Attachment 6 - CAVAF SOW.pdf

CAV AF CFM

STATEMENT OF WORK

31 Aug 2011

The purpose of this statement of work (SOW) is to provide Contract Depot Maintenance (CDM) guidance for contractor technical, responsibilities and reporting requirements of the Commercial Asset Visibility Air Force (CAV AF) system. CAV AF shall be the primary system of record for providing daily status of all Government owned assets located at contractors facilities. Reporting within CAV AF shall not be limited to end items subject to repair but are to include assets stored as an inventory control point (ICP). Equipment identified as Government Furnished Equipment (GFE) may be reported within CAVAF. Enhancements to the CAV AF system will be identified on the CAV AF home web page. Contractors are responsible for ensuring current User Guides are utilized by their respective facility.

TECHNICAL CONSIDERATIONS:

1. Contractors accessing CAV AF shall present a valid DoD PKI certificate to log into CAV AF.

Contractors working at DoD facilities, who have a common access card (CAC), should already have a PKI certificate. Contractors working outside of DoD facilities can purchase a valid DoD PKI certificate through one of three External Certificate Authorities (ECAs). A listing of ECAs and additional information on purchasing a valid DoD PKI can be found at the following web site: http://iase.disa.mil/pki/eca/ . Each contractor employee accessing CAV AF will need an Identity Certificate only; an Encryption Certificate is not required.

2. Utilizing subcontractors in the repair of government assets in partnership by the awarded prime contractor shall conform to all applicable reporting requirements contained within this contract. Inherently, the awarded prime contractor shall bear sole responsibility for all reporting actions.

3. CONTRACTOR RESPONSIBILITY OF CAV AF HARDWARE AND SYSTEM ACCESS:

It is the contractor’s responsibility to ensure systemic connectivity with CAV AF system is achieved and reporting capability is successful. When contractor experiences connectivity problem after receiving initial contract delivery order they should contact the Inventory Control Point (ICP) CAV AF System Administrator (SA) within 24 hours.

CONTRACTOR RESPONSIBILITY:

1. Contractor reporting requirements to CAV AF shall be accomplished daily and/or within 24 hours of a supply or maintenance action occurrence IAW the applicable CAV AF CDRL, CAV AF version 7.2 or higher Contractor Users. Accurate and timely reporting of maintenance transactions into CAV AF is critical to the management of repair requirements and the management of world-wide asset distribution. CAV AF transmits daily to Air Force internal data systems for financial and asset tracking. Inaccurate or lack of CAV AF reporting will cause significant loss to the Air Force. Contractor shall ensure asset record in CAV AF is an accurate reflection of physical asset on hand at all times.

2. Proper usage of DD Form 1348-1A, Issue Release/Receipt Document in relation to CAVAF reporting requirements.

a. Receipt Actions: Contractor will use government issued shipment document numbers for CAV AF end item receipt transaction reporting only in the absence of missing DD Form 1348-1A or shipment document number. Contractors are not authorized to generate pseudo shipment document numbers for receipt transactions because this creates disconnects in shipment tracking within government inventory systems.

b. Shipping Actions: DD Form 1348-1A shall be used as the shipping document for shipment transactions of all end items. A DD Form 1348-1A is also applicable to all Consolidated Serviceable Inventory/Consolidated Reparable Inventory (CSI/CRI) assets regardless of tracking or reporting purposes. DD Form 250 or DD Form 1149 are not acceptable or authorized as a shipment document, and shall not accompany any material shipments on repair contracts. DD Form 1348-1A shipping documents will be prepared for each NSN shipment from contractor’s facility, regardless of destination. The entire form, complete with bar coding, will be printed on a laser printer as specified under technical considerations. Two copies of the DD Form 1348-1A are provided by CAV AF. Place one copy on the outside of the shipment container and one copy inside the shipment container. For end item shipments the DD Form 1348-1A shipment document number shall be comprised as one of the following actions:

i. Back to Depot Shipments:

(1) For a “single” unit NSN shipment, the default shipment document number will be the CAV AF record control document number (RCDN) of item being shipped.

