Dd Form 2962 PDF Details

The DD Form 2962, officially titled "Personnel Security System Access Request (PSSAR)," serves as a crucial document within the defense manpower data management processes. This form is utilized by individuals seeking access to various Department of Defense (DoD) Personnel Security Systems, including but not limited to the Defense Central Index of Investigations (DCII), Secure Web Fingerprint Transmission (SWFT), Joint Clearance Access Verification System (JCAVS), and the Joint Adjudication Management System (JAMS). Under the auspices of the Defense Manpower Data Center (DMDC), the form plays an instrumental role in validating the trustworthiness and eligibility of personnel for access to sensitive information and systems, in alignment with DoD 5200.2-R, Department of Defense Personnel Security Program Regulation, Executive Orders, and other guiding regulations. The comprehensive form captures essential personal and professional details of applicants, outlines required training completions, specifies access levels requested, and incorporates sections for various official certifications. Submission procedures underscore the importance of meticulous compliance, ensuring that personnel entrusted with access to critical systems are duly authenticated and authorized in support of national security objectives.

QuestionAnswer
Form NameDd Form 2962
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesda 2962, dd form 2962 volume 2, diss pssar, dd form 2962 jan 2020

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NAME (Last Name, First Name, Middle Initial)

PERSONNEL SECURITY SYSTEM ACCESS REQUEST (PSSAR)

DEFENSE MANPOWER DATA CENTER (DMDC)

OMB No. 0704-0496 OMB approval expires Mar 31, 2016

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, Information Management Division, 4800 Mark Center Drive, Alexandria, VA 22350-3100 (0704-0496). 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 does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.

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 http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html 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

INITIAL

 

MODIFICATION

 

 

 

DEACTIVATE

DATE (YYYYMMDD)

USER ID _________________

PART 1 (To be completed by Applicant) - PERSONAL INFORMATION

1. NAME (Last, First, Middle Initial)

2. ORGANIZATION

 

 

3.OFFICE SYMBOL/DEPARTMENT

5.OFFICIAL E-MAIL ADDRESS

4.PHONE (DSN or Commercial)

6. JOB TITLE AND GRADE/RANK

7. OFFICIAL MAILING ADDRESS

8. CITIZENSHIP

9. DATE OF BIRTH (YYYYMMDD)

10. PLACE OF BIRTH

11. SOCIAL SECURITY NUMBER

12.CAGE CODE (NISP CTR ONLY)

13. DESIGNATION OF PERSON

DoD MILITARY

DoD CIVILIAN

DoD CONTRACTOR

NON-DoD NISP

NON-DoD

PART 2 (To be completed by Applicant) - TRAINING

14.

 

I have completed Annual Information Awareness Training.

DATE (YYYYMMDD)______________

 

 

 

 

15.

 

I have completed Personally Identifiable Information Training.

DATE (YYYYMMDD)________________

 

 

 

 

16.

 

I have completed JPAS Training Requirements (if requesting a JPAS account).

DATE (YYYYMMDD)

 

 

 

 

 

 

 

PART 3 (To be completed by Applicant) - APPLICATIONS

 

 

 

 

 

17.

DEFENSE CENTRAL INDEX OF INVESTIGATIONS (DCII)

 

 

 

 

 

 

AGENCY CODE_____________ OR AGENCY ACRONYM

 

 

 

 

 

 

 

 

USER (Select Permissions Below)

 

FILE DEMAND (Provide Accreditation Code): ___________

QUERY (SEARCH)

DELETE

 

FILE DEMAND PRINT

 

EXECUTIVE ADMINISTRATOR

ADD

 

UPDATE

 

AGENCY ADMINISTRATOR

IA (ROOT) ADMINISTRATOR

 

 

 

 

 

 

 

 

18.SECURE WEB FINGERPRINT TRANSMISSION (SWFT) CAGE CODE(S):

