Questionaire_Response_Attachment_20180119.pdf

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Questionaire Response Attachment 20180119

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UNCLASSIFIED//FOR OFFICIAL USE ONLY

This document and/or any attachments may contain Privacy Act (1974 as amended) information which must be protected IAW 5 USC 301, DoD Regulation 5200.2.R, NSA/CSS Policy 1-34, and DIA Manual 50-8, or be removed prior to further disclosure. This information is For

Official Use Only (FOUO). Privacy Sensitive: Any misuse or unauthorized access may lead to disciplinary action.

DEPARTMENT OF DEFENSE

UNITED STATES CYBER COMMAND

9800 SAVAGE ROAD, SUITE 6477

FORT GEORGE G. MEADE, MARYLAND 20755

MEMORANDUM FOR: US CYBER COMMAND OFFICE OF SECURITY

FROM:

Subject: Explanation(s) to the US Cyber Command Special Security Office Pre-Screen

Interview Questionnaire (USCYBERCOM SSO Form 2)

Reference 1: DoDM 5105.21 Volume 3, Section 4 (a)(2)

1. (U//FOUO) The following information is provided regarding all YES answers from the SCI

Questionnaire (USCYBERCOM SSO Form 2). List the Question Number first when providing the response.

2. (U//FOUO) I attest that all answered information on this form is truthful and accurate along with any attachments explaining any YES answers. I further attest that I did not in any way, with or without purposeful or negligent intent, provide any misleading, incorrect, or false information. I further understand that any false or misleading answers shall be subject to any applicable criminal and/or UCMJ violations, and/or other administrative actions.

Signed: Date:

2 UNCLASSIFIED//FOR OFFICIAL USE ONLY

This document and/or any attachments may contain Privacy Act (1974 as amended) information which must be protected IAW 5 USC 301, DoD Regulation 5200.2.R, NSA/CSS Policy 1-34, and DIA Manual 50-8, or be removed prior to further disclosure. This information is For

Official Use Only (FOUO). Privacy Sensitive: Any misuse or unauthorized access may lead to disciplinary action.

3 UNCLASSIFIED//FOR OFFICIAL USE ONLY

This document and/or any attachments may contain Privacy Act (1974 as amended) information which must be protected IAW 5 USC 301, DoD Regulation 5200.2.R, NSA/CSS Policy 1-34, and DIA Manual 50-8, or be removed prior to further disclosure. This information is For

Official Use Only (FOUO). Privacy Sensitive: Any misuse or unauthorized access may lead to disciplinary action.

4 UNCLASSIFIED//FOR OFFICIAL USE ONLY

This document and/or any attachments may contain Privacy Act (1974 as amended) information which must be protected IAW 5 USC 301, DoD Regulation 5200.2.R, NSA/CSS Policy 1-34, and DIA Manual 50-8, or be removed prior to further disclosure. This information is For

Official Use Only (FOUO). Privacy Sensitive: Any misuse or unauthorized access may lead to disciplinary action.

Name/SSN:
Date Signed:
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