(2) For “multiple” quantity shipments, it is recommended the CAV AF RCDN of the lead item of the shipment be used as the shipment document number.

ii. Amended Shipping Instructions (ASI): Are used to divert material that is due-in from a contractor to a requisitioner. Government disposition instructions will provide a shipment document number to the contractor to be utilized for CAV AF shipment transaction reporting and the DD Form 1348-1A.

NOTE: In the event CAV AF system is inoperable, DD Form 1348-1A shall be manually generated (printed) by contractor. When CAV AF is again operable, the contractor shall complete a DD Form 1348-1A and the shipment process in CAV AF.

3. Contract/Delivery Order Closure Level Disposition Instructions – Government will provide disposition instructions to contractor. Contractor shall comply with disposition instructions within 10 days of receipted government instructions and shall have complied no later than 30 days after receipt of instructions. Contractor shall be fully responsible to ensure all corresponding CAV AF reporting actions associated with disposition instructions occur within 24 hrs of related shipment action.

4. Contractual Induction-at-Risk of end items is prohibited on all repair contracts.

5. All NSNs identified as Nuclear Weapon Related Material (NWRM) shall require contractor reporting utilizing CAV AF for production management, to track and report NWRM end items in repair to the Serial Number level. Contractors shall capture each NWRM assets Serial Number when reparable is received. NWRM assets received shall be receipted in CAV AF, with Serial Number identification within 24 hours for asset visibility and serial number tracking.

Contractors shall follow all NWRM management requirements outlined in AFI 20-110, NWRM Management, to include but not limited to packaging, marking, labeling, storage, transportation and receipt of all NWRM assets, with emphasis on positive inventory control (PIC) and records management by the contractor and government to assure compliance. The successful application of these procedures requires the full cooperation of all personnel associated with the storage, shipping, transshipping and receiving of all NWRM assets.

CAVAF CONTRACTOR TRANSACTION REPORTING REQUIREMENTS:

1. “Not-on-Contract” receipt transactions shall be utilized for assets which are not repair end items. Not-on-contract assets are associated to a contractor facility DoDAAC and not an active contract delivery order. Regardless of asset condition code status, Not-on-contract shall be used for the following reporting actions:

a. Discrepancy Items – Are identified as misrouted, shipments, misidentified shipments or damaged end items. Contractor will address discrepancy issues weekly to acquire resolution to discrepancy within 30 days of receipt transaction. The contractor shall comply with disposition instructions provided by the Government within 10 days and complete all associated reporting actions within same period. Contractor reporting actions shall be resolved using reversals of individual record document control numbers (RCDN) or may be accomplished utilizing a ‘bulk’ shipment action of RCDN.

b. Inventory Control Point Items – are identified as assets stored at contractor facility and are not repair end items or discrepancies items. Movement of assets from “Not-on- Contract” category shall be resolved using reversals of individual record document control numbers (RCDN) or may be accomplished utilizing a ‘bulk’ shipment action of

RCDN.

NOTE: Contractor is responsible for all “Not-on-Contract” assets ensuring physical asset balances are reflected and CAVAF reporting actions occur within 24 hr of supply action.

NOTE: Not-on-Contract receipt actions will not be utilized for quality deficiency report (QDR) items.

CAUTIONARY AREAS OF CONTRACTOR CAV AF REPORTING:

1. Systemic data problems created by contractor’s failure to report data accurately or in a timely manner are subject to immediate Program Management Review (PMR). Examples of documented system data problems include but are not limited to:

a. Timely reporting means compliance with 24 hour requirement for contractor CAV AF reporting of maintenance transactions. Contractor’s are not authorized to report all receipt, induction, complete and ship transactions the same day to ‘catch-up’ due to periodic reporting.

This affects government inventory management systems and balances creating D035 Stock Control Supply System (SCSS) controlled exceptions (associated with same day reporting issue).

b. Contractors not using government issued DD Form 1348-1A document numbers on CAV AF contractor reporting on end item receipt transactions. This creates a data variance disconnect with government inventory D035 Stock Control System (SCS). Contractors are required to use DD Form 1348-1A document numbers for end item receipt transactions. NOTE: If the DD Form 1348-1A is missing or no shipment document number is available, contractors are to immediately contact Production Management Specialist (PMS) and acquire government issued shipment document number from Inventory Management Specialist (IMS).

