use your “physical address”) CITY/BASE: User’s official mailing city or base address.

STATE/COUNTRY: User’s official mailing state or country address.

ZIP +4: User’s official mailing zip +4 code.

E-MAIL ADDRESS: User’s complete official e-mail address.

PORTAL LOGON: User’s PORTAL Logon ID.

MAJCOM: Major Command that user works for.

FUNCTIONAL JOB TITLE: User’s functional job title (Equip. Spec., Item Mgr., Engineer/TCTO Mgr., etc.)

WEAPON SYSTEM/EQUIPMENT: List aircraft model/design/series (MDS) or equipment designators (C-E, ATE, ENGINES, etc.) for which data is required in the performance of the user’s job duties.

TABLES/FILES MAINTAINED: List tables (WUC, SRD Code, or Configuration, etc) and/or files (MDD inputs, part numbers, TCTO inputs, flying hours, etc.) for which access is required in the performance of the user’s job duties.

ACCESS REQUIRED: User should mark all applicable.

USER SIGNATURE: Please read statement above signature block before signing. User’s signature indicates agreement with this statement.

DATE: Date signed by user.

SECTION 2 – SECURITY CLEARANCE OR NATIONAL AGENCY CHECK (AFI33-119): TO BE COMPLETED FOR ALL REQUESTS (GOVERNMENT OR CONTRACTOR) [Contractors: Use your Company Security Officer]

USER’S TYPE/LEVEL: Indicate type or level of current security clearance (NAC, Secret, or Top Secret).

USER’S LATEST INVESTIGATION DATE: Date of latest investigation. If investigation has been submitted but not completed enter the word “submitted” and the date of submission.

SECURITY OFFICIAL (PRINTED NAME): Printed name of security official.

ORG: Organizational symbol of security official.

FULL DUTY PHONE: Commercial and/or DSN duty phone number of user’s security official.

SECURITY SIGNATURE: Signature of security official. Signature indicates certification of clearance or NAC information.

DATE: Date signed by security official.

SECTION 3 – VALIDATION and APPROVAL SIGNATURES: TO BE COMPLETED FOR ALL REQUESTS (GOVERNMENT OR CONTRACTOR). [ Contractors: Your Company Supervisor’s signature]

USER SUPERVISOR (PRINTED NAME): Printed name of user’s immediate supervisor.

ORG: Organizational symbol of user’s immediate supervisor.

FULL DUTY PHONE: Commercial and/or DSN duty phone number of user’s immediate supervisor.

SUPERVISOR SIGNATURE: Signature of user’s immediate supervisor. Signature indicates agreement that REMIS access is required in for the performance of the user’s job duties.

DATE: Date signed by user’s immediate supervisor.

ATTENTION CONTRACTORS: Please have Section 4 completed before continuing with the remainder of Section 3.

ACCESS GROUP(s) REQUIRED: (To be completed by local government organizational REMIS OPR) List all REMIS access group numbers required for the performance of the user’s job duties.

GOVT. ORG/REMIS OPR (PRINTED NAME): Printed name of designated local government organizational REMIS OPR designated by your MAJCOM representative at: https://remisweb.wpafb.af.mil//majcoms.htm. For AFMC customers use REMIS ALC Points of Contact at: https://remisweb.wpafb.af.mil//alcpocs.htm ORG: Organizational symbol of local government organizational REMIS OPR.

FULL DUTY PHONE: Commerial and/or DSN duty phone number of local government organizational REMIS OPR.

GOVT. ORG/REMIS OPR SIGNATURE: Signature of local government organizational REMIS OPR. Signature indicates approval of listed REMIS access group for this user.

DATE: Date signed by local government organizational REMIS OPR.

MAJCOM REP. (PRINTED NAME): Printed name of MAJCOM REMIS representative ; see above for URL (designated in writing to REMIS PMO).

ORG: Organizational symbol of MAJCOM REMIS representative.

FULL DUTY PHONE: Commercial and/or DSN duty phone number of MAJCOM REMIS representative.

MAJCOM REP. SIGNATURE: Signature of MAJCOM REMIS representative. Signature indicates final approval of REMIS access as indicated above.

