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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.

SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR) PRIVACY ACT STATEMENT Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act. To record names, signatures, and other identifiers for the purpose of validating the trustworthiness of individuals requesting

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Page 1 of 3. PREVIOUS EDITION IS OBSOLETE. DD FORM 2875, AUG 2009. SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR) PRIVACY ACT STATEMENT AUTHORITY: Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act

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DVS RECORD REQUEST St. Paul, MN 55101-5161

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