DISCREPANCIES INCIDENT TO SHIPMENT:

1. There are transportation and item discrepancies, each having different reporting requirements.

Detailed information for each report is in the pertinent service publications.

2. Discrepancies incident to shipment include misidentified items, variations in quantity, non-requisitioned items, lost or damaged parcel post, and items in dubious condition. These discrepancies shall be reported and resolved using the DoD web-based application WebSDR link located within the CAV AF system. The Web address for Online CAV AF access is:

https://www.cavaf.com This system of reporting a Supply Discrepancy Report (SDR), formerly called Report of Discrepancy (ROD), has been developed in compliance with DoD regulations 4140.1-R and 4000.25-M Volume 2, which requires automated SDR processing. In those situations where the SDR initiator is unable to gain access to the AF WebSDR, continued use of manual forms is permitted. A copy of the form will be forwarded through the CAO and Quality Assurance (QA) activity for corrective action.

3. Transportation discrepancies and item transaction discrepancies shall be coordinated with the DCMA Property Administrator and ACO immediately upon discovery for corrective action in addition to AF WebSDR submittal.

4. Contract line items received with missing components (Missing On Induction, (MOI)) the contractor shall process a SDR (SF Form 364) immediately upon discovery in accordance with AFJMAN 23-215 and provide a copy of submitted MOI SDR form to the ACO within 2 days of discovery.

5. Misdirected shipments of GFP shall be immediately reported by telephone to the Property Administrator (PA) followed by written notification within three work days. The PA will issue appropriate disposition instructions for the misdirected items. Misdirected items received by the contractor which are not part of this contract will not be receipted into CAV AF.

6. Overages, shortages, and misidentified items which are part of this contract and received by the contractor shall be reported into CAV AF with the actual received quantity and with the correct NSN. An SDR shall be processed in accordance with standard procedures identified above for these overages, shortages, and misidentified items.

ATTACHMENT 1

CONTRACTOR COMMUNICATIONS NETWORK (CCN)

1. GENERAL INFORMATION:

1.1. The purpose of this attachment is to provide the specific conditions, hardware specifications, and communications interface to support contractor End Item reporting requirements and supply requisitions. Through the CCN Air Force contractors, with aircraft, engine or equipment repair contracts, have the capability to electronically process End Item transactions.

1.2. Initial CAV AF training will be provided by the contracting ALC. Any follow up training will be the responsibility of the contractor. For training and/or questions on CAV AF, please contact CAV AF Contract Manager (CM) for contract issued by respective ALC, from one of the following areas:

a. Warner Robins AFB, GA, call (478) 327-6602 or 327-6603, or send email request to:

406scms.cav.af.ar@robins.af.mil

b. Hill AFB, UT, call (801) 777-4803 or 775-6403

c. Tinker AFB, OK, send e-mail request to 428scms.cdmwork@tinker.af.mil, please ensure applicable Tinker contract number is included. A CAVAF representative will contact you for training and/or questions.

NOTE: Contractor’s guide can be accessed via CAV AF main menu at bottom of screen.

2. WEB SITE:

2.1. CAV AF web site accessed through the internet will be used to submit all End Item transactions. Each contractor user shall be required to complete a System Authorized Access Request, DD Form 2875, prior to using CAV AF.

2.2. The Web address for Online CAV AF access is: https://www.cavaf.com

2.3. The DLA/DAASC front-end computer at Wright-Patterson AFB, Ohio will act as host for GFM requisitions and MILSTRIP Status updates processed through CAV AF as batch end-of-day/beginning-of-day transactions.

3. CICA XML: Commercial vendors with XML capability on their in-house systems will be able to transmit XML batch files via a DLA/DLMSO format known as CICA XML. CAV AF XML files are transmitted via the Defense Automatic Addressing System Center (DAASC) network. DAASC receives, edits, and routes logistics transactions for the Military Services and Federal Agencies. There is only one way to access DAASC:

a. Use the services of a Value Added Network (VAN), with a current access/connectivity DAASC license agreement

3.1 Establishing an access/connectivity license agreement with a VAN/DAASC is an initial and essential action requiring execution at the earliest opportunity. Once this has been accomplished, DAASC will need to know the ISA/GS addressing id’s for each contractor so the information can be setup. Depending on the VAN selected, DAASC main ISA id is DTDN.