USER

MULT. COMPANY UPLOADER

ACCOUNT MANAGER

EXECUTIVE ACCOUNT MANAGER

SWFT ADMINISTRATOR

19. JOINT CLEARANCE ACCESS VERIFICATION SYSTEM (JCAVS)

TYPE OF ACCOUNT REQUESTED:

ACCOUNT MANAGER

 

USER

 

PERMISSION REQUESTED:

INITIATE PSI

REVIEW e-QIP

OVERRIDE PSI

APPROVE e-QIP

DD FORM 2962, SEP 2013

Adobe Designer 9.0

NAME (Last Name, First Name, Middle Initial) _______________________________________

20. ACCESS REQUESTED - INDUSTRY:

 

 

 

21. ACCESS REQUESTED - NON-INDUSTRY:

 

 

 

 

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

 

 

22. JOINT ADJUDICATION MANAGEMENT SYSTEM (JAMS) USER ROLES (DoD/NON-INDUSTRY ONLY)

CAF:

 

 

CAF TEAM:

 

EMPLOYEE CODE:

 

 

 

 

 

23. ACCESS REQUESTED:

 

 

24. USER PERMISSIONS:

ACCOUNT MANAGER

 

CUSTOMER SUPPORT

SAP

CASE MANAGEMENT

MANAGER

 

ADJUDICATOR

SCI

UPDATE CASE COMPONENT

COMPUTER ANALYST

MANAGEMENT

TS

ASSIGN CAF CASES

CASE ASSIGNMENT

 

SUPPORT

SECRET

REVIEW REQUIRED

 

 

 

 

PERSONNEL

 

PENDING USER

REPORTS

REASSIGN TO OTHER CAF

 

 

SECURITY ASSISTANT

SUPERVISOR

JCAVS

ASSIGN/REASSIGN CASES

 

 

MAILROOM

LAA

REASSIGN FROM OTHER EMPLOYEE

 

 

 

 

 

 

25. SPECIAL CASE USER CAN HANDLE

 

 

CAF EMPLOYEES

PRESIDENTIAL SUPPORT

GS-15/GENERAL OFFICER

 

 

 

 

 

26. INVESTIGATION REQUEST PERMISSIONS:

REVIEW PSQ

 

APPROVE e-QIP

 

 

 

 

 

 

 

PART 4 (To be completed by Applicant) - APPLICANT'S CERTIFICATION

 

 

 

 

 

 

 

 

 

I hereby certify that I understand that by signing this personnel security system access request, I am solely responsible for the use and protection of the account that I will be provided. I also understand that I am not authorized to share my account or logon credentials with any other individuals. I will utilize all tools and applications in accordance with the account management policy and security policy, as well as all applicable U.S. laws and DoD regulations. I understand that if I violate any account management policy, security policy, U.S. laws or DoD regulations, my account will immediately be terminated, I will no longer be responsible for an account, and may be subject to criminal charges and penalties.

27. APPLICANT'S SIGNATURE

 

28. DATE (YYYYMMDD)

 

 

 

 

PART 5 - NOMINATING OFFICIAL'S CERTIFICATION

 

 

 

I certify that the above named individual meets the requirements for access, has the appropriate need-to-know, and if applicable, meets the requirements for account management privileges. I am also aware that I am responsible for ensuring this individual will follow all account policies, security policies, and all applicable DoD regulations and U.S. laws. Furthermore, I certify that the named applicant requires account access as indicated above in order to perform assigned duties. These duties include:

29.

NOMINATING OFFICIAL'S PRINTED NAME (Last, First, Middle Initial)

30.

NOMINATING OFFICIAL'S SIGNATURE AND DATE

 

 

 

 

31.

NOMINATING OFFICIAL'S TITLE

32.

NOMINATING OFFICIAL'S TELEPHONE NUMBER

 

 

 

 

PART 6 - VALIDATING OFFICIAL'S VERIFICATION

 

 

 

 

I have verified that minimum investigative requirements for the above applicant have been met and the applicant has the necessary need- to-know to access the personnel security systems requested.

33.

CLEARANCE LEVEL:

34.

