Dd Form 2962 - Personnel Security System Access Request (Pssar) Defense Manpower Data Center (Dmdc)
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NAME (LAST NAME, FIRST NAME, MIDDLE INITIAL)
OMB No. 0704-0542
PERSONNEL SECURITY SYSTEM ACCESS REQUEST (PSSAR)
OMB approval expires
DEFENSE MANPOWER DATA CENTER (DMDC)
Sep 30, 2018
The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, Alexandria,
VA 22350-3100 (0704-0542). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.
does not display a currently valid OMB control number.
Return completed form to the appropriate Account Manager or DMDC Contact Center, as indicated in the instructions.
PRIVACY ACT STATEMENT
AUTHORITY: DoD 5200.2-R, Department of Defense Personnel Security Program Regulation; E.O. 12829, National Industrial Security Program; the JPAS
Account Management Policy; and E.O. 9397, as amended.
PRINCIPAL PURPOSE(S): To request the establishment of user roles and access and validate the trustworthiness of individuals seeking access to DCII,
SWFT, JCAVS, or JAMS.
ROUTINE USE(S): The blanket routine uses found at may apply.
DISCLOSURE: Voluntary. However, failure to provide the requested information may impede, delay, or prevent further processing of your request. The
Social Security Number is used to verify the trustworthiness status in JPAS.
TYPE OF REQUEST (REQUIRED)
DATE (YYYYMMDD)
INITIAL
MODIFICATION
DEACTIVATE
USER ID (EXISTING ACCOUNTS) _________________
PART 1 - PERSONAL INFORMATION
2. ORGANIZATION
1. NAME (LAST, FIRST, MIDDLE INITIAL)
3. OFFICE SYMBOL/DEPARTMENT
4. TELEPHONE (DSN or COMMERCIAL)
6. JOB TITLE AND GRADE/RANK
5. OFFICIAL E-MAIL ADDRESS
7. OFFICIAL MAILING ADDRESS
8. CITIZENSHIP
9. DATE OF BIRTH (YYYYMMDD)
10. PLACE OF BIRTH (CITY & STATE/COUNTRY)
11. SOCIAL SECURITY NUMBER
12. CAGE CODE (CTR ONLY)
13. DESIGNATION OF APPLICANT
DoD CIVILIAN
INDUSTRY
NON-DoD
MILITARY
PART 2 - APPLICATIONS
14. DEFENSE CENTRAL INDEX OF INVESTIGATIONS (DCII) (GOVERNMENT ONLY)
______________________
a. DCII AGENCY CODE ______________________________________
OR
DCII AGENCY ACRONYM
b. USER PERMISSIONS
QUERY (SEARCH)
ADD
UPDATE
DELETE
EXECUTIVE ADMINISTRATOR
AGENCY ADMINISTRATOR
FILE DEMAND PRINT
FILE DEMAND (PROVIDE ACCREDITATION CODE): ______________
IA (ROOT ADMINISTRATOR)
15. SECURE WEB FINGERPRINT TRANSMISSION (SWFT) (GOVERNMENT/INDUSTRY)
a. PERMISSIONS - FINGERPRINT SUBMISSION
USER
MULTI-SITE UPLOADER
SITE ADMINISTRATOR
ORGANIZATION/COMPANY ADMINISTRATOR
b. PERMISSIONS - FINGERPRINT ENROLLMENT
ENROLLER
TRANSACTION VIEWER
ENROLLER SITE ADMINISTRATOR
ENROLLER GROUP ADMINISTRATOR
___________________________
c. ADDITIONAL CAGE/ORGANIZATION CODE(S):
OTHER:
16. JOINT CLEARANCE ACCESS VERIFICATION SYSTEM (JCAVS) (GOVERNMENT/INDUSTRY)
a. TYPE OF ACCOUNT REQUESTED:
ACCOUNT MANAGER
b. ACCESS REQUESTED - INDUSTRY:
c. ACCESS REQUESTED - GOVERNMENT ONLY:
LEVEL 2
CORPORATE OFFICER (SCI)
LEVEL 2
MACOM/ACTIVITY/HQ/AGENCY SSO
LEVEL 3
COMPANY FSO OFFICER/MANAGER (SCI)
LEVEL 3
BASE/POST/SHIP/etc. SSO
LEVEL 4
CORPORATE OFFICERS MANAGER
LEVEL 4
MACOM NON-SCI SECURITY MANAGER
LEVEL 5
COMPANY FSO OFFICERS/MANAGER
LEVEL 5
BASE/POST/SHIP/NON-SCI SECURITY MGR.
LEVEL 6
UNIT SECURITY MGR/VISITOR CONTROL
LEVEL 6
UNIT SECURITY MANAGER
LEVEL 7
GUARD ENTRY PERSONNEL
LEVEL 7
COLLATERAL ENTRY CONTROLLER
LEVEL 8
GUARD ENTRY PERSONNEL (SCI)
LEVEL 8
SCIF ENTRY CONTROLLER
LEVEL 10
VISITOR MANAGEMENT
LEVEL 10
VISITOR MANAGEMENT
d. PERMISSION REQUESTED:
REVIEW e-QIP
OVERRIDE PSI
APPROVE e-QIP
INITIATE PSI
DD FORM 2962, NOV 2015
PREVIOUS EDITION IS OBSOLETE.
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