ACS_050515_eform.pdf
PDF 823 KB Posted
- Attached to
- Enterprise Architecture (EACOE) Quick Start
- Solicitation number
- HB0001-18-R-0003
- Issued by
-
Department of Defense Cyber Command
About this file
ACS_050515_eform
View the file
Other files
Show all 27
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
AACCSS MMiilliittaarryy AAddddiittiioonnaall CCoonnttaacctt SShheeeett ((AACCSS))
Associate Type (relationship to you): Gender:
Citizenship Status:
If associate is not currently naturalized, do they intend to become naturalized?
Past Citizenship(s) (if applicable):
Primary Phone:
Secondary Phone(s):
Work Phone:
E-Mail:
Occupation:
*If retired, list from what/where they are retired.
Employer: Employer Address:
Frequency of Current Contact:
Daily Weekly Monthly Quarterly Yearly Other (explain):
Frequency of Future Contact:
Daily Weekly Monthly Quarterly Yearly Other (explain):
Means of Current Contact In-Person E-Mail Phone
(check all that apply): Social Media Other (explain):
Means of Future Contact In-Person E-Mail Phone
(check all that apply): Social Media Other (explain):
When First Contacted (MM/YY):
When Last Contacted (MM/YY):
Describe the circumstances under which you first met:
Has this associate ever been affiliated with a foreign government or military?
Does the associate maintain contact with individuals from his/her birth country?
Is this associate aware of your US government/military/intelligence affiliation?
If you answer yes to any of the following questions, please provide a detailed answer in the space below.
Your Last Name: SSN(Last 4): Date (MM/DD/YY): Initials:
| Initials: |
| CurrentText: |
| Future Text: |
| Means Current Text: |
| Means Future Text: |
| AssocType: [-Please Select-] |
| Intend: [-Please Select-] |
| AssocCitizenship: [-Please Select-] |
| AssocLast Name: |
| AssocName: |
| AssocMiddle Name: |
| AssocSuffix: [-N/A-] |
| AssocCurrent Postal: |
| Ntcrtno: Certificate #: |
| AssocGender: Off |
| IfNat2: If U.S. Naturalized: |
| AssocPrimPhone: |
| AssocWorkPhone: |
| AssocSecPhone: |
| AssocEmail: |
| AssocOcc: |
| AssocEmployer: |
| AssocEmpAdd: |
| AssocCurrContact: Off |
| AssocFutureContact: Off |
| AppxAge: |
| OrAppx: Or Approx. Age: |
| FirstContact: |
| LastContact: |
| ForeignGovt: [-Please Select-] |
| MaintainContact: [-Please Select-] |
| Aware: [-Please Select-] |
| AssocSignDate: |
| Clear Contact Sheet: |
| PastCitz: [-Please Select-] |
| PastCitz2: [-Please Select-] |
| ApxdateNat: Off |
| CheckifApprox: Check if this is an approximate date. |
| ACS_LastName: |
| ACS_SSN: |
| AssocBirth_Country: [-Please Select-] |
| AssocBirth_City_Town: |
| AssocDate_Issued: |
| AssocPlace_Issued: -Please enter place issued- |
| AssocCurrent_City_Town: |
| AssocCurrent_State_Prov: |
| Circumstances_Text: |
| AssocCurrent_Country: [-Please Select-] |
| AssocCurrent_Street_Address: |
| AssocBirth_State_Province: |
| AssocDOB: |
| Affiliated_Text: |
| Maintain_Text: |
| Aware_Text: |
| Alien Registration Number:: Alien Registration Number: |
| AssocNatCertNo: [-Please Enter or Select Unknown-] |
| AssocAlienNo: [-Please Enter or Select Unknown-] |
| AssocOther_Last: |
| AssocOther_First: |
| AssocOther_MI: |
| Phone2: Off |
| Oth2: Off |
| E-mail2: Off |
| Social2: Off |
| In-Person2: Off |
| Phone: Off |
| Oth: Off |
| E-mail: Off |
| Social: Off |
| In-Person: Off |
| LNAME: Last Name: |
| FNAME: First Name: |
| MNAME: Middle Name: |
| SUFFIX: Suffix: |
| OTHNAME: Other Last Names Used (Examples: Maiden, Birth, Alias): |
| OTHNAME2: Other Names Used (First Name): |
| OTHNAME3: Other Names Used (Middle Name): |
| Male: Male |
| Female: Female |
| DOB: Date of Birth: |
| BCOUNTRY: Birth Country: |
| BCITY: Birth City/Town: |
| BSTATE: Birth State/Province: |
| CURRST: Current/Last Known Street Address: |
| CCOUNTRY: Country: |
| CCITTY: City/Town: |
| CSTATE: State/Province: |
| CPOSTAL: Postal: |
| Text4: UNCLASSIFIED//FOR OFFICIAL USE ONLY |
| Text3: Appendix 2 to Annex A, Policy 5-1, 2011 (Form Rev. 5 May 2015) |
| AssocCit_Country: [-Please Select-] |
| AssocCit_Country2: [-Please Select-] |
| AssocCtryTxt: Country of Current Citizenship: |
| AssocCtryTxt2: If this contact is a Dual Citizen, please enter the second country citizenship: |
| DtPlcIssued: Date Issued: |
| PlcIssued: Place Issued: |
| Disclaimer: Answer the questions below to the best of your ability for each of your foreign-born associate(s); indicate “UNK” or “N/A” if appropriate. Incomplete forms (i.e., areas left blank) will not be accepted and will cause delays in your processing. (NOTE: If the associate is deceased, please provide all last known information.) |
| PAS: PRIVACY ACT STATEMENT: Authority for collecting the requested information is contained in 50 U.S.C. § 401-441, Executive Order 10450, Executive Order 13526, Executive Order 12968, and ICD 704. DoD's Blanket Routine Uses (found at Appendix C of 32 CFR Part 310) apply to this information. Authority for requesting your Social Security Number (SSN) is Executive Order 9397, as amended. The requested information you provide will be used to confirm your identity in order to verify clearances and access. Your disclosure of the requested information is voluntary. However, failure to furnish the requested information may delay or prevent the processing of your access request. |
File details come from the government source that posted it.