VAN https://www.daas.dla.mil/daashome/edi-vanlist-dla.asp DAASC https://www.daas.dla.mil/sar/gex_sar.asp

VAN/DAASC connectivity related information is located on a DLA dot mil domain and contractors will require Air Logistic Center CDM personnel assistance to gain access to the site.

This coordinated effort is required with either VAN or DAASC access the contractor pursues.

Contractor sponsorship requirements exist where contractors requesting DAASC access must be sponsored by their U.S. Government Contracting Officer or Contracting Officer's Representative.

Close coordination between the Air Logistics Center's (ALC) CAV AF System Administrator (SA) and the contractor's programmer is required.

NOTE: Contractors will report their repair transactions to CAV AF either by CAV Web or CAV XML. Both methods cannot be utilized at the same time. When the Air Logistics Center's (ALC) CAV AF System Administrator loads the Contractor's Profile into CAV AF a reporting decision is made whether a contractor uses CAV Web or CAV XML reporting.

3.2. Contractor shall contact CAV AF CM (listed above; para 1.2.) to obtain most recent XML lessons learned document. Document contains recorded issues/problems and may alleviate anticipated problem areas associated to XML.

4. TECHNICAL CONSIDERATIONS:

4.1. Contractors accessing CAV AF shall present a valid DoD PKI certificate to log into CAV AF. Contractor’s working at DoD facilities who have a common access card (CAC), should already have a PKI certificate. Contractors working outside of DoD facilities can purchase a valid DoD PKI certificate through one of three External Certificate Authorities (ECAs). A listing of ECAs and additional information on purchasing a valid DoD PKI can be found at the following web site: http://iase.disa.mil/pki/eca/ . Each contractor employee accessing CAV AF will need an Identity Certificate only; an Encryption Certificate is not required.

4.2. The CAV AF program is designed to be accessible using Microsoft Internet Explorer (IE6) v6.0 or higher or Netscape 4.75 or higher on a Windows 2000 or newer platform. IE6 is suggested and contains the required 128-bit encryption capability, and DoD certification. The following hardware is suggested as a minimum to adequately support CAV AF reporting with a minimum system requirement using Windows 2000 or newer platform: IBM compatible PC (1.5

GHZ Pentium), 512 MB RAM, 20 GB hard drive, 56 K BPS or faster data transmission modem, or connection to WAN/LAN, Laser Printer with 300 DPI resolution, (must support true type font).

4.3. The following software is required to accomplish CAV AF Web-based reporting: Operating System: Windows 2000 or Windows XP, Web Browser: Internet Explorer, version 6.0 (preferred), or Netscape version 4.75 (or higher) is also compatible.

4.4. CAV AF Web-based software will reside on the AF mid-tier server. CAV AF software changes will be made at the mid-tier server and they will be available to the repair vendor upon log-on to the CAV AF system. Changes to CAV AF software by the commercial repair vendors are not authorized.

5. CONTRACTOR RESPONSIBILITY:

5.1. The contractor shall be responsible for the maintenance of the hardware and supplies (paper, ink, ribbons, extra disks, etc) to keep the PC system operational and compatible with the host computer.

5.2. The contractor shall use the CCN/CAV AF Reporting System to report all end item transactions. These transactions shall be entered into CAV AF on a real time basis or as changes generate, but not later than 24 hours from the date of occurrence.

5.3. System failures that cannot be corrected within 24 hours shall be reported to the contracting ALC by fastest means possible.

6. SYSTEM AUTHORIZED ACCESS REQUEST (SAAR):

6.1. The SAAR, DD Form 2875, shall be completed by the contractor and submitted to the managing ALC CAV AF POC. A blank SAAR, DD Form 2875, and instructions on how to complete the form are identified below in the WORD document instruction.

