DD Form 2962: Personnel Security System Access Request (PSSAR)

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.

Enter User ID if selecting "modification" or "deactivate."

In Box 1, NAME, enter the Last Name, First Name, Middle Initial of the applicant. If no middle initial, enter "NMN."

In Box 2, ORGANIZATION, enter the employing organization or company name of the applicant; in Box 3, OFFICE SYMBOL / DEPARