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SAAR

 SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)

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 USERS: None.

DISCLOSURE: Disclosure of the information is voluntary; however, failure to provide the requested information may impede, delay or prevent further processing of this request.

TYPE OF REQUEST                                 

INITIAL   MODIFICATION   DEACTIVATE   USER ID       

     DATE
SYSTEM NAME (Platform or Applications)       
   
  LOCATION (Physical Location of System
   
PART I (To be completed by Requestor)
1. NAME(Last, First, Middle Initial)     
2. ORGANIZATION
                                                                                 
3. OFFICE SYMBOL/DEPARTMENT
4. PHONE(DSN OR Commercial)
5. OFFICIAL E-MAIL ADDRESS
6. JOB TITLE AND GRADE/RANK
7. OFFICIAL MAILING ADDRESS
 
8. CITIZENSHIP
 US   FN  
 OTHER

 

9.DESIGNATION OF PERSON
 MILITARY  CIVILIAN  

 CONTRACTOR

10. IA TRAINING AND AWARENESS CERTIFICATION REQUIREMENTS (Complete as Required for the user or functional level access.)

 I have completed Annual Information Awareness Training                                                                                                                DATE 
11. USER SIGNATURE                                                                                                                                                                                       12. DATE  
PART II - ENDORSEMENT OF ACCESS BY INFORMATION OWNER, USER SUPERVISOR OR GOVERNMENT OR GOVERNMENT SPONSOR( if individual is a contractor - provide company name, contract number, and date of contract expiration in Block 16.)

13. JUSTIFICATION FOR ACCESS

14. TYPE OF ACCESS REQUIRED:
 AUTHORIZED               PRIVILEGED  

15. USER REQUIRES ACCESS TO:  UNCLASSIFIED   CLASSIFIED  (specify category)
 OTHER 

16. VERIFICATION OF NEED TO KNOW 

I certify that this user requires access as requested.       
16a. ACCESS EXPIRATION DATE (Contractors must specify company name,
contract number, expiration date. Use Block 27 if needed
.)   
17. SUPERVISOR'S NAME (Print Name)
18. SUPERVISOR'S SIGNATURE
19. DATE
20. SUPERVISOR'S ORGANIZATION/DEPARTMENT
20a. SUPERVISOR'S E-MAIL ADDRESS
20b. PHONE NUMBER 
21. SIGNATURE OF INFORMATION OWNER/OPR
21a. PHONE NUMBER
21b.  DATE
22. SIGNATURE OF IAO OR APPOINTEE
23. ORGANIZATION/DEPARTMENT
24. PHONE NUMBER 
25. DATE

DD FORM 2875, AUG 2009                                                                    PREVIOUS EDITION IS OBSOLETE
 

26. NAME (Last, First, Middle Initial)
 
27. OPTIONAL INFORMATION (Additional information)

 

PART III - SECURITY MANAGER VALIDATES THE BACKGROUND INVESTIGATION OR CLEARANCE INFORMATION
28. TYPE OF INVESTIGATION
                                            
28a. DATE OF INVESTIGATION 
28b. CLEARANCE LEVEL 
                                                       NATO DATE
28c. IT LEVEL DESIGNATION
 LEVEL I   LEVEL II    LEVEL III
29. VERIFIED BY (Print Name)
30. SECURITY MANAGER TELEPHONE NUMBER 
31. SECURITY MANAGER SIGNATURE
32. DATE
PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION
TITLE:  SYSTEM            ACCOUNT CODE 
             DOMAIN                                          
             SERVER                                          
             APPLICATION                                 
             DIRECTORIES                                
             FILES                                               
             DATASETS                                      
DATE PROCESS
PROCESSED BY (Print name and sign)
DATE 
DATE REVALIDATED
REVALIDATED BY (Print name and sign)
DATE 

DD FORM 2875 (BACK), AUG 2009


DD 2875 ADDENDUM
STANDARD MANDATORY NOTICE AND CONSENT PROVISION
FOR ALL DOD INFORMATION SYSTEM USER AGREEMENTS


                                             By signing this document, you acknowledge and consent that when you access Department of Defense (DoD) information systems:

                                             1) You are accessing a U.S. Government (USG) information system (IS) (which includes any device attached to this information
                                                   system) that is provided for U.S. Government authorized use only.