Instructions for 2875 dd2875 Blank.pdf

6.2. Send DD Form 2875 to the respective ALC CAV AF System Administrator POC listed below:

a. Warner Robins AFB, GA, FAX (478) 926-4241

b. Hill AFB, UT, FAX (801) 777-5692

c. Tinker AFB, OK, send e-mail request to 428scms.cdmwork@tinker.af.mil, please

6.3. CAV AF user IDs will be in a standard format for all users. The user ID and initial password normally will be emailed. Users will be required to change password following system entry. Users requiring password resets should contact the System Administrator POC listed below:

a. Warner Robins AFB, GA, call (478) 327-6602 or 926-2760

b. Hill AFB, UT, call (801) 777-4803 or 775-6403

c. Tinker AFB, OK, send e-mail request to 428scms.cdmwork@tinker.af.mil, please

Instructions for 2875

Input Date on Top Right block

Fill out blocks 1-6, 8-10 (Block 2 should be last 4 of SSN only)

Leave IA block blank.

Fill out blocks 11-12.

Check block 16

Block 16a – Company Name and DODAAC (EZXXXX) – we need both – if they don’t fit in this block, put them in block 27.

Fill out blocks 17-20b

In block 27, put “User” if you will be inputting to the system and “View Only” if you will only be viewing the data in the system.

In block 27, applicant must indicate which ALC issued repair contract they are applying access for and contract number, if available.

Supervisor/Security Manager fills out 28-28b and 29-32 if info is available – Should be either investigation for security clearance or background investigation

Fax to our office at (405) 736-5308

SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)

PRIVACY ACT STATEMENT

Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act.

To record names, signatures, and Social Security Numbers 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.

None.

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

TYPE OF REQUEST

INITIAL MODIFICATION DEACTIVATE

DATE (YYYYMMDD)

PART I (To be completed by Requestor)

1. NAME (Last, First, Middle Initial) 2. SOCIAL SECURITY NUMBER

3. ORGANIZATION 4. OFFICE SYMBOL/DEPARTMENT

9. CITIZENSHIP

7. JOB TITLE AND GRADE/RANK

5. PHONE (DSN or Commercial)

I accept the responsibility for the information and DoD system to which I am granted access and will not exceed my authorized level of system access. I understand that my access may be revoked or terminated for non-compliance with DoD security policies. I accept responsibility to safeguard the information contained in these systems from unauthorized or inadvertent modification, disclosure, destruction, and use. I understand and accept that my use of the system may be monitored as part of managing the system, protecting against unauthorized access and verifying security problems. I agree to notify the appropriate organization that issued my account(s) when access is no longer required.

11. USER SIGNATURE 12. DATE (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.)

16a. ACCESS EXPIRATION DATE (Contractors must specify Company Name, Contract Number, Expiration Date. Use Block 27 if needed.)

18. SUPERVISOR'S SIGNATURE17. SUPERVISOR'S NAME (Print Name) 19. DATE (YYYYMMDD)

14. TYPE OF ACCESS REQUIRED:

AUTHORIZED PRIVILEGED

15. USER REQUIRES ACCESS TO: UNCLASSIFIED CLASSIFIED (Specify category)

13. JUSTIFICATION FOR ACCESS

16. VERIFICATION OF NEED TO KNOW

I certify that this user requires access as requested.

22. SIGNATURE OF IAO OR APPOINTEE

20. SUPERVISOR'S ORGANIZATION/DEPARTMENT 20b. PHONE NUMBER

25. DATE (YYYYMMDD)

21. SIGNATURE OF INFORMATION OWNER/OPR

23. ORGANIZATION/DEPARTMENT

21a. PHONE NUMBER 21b. DATE (YYYYMMDD)

8. OFFICIAL MAILING ADDRESS

6. OFFICIAL E-MAIL ADDRESS

DD FORM 2875, APR 2005 PREVIOUS EDITION IS OBSOLETE.

