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
9.DESIGNATION OF PERSON
10. IA TRAINING AND AWARENESS CERTIFICATION REQUIREMENTS (Complete as Required for the user or functional level access.)
13. JUSTIFICATION FOR ACCESS
Access is required for email, internet, sharepoint, sharedrive, and to access daily curriculum.
15. USER REQUIRES ACCESS TO: UNCLASSIFIED CLASSIFIED (specify category)
DD FORM 2875, AUG 2009 PREVIOUS EDITION IS OBSOLETE
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
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
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: ________________________________________