DD 2875 SUPPLEMENTAL INSTRUCTIONS (Specific …

1 Revision 1, 20 Nov 2019 DD2875 SUPPLEMENTAL INSTRUCTIONS ( specific to JS Networks) GENERAL GUIDELINES The following INSTRUCTIONS are provided for assistance in completing and submitting the DD2875 (aka SAAR Form). Please use ONLY the latest version DD2875 (August 2009) posted on the JEMIS Portal. Joint Staff will NOT accept modified versions of the SAAR Form. The DoD CAC generated digital signature is the preferred Signature Certificate for all SAAR Form signature entries. The time stamp contained in the Digital Signature should match the Date Entry blocks. However, some variance between the two is acceptable, but the digital signature date MUST be within 1 year of the Event Registration Date.

2 The MINIMUM processing time for all forms is 5 working days. Late or short notice submissions may not be processed in time to meet Event requirements. specific INSTRUCTIONS (For Filling out the Form) A. PART I (User Agreement): The following information is provided by the User when requesting a USER ID for Joint Staff networks and systems. Type of Request: Place an X in the Initial box (or appropriate box). Date: The date that the User completes the form. System Name: List all systems or networks for which an account is needed. For Example: JTEN EXERCISE, PERSISTENT, COX, COWAN, etc. Location: Geographic location of the User when accessing the system network ( home station, Suffolk, etc.)

3 Name: The last name, first name, and middle initial of the User. Organization: The User s current organization ( , JWFC, II MEF, ACC) Office Symbol/Department: The office symbol of the User s current duty assignment ( , JT/EOD, JT/EAD, etc.). Telephone Number/DSN: The Defense Switching Network (DSN) phone number of the User. If DSN is unavailable, a commercial number is acceptable. Official E-mail Address: The User s official e-mail address. (MANDATORY ENTRY FOR PERSISTENT ACCOUNTS) Job Title/Grade/Rank: The civilian job title (Example: Systems Analyst, GS-14, Pay Clerk, GS-5), military rank (COL, United States Army, CMSgt, USAF) or CTR for contractors.

4 Official Mailing Address: The User s official mailing address. Citizenship: The User s citizenship status ( , US, Foreign National, or Other). Designation of Person: The User s designation ( , Military, Civilian, or Contractor). Cybersecurity Training Verification: The User acknowledges completion of their annual DoD Cyber Security Awareness Challenge Training (course) and includes the completion date. NOTE: The Cybersecurity Training Completion Date MUST be within 1 year of the Event Registration Date and be valid for the entire duration of the Event. If the training date does not meet these requirements, the form will be rejected, and the user risks loss of account access and/or loss of JTEN privileges.

5 Revision 1, 20 Nov 2019 The (official) DoD Cyber Awareness Challenge Training C ourse is available at any of the following sites: Non-CAC log-in options: JKO: IA Signal: DISA site: CAC Log-in options: CMIS: iCompass: User Signature: User signs the DD Form 2875 with the understanding that they are responsible and accountable for their password and the information they access on the system (see signature date requirements in the GENERAL GUIDELINES Section Date: The date that the User signs the form. B. PART II (Need-to-Know): The information below requires the endorsement from the User s Supervisor or Government Sponsor. NOTE: A Government Sponsor is a Military or Civilian individual who is directly associated with and endorses User participation in the eve nt.)

6 For Event Accounts (non Persistent) a contractor (who functions as the User s supervisor) can sign Part II. For Persistent Accounts the form MUST be signed by a Government Sponsor. If a company representative signs as the User s supervisor, the Government Sponsor must complete the Information Owner section, Blocks 21 thru 21b. Justification for Access: , New User, change in access (privileged access) Type of Access Required: Place an X in the Authorized box for normal access. Place an X in the Privileged box for anything other than normal User access. User Requires Access To: Place an X in the correct box. If Other, list proper classification ( , US Secret/REL IASAF, etc.)

7 Verification of Need to Know: Indication that the User requires access as requested. Place an X in the box. Access Expiration Date: If requesting an Event Account, enter your Contract Number and add the End Date of the Event; if requesting a Persistent Account, include your Contract Number and its Expiration Date. Supervisor s Name (Print Name): The supervisor or representative prints his/her name to indicate that the above information has been validated and the access is required. Supervisor s Signature: Supervisor enters his/her signature to endorse the Need-to-Know information provided in this section (see signature requirements noted in previous sections).

8 Date: D ate supervisor signs the form. Supervisor s Organization/Department: Supervisor s organization and department. a. (20a) Supervisor s E-mail Address: Supervisor s e-mail address. b. (20b) Phone Number: Supervisor s telephone number. (21) (25) To be completed by Government Sponsor (if necessary) and/or other relevant personnel when needed. Proceed to item #26. Name: The last name, first name, and middle initial of the User, repeated on Page 2. Additional Information: For Privilege Access Requests Only: Revision 1, 20 Nov 2019 List certifications required from IA Workforce requirements: List Security Certification and OS certification related to access.

9 Provide copies of both certifications when submitting DD 2875. C. PART III (Clearance Validation): Certification of Background Investigation or Clearance. Type of Investigation: The user s last type of background investigation ( , NAC, NACI, or SSBI). Date of Investigation: Date of most recent security investigation. Clearance Level: The User s current security clearance level (Secret or Top Secret). IT Level Designation: The User s IT designation (Level I, Level II, or Level III). Leave blank if normal user access is requested. Verified By: The Security Manager or representative prints his/her name to indicate that the above clearance and investigation information has been verified.

10 Security Manager Telephone Number: The telephone number of the Security Manager or his/her representative signing. Security Manager Signature: The User s Security Manager (or his/her representative) signature indicates that the above clearance and investigation information has been verified. Date: The date that the form was signed by the Security Manager or his/her representative. D. PART IV: This information is site specific and can be customized by the DoD, functional activity, or the customer with approval of the DoD. This information will specifically identify the access required by the User. E. DISPOSITION OF FORM: Once this Form is completed, with appropriate Signatures in Part I thru Part III, upload it to your record in JEMIS.