USER ID

SYSTEM NAME (Platform or Applications) LOCATION (Physical Location of System)

10. DESIGNATION OF PERSON

OTHER

24. PHONE NUMBER

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

USER AGREEMENT

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

I have completed Annual Information Awareness Training. DATE (YYYYMMDD)

20a. SUPERVISOR'S E-MAIL ADDRESS

US FN

OTHER

MILITARY CIVILIAN

CONTRACTOR

Adobe Designer 7.0

DD FORM 2875 (BACK), APR 2005

PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION

PROCESSED BY (Print name and sign) DATE PROCESSED

(YYYYMMDD)

DATE (YYYYMMDD)

27. OPTIONAL INFORMATION (Additional information)

SYSTEM

DOMAIN

SERVER

APPLICATION

DIRECTORIES

FILES

DATASETS

TITLE: ACCOUNT CODE

REVALIDATED BY (Print name and sign) DATE (YYYYMMDD)

28b. CLEARANCE LEVEL

28. TYPE OF INVESTIGATION

PART III - SECURITY MANAGER VALIDATES THE BACKGROUND INVESTIGATION OR CLEARANCE INFORMATION 28a. DATE OF INVESTIGATION (YYYYMMDD)

28c. IT LEVEL DESIGNATION

31. SECURITY MANAGER SIGNATURE29. VERIFIED BY (Print name) 32. DATE (YYYYMMDD)

26a. NAME (Last, First, Middle Initial) 26b. SOCIAL SECURITY NUMBER

LEVEL I LEVEL II LEVEL III

30. SECURITY MANAGER

TELEPHONE NUMBER

DATE REVALIDATED

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) Social Security Number. The social security number of user.

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

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

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

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

(7) 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 "CONT" if user is a contractor.

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

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

(10) Designation of Person (Military, Civilian, Contractor).

IA Training and Awareness Certification Requirements. User must indicate if he/she has completed the Annual Information Awareness Training and the 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 his/her name to indicate that the above information has been verified and that access is required.

(18) Supervisor's Signature. Supervisor's signature is required by the endorser or his/her representative.

(19) Date. Date supervisor signs the form.

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

(20a) E-mail Address. Supervisor's e-mail address.

DD FORM 2875 INSTRUCTIONS, APR 2005

INSTRUCTIONS

The prescribing document is as issued by using DoD Component.

(20b) Phone Number. Supervisor's telephone number.

(21) Signature of Information Owner/OPR. Signature of the functional appointee responsible for approving access to the system being requested.

(21a) Phone Number. Functional appointee telephone number.

(21b) Date. The date the functional appointee signs the DD Form 2875.

(22) Signature of Information Assurance Officer (IAO) or Appointee.

Signature of the IAO or Appointee of the office responsible for approving access to the system being requested.

(23) Organization/Department. IAO's organization and department.

(24) Phone Number. IAO's telephone number.

(25) Date. The date IAO signs the DD Form 2875.

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

C. PART III: Certification of Background Investigation or Clearance.

(28) Type of Investigation. The user's last type of background investigation (i.e., NAC, NACI, or SSBI).

(28a) Date of Investigation. Date of last investigation.

(28b) Clearance Level. The user's current security clearance level (Secret or Top Secret).

(28c) IT Level Designation. The user's IT designation (Level I, Level II, or Level III).

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

(30) Security Manager Telephone Number. The telephone number of the Security Manager or his/her representative.

(31) Security Manager Signature. The Security Manager or his/her representative indicates that the above clearance and investigation information has been verified.

(32) Date. The date that the form was signed by the Security Manager or his/her representative.

D. PART IV: This information is site specific and can be customized by either the DoD, functional activity, or the customer with approval of the DoD. 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 "FOR OFFICIAL USE ONLY" 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 IAO. Recommend file be maintained by IAO adding the user to the system.

DD Form 2875, System Authorization Access Request (SAAR), April 2005 whs/esd/imd

D:20050407095419- 04'00'

D:20060824101837- 04'00'

SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)

PRIVACY ACT STATEMENT

Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act.

To record names, signatures, and Social Security Numbers 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.

None.

