DD1540.pdf

REGISTRATION FOR SCIENTIFIC AND TECHNICAL INFORMATION SERVICES

(Read Privacy Act Statement and Instructions on back before completing this form.)

OMB No. 0704-0264 OMB approval expires Nov 30, 2010

SECTION I - GENERAL INFORMATION (All applicants must complete Section I.) FOR DTIC USE ONLY

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. SEND YOUR COMPLETED FORM TO: DEFENSE TECHNICAL INFORMATION CENTER, ATTN: DTIC-BC, 8725 JOHN J. KINGMAN ROAD, SUITE 0944, FORT BELVOIR, VA 22060-6218.

The public reporting burden for this collection of information is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 1155 Defense Pentagon, Washington, DC 20301-1155 (0704-0264). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

1. ORGANIZATION NAME 2. SUBORGANIZATION NAME

3.a. CLASSIFIED/BUSINESS MAILING ADDRESS b. CITY c. STATE d. ZIP CODE

4. ATTENTION

a. NAME (Last, First, Middle Initial) c. POSITION/TITLE d. OFFICE SYMBOL

5. TELEPHONE NUMBER (Include area code)

a. COMMERCIAL b. DSN

6. FAX NUMBER (Include area code)

7. E-MAIL ADDRESS 8.a. PRIME CONTRACT NUMBER (Contractors only)

b. EXPIRATION DATE

(YYYYMMDD)

a. COMMERCIAL b. DSN

b. SSN

DTIC USER CODE

USER TYPE

CHARGE CODE

SERVICE LEVEL SPONSOR

FACILITY CLEARANCE

ENTITY CODE

SECURITY CLEARANCE

11. CAGE CODE

TYPE RD CNWDI NATO

12. DUNS NUMBER

9. CURRENT OR FORMER DTIC

USER (X one)

NO

YES (Enter DTIC user code)

10.a. MILITARILY CRITICAL TECHNICAL DATA AGREEMENT CERTIFICATION NUMBER (Contractors only)

b. EXPIRATION DATE

(YYYYMMDD)

13. TYPE OF ACCESS REQUESTED (X as applicable)

UNCLASSIFIED/LIMITED (Controlled distribution)

UNCLASSIFIED/UNLIMITED (Public release)

a. UNCLASSIFIED: c. SPECIAL ACCESSES:

RESTRICTED DATA

CNWDI

NATO UNCLASSIFIED

NATO CONFIDENTIAL

NATO SECRET

CNWDI DATE BRIEFED: NATO DATE BRIEFED:

SECTION II - SECURITY OFFICER (Complete Section II if requesting access to classified data.)

14. SECURITY OFFICER CERTIFICATION

I certify that the organization listed in Section I may receive and store classified data at the access level indicated in Section I, and the individual listed in Section I has been cleared and briefed for all requested special accesses.

a. NAME (Last, First, Middle Initial) b. ORGANIZATION NAME

e. TELEPHONE NUMBER (Include area code)

(1) COMMERCIAL (2) DSN

f. SIGNATURE g. DATE SIGNED (YYYYMMDD)

c. E-MAIL ADDRESS d. SSN

SECTION III - U.S. GOVERNMENT APPROVING OFFICIAL (DOD organizations requesting access to classified data, Non-DOD Government organizations requesting access to unclassified, limited or classified data, and all contractors requesting either unclassified or classified data must complete Section III. See Instructions for detailed explanation of Government Approving Official.)

15. APPROVING ORGANIZATION NAME 16.a. BUSINESS ADDRESS b. CITY c. STATE d. ZIP CODE

17.a. APPROVING OFFICIAL NAME (Last, First, Middle Initial) b. POSITION/TITLE

e. TELEPHONE NUMBER (Include area code) f. SIGNATURE g. DATE SIGNED (YYYYMMDD)

(1) COMMERCIAL (2) DSN

FOR DTIC USE ONLY

c. E-MAIL ADDRESS d. SSN

DD FORM 1540, NOV 2007 PREVIOUS EDITION IS OBSOLETE. Adobe Professional 7.0

FOR OFFICIAL USE ONLY

CONFIDENTIAL

SECRET

b. CLASSIFIED:

INSTRUCTIONS FOR COMPLETING DD FORM 1540,

REGISTRATION FOR SCIENTIFIC AND TECHNICAL INFORMATION SERVICES

DD FORM 1540 (BACK), NOV 2007

A. WHO IS ELIGIBLE

- Department of Defense (DoD) members and employees

- U.S. Government employees

- Government contractors

B. WHERE TO FILE

Mail completed DD Form 1540 to:

c. Section III - U.S. Government Approving Official. Signature required if access to Unclassified/Limited (controlled distribution) or classified data is requested.

