Attachment G_PSCForm82.pdf

INFORMATION SYSTEMS SECURITY

EMPLOYEE’S OFFICE

PSC Graphics: (301) 443-1090 EF

DATE OF SEPARATION/TRANSFER

Initial to clear *

PSC-82 (1/10)

ADMINISTRATIVE OPERATIONS

FINANCIAL MANAGEMENT OPERATIONS

NAME

REASON FOR CLEARANCE (check one) :

CLEARANCE OFFICIALS

SUPERVISOR

CLEARANCE ITEMS

FORWARDING ADDRESS

BUILDING/LOCATION

TIMEKEEPER ITAS COORDINATOR

Travel Advance

19 AOS Systems:

Debbie Orfe, Eddie MoorePropShop - Web Ordering System

Property Management System (PMIS) Martha Diskin, Myla Haines

Debbie Orfe, Eddie MooreWarehouse Inventory Mgmt. Sys. (webWIMS)

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PROGRAM SUPPORT CENTER

CLEARANCE OF EMPLOYEES/CONTRACTORS

FOR SEPARATION OR TRANSFER

Gretchen Bailey

PSC Travel Charge Card Michael Walker

Employee Emergency Payments June Hacker, Randy Pollack

Security Clearance Malissa Marceron

Financial Disclosure Dan Clutch, Billy Absher

Separating from the Federal Government

Dept./Agency/Service/Branch transferring to:

Transferring to another Federal component

Employee

Contractor

Keys (office)

ITAS Coordinator (see TAB 1)Time and Attendance

Official Files, Records, Accountable Forms

Supervisor

Supervisor

Supervisor (FOH, see TAB 1)

Supervisor

Supervisor

Supervisor

Separation SF-52 initiated in Capital HR

Supervisor

HHS Owned Equipment, Hardware, Software

Voice Mail

Cell Phone, Blackberry, Pager, PDA

LAN, Remote Access, and E-Mail

Employment Agreement (outside training, relocation expenses, physician contract, etc.)

Supervisor

AGENCY/SERVICE/DIVISION/BRANCH

Page 1 of 4 Pages

Childcare Subsidy

Transhare

Building Passes/IDs See TAB 1

Parking Permit See TAB 1

See TAB 1

Rebecca Donnelly

SAS Systems:20

Sheri Kretschmaier, Patrick JoyPSC Purchase Card

Irene GrubbELITE Series System

CLEARANCE OFFICIALSCLEARANCE ITEMS

CLEARANCE OF EMPLOYEES/CONTRACTORS FOR SEPARATION OR TRANSFER (continued)

INFORMATION SYSTEMS SECURITY (continued)

Page 2 of 4 Pages

DATE

* or attach an e-mail or fax copy with clearance information

SIGNATURE OF SENIOR PSC INFORMATION SYSTEMS SECURITY OFFICER (ISSO)

SIGNATURE OF SUPERVISOR - I certify that I have reviewed this form and that all required clearances have been obtained. DATE

PSC-82 (1/10)

Commissioned Officers’ Personnel and Payroll System:

COPPS Oracle

AOS/Commissioned Corps Systems:

OCCSS WANG and LAN

RACF/IBM Mainframe

Minh Tran, John (Tim) Devlin, Saranya Rao

Frank Dunn

Frank Dunn

25 ODASPS Systems:

PRICES Daniel Agee, Milton Johnson

DATESIGNATURE OF EMPLOYEE

21 FMS Systems:

Gov Trip \GovNet-NG

Accounting For Pay System

Vince Watson

Bruce SoutherlandDebt Management and Collection System

Errol Brown, Steve Voyta, Jane AllenUnited Financial Management System (UFMS)

Bruce Southerland

Jeff Curfman, Hanna Huynh

Managing/Accounting Credit Card System

Payment Management System

Bruce Southerland

Brandon Edwards

FOH Systems:

FOH Network Dave Fisher, Kim Frasher

CORE Accounting System

FOH Extranet

Services Tracking & Management (STM)

FOH Staff Portal

Customer Relationship Management (CRM)

