System_Authorization_Access_Request_Navy.pdf

SYSTEM AUTHORIZATION ACCESS REQUEST NAVY (SAAR-N)

PRIVACY ACT STATEMENT

AUTHORITY: Executive Older 10450, 9397; and PtbIic law 99-474, the Computer Fraud and Abuse Act.

PRINCIPAL PURPOSE: To record! names, signalUJeS, and Social 5ecurity Numbers for the purpose ofvalidating the trustworthiness of

IndMd'uaIs requesting access 10 Department of Defense (DoD) systems and information. NOTE: Records will be maintained in paper fmn.

ROUTINE USES: None.

DfiSCLOSURE : Disdosure dlhis infoonalion is voIun1my; however, failure to provide the requested information may impede, delay or pt'&\I8fIt ft»1Jtef: processing of this request

TYPE OF REQUEST DATE (YYYYMMDD)

~iritioI D MolMcaIion D DEACTIVATE D USERID

SYSTEM NAME (i.R, NMCI, ml, OIleNET, etc.) LOCATION (Physical Location of System)

PART I (To be completed by Requester)

1. NAME (Lost, First, MMfdIe Initial) 2. SOCIAL SECURITY NUMBER (LAST FOUR)

3. ORGANIZATION

6. OFHCW. E-MIUl ADDRESS

4. OFFICE SYMBOlIDEPARTMENT

7. JOB TITlE AND GRADE/RANK

5. PHONE (DSN and Commercial)

DSN: COM:

a. OFFlCiIAl.. MAILING ADDRESS 9- CITIZENSHIP

DUS

DOlher

DFN

10. DESIGNATION OF PERSON

D Militmy D Contractor

DCiviIian

11. IA TRAINING AND AWARENESS CERllACAlION REQUlijEMENTS (Complete as required fOr user Of tunctjana/level access.)

D I haw ~Amuolll'lfot'mation Awareness Tmining. DATE (YYYYMMOO)

12 USER SIGNATURE 13. DATE (YYYYMMOO)

PART II - ENDORSEMENT OF ACCESS BY INFORMATION OWNER, USER SUPERVISOR OR GOVERNMENT SPONSOR (If an individual ts a cooh'm:ft::Il- Plovtde oompMY #'"ll1ffl&, conImctnumber, ond dete ofcootmct expiration in BlocJc 170).

141. JUSTlflCATlION FOR ACCESS

Acces..., to GovemmentlT Syl,1etllS are equiIed to execute duties 8S assigned.

15. TYPE OF ACCESS REQUIRED:

D AUTHORIZED D PRMLEGED

16. USER REQUIRES ACCESS TO:

D UNIClASSIFIED D CLASSIRED (Specify Categocy): D OTHER:

17. VERIFICATION OF NEED TO KNOW 17a. ACCESS EXPIRATION DATE (Cantractors must specify Company Name, Contract Number, Expiration Date.

II C9fIify thai lis US8f requires access as requested. D

18b. DATE (VYYYMMDD)18- SUPERVISOR'S NAME (Print Name) 188. SUPERVISOR'S SIGNATURE

19b. PHONE NUMBER19. SUPERVISOR'S ORGANIlATlONJDEPARTMENT 198. SUPERVISOR'S E-MAIL ADDRESS

2fl SIGNATURE OF INH)NMATI 20b. DATE {YYYYMMDD}2118. PHONE NUMBI:R

21. SIGNAlURE OF lAO OR APPOINTEE 23. PHONE NUMBER 24. DATE (VYYYMMOO)Xl. ORGANlZATiONIDEPARTMENT

OPNAY 5239114 (JUl2.008) FOr 0IficiaI Use Only Page 10f4

2~. NAME (Last Fifs(, M§dcMe ImtiaI) 1258. SOCIAl SECURITY NUMBER (lAST FOUR)

2ft USER AGREEMENT - STANDARD MANDATORY NOTICE AND CONSENT PROVISION

By s91ir!g this document, you admowfedge andI consent that when you access Department of Defense (DoD) information systems:

- You me ac:cessq 81 U.S. Govefnment (USG) infOrmation system (IS) (which includes any device attached to this infbfmation system) that is pt'cW:fed foc U.S. GowmmenI:-aulhOOzedl use onJy.

