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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. COMPLETION DATE (YYYYMMDD)11. USER DIGITAL SIGNATURE (or UAM digital signature for ACTIVATION, DELETION or DEACTIVATION requests) 12.)

16.ACCESS REQUEST INFORMATION ADD-ACCESS Unit Name: PreferenceUICs: Preference Jobs: Choosing a Preference Job that begins with double asterisks (**), will require additional approval from AMIS. Primary Job Role(s): Assigned UIC: Responsible UIC: DODAAC (Required for Jobs: 40, 45, 46 47, 51, 53, 54)

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