                                              2) You consent to the following conditions:

                                                  a) The U.S. Government routinely intercepts and monitors communications on this information system for purposes including,
                                                          but not limited to, penetration testing, communications security (COMSEC) monitoring, network operations and defense,
                                                          personnel misconduct (PM), law enforcement (LE), and counterintelligence (CI) investigations.

                                                  b) At any time, the U.S. Government may inspect and seize data stored on this information system.

                                                  c) Communications using, or data stored on, this information system are not private, are subject to routine monitoring,
                                                         interception, and search, and may be disclosed or used for any U.S. Government-authorized purpose.

                                                  d) This information system includes security measures (e.g., authentication and access controls) to protect U.S. Government
                                                         interests--not for your personal benefit or privacy.


                                                  e) Notwithstanding the above, using an information system does not constitute consent to personnel misconduct, law
                                                      enforcement, or counterintelligence investigative searching or monitoring of the content of privileged communications or data
                                                      (including work product) that are related to personal representation or services by attorneys, psychotherapists, or clergy, and
                                                      their assistants. Under these circumstances, such communications and work product are private and confidential, as further
                                                      explained below:

                                                        i) Nothing in this User Agreement shall be interpreted to limit the user's consent to, or in any other way restrict or affect, any
                                                       U.S. Government actions for purposes of network administration, operation, protection, or defense, or for
                                                       communications security. This includes all communications and data on an information system, regardless of any
                                                       applicable privilege or confidentiality.

                                                       ii) The user consents to interception/capture and seizure of ALL communications and data for any authorized purpose
                                                       (including personnel misconduct, law enforcement, or counterintelligence investigation). However, consent to
                                                       interception/capture or seizure of communications and data is not consent to the use of privileged communications or
                                                       data for personnel misconduct, law enforcement, or counterintelligence investigation against any party and does not
                                                       negate any applicable privilege or confidentiality that otherwise applies.

                                                       iii) Whether any particular communication or data qualifies for the protection of a privilege, or is covered by a duty of
                                                       confidentiality, is determined in accordance with established legal standards and DoD policy. Users are strongly
                                                       encouraged to seek personal legal counsel on such matters prior to using an information system if the user intends to
                                                       rely on the protections of a privilege or confidentiality.

                                                       iv) Users should take reasonable steps to identify such communications or data that the user asserts are protected by any
                                                       such privilege or confidentiality. However, the user's identification or assertion of a privilege or confidentiality is not
                                                       sufficient to create such protection where none exists under established legal standards and DoD policy.

                                                       v) A user's failure to take reasonable steps to identify such communications or data as privileged or confidential does not
                                                       waive the privilege or confidentiality if such protections otherwise exist under established legal standards and DoD
                                                       policy. However, in such cases the U.S. Government is authorized to take reasonable actions to identify such
                                                       communication or data as being subject to a privilege or confidentiality, and such actions do not negate any applicable
                                                       privilege or confidentiality.

                                                       vi) These conditions preserve the confidentiality of the communication or data, and the legal protections regarding the use
                                                       and disclosure of privileged information, and thus such communications and data are private and confidential. Further,
                                                       the U.S. Government shall take all reasonable measures to protect the content of captured/seized privileged
                                                       communications and data to ensure they are appropriately protected.

                                                 f) In cases when the user has consented to content searching or monitoring of communications or data for personnel
                                                   misconduct, law enforcement, or counterintelligence investigative searching, (Le., for all communications and data other
                                                   than privileged communications or data that are related to personal representation or services by attorneys,
                                                   psychotherapists, or clergy, and their assistants), the U.S. Government may, solely at its discretion and in accordance with
                                                   DoD policy, elect to apply a privilege or other restriction on the U.S. Government's otherwise-authorized use or disclosure of
                                                   such information.
                                                g) All of the above conditions apply regardless of whether the access or use of an information system includes the display of a
                                                   Notice and Consent Banner ("banner"). When a banner is used, the banner functions to remind the user of the conditions
                                                   that are set forth in this User Agreement, regardless of whether the banner describes these conditions in full detail or
                                                   provides a summary of such conditions, and regardless of whether the banner expressly references this User Agreement.



                                                                                                                                User Digital Signature: ________________________________________