TYPE OF INVESTIGATION:

 

 

 

 

35.

CLEARANCE GRANTED DATE:

36.

DATE INVESTIGATION COMPLETED:

 

 

 

 

37.

CLEARANCE ISSUED BY:

38.

INVESTIGATION CONDUCTED BY:

 

 

 

 

39.

VALIDATING OFFICIAL'S PRINTED NAME (Last, First, Middle Initial)

40.

VALIDATING OFFICIAL'S SIGNATURE AND DATE

 

 

 

 

DD FORM 2962 (BACK), SEP 2013

PERSONNEL SECURITY SYSTEM ACCESS REQUEST (PSSAR) INSTRUCTIONS

Name. Last Name, First Name, Middle Initial of Applicant. If no middle initial, enter "NMN."

Type of Request. Select "initial" for a new account, "modification" for a change in privileges to an existing account, "deactivate" to remove all access and disable an existing account. Complete the User ID field if selecting "modification" or "deactivate."

Date. Date request is submitted.

Part 1 - Personal Information.

1.Name. Last Name, First Name, Middle Initial of Applicant. If no middle initial, enter "NMN."

2.Organization. Employing organization of Applicant.

3.Office Symbol/Department. Employing office symbol or department.

4.Phone. Telephone number of Applicant. Enter DSN or Commercial as appropriate.

5.Official E-mail Address. Official e-mail address of Applicant to be used for account communication.

6.Job Title and Grade/Rank. Job title and pay grade or military rank of Applicant.

7.Official Mailing Address. Official mailing address of Applicant.

8.Citizenship. Country of citizenship. If dual, enter both countries.

9.Date of Birth. Applicant's date of birth.

10.Place of Birth. City and state, if U.S. citizen. Otherwise, enter country and city.

11.Social Security Number. SSN of Applicant.

12.CAGE Code. NISP Contractor only: CAGE code of Applicant.

13.Designation of Person. Mark (X) the appropriate box for DoD (e.g., military branches, DoD agencies, DoD contractor companies, non-DoD NISP partner and non-DoD affiliated).

Part 2 - Training.

14.- 16. Training Requirements. Mark (X) the box to certify training was completed and enter the completion date for all new accounts. Training requirements are defined in the respective System Account Management Policies available from the DMDC PSA website.

Part 3 - Applications.

17.Agency Code/Agency Acronym. Complete if requesting a DCII account.

User: Complete if requesting a DCII account.

File Demand: Complete if requesting a DCII account.

18.CAGE Code(s). CAGE code(s) of Applicant.

19.Type of Account Requested. Select "Account Manager" only if Applicant is to manage JCAVS accounts on behalf of the organization/ company service.

Permissions Requested: Select appropriate permission(s).

20.Access Requested - Industry. Select appropriate permission(s).

21.Access Requested - Non-Industry. Select appropriate permission(s).

22.JAMS User Roles. Provide information and select appropriate boxes for user functions, access and permissions. JAMS is only authorized for DoD CAFs.

23.Access Requested. JAMS access requested.

24.User Permissions. JAMS user permission(s).

25.Special Case User Can Handle. Select high priority cases JAMS user can handle.

26.Investigation Request Permissions. Select Investigation Request permissions for JAMS user.

Part 4 - Applicant's Certification.

27.Applicant's Signature. Signature of Applicant acknowledging DoD and system policies.

28.Date. Date application signed by Applicant.

Part 5 - Nominating Official's Certification.

29.Nominating Official's Name. First Name, Middle Initial, and Last Name. If no middle initial, enter "NMN."

30.Nominating Official's Signature and Date. The Nominating Official is the individual who is authorizing that the Applicant should have the access requested. The Nominating Official may be a Corporate Officer (KMP) listed in ISFD, Facility Security Officer, or Security Officer/Manager. For JCAVS Industry Account Managers, the PSSAR must be signed by the same KMP who signed the Appointment Letter. The Nominating Official CANNOT be the same as the Applicant unless it is a single person facility.