Dave Fisher, Kim Frasher

Dave Fisher, Kim Frasher

Dave Fisher, Kim Frasher

Dave Fisher, Kim Frasher

23 ISMS Systems:

RACF/IBM Mainframe

Capital HR

Historical Database

Workforce Data System

HHS Career System

GovNet Workforce Reporting System

Joyce Brincefield-Sanders, Ed Szymanski

Joyce Brincefield-Sanders, Ed Szymanski

Joyce Brincefield-Sanders, Ed Szymanski

Joyce Brincefield-Sanders, Ed Szymanski

Joyce Brincefield-Sanders, Ed Szymanski

Joyce Brincefield-Sanders, Ed Szymanski

Med. Eval./Rqmts. Info. Track. Sys. (MERITS) Dave Fisher, Kim Frasher

Occ. Health Info. Mgmt. System (OHIMS) Dave Fisher, Kim Frasher

Initial to clear *

Calling Card Roxanne Sowell, Joan Koval

Steve Voyta, Errol Brown, Jane AllenHCAS (PRISM)

SEPARATION/TRANSFER PROCEDURES:

PSC-82 (1/10)

Following the completion of the clearance processing and satisfactory resolution of any issues (all items initialed except those that cannot be completed until the employee actually separates, such as e-mail and systems that the employee is using until separation), the supervisor will obtain the employee’s signature and date on the form. If the employee is unable or unwilling to sign, the supervisor will note this and initial in the employee’s signature box.

The supervisor will sign and date in the appropriate box certifying that all required clearances have been obtained.

Page 3 of 4 Pages

Clearance Officials must initial each line item to indicate clearance and/or access removal even if an item is not applicable to the employee (e.g., if employee does not have parking, he/she must still be cleared by the clearance official listed for parking). The reason for not clearing an item must be explained on the item line or on a separate continuation sheet. If an uncleared item is later cleared, the clearance official should sign and date the item (or send e-mail or fax notification of clearance). For any item lost by the employee, a signed statement from the employee explaining the loss must be attached to the form.

Employees are responsible for hand-carrying the clearance form to officials located in their building. When an official is not located in the same building, the supervisor or employee should receive and attach an e-mail or fax clearance to the form. Telephone clearances may only be obtained by the supervisor. If a telephone clearance is obtained, the supervisor should annotate the form with the name of the official contacted, status, and date contacted.

The employee’s supervisor is responsible for providing the clearance form PSC-82 to the employee at least one week prior to his/her last day on duty, and for ensuring its completion before the employee leaves. For further information, the General Administration Manual (GAM), Chapter 1-90, provides detailed procedures and instructions for completing the clearance form. The supervisor should also send an e-mail to HHS_ITIO_Service_Desk@hhs.gov requesting the employee’s removal from the LAN, remote access and e-mail. The ITIO Service Desk will then e-mail a "Request for Access/Change of Access) form to the Supervisor which (s)he should complete and fax back to the ITIO Service Desk (the Rules of Behavior page does not need to be completed for departing or transferring employees). The ITIO Service Desk, upon receipt of the form will remove the e-mail accounts and clear the employee as instructed on the form..

PRIVACY ACT STATEMENT:

The GAM, Chapter 1-90, page 7, paragraph 7, states that for all departing employees “ADP related identification codes, computer passwords and account numbers will be changed or deleted on all systems, networks, etc., prior to or simultaneous with the transfer or separation of the employee.”.

The supervisor or his/her administrative contact will make a copy of the clearance form for the employee and give the original to the Service Director’s office within two days of the employee’s last day on duty. The Service Director’s office will ensure that the information is complete and send the original to the PSC Information Systems Security Official (ISSO). The ISSO will sign the form last, verifying and certifying that all necessary signatures and clearances have been obtained. Completed forms will be maintained in the Service Director’s Office for one year or for one year after any indebtedness is recovered, whichever is longer.

. If an employee has an outstanding debt that is unresolved at the time of separation, the supervisor is responsible for sending an explanatory memorandum to payroll through the payroll liaison.

Payroll will withhold the amount of the debt from the final salary payment and/or lump-sum annual leave payment. Additional information on employee indebtedness can be found in the GAM, Chapter 1-90, page 4, “Separating from the Government.”

To the Employee:

In compliance with the Privacy Act of l974, the following information is provided: Solicitation of this information is authorized by the Federal Property and Administrative Service Act of 1949, as amended (63 Stat. 377); Part III, Title 5 USC. The purpose is to ensure that you have satisfied all obligations to the Government prior to your transfer within or separation from the PSC.