- You consent to !he foIIowif1g conditions:

" The U.s. Govemmefll routinely inlefcepts and monitors communicaIions on this information system for purposes including, but 004.1imi1ed to, penetration testing, cotmlUflicatiOOs security (COMSEC) moniloring, network opemtions and defense, personnel fl'liscl:ln<lJct (PM), law enforcement (lE) and comterinIeIlige (CI) investigations.

<;) At ooy lime, the U.S. Government may inspect and seize data stored on this information system.

'0 Communications using, or data stored on, this information system are not private, are subject 10 routine monitoring, interception, and soordl, and mey be disdosed or used fof any U.S. GoYernment-aulhorized purpose.

'0 This inlOfll'l8tion systllm includes secuJi1y measures (e.g., authtmtimtion and access controls) to protect U.S. Government inlerests oot fof your peISOI'I8I benefit or privm;:y.

" NotwilliStUfldi1g the above, using an infoona1ion system does not cons1itute consent to personnel misconduct, law enforcement, or cou~e investigoliiVe searching or monitorl1g of the content of privileged communications or data (including wor1t product) that are rel8ted to persoml representation or services by attorneys, psychotherapists, or clergy, and 1heir assistants. Under these dmtmstances, such commmic8tioos and WOl1C product are private Ufld confidential, as further explained below:

- NoUUng in this User Agreement shall be interpreted 10 limit the user's consent to, or in any other way restrict or affect, any . U-S. Government ac1iOOs for purposes of network a.dministmtion, opem1ion, protection, or defense, or for communications setlIfiIy. This indtldes at c:ornrmncations and data On an information system, regardless of any applicable privilege or c~~ .

_ The lJS9I' consents to interception/capture and seime of ALL communications and data for any authorized purpose (including personnel misconduct, law 8I1fort.ement, or counterintelligence invesligatlon). However, consent to interceptionfcapture or .

seizure of communications and data is not consent to the use of privileged communications or data for personnel misconduct, law oofoo:ement, or counterintelJigence investigation against any party and does not negate any applicable privilege or cooIden!iality that o1h8fWiise applies.

- 'Nhe1her any pMicutar communication or dolo qualifies for the protection of 8 privilege, or is covered by a duty of ~!iality.is determined in accordance with established legal standards and DoD policy. Users are strongly encouraged to seel personal tegoI counsel on such mattefsprior 10 using an information system if the user intends to rely on the protections of 8 privilege or conlidentiaJity.

- Users should toke reasonable steps to identify such communications or data that the user asserts are protected by any such PlfM. or conMentiolity. However, the useI's ldentific:ation or assertion ofa privilege or confidentiality is not suffICient to c,eate such proIectioo where I'IOOG exists under estDbIished legal standards and DoD policy.

- A use(s faltJm to take masonabIe steps to identify such communications or data as privileged or confidential does not waive the privilege or confiderltialit if such protecIions otherwise exist under established legal standards and DoD policy. However, In sum cases the U.S. Government is atdtlOOzed 10 1Dke reasonable actions 10 identify such communication or data as being subject to a privilege or confidentiaity, and such actions do not. negm9 any applicable privilege or confidentiality.

- These COtIldiIions preseMt the conIidentiality of the c:ommunication or data, and the legal pt'otections regarding the use and disdIlsure ofpriiviIeged information, and thus such communications and data are private and confidential. Further, the U.S.

Govemment shafl1ake aft reasonobte measures to protect the content of capturedlseized privileged communications and data to 8I1SIlft they me appropriately protected.