NOTE: PSSARs submitted without the Nominating Official's statement regarding duties and signature will not be processed.

31.Nominating Official's Title. Title of Nominating Official.

32.Nominating Official's Phone Number. DSN or Commercial telephone number of Nominating Official.

Part 6 - Validating Official's Verification.

33.Clearance Level. Clearance level of individual. See applicable System Account Management Policies/Access Request Procedures available from the respective DMDC PSA system website for minimum clearance requirements.

34.Type of Investigation. Type of investigation completed for Applicant.

35.Clearance Granted Date. Date clearance granted. If not final, state date of interim.

36.Date Investigation Completed. Date investigation completed.

37.Clearance Issued By. Organization that issued clearance.

38.Investigation Conducted By. Investigating agency.

39.Validating Official's Printed Name. First Name, Middle Initial, and Last Name. If no middle initial, enter "NMN."

40.Validating Official's Signature and Date. The Validating Official signature serves to affirm the information provided on the following lines (verify before signing): Clearance Level; Clearance Granted Date; Clearance Issued By; Type of Investigation; Date Investigation Completed; and Investigation Conducted By. For non-DoD government agency requests, the Chief of Security or designee must complete this section.

Return completed forms to the appropriate Account Manager or the DMDC Contact Center as outlined in the respective System Access Request Procedures available from the DMDC PSA website.

DD FORM 2962 (INSTRUCTIONS), SEP 2013

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How to fill in pssar diss part 1

2. Immediately after this part is filled out, proceed to enter the suitable details in these - TYPE OF REQUEST, DATE YYYYMMDD, INITIAL, MODIFICATION, DEACTIVATE, USER ID, NAME Last First Middle Initial, ORGANIZATION, PART To be completed by Applicant, OFFICE SYMBOLDEPARTMENT, PHONE DSN or Commercial, OFFICIAL EMAIL ADDRESS, JOB TITLE AND GRADERANK, OFFICIAL MAILING ADDRESS, and CITIZENSHIP.

INITIAL, PART To be completed by Applicant, and NAME Last First Middle Initial of pssar diss

3. The next step should be relatively simple, USER Select Permissions Below, FILE DEMAND Provide Accreditation, QUERY SEARCH, ADD, DELETE, UPDATE, FILE DEMAND PRINT, EXECUTIVE ADMINISTRATOR, AGENCY ADMINISTRATOR, IA ROOT ADMINISTRATOR, SECURE WEB FINGERPRINT, CAGE CODES, USER, MULT COMPANY UPLOADER, and ACCOUNT MANAGER - each one of these fields will have to be filled in here.

Part number 3 for filling in pssar diss

4. This fourth paragraph arrives with these particular blanks to consider: NAME Last Name First Name Middle, ACCESS REQUESTED INDUSTRY, ACCESS REQUESTED NONINDUSTRY, LEVEL, LEVEL, LEVEL, LEVEL, LEVEL, LEVEL, LEVEL, CORPORATE OFFICER SCI, COMPANY FSO OFFICERMANAGER SCI, CORPORATE OFFICERS MANAGER, COMPANY FSO OFFICERSMANAGER, and UNIT SECURITY MGRVISITOR CONTROL.

Writing segment 4 in pssar diss

5. The very last step to finalize this form is pivotal. You need to fill in the necessary blank fields, and this includes MAILROOM, LAA, REASSIGN FROM OTHER EMPLOYEE, SPECIAL CASE USER CAN HANDLE, CAF EMPLOYEES, PRESIDENTIAL SUPPORT, GSGENERAL OFFICER, INVESTIGATION REQUEST PERMISSIONS, REVIEW PSQ, APPROVE eQIP, PART To be completed by Applicant, I hereby certify that I understand, APPLICANTS SIGNATURE, DATE YYYYMMDD, and PART NOMINATING OFFICIALS, prior to submitting. Neglecting to do this may generate an unfinished and potentially invalid form!

Filling in part 5 of pssar diss

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