Information in these records may be disclosed to:

The Office of Personnel Management, Merit Systems Protection Board, Equal Employment Opportunity Commission, and the Federal Labor Relations Authority in carrying out their functions;

An agency handling an appeal made outside the Department to which the records are relevant;

The Department of Justice to receive advice as to whether a particular record must be disclosed under the Freedom of Information Act;

An enforcement agency if a record indicates a violation or potential violation of law;

Federal, state, or local agency maintaining relevant enforcement records or other pertinent records if necessary to obtain a record relevant to an agency decision concerning the hiring or retention of an employee, the issuance of a security clearance, the letting of a contract, or the issuance of a license, grant, or other benefit;

A federal agency, in response to its request, in connection with the hiring or retention of an employee, the issuance of a security clearance, the reporting of an investigation of an employee, the letting of a contract, or the issuance of a license, grant, or other benefit by the requesting agency, to the extent that the record is relevant and necessary to the requesting agency’s decision on the matter;

Federal agencies having the power to subpoena other federal agencies’ records;

(1)

A labor organization pursuant to contract;

An agency contractor for the purpose of collating, analyzing, aggregating or otherwise refining records;

The Department of Justice for defense of litigation; and

A congressional office in response to an inquiry from the congressional office made at the request of the subject of the record;

Individuals performing functions for the department but technically not having the status of agency employees, if they need access to the records in order to perform their assigned agency functions.

Disclosure by you is mandatory. Failure to provide requested information will prevent processing of final check or retirement papers, or other appropriate actions.

(2)

(3)

(4)

(6)

(5)

(7)

(8)

(9)

(10)

(12)

(11) mailto:HHS_ITIO_Service_Desk@hhs.gov

FOH EMPLOYEES

Linda Barnes

Charlene Freeman, Kimberly Tran, Justin Fegan

SupervisorDonald Williams Supervisor

Seattle, WA

(SEA)

New York, NY

Bethesda, MD

Boston, MA

Philadelphia, PA

Atlanta, GA

Chicago, IL

Dallas, TX

Kansas City, MO

Denver, CO

San Francisco, CA

Seattle, WA-(AO)

PSC-82 (1/10)

TAB 1. PSC AUTHORIZED CLEARANCE OFFICIALS BY BUILDING LOCATION AND/OR SERVICE FOR THE ON-LINE CLEARANCE FORM

LOCATIONS

14. Keys (office)9. Parking Permit 10. Transhare8. Building Passes/IDs

No PSC Employees

Charlene Freeman, Kimberly Tran, Justin Fegan

Malissa Marceron, Shannon Egan Supervisor

Charlene Freeman, Kimberly Tran, Justin Fegan

Charlene Freeman, Kimberly Tran, Justin Fegan

Trisha Futty

Supervisor

CLEARANCE ITEMS (dependent upon Building location and/or Service)

