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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 .) D I have completed annual Information Awareness training.)

DD FORM 2875 - SYSTEM AUTHORIZATION ACCESS REQUEST SAAR "RED" Fields are Mandatory PRIVACY 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

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Document justification for access in block 13 on DD Form 2875. The Information Assurance Officer (IAO) or ap-pointee will sign in block 22. The IAO or appointee will be the individual responsible for approving access to the system being requested. This person is usually referred to as the Government ISSM/ISSO Block 21 is not a requirement. After

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DD FORM 2875 INSTRUCTIONS, AUG 2009 INSTRUCTIONS The prescribing document is as issued by using DoD Component. (21) Signature of Information Owner/OPR. Signature of the functional appointee responsible for approving access to the system being requested. (21a) Phone Number. Functional appointee telephone number. (21b) Date.

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