Dd Form 2928 - Defense Civilian Pay System (Dcps) Payroll Office Access

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DEFENSE CIVILIAN PAY SYSTEM (DCPS) PAYROLL OFFICE ACCESS FORM

PRIVACY ACT STATEMENT

AUTHORITY: Executive Orders 10450 and 9397 (SSN), Public Law 99-474, The Computer Fraud and Abuse Act (as amended), and 18 U.S.C. Section

1030 (as amended).

PRINCIPAL PURPOSE(S): To record names, signatures, and Social Security Numbers for the purpose of validating the trustworthiness of individuals

requesting access to Department of Defense (DoD) systems and information.

ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained

therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: The DoD "Blanket Routine Uses" set

forth at the beginning of DoD's compilation of systems of records notices apply to this system.

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

processing of this request.

PART I. USER PERSONAL INFORMATION (To be completed by Requestor)

1. NAME (Last, First, Middle Initial)

2. EMPLOYEE ID

3. AGENCY/MAJOR CLAIMANT

(SSN/LN #/SOFA #)

MAJOR CLAIMANT

AGENCY CODE:

CODE:

4. AFFILIATION (If affiliation is Foreign National, provide country code)

CIVILIAN (C)

CONTRACTOR (R)

MILITARY (M)

FOREIGN NATIONAL (F)

COUNTRY CODE:

5. DCPS SECURITY AWARENESS ONLINE COURSE COMPLETION CERTIFICATION

(IMPORTANT: New users must complete this course before

requesting access)

I have completed the DCPS Security Awareness Online Course.

DATE (YYYY-MM-DD):

PART II. USER ACCESS INFORMATION (To be completed by the user or the user's supervisor/government sponsor.)

6. DATABASE DESIGNATOR

(X all that apply for a payroll office and enter designator(s) in column 9. A different form must be submitted for each payroll office.

CPI

OMA

ZFA

ZFR

ZKA

ZKE

ZPA

ZPV

ZGT

ZLO

ZPB

ZPD

ZPH

a. HOME ACTIVITY CODE

b. SITE ACTIVITY CODE

c. SITE INDICATOR CODE

7. PRINTER ID FOR REPORTS

USER TYPE: N - Payroll Office (PRO) User

ACTION CODE

(Enter in Column 8)

AUTHORIZATION TYPE

(Enter in Column 10)

A - Add

B - PRO Debt Technician

P - PRO Tables Maintenance

C - Change

E - PRO PDS Reconciliation Technician

R - PRO Retirement Clerk

D - Delete

G - PRO TSP Technician

S - PRO Supervisor

AUTHORIZATION NUMBER

H - PRO Health Technician

T - PRO T&A Clerk

(Enter in Column 11)

If Column 10 is K, M, or T, enter user's 3-digit pay

K - PRO Technician (SF50 and non-SF50)

U - PRO Leave Buy Back Technician

block assignment. If any other codes, leave blank.

M - PRO MER Clerk (non-SF50)

V - PRO View

8. ACTION CODE

9. DATABASE 10. AUTH TYPE 11. AUTH NO.

8. ACTION CODE

9. DATABASE

10. AUTH TYPE

11. AUTH NO.

USER AGREEMENT

I accept the responsibility for the information and DoD system to which I am granted access and will not exceed my authorized level of system access.

I understand that my access may be revoked or terminated for non-compliance with DoD security policies. I accept responsibilities to safeguard the

information contained in these systems from unauthorized or inadvertent modification, disclosure, destruction, and use. I understand that my use of the

system may be monitored as part of managing the system, protecting against unauthorized access and verifying security problems. I will ensure system

media and output are properly marked, controlled, stored, transported and destroyed based on sensitivity and need-to-know. I will report all DCPS IA-

related suspicious threats and vulnerabilities to the appropriate organization. I have completed a U.S. Government background investigation equal with

the level of access granted. I will use strong passwords, protect workstation, and not leave my CAC card or other authentication device unattended. I will

keep my security training current. I agree to notify the appropriate organization that issued my account(s) when access is no longer required.

12. USER'S SIGNATURE

13. DATE

(YYYY-MM-DD)

14. SUPERVISOR APPROVAL (Completed by user's supervisor or government sponsor)

a. CERTIFICATION OF NEED-TO-KNOW

I certify that this user requires access as requested in block 13 of the user's DD Form 2875.

c. SIGNATURE

b. SUPERVISOR/GOVERNMENT SPONSOR'S FULL NAME

d. DATE (YYYY-MM-DD)

IMPORTANT: Submit this form with the user's DD Form 2875, "System Authorization Access Request (SAAR)".

PREVIOUS EDITION IS OBSOLETE.