Irene Grubb

Supervisor, Malissa Marceron, Shannon Egan

Supervisor

Charlene Freeman, Kimberly Tran, Justin Fegan

Supervisor

Supervisor

Malissa Marceron, Shannon Egan Supervisor

Perry Point

Silver Spring

SW

Complexes

Rockwall

Alain Maghsadi

Charlene Freeman, Kimberly Tran, Justin Fegan

Cyrus Maclellan

Jennifer Conard

Flora Lambert

Mike Downing

Xravette Dabney

Betty Klein

Carolyn Sailer

James Daugherty

Alain Maghsadi

Molly Satterfield

See below*

Cyrus Maclellan

Donna Regalbuto, Mark Delowery

N/A

Cathy Joseph, LaDonna Coleman

Douglas Pickup, Henry Williams

Jeannie LaJoie

Sally L. Butler, Bruce Hills

James Daugherty

Regina B. Davis, Arlene Engelstad

See below*

N/A

Linda Barnes

Cyrus Maclellan

N/A

N/A

Cathy Joseph, LaDonna Coleman

Douglas Pickup, Henry Williams

Jeannie LaJoie

Denver.Megacenter@ GSA.gov

N/A

N/A

Linda Barnes

Kimberly Tran, Howard Sprague, Charlene Freeman, Justin Fegan

Page 4 of 4 Pages

Parklawn & Gaithersburg Warehouse

Service *12. ITAS Coordinator

Clearance Official

AOS

FMS

ISMS Landa Fox, Tawanna Rock

June Hacker, Randy Pollack

Service Clearance Official

FOH Kathleen M. Edelman, Jeannie Lajoie

SAS

OD Ruth Gaines, Phillip Ames

Irene Grubb, Mark Burchess, Debbie Mahoney, Sheri Kretshmaier

Cyrus Maclellan

*12. ITAS

Coordinator

See below*

Donna Regalbuto

Bobbie Andrews

Cathy Joseph, LaDonna Coleman

Douglas Pickup, Henry Williams

Teresa Young

Denver.Megacenter@ GSA.gov

James Daugherty

Regina B. Davis, Arlene Engelstad

Molly Satterfield

Mary Hall

INFORMATION SYSTEMS SECURITY

EMPLOYEE’S OFFICE

PSC Graphics: (301) 443-1090

EF

DATE OF SEPARATION/TRANSFER

Initial to clear *

PSC-82 (1/10)

ADMINISTRATIVE OPERATIONS

FINANCIAL MANAGEMENT OPERATIONS

NAME

REASON FOR CLEARANCE (check one) :

CLEARANCE OFFICIALS

SUPERVISOR

CLEARANCE ITEMS

FORWARDING ADDRESS

BUILDING/LOCATION

TIMEKEEPER

ITAS COORDINATOR

Travel Advance AOS Systems:

Eh O S Systems:

Debbie Orfe, Eddie Moore PropShop - Web Ordering System Property Management System (PMIS) Property Management System (P M I S) Martha Diskin, Myla Haines Debbie Orfe, Eddie Moore Warehouse Inventory Mgmt. Sys. (webWIMS) Warehouse Inventory Management Systems (web WIMS)

DEPARTMENT OF HEALTH AND HUMAN SERVICES PROGRAM SUPPORT CENTER

CLEARANCE OF EMPLOYEES/CONTRACTORS FOR SEPARATION OR TRANSFER

Gretchen Bailey PSC Travel Charge Card Michael Walker Employee Emergency Payments June Hacker, Randy Pollack Security Clearance Malissa Marceron Financial Disclosure Dan Clutch, Billy Absher Separating from the Federal Government Dept./Agency/Service/Branch transferring to:

Transferring to another Federal component Employee Contractor Keys (office) ITAS Coordinator (see TAB 1) I T Eh S Coordinator (see TAB 1) Time and Attendance Official Files, Records, Accountable Forms Supervisor Supervisor Supervisor (FOH, see TAB 1) Supervisor Supervisor Supervisor Separation SF-52 initiated in Capital HR Supervisor HHS Owned Equipment, Hardware, Software Voice Mail Cell Phone, Blackberry, Pager, PDA LAN, Remote Access, and E-Mail Employment Agreement (outside training, relocation expenses, physician contract, etc.)

Supervisor

AGENCY/SERVICE/DIVISION/BRANCH

Page 1 of 4 Pages Childcare Subsidy Transhare Building Passes/IDs Building Passes / I Dees See TAB 1 Parking Permit See TAB 1 See TAB 1 Rebecca Donnelly Program Support Center Logo.

..\PSC Logo 03 - 450bit.tif SAS Systems:

Sheri Kretschmaier, Patrick Joy PSC Purchase Card Irene Grubb ELITE Series System

CLEARANCE OFFICIALS

CLEARANCE ITEMS

CLEARANCE OF EMPLOYEES/CONTRACTORS FOR SEPARATION OR TRANSFER (continued) INFORMATION SYSTEMS SECURITY (continued) Page 2 of 4 Pages

DATE

Page 2 Footnote.

or attach an e-mail or fax copy with clearance information

SIGNATURE OF SENIOR PSC INFORMATION SYSTEMS SECURITY OFFICER (ISSO)

SIGNATURE OF SUPERVISOR - I certify that I have reviewed this form and that all required clearances have been obtained.

