Va Form 9957 - Acrs Time Sharing Request Form
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1ACRS TIME SHARING REQUEST FORM
Department of Veterans Affairs
PRIVACY ACT STATEMENT: The information is solicited under authority of Title 38, United States Code and Executive Order 9397 and is necessary to
accomplish the action requested by the requester, including establishing, modifying or deleting a Time Sharing Customer Account. Furnishing the information on
this for, including your Social Security Number, is voluntary; however, if the information is not furnished, we will be unable to take further action on your
request.
NOTE: Information from this form is used to establish a Time Sharing Account.
1. ACTION REQUESTED (Check only one of the three items)
CREATE NEW CUSTOMER
MODIFY EXISTING CUSTOMER
DELETE EXISTING CUSTOMER
2. CUSTOMER INFORMATION
A. NAME
B. TIME SHARING CUSTOMER ID
C. SOCIAL SECURITY NUMBER
Enter your name
Leave this blank
Enter your SSN
D. TELEPHONE NUMBER (Include Area Code)
E. FACILITY (STATION) NUMBER/SUFFIX
F. MAIL ROUTING SYMBOL OR STOP CODE
Enter your office telephone
OGA
AF users enter: 061
AR and Navy users enter: 062
G. JOB TITLE
H. SUBSYSTEM APPLICATION FUNCTION CODE
(SAFC)
Enter your job title
26D2
I. IF FOR CONTRACTOR, OR IF TEMPORARY ACCESS, SHOW EXPIRATION
J. EMPLOYER (For Contractor or Other Government Organization)
DATE (Month, day, year)
Enter Army, Navy or Air Force
Leave this blank (unless a contractor)
K. OFFICE ADDRESS (Street, City, State, Zip Code, for Contractor or Other Government Organization)
Enter Your Office Address
Proxy Server/IP Address: If you look up or order records, you
(Include Room Number and Office Symbol)
must enter your Proxy server address here. Contact your System
Administrator for the Proxy Server address through which
your Internet traffic flows. If there is none at your MTF,
E-mail address: Enter your e-mail address
enter the IP address of your worksite computer.)
NOTE: See reverse for instructions.
3. FUNCTIONAL TASKS
CHECK
APPROPRIATE
CONCURRING SYSTEM MANAGER OF RECORD (SMR) DESIGNEE
FUNCTIONAL TASK CODES
BOX
SIGNATURE & TITLE (If required)
ADD
DELETE
Check the ADD box if the user is authorized to look up and to ORDER
1NARA85--MRS Record Order
records from the MRS
1NARA86--MRS Look-up
Check the ADD box if the user is only authorized to LOOK UP records
only
on the MRS but may not submit record orders
Send the completed form to:
National Personnel Records Center
Attn: NRPS-Rademacher
9700 Page Ave., Room 2076
St. Louis, MO 63132
4. SIGNATURES
REQUESTING OFFICIAL & TITLE
DATE
Obtain your boss's signature/title
Enter date
APPROVING OFFICIAL & TITLE
DATE
Obtain approving official's signature/title
Enter date
SECOND APPROVING OFFICIAL & TITLE (If required)
DATE
FACILITY POINT OF CONTACT
DATE
VA FORM
9957
JUL 1997(R)
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