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

TYPE OF REQUEST

INITIAL

MODIFICATION

DEACTIVATE

DATE (YYYYMMDD)

PART I (To be completed by Requestor)

1. NAME (Last, First, Middle Initial)

2. SOCIAL SECURITY NUMBER

3. ORGANIZATION

4. OFFICE SYMBOL/DEPARTMENT

9. CITIZENSHIP

7. JOB TITLE AND GRADE/RANK

5. PHONE (DSN or Commercial)

I accept the responsibility for the information and DoD system to which I am granted access and will not exceed my authorized level of system access. I understand that my access may be revoked or terminated for non-compliance with DoD security policies. I accept responsibility to safeguard the information contained in these systems from unauthorized or inadvertent modification, disclosure, destruction, and use. I understand and accept that my use of the system may be monitored as part of managing the system, protecting against unauthorized access and verifying security problems. I agree to notify the appropriate organization that issued my account(s) when access is no longer required.

11. USER SIGNATURE

12. DATE (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.)

16a. ACCESS EXPIRATION DATE (Contractors must specify Company Name, Contract Number, Expiration Date. Use Block 27 if needed.)

18. SUPERVISOR'S SIGNATURE

17. SUPERVISOR'S NAME (Print Name)

19. DATE (YYYYMMDD)

14. TYPE OF ACCESS REQUIRED:

AUTHORIZED

PRIVILEGED

15. USER REQUIRES ACCESS TO:

UNCLASSIFIED

CLASSIFIED (Specify category)

13. JUSTIFICATION FOR ACCESS

16. VERIFICATION OF NEED TO KNOW I certify that this user requires access as requested.

22. SIGNATURE OF IAO OR APPOINTEE

20. SUPERVISOR'S ORGANIZATION/DEPARTMENT

20b. PHONE NUMBER

25. DATE (YYYYMMDD)

21. SIGNATURE OF INFORMATION OWNER/OPR

23. ORGANIZATION/DEPARTMENT

21a. PHONE NUMBER

21b. DATE (YYYYMMDD)

8. OFFICIAL MAILING ADDRESS

6. OFFICIAL E-MAIL ADDRESS

DD FORM 2875, APR 2005

PREVIOUS EDITION IS OBSOLETE.

USER ID

SYSTEM NAME (Platform or Applications)

LOCATION (Physical Location of System)

10. DESIGNATION OF PERSON

OTHER

24. PHONE NUMBER

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

USER AGREEMENT

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

I have completed Annual Information Awareness Training.

DATE (YYYYMMDD)

20a. SUPERVISOR'S E-MAIL ADDRESS

US

FN

OTHER

MILITARY

CIVILIAN

CONTRACTOR

Type of request. Press space bar to mark X in first box if initial, second box if modification, third box if deactivate, or fourth box if user i.d.

9. Citizenship. Mark X in first box if U.S., second box if foreign, third box if other.

10. Designation of person. Mark X in first box if military, second box if civilian, third box if contractor.

Adobe Designer 7.0

DD FORM 2875 (BACK), APR 2005

PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION

PROCESSED BY (Print name and sign)

DATE PROCESSED

(YYYYMMDD)

DATE (YYYYMMDD)

27. OPTIONAL INFORMATION (Additional information)

SYSTEM

DOMAIN

SERVER

APPLICATION

DIRECTORIES

FILES

DATASETS

TITLE:

ACCOUNT CODE

REVALIDATED BY (Print name and sign)

DATE (YYYYMMDD)

28b. CLEARANCE LEVEL

28. TYPE OF INVESTIGATION

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

28a. DATE OF INVESTIGATION (YYYYMMDD)

28c. IT LEVEL DESIGNATION

31. SECURITY MANAGER SIGNATURE

29. VERIFIED BY (Print name)

32. DATE (YYYYMMDD)

26a. NAME (Last, First, Middle Initial)

26b. SOCIAL SECURITY NUMBER

LEVEL I

LEVEL II

LEVEL III

30. SECURITY MANAGER

TELEPHONE NUMBER

28.c. IT level designation. Mark X in first box if level I, second box if level II, third box if level III.

DATE REVALIDATED

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) Social Security Number. The social security number of user.

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

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

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

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

(7) 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 "CONT" if user is a contractor.

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

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

(10) Designation of Person (Military, Civilian, Contractor).

IA Training and Awareness Certification Requirements. User must indicate if he/she has completed the Annual Information Awareness Training and the 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 his/her name to indicate that the above information has been verified and that access is required.

(18) Supervisor's Signature. Supervisor's signature is required by the endorser or his/her representative.