DATE

PSC-82 (1/10)

Commissioned Officers’ Personnel and Payroll System:

COPPS Oracle C O P P S Oracle AOS/Commissioned Corps Systems:

OCCSS WANG and LAN O C C S S WANG and LAN RACF/IBM Mainframe R Eh C F/ I B M Mainframe Minh Tran, John (Tim) Devlin, Saranya Rao Frank Dunn Frank Dunn ODASPS Systems:

O D eh S P S Systems:

PRICES

Daniel Agee, Milton Johnson

DATE

SIGNATURE OF EMPLOYEE

FMS Systems:

Gov Trip \GovNet-NG Accounting For Pay System Vince Watson Bruce Southerland Debt Management and Collection System Errol Brown, Steve Voyta, Jane Allen United Financial Management System (UFMS) Bruce Southerland Jeff Curfman, Hanna Huynh Managing/Accounting Credit Card System Payment Management System Bruce Southerland Brandon Edwards FOH Systems:

FOH Network F O H Network Dave Fisher, Kim Frasher CORE Accounting System FOH Extranet F O H Extranet Services Tracking & Management (STM) FOH Staff Portal F O H Staff Portal Customer Relationship Management (CRM) Customer Relationship Management (C R M) Dave Fisher, Kim Frasher Dave Fisher, Kim Frasher Dave Fisher, Kim Frasher Dave Fisher, Kim Frasher ISMS Systems:

RACF/IBM Mainframe R Eh C F/ I B M Mainframe Capital HR Capital H R Historical Database Workforce Data System HHS Career System H H S Career System GovNet Workforce Reporting System Joyce Brincefield-Sanders, Ed Szymanski Joyce Brincefield-Sanders, Ed Szymanski Joyce Brincefield-Sanders, Ed Szymanski Joyce Brincefield-Sanders, Ed Szymanski Joyce Brincefield-Sanders, Ed Szymanski Joyce Brincefield-Sanders, Ed Szymanski Med. Eval./Rqmts. Info. Track. Sys. (MERITS) Dave Fisher, Kim Frasher Occ. Health Info. Mgmt. System (OHIMS) Occ. Health Info. Mgmt. System (O H I M S) Dave Fisher, Kim Frasher Initial to clear * Calling Card Roxanne Sowell, Joan Koval Steve Voyta, Errol Brown, Jane Allen

HCAS (PRISM)

SEPARATION/TRANSFER PROCEDURES:

PSC-82 (1/10)

P S C-82 (7/08) Following the completion of the clearance processing and satisfactory resolution of any issues (all items initialed except those that cannot be completed until the employee actually separates, such as e-mail and systems that the employee is using until separation), the supervisor will obtain the employee’s signature and date on the form. If the employee is unable or unwilling to sign, the supervisor will note this and initial in the employee’s signature box. The supervisor will sign and date in the appropriate box certifying that all required clearances have been obtained.

Page 3 of 4 Pages Clearance Officials must initial each line item to indicate clearance and/or access removal even if an item is not applicable to the employee (e.g., if employee does not have parking, he/she must still be cleared by the clearance official listed for parking). The reason for not clearing an item must be explained on the item line or on a separate continuation sheet. If an uncleared item is later cleared, the clearance official should sign and date the item (or send e-mail or fax notification of clearance). For any item lost by the employee, a signed statement from the employee explaining the loss must be attached to the form.

Employees are responsible for hand-carrying the clearance form to officials located in their building. When an official is not located in the same building, the supervisor or employee should receive and attach an e-mail or fax clearance to the form. Telephone clearances may only be obtained by the supervisor. If a telephone clearance is obtained, the supervisor should annotate the form with the name of the official contacted, status, and date contacted.

The employee’s supervisor is responsible for providing the clearance form PSC-82 to the employee at least one week prior to his/her last day on duty, and for ensuring its completion before the employee leaves. For further information, the General Administration Manual (GAM), Chapter 1-90, provides detailed procedures and instructions for completing the clearance form. The supervisor should also send an e-mail to HHS_ITIO_Service_Desk@hhs.gov requesting the employee’s removal from the LAN, remote access and e-mail. The ITIO Service Desk will then e-mail a "Request for Access/Change of Access) form to the Supervisor which (s)he should complete and fax back to the ITIO Service Desk (the Rules of Behavior page does not need to be completed for departing or transferring employees). The ITIO Service Desk, upon receipt of the form will remove the e-mail accounts and clear the employee as instructed on the form.

