ATT 56 PegNetAccRqstFrm.pdf

U.S. Navy PegNet - New User Account Request Please read and follow instructions carefully:

• Access is granted to Foreign Nationals based upon the status of any agreement/contract with their employer or between the Department of Defense and their country of citizenship. Additional documentation may be required depending upon the data being disclosed. You must provide your country of citizenship in the space provided below.

• Save completed form as your_name_PegNet.pdf and email to jeffrey.j.ritchie@navy.mil.

Name and Phone Numbers Work Location (mailing address) Last Name: Location Name:

First Name: Address 1:

Middle Initial: Address 2:

Work Phone1: City:

Alternate Phone1: State:

FAX Number1: Zip:

Primary Email2: country:

Alternate Email3:

Contractor Government Company:

Organizational Unit: Title:

Department: Manager:

Title/Position: Contract Number:

Manager/Supervisor: Government sponsor Digital Signature:

Military Branch: Rank:

Business Purpose for This Account Citizenship

US Other (Specify):

1. North America phone numbers must include area code. International phone numbers must include country code and city code. If an extension is required, place after main number, preceded by ‘X’. For example, (904) 555-1212 X12345, or for international 011-44-01179-111111 X12345.

2. Your primary email must be a military or government account, if possible (navy.mil). If you are a contractor and do not have a .mil or .gov email account, then it must be your corporate domain. PegNet cannot communicate to you using a public domain, such as Gmail or Yahoo.

3. If you have a .mil or .gov listed as your primary email and you are a contractor, you can list your corporate email here. As with primary emails, PegNet cannot communicate to you using a public domain, such as Gmail or Yahoo.

Additional Usage Requirements Is the new user part of the TD Verification process?

No Yes Does the new user require access to any CDRLs?

No Yes List:

Will this user be an Action Tracker team member?

No Yes Teams:

Is the new user responsible for reviewing CDRLs?

No Yes List:

Will this user be an Action Tracker team lead?

No Yes Teams:

Is the new user responsible for delivering CDRLs?

No Yes List:

To access PegNet, you must possess a valid DoD-issued Computer Access Card (CAC) or a PKI certificate obtained from a DoD-approved External Certification Authority. Please sign this form with the digital certificate you will use to access PegNet.

Name:

Digital Signature:

ATTACHMENT 56

PegNet Acct Request Form N61340-18-FOSR-0001