NOTE: The Government Approving Official is a government employee in a supervisory or managerial position, who is knowledgeable of your eligibility to perform the official duties of your position, has official control and responsibility over you and the position you occupy.

3. Contractors, Subcontractors, Potential Contractors, CRDA Partners, and Grantees

a. Section I - General Information. Contractors complete Section I.

Enter the contract number and expiration date in blocks 8.a. and b.

(1) Submit a certified copy of your DD Form 2345, "Militarily Critical Technical Data Agreement", to DTIC for access to export controlled data.

(2) Enter the CAGE code in block 11 and DUNS number in block 12.

Contact your security officer if you need assistance in obtaining this information.

b. Section II - Security Officer. Your Facility Security Officers' (FSO) signature is required in block 14.f. in order for DTIC to grant access to classified data. Signature is confirmation that you are eligible to receive, and have the capability to store, the classified data at the access level requested in Section I (block 13, "Type of Access Desired").

(1) Security officer must enter date(s) briefed for access to: CNWDI and NATO in block 13.

c. Section III -- U.S. Government Approving Official. Complete Section III. Signature of Government Approving Official is required.

The government approving official must be one of the following:

- Primary Contracting Officer (PCO)

- Administrative Contracting Officer (ACO), when designated in writing by the PCO, to DTIC

- Contracting Officer's Technical Representative (COTR)

- Contracting Officer's Representative (COR)

- Program Manager

- Project Manager

D. AFTER REGISTRATION

1. DTIC will email a numeric user code to the user upon approval.

2. Registered DTIC users must notify DTIC, in writing, of any changes to their current DD Form 1540. Please send an e-mail with changes to reghelp@dtic.mil.

3. Registered users will receive a notice from DTIC 60 days prior to the scheduled expiration date of their service.

E. ADDITIONAL INFORMATION

Visit DTIC's web site for information on registering for online services. The URL is www.dtic.mil.

Defense Technical Information Center DTIC-BC, (Registration) 8725 John J. Kingman Road, Suite 0944 Fort Belvoir, VA 22060-6218

Telephone: (703) 767-8273 Fax: (703) 767-9459

E-mail: reghelp@dtic.mil

C. GENERAL INSTRUCTIONS

1. DoD Members/Employees.

a. Section I - General Information. For Unclassified/Limited data complete Section I only.

b. Section II - Security Officer. Your Facility Security Officers' (FSO) signature is required in block 14.f. in order for DTIC to grant access to classified data. Signature is confirmation that you are eligible to receive, and have the capability to store, the classified data at the access level requested in Section I (block 13, "Type of Access Desired").

(1) Security officer must enter date(s) briefed for access to: CNWDI and NATO in block 13.

c. Section III - U.S. Government Approving Official. Sign block 17.f. if access to classified data is requested.

NOTE: The Government Approving Official is a government employee in a supervisory or managerial position, who is knowledgeable of your eligibility to perform the official duties of your position, has official control and responsibility over you and the position you occupy.

2. U.S. Government Employees.

A current SF-50, or comparable personnel document, for the applicant, security officer and/or government approving official, is required for employment verification. Please send with the completed DD Form 1540.

a. Section I - General Information. For Unclassified/Unlimited (public release) data complete Section I only.

b. Section II - Security Officer. Your Facility Security Officers' (FSO) signature is required in block 14.f. in order for DTIC to grant access to classified data. Signature is confirmation that you are eligible to receive, and have the capability to store, the classified data at the access level requested in Section I (block 13, "Type of Access Desired").

(1) Security officer must enter date(s) briefed for access to: CNWDI and NATO in block 13.

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C. 301; E.O. 9397.

PRINCIPAL PURPOSE(S): To register for scientific and technical information services provided by Defense Technical Information Center (DTIC).

DoD individuals must be verified through Defense Manpower Data Center (DMDC). This verification process is used to validate an individual's required affiliation with a DoD organization.

ROUTINE USE(S): None.

DISCLOSURE: Voluntary; however, failure to provide the requested personal information will result in the individual not being registered for scientific and technical information services.