The employee’s supervisor is responsible for providing the clearance form P S C-82 to the employee at least one week prior to his/her last day on duty, and for ensuring its completion before the employee leaves. For further information, the General Administration Manual (G Eh M), Chapter 1-90, provides detailed procedures and instructions for completing the clearance form. The supervisor should also send an e-mail to the I T Service Center requesting the employee’s removal from the LAN, remote access and E mail. The I T Service Center (I T S C) will then e-mail a "Request for Access/Change of Access) form to the Supervisor which (s)he should complete and fax back to the I T Service Center (the Rules of Behavior page does not need to be completed for departing or transferring employees). The I T S C, upon receipt of the form will remove the E mail accounts and clear the employee as instructed on the form.

PRIVACY ACT STATEMENT:

The GAM, Chapter 1-90, page 7, paragraph 7, states that for all departing employees “ADP related identification codes, computer passwords and account numbers will be changed or deleted on all systems, networks, etc., prior to or simultaneous with the transfer or separation of the employee.”

The G Eh M, Chapter 1-90, page 7, paragraph 7, states that for all departing employees “Eh D P related identification codes, computer passwords and account numbers will be changed or deleted on all systems, networks, etc., prior to or simultaneous with the transfer or separation of the employee.”

The supervisor or his/her administrative contact will make a copy of the clearance form for the employee and give the original to the Service Director’s office within two days of the employee’s last day on duty. The Service Director’s office will ensure that the information is complete and send the original to the PSC Information Systems Security Official (ISSO). The ISSO will sign the form last, verifying and certifying that all necessary signatures and clearances have been obtained. Completed forms will be maintained in the Service Director’s Office for one year or for one year after any indebtedness is recovered, whichever is longer.

The supervisor or his/her administrative contact will make a copy of the clearance form for the employee and give the original to the Service Director’s office within two days of the employee’s last day on duty. The Service Director’s office will ensure that the information is complete and send the original to the P S C Information Systems Security Official (I S S O). The I S S O will sign the form last, verifying and certifying that all necessary signatures and clearances have been obtained. Completed forms will be maintained in the Service Director’s Office for one year or for one year after any indebtedness is recovered, whichever is longer.

If an employee has an outstanding debt that is unresolved at the time of separation, the supervisor is responsible for sending an explanatory memorandum to payroll through the payroll liaison. Payroll will withhold the amount of the debt from the final salary payment and/or lump-sum annual leave payment. Additional information on employee indebtedness can be found in the GAM, Chapter 1-90, page 4, “Separating from the Government.”

If an employee has an outstanding debt that is unresolved at the time of separation, the supervisor is responsible for sending an explanatory memorandum to payroll through the payroll liaison. Payroll will withhold the amount of the debt from the final salary payment and/or lump-sum annual leave payment. Additional information on employee indebtedness can be found in the G Eh M, Chapter 1-90, page 4, “Separating from the Government.”

To the Employee:

In compliance with the Privacy Act of l974, the following information is provided: Solicitation of this information is authorized by the Federal Property and Administrative Service Act of 1949, as amended (63 Stat. 377); Part III, Title 5 USC. The purpose is to ensure that you have satisfied all obligations to the Government prior to your transfer within or separation from the PSC.

Information in these records may be disclosed to:

The Office of Personnel Management, Merit Systems Protection Board, Equal Employment Opportunity Commission, and the Federal Labor Relations Authority in carrying out their functions;

An agency handling an appeal made outside the Department to which the records are relevant;

The Department of Justice to receive advice as to whether a particular record must be disclosed under the Freedom of Information Act;

An enforcement agency if a record indicates a violation or potential violation of law;

Federal, state, or local agency maintaining relevant enforcement records or other pertinent records if necessary to obtain a record relevant to an agency decision concerning the hiring or retention of an employee, the issuance of a security clearance, the letting of a contract, or the issuance of a license, grant, or other benefit;

A federal agency, in response to its request, in connection with the hiring or retention of an employee, the issuance of a security clearance, the reporting of an investigation of an employee, the letting of a contract, or the issuance of a license, grant, or other benefit by the requesting agency, to the extent that the record is relevant and necessary to the requesting agency’s decision on the matter;

Federal agencies having the power to subpoena other federal agencies’ records;

(1) A labor organization pursuant to contract;

An agency contractor for the purpose of collating, analyzing, aggregating or otherwise refining records;

The Department of Justice for defense of litigation; and A congressional office in response to an inquiry from the congressional office made at the request of the subject of the record;

Individuals performing functions for the department but technically not having the status of agency employees, if they need access to the records in order to perform their assigned agency functions.