(19) Date. Date supervisor signs the form.

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

(20a) E-mail Address. Supervisor's e-mail address.

DD FORM 2875 INSTRUCTIONS, APR 2005

INSTRUCTIONS

The prescribing document is as issued by using DoD Component.

(20b) Phone Number. Supervisor's telephone number.

(21) Signature of Information Owner/OPR. Signature of the functional appointee responsible for approving access to the system being requested.

(21a) Phone Number. Functional appointee telephone number.

(21b) Date. The date the functional appointee signs the DD Form 2875.

(22) Signature of Information Assurance Officer (IAO) or Appointee. Signature of the IAO or Appointee of the office responsible for approving access to the system being requested.

(23) Organization/Department. IAO's organization and department.

(24) Phone Number. IAO's telephone number.

(25) Date. The date IAO signs the DD Form 2875.

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

C. PART III: Certification of Background Investigation or Clearance.

(28) Type of Investigation. The user's last type of background investigation (i.e., NAC, NACI, or SSBI).

(28a) Date of Investigation. Date of last investigation.

(28b) Clearance Level. The user's current security clearance level (Secret or Top Secret).

(28c) IT Level Designation. The user's IT designation (Level I, Level II, or Level III).

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

(30) Security Manager Telephone Number. The telephone number of the Security Manager or his/her representative.

(31) Security Manager Signature. The Security Manager or his/her representative indicates that the above clearance and investigation information has been verified.

(32) Date. The date that the form was signed by the Security Manager or his/her representative.

D. PART IV: This information is site specific and can be customized by either the DoD, functional activity, or the customer with approval of the DoD. 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 "FOR OFFICIAL USE ONLY" 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 IAO. Recommend file be maintained by IAO adding the user to the system.

28.c. IT level designation. Mark X in first box if level I, second box if level II, third box if level III.:

System.:

Location (physical location of system).:

Requestor name (last, first, middle initial).:

Social security number.:

3. Organization.:

4. Office symbol/department.:

5. Phone (DSN or commercial).:

6. Official e-mail address.:

7. Job title and grade/rank.:

8. Official mailing address.:

IA training and awareness certification requirements. Mark X if: I have completed Annual Information Awareness Training.:

11. User name.:

Part 2 - Endorsement of Access by Information Owner, User Supervisor or Government Sponsor. 13. Justification for Access.:

14. Type of access required. Mark X if Authorized.:

14. Mark X if Privileged.:

15. User requires access to: Mark X if Unclassified.:

15. Mark X if classified.:

15. If classified, specify category.:

15. Mark X if other.:

15. Specify other access.:

16. Verification of need to know. Mark X if: I certify that this user requires access as requested.:

16.a. (Contractors must supply company name, contract number, expiration date. Use Block 27 if needed).:

17. Supervisor's name (print).:

18. Supervisor's signature.:

20. Supervisor's organization/department.:

20a. Supervisor's e-mail address.:

20b. Phone number.:

21. Signature of information owner/OPR.:

21.a. Phone number.:

22. Signature of IAO or appointee.:

23. Organization/department.:

24. Phone number.:

Press this Reset button to clear the data from all fields.:

Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

12. Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

19. Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

21b. Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

25. Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

16.a. Access expiration date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

User ID.:

Revalidated by (signature).:

27. Optional Information.:

Part 3 - Security Manager Validation. 28. Type of investigation.:

28.b. Clearance level.:

29. Verified by (print name).:

30. Security manager telephone number.:

31. Security manager signature.:

Part 4 - Completion by authorized staff preparing account information. Title, line 1.:

Account code.:

Title, line 2.:

Domain.:

Account code.:

Title, line 3.:

Account code.:

Server.:

Title, line 4.:

Account code.:

Application.:

Title, line 5.:

Account code.:

Directories.:

Title, line 6.:

Account code.:

Files.:

Title, line 7.:

Account code.:

Datasets.:

Processed by (print name).:

Revalidated by (print name).:

28a. Date of investigation. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

32. Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

Date processed. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

Date revalidated. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.:

Date. Enter as 4 digit year, 2 digit month, 2 digit day, no dividers.: