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SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)

SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)PRIVACY ACT STATEMENTE xecutive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse record names, signatures, and other identifiers for the purpose of validating the trustworthiness of individuals requestingaccess to Department of Defense (DoD) systems and information. NOTE: Records may be maintained in both electronicand/or paper of this information is voluntary; however, failure to provide the requested information may impede, delay orprevent further processing of this OF REQUESTINITIALMODIFICATIONDEACTIVATEDATE (YYYYMMDD)PART I (To be completed by Requestor)1. NAME (Last, First, Middle Initial)2. ORGANIZATION3. OFFICE SYMBOL/DEPARTMENT8. CITIZENSHIP6. JOB TITLE AND GRADE/RANK4. PHONE (DSN or Commercial)PART II - ENDORSEMENT OF ACCESS BY INFORMATION OWNER, USER SUPERVISOR OR GOVERNMENT SPONSOR (If individual is acontractor - provide company name, contract number, and date of contract expiration in Block 16.)

E. DISPOSITION OF FORM: TRANSMISSION: Form may be electronically transmitted, faxed, or. mailed. Adding a password to this form makes it a minimum of "FOR OFFICIAL USE ONLY" and must be protected as such. ... DD Form 2875, System Authorization Access Request, August 2009 Author:

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