Da Form 12-R - Request For Establishment Of A Publications Account
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1REQUEST FOR ESTABLISHMENT OF A PUBLICATIONS ACCOUNT
For use of this form, see DA PAM 25-33; the proponent agency is ODISC4
1. ACCOUNT NUMBER
2. DATE
3. TYPE OF SUBMISSION
a.
INITIAL b.
CHANGE c.
CLOSE
4. FROM
(Include nine-digit ZIP Code)
5. THRU
(Include nine-digit ZIP Code)
6. TO
SECTION I - GENERAL
7a. REQUEST AN ACCOUNT BE ESTABLISHED FOR THE FOLLOWING SERVICE:
PUBLICATIONS
BLANK FORMS
TEST MATERIAL
(see para 2-5, DA PAM 25- 33)
(Use a separate sheet of paper if more space is needed.)
7b. JUSTIFICATION FOR BLANK FORMS
8. UNIT DESCRIPTION DATA
(FAILURE TO COMPLETE THIS BLOCK WILL RESULT IN YOUR REQUEST BEING RETURNED.)
a. Component
(Contractors must complete Block 8e and/or 8f.)
Active Army
Army Reserve
National Guard
Air Force
Marine Corps
Navy
DOD Activity
Contractor
Other
b. TOE Number or TDA Number
(Army Only)
e. Commercial and Government Entity (CAGE) Code
(Contractors)
c. Unit Identification Code (UIC) (Army Users)
f. Contract Number (if applicable)
d. Military Assistance Program Address Code (FMS Users)
g. DOD Activity Address Code (Non-Army Users) or Navy UIC
9. PUBLICATIONS OFFICER FOR THIS ORGANIZATION WILL BE:
a. Typed Name, Grade and Title
b. Signature
c. Telephone Number
(DSN and Commercial)
SECTION II - ACCOUNT CLASSIFICATION LEVEL
10. REQUEST THE FOLLOWING CLASSIFICATION LEVEL FOR THIS
ACCOUNT:
UNCLASSIFIED
CONFIDENTIAL
SECRET
11.
THIS ORGANIZATION HAS ADEQUATE EQUIPMENT AND PROPERLY CLEARED PERSONNEL TO RECEIVE AND SAFEGUARD
MATERIAL ACCORDING TO THE CLASSIFICATION REQUESTED FOR THIS ACCOUNT. IF CLASSIFIED SERVICE IS APPROVED,
THE SECURITY OFFICER WILL BE:
a. Typed Name, Grade and Title
b. Signature
c. Telephone Number
(DSN and Commercial)
SECTION III - CHANGE OF ADDRESS
b. NEW ADDRESS
12a. OLD ADDRESS
(Include 9-digit Zip Code)
(Include 9-digit Zip Code)
Effective Date:
SECTION IV - AUTHENTICATING OFFICIALS
b. Signature
c. Telephone Number
13a. Typed Name, Grade and Title of Commander
(DSN and Commercial)
c.
b. Signature
Telephone Number
14a. Typed Name, Grade and Title of PCO/PSM
(DSN and Commercial)
APD LC v2.01ES
PREVIOUS EDITIONS ARE OBSOLETE
DA FORM 12-R, APR 1996
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Parent category: Business