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DD Form 2875, System Authorization Access Request, August …

System Authorization Access request (SAAR). 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 requesting Access to Department of Defense (DoD) systems and information. NOTE: Records may be maintained in both electronic and/or paper form. ROUTINE USES: None. DISCLOSURE: Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or prevent further processing of this request . TYPE OF request DATE (YYYYMMDD). INITIAL MODIFICATION DEACTIVATE USER ID. System NAME (Platform or Applications) LOCATION (Physical Location of System ). NISP- Enterprise Mission Assurance Support Service (eMASS) N/A. PART I (To be completed by Requestor). 1. NAME (Last, First, Middle Initial) 2. ORGANIZATION. 3. OFFICE SYMBOL/DEPARTMENT 4.

Title: DD Form 2875, System Authorization Access Request, August 2009 Author: WHS/ESD/IMD Created Date: 1/22/2014 2:29:56 PM

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Transcription of DD Form 2875, System Authorization Access Request, August …

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