DATE: Date signed by MAJCOM REMIS representative.

SECTION 4 – FOR CONTRACTOR USERS ONLY. TO BE COMPLETED FOR CONTRACTOR REQUESTS ONLY. THIS SECTION IS USED TO VERIFY THE EXISTANCE OF A VALID CONTRACT.

CONTRACT NUMBER: Contract number and delivery/task order number for which the user requires access to REMIS in order to perform contractual duties.

CONTRACT DATES: Contract period of performance dates of the above contract and delivery/task order. Must include month, day, and year (of contract expiration date).

CONTRACTOR ACCESS REQUEST LETTER ATTACHED: Check one. A new letter required each time contract is renewed/extended. (See sample letter) PCO/COTR/ACO (PRINTED NAME): Printed name of government procuring contracting official (PCO), contracting official technical representative (COTR), or administrative contracting official (ACO) knowledgable of the contract details.

ORG.: Organizational symbol of the government PCO/COTR/ACO.

DUTY PHONE: Commercial and/or DSN duty phone number of the government PCO/COTR/ACO.

PCO/COTR/ACO SIGNATURE: Signature of the government PCO/COTR/ACO. Signature indicates detailed knowledge of the listed contract and the need for this user’s access to REMIS for the performance of said contract.

The purpose of this signature is to verify the existence of a valid contract.

DATE: Date signed by government PCO/COTR/ACO.

INSTRUCTIONS FOR COMPLETION OF REMIS USER ACCESS REQUEST

REMIS FORM XXXC 1 PREVIOUS EDITIONS ARE OBSOLETE

INSTRUCTIONS 19 NOV 2003

******SECTION 1**** USER INFORMATION**********

USER TYPE:

|_| GOVERNMENT |_| CONTRACTOR

REQUEST TYPE:

|_| INITIAL |_| UPDATE |_| DELETE

USER ID:

LAST

NAME

NAME

COMM.

PHONE

(LAST 4)

CITIZEN

|X|YES

|_| NO

ORGANIZATION/

COMPANY NAME

ADDRESS

(STREET)

COUNTRY

WEAPON SYSTEM/

EQUIPMENT

MAINTAINED

ACCESS REQUIRED:

|_| READ ONLY |_| EIMSURS |_| PPS |_| GCSAS |_| OTHER (specify)

THE INFORMATION GIVEN IS CORRECT. I AGREE TO PROTECT MY USER ID/PASSWORD. TO COMPLY WITH AIR FORCE SECURITY REGULATIONS AND TO REPORT MISUSE/EXPOSURE IAW AFMAN 33-223.

USER SIGNATURE

***SECTION 2****SECURITY CLEARANCE OR NATIONAL AGENCY CHECK (AFI 31-501)*****

INVESTIGATION DATE

SECURITY OFFICIAL

(PRINTED NAME)

PHONE

SECURITY

SIGNATURE

***SECTION 3****VALIDATION/APPROVAL SIGNATURES**********

USER SUPERVISOR

(PRINTED NAME)

FULL DUTY

PHONE

SUPERVISOR

SIGNATURE

GOVT. ORG/REMIS OPR

(PRINTED NAME)

PHONE

GOVT. ORG/REMIS OPR SIGNATURE

MAJCOM REP.

(PRINTED NAME)

PHONE

MAJCOM REP.

SIGNATURE

***SECTION 4****FOR CONTRACTOR USE ONLY*****

PCO/COTR/ACO

(PRINTED NAME)

PHONE

PCO/COTR/ACO

SIGNATURE

AUTHORITY: 10 U.S.C., CHAPTER 40; 37 U.S.C., CHAPTER 9, EO 9397, NOVEMBER 1943 PRINCIPLE PURPOSES: TO AUTHORIZE AND TRACK USERS OF THE REMIS DATABASE. ROUTINE USES: SAME AS PRINCIPLE PURPOSES. DISCLOSURE: FILLING OUT THIS FORM IS VOLUNTARY, HOWEVER, FAILURE TO DO SO WILL RESULT IN REFUSAL OF ACCESS TO THE REMIS DATABASE.

REMIS FORM XXXC 19 NOV 2003 PREVIOUS FORMS ARE OBSOLETE