Disclosure by you is mandatory. Failure to provide requested information will prevent processing of final check or retirement papers, or other appropriate actions.

(2) (3) (4) (6) (5) (7) (8) (9) (10) (12) (11)

FOH EMPLOYEES

Linda Barnes Charlene Freeman, Kimberly Tran, Justin Fegan Supervisor Donald Williams Supervisor Seattle, WA (SEA) Seattle, Washington (Seattle) New York, NY New York, New York Bethesda, MD Bethesda, Maryland Boston, MA Boston, Massachusetts Philadelphia, PA Philadelphia, Pennsylvania Atlanta, GA Atlanta, Georgia Chicago, IL Chicago, Illinois Dallas, TX Dallas, Texas Kansas City, MO Kansas City, Missouri Denver, CO Denver, Colorado San Francisco, CA San Francisco, California Seattle, WA-(AO) Seattle, Washington. (Eh O)

PSC-82 (1/10)

TAB 1. PSC AUTHORIZED CLEARANCE OFFICIALS BY BUILDING LOCATION AND/OR SERVICE FOR THE ON-LINE CLEARANCE FORM

LOCATIONS

14. Keys (office)

9. Parking Permit

10. Transhare

8. Building Passes/IDs

8. Building Passes / I Dees No PSC Employees Charlene Freeman, Kimberly Tran, Justin Fegan Malissa Marceron, Shannon Egan Supervisor Charlene Freeman, Kimberly Tran, Justin Fegan Charlene Freeman, Kimberly Tran, Justin Fegan Trisha Futty Supervisor CLEARANCE ITEMS (dependent upon Building location and/or Service) Irene Grubb Supervisor, Malissa Marceron, Shannon Egan Supervisor Charlene Freeman, Kimberly Tran, Justin Fegan Supervisor Supervisor Malissa Marceron, Shannon Egan Supervisor Perry Point Silver Spring SW Complexes South West Complexes Rockwall Alain Maghsadi Charlene Freeman, Kimberly Tran, Justin Fegan Cyrus Maclellan Jennifer Conard Flora Lambert Mike Downing Xravette Dabney Betty Klein Carolyn Sailer James Daugherty Alain Maghsadi Molly Satterfield See below* See footnote below.

Cyrus Maclellan Donna Regalbuto, Mark Delowery N/A Cathy Joseph, LaDonna Coleman Douglas Pickup, Henry Williams Jeannie LaJoie Sally L. Butler, Bruce Hills James Daugherty Regina B. Davis, Arlene Engelstad See below* See footnote below.

N/A Not Applicable Linda Barnes Cyrus Maclellan N/A Not Applicable N/A Not Applicable Cathy Joseph, LaDonna Coleman Douglas Pickup, Henry Williams Jeannie LaJoie Denver.Megacenter@ GSA.gov Denver dot Megacenter at G S eh dot gov N/A Not Applicable N/A Not Applicable Linda Barnes Kimberly Tran, Howard Sprague, Charlene Freeman, Justin Fegan Page 4 of 4 Pages Parklawn & Gaithersburg Warehouse Service *12. ITAS Coordinator Footnote. 12. I T Eh S Coordinator Clearance Official

AOS

Eh O S

FMS

F M S

ISMS

E S S Landa Fox, Tawanna Rock June Hacker, Randy Pollack Service Clearance Official

FOH

F O H Kathleen M. Edelman, Jeannie Lajoie

SAS

S Eh S

OD

O D Ruth Gaines, Phillip Ames Irene Grubb, Mark Burchess, Debbie Mahoney, Sheri Kretshmaier Cyrus Maclellan *12. ITAS Coordinator See footnote. 12. I T Eh S Coordinator See below* For All Number 12 I T Eh S Coordinator, See footnote below.

Donna Regalbuto Bobbie Andrews Cathy Joseph, LaDonna Coleman Douglas Pickup, Henry Williams Teresa Young Denver.Megacenter@ GSA.gov Denver dot Megacenter at G S eh dot gov James Daugherty Regina B. Davis, Arlene Engelstad Molly Satterfield Mary Hall Clearance of Employees/Contractos for Separation or Transfer

PSC

Clearance of Employees/Contractos for Separation or Transfer