<;) in cases when the lIS6f has consented to content seerchillg or monitoring of communications or data for personnel misconduct, law enfortemen1. or counIerintelligenc:e in1Iestigutive seard1ing, (i.e., for all communications and data other than privileged ~ or daln that. me related to personoI representation or sefvices by attorneys, psychotherapists, or clergy, and their assis1M1s). the U.S. Govemment may, sdeIy at its discretion and in accordance with DoD policy, elect to apply a privilege or other mstJiction on the U.S. Govemmenfs oUJecwise-aulhorized use or disdosiJre of such inklrmation.

"" AI of the abo¥9 eoo<I1ioos apply regardless ofwhether the access or use of an information system indudes the display of a Notice and Consent B8Mer ("bemerj. When a banner is used, the bonner functions to remind the user of the conditions that are set forth in this Useu Agreement. regardess of whether the bam1er describes these conditions in fuR detail or provides 8 summary of such cooditions, lIf1d regmdless ofwhether the bonner expressty references this User Agreement

21. USER SiGNATURE 28. DATE (YYYYMMDD)

OPNAY 523911i~ (JUl2008) For 0fIiciaI Use Only Page20f4

298. SOCIAl SECURITY NUMBER (lAST FOUR)29. NAME (LasI;, First, Itliddle Initial)

30.. USER RESPONSIBIlITIES

I U!nderatand that to ensure the 1ntegIity, safety Md security of Navy IT resources, when using those resources, I shall:

- sategUllld infoonalion lIfTd irIti:lmrildioo systems from unauthorized or inadvertent modilicalion, disdosure, destruction, or use.

- Preted CommI'ed Uocfossified Infomtalioo (CUI) and classified information to Pftlvent unauthorized access, compromise, tampering, or expbtatioo of the infOmTation.

- Prated passWllfds for systems mquifiJlg logon authentication and safeguard passwords at the sensitivity level of the system for dassified systems ood at the toofidel'llialjly level for undassiIied systems. Passwords wiR be dassified at the highest level of information processed on thai: system.

- VtruS cJheck aI infOl1l'l8tioo, programs, and other files prior 10 uploading onto any Navy IT resource.

- Report al socuriIy irltidenls inmediateiy in ac.axdonce with local procedures and CJCSM 6510.01 (series).

- Access only 1heI. data, coolrol infonnatioo, software, hardware, and firmware for which I am authorized access and have a need-to-know, and

86'SlIme ooly those roles and privileges for whkh I am auIhorized.

I fUrther unclemand that, when using Navy IT resources, I shall not:

- Access COOII'fleICiai web-based &mlIt1 (e.g. HOTMAJl, YAHOOI, AOl, etc.)

- Aulo-forward offidaI e-mail to a c:MlrOOfCi8I &-m8iIaccOUl1t

- Bypess, shin, or tesllA rnecIlanisms (e.g., FimwaIIs, conIent 1iIteIs, anti-virus programs, etc.). If IA mechanisms must be bypassed, I shall

~ 1tTe procedure and receMl writIen 8JlflfOV8I from the locailA AuthOIily (CO or Ole).

- InlJroduce or use unoo1horized soft.wfue, firmware. or hardware on any Navy IT resource.

- Relocate Of dwIge eqUpme.rlt or tile oolWOOt connedivity of equipment Without authoJizalion from my LocaIlA Authority.

- Use ~mmed! h8IdIware. software, shareware, or public domain software without authorization from the Local IA Authority.

- UpkladI exewtuble IiIes (e.g., .exe, .rom, .vbs, or .bat) onto Navy IT resources without the approval of !he LocallA Authority.

- P8I1ic~ in or ctJrdllitJule to any odMty resulting in a dismptiion ordeJiaI of seMce.

- write, rode, rompiIe, stoI'e,lmnsmit, transfer, or intmckIce malicious software, programs, or code.

.. Put Navy IT resoorces to uses that woo1IdI reflect adversely on !he Navy (such as uses involving pornography; chain letters; unofficial odwdsing, sdiciting Of seIIirlg except on authorized bulletin boards established for such use; violation of staMe or regutatiOn;

iilBppmpl'i8Ilely IlanlIed classified informalion; and olher uses that are incompatible with public seIVice).

