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DD FORM 2875 - SYSTEM AUTHORIZATION ACCESS …

DD form 2875 - SYSTEM AUTHORIZATION ACCESS request SAAR "RED" Fields are MandatoryPRIVACY ACT STATEMENT AUTHORITY: Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act. PRINCIPAL PURPOSE: To record names, signatures, and other identifiers for the purpose of validating the trustworthiness of individuals TYPE OF request SYSTEM NAME (Application Platforms)TC-AIMS II PART I (To be completed by Requestor 1. NAME (Last, First, Middle Initial)3. OFFICE SYMBOL/DEPARTMENT5. OFFICIAL E-MAIL ADDRESS USER IDDATELOCATION2. ORGANIZATION 4. PHONE (DSN and/or Commercial)6. JOB TITLE AND GRADE/RANK7. OFFICIAL MAILING ADDRESS8. CITIZENSHIP9. DESIGNATION OF PERSON10. IA TRAINING AND AWARENESS CERTIFICATION REQUIREMENTS (Complete as required for user and/or functional level ACCESS .))

24.type of investigation 25.date of investigation (yyyymmdd) 26.clearance level 27.it level designation 28.veri fl ed by (print name) 29.security manager phone 31.date (yyyymmdd) number 30.security manager digital signature part iv - completion of request review and …

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