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
Justification for access
15. USER REQUIRES ACCESS TO: UNCLASSIFIED CLASSIFIED (specify category)
DD FORM 2875, AUG 2009 PREVIOUS EDITION IS OBSOLETE
DD FORM 2875 (BACK), AUG 2009