32. DATE31, USER SIGNATURE

PART In • SECUR11Y MANAGER VAUDATES THE BACKGROUND INVESTIGATION OR CLEARANCE INFORMATION

33. TYPE OF INVESTIGATION 338. DATE OF INVESTIGATION (VYYYMMOO)

33c. IT LEVEL DESIGNATION33b. Cl..EARMlCE lEVEL

D lEVEL 1 D LEVEL 2 D LEVEL 3

37. DATE (YYYYMMDO)35. So..UKJ IT MRNAGER 36. SECURITY MANAGER SIGNATURE341. VERIRED BY (Print name) TElEPHONE NUMBER

PART ty. COIIPlEI1ON BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMAT1ON

38.. 1filE:

~.. [}AiE PROCESSED (YY't"tMMDOI

40 DATE REVALIDATED (YYV1IIIoIMOO)

38a.SYSTEM

38c, DOMAIN

38d.SERVER

JUe.

38f. DIRECTORIES

JOg. FILES

38h. DATASETS

39b. PROCESSED BY (Print 1181118 and sign)

4Oa. REVAlIDATED (Prlnt name and sign)

38b, ACCOUNT CODE

39c. DATE (YYYYMMOo)

401>. DATE (YYYYMMOO)

.............. -"...... ,....... <tWill For 0IliciaI Use Only page 3014

INSTRUCTIONS

A. PART I: The tolXlwing inklma1ioo is pmNided by the user when 8S~ 01f ~ Ileilt· USER ID.

(1:) Niame. The last name, filst name, and middle iniIiaI of !he user.

(2) SociafI ~NUnber. The last rOOI runbers in !he soc:i8j secmty nllJmbeJ" of 1ITe user:

(3) Organilatioo. The usef'S ctJmlritCfgOniIza1ioo (i.e., USS xx, DoD, and ~ agency OI! CCfIlfl'lefti8l mm).

(4) OII'ace ~rnent.. lI1le office symbol wIhin the cunent

OATgoniflBlioo (te., SOl)..

(5) T~NImlberiOSN. The DefMse Switching Nel.woIk. (DSN) and toolll'JOOfdali pOOne oombef of #Ie user.

(6) 0IfidaI1 E~mM Address. The user's ofIicioj e-mail address.

(7) Job liMeJGl'adeJRonlt The civifion job tilIe (te., Systems Analyst, YA-U2, miililfY rant (CAPT. United States Navy) or "CONT"' if user is a oonlrador.

(6) 0IkiaI! Mailing Address.. The use(s oftidaIIlIl8Uig address.

(9) ~ (US., Foolign NBtiooei or Oller).

(10) ~ion or Person (MifiWy, Civilim, Conlmdor).

(111) IA Trmng nnd Awoomess CerIitk:ation RequWemenls. User roost iFdctde if hetStle has completed lhe Annuellnfom1e1ion Awareness

Tml1inlg 8IllllIlhe da:le.

(12) UseI''s~. U5eI' must sign the OPNAV 5239114 with the tll1dElls1Dlndng Itd.lley &le ~ and atcoon1Bble for their pa:ss\\\OJd and aa:ess 10 the syslem(s).

("13) l)a1e. The dt'IIte lhe user siQns the klfm.

B. PART II: The il'lkll1natioo below requims the endorsement from 1he use(s Su~ or lhe GovemmeIilt Sponsor.

(14) Juastiftittdion lor Access. A Ixief statement is requited to justify esll'lllisJwnent of an iniIiaI USER 10. Provide appropriate inIonnatioo lithe USER ID or access to the Ulfl6flt USER 10 is modilifxt

("15) Type of Access Reqljred: PIoce an ·X· in the 8Wl'opriate box.

(Aut.mrized - I!OOtviduaI with nooooJ aa:ess. Privileged - Those with ptivilege to amend Of dlange sys1em confIgUration, pammeters

(If setIimgs)

(16) IJsef Requires At:tess To. PIlK:e an,·X'" in the appropriate box.

Specfy category

(11) VeriftaJtioo oUoIeedI to Know. To verify that the user requires access as requeslltd.

(110) EXpiration Dale 1m' Aa:ess. The user mustspecifyexpimlion date if less lhM 1 year.

('18) ~ NInme (Prim NIame) The supervisor or repmsenlative pmls M.i11ername to il.cIkate 1hallhe allow information h&s been \/'Elrilieltt and thot at.QlSS is mqulfed.

filla) ~ Signature. SUpe!visor's signalule is required by the endorsef Of hsIhef' ~ative.

(18b) Ol:de Date supervisor signs the fOrm

(19) SlJJMlNisor's ~ 5upervisor'sorgaOzation and depaIlrmenl ('190.) E-mail Ad<hss.. ~s e-mail address.

(19b) F!tQle Noolbef.. SUpervisol!"s telephone lWI'l\ber.

(;to) ~ or Inroonatioo OwneftoPR Sigoottn of the runctional ~J~ faf~access to the system being requested.

(2Oa.) Ptlooe Nm1ber•. Func:tioMl appointee teJephooe mmber.

(2£Ml,) l)a1e, The dale lhe Itlndiorl8l appointee signs the OPNAV 5239114.

(21) Signature of Information AsSlJlllflce Officer (lAO) or Appointee.

Signature of the lAO or Appointee of the oIfice responsible for approving access 10 the system being requested.

(22) OrganizationlDepartment lAO's organization and department

(23) Phone Nlmber. lAO's lelephone number.

(24) Oale.The date lAO signs the OPHAV 5239114.

(25) Name. The last name, first name, and middle initial of the user.

(25a) SociaI5ecurily Number. The last four numbers in the user's social security number.

(26) Standard Mandatory Nolice and Consent Provision. This item is in accordance with 000 memo dtd May 9, 2008 (Policy on Use of 000 Inrormation Systems - Standard COnsent Banner and User Agreement

(21) User Signature. User signs.

(28) Date. Date signed.

(29) Name,. The last name, first, name and middle initial of the user.

(298) SociaI5ecurily Number.. The last four numbers in the social security number of the user.

(30) User Responsibilities

(31) User Signature. Member signs.

(32) Date, Date signed.

c. PART III: certification or Background Investigation or Clearance.

(33) Type of Investigation. The user's lasltype or backgroUnd investigation (i.e., NAC, HACI or 55BI).

(338) Date or Investigalion. Date of last investigation.

(33b) Cktamnce level. The user's current security clearance level

(Seaet or Top secret).

(33c) IT level Designation. The users IT designation

(levet I, Levell! Of Level III).

(34) Verified By. The 5ecurily Manager or represenlative prints hislher name 10 indicate that the above clearance and investigation information has been verified.

(35) Security ManagerTelephone Number. The telephone number of the

Security Manager or hislher representative.

(36) SecuJity Manager Signature. The security Manager or hlslher representative indicates that the above clearance and investigation information has been verIDed.

(31) Dale. The date that the roon was signed by the security Manager or hislher representative.

D. PART IV: This inlonna1ion is site specific and can be customized by either the functional activity or the customer with approval from NAVNETWARCOM. nus information will specifically identify Ihe access required by the user.

(38 - 4Ob). FiR in appropriate intormation.

E. DISPOSITION OF FORM:

TRANSMISSION: Form may be electronically transmitted, laKed or mailed.

If transmi1ted electronically, the email must be digitally signed and encrypted.

AUNG: Retention oIlhisroon shall be in accordance with 5ECNAV M521Q.1, Records Management Manual (Section 5230.2 opplies).

OPNAV 523tN4 (Jut HOI) FOI" 0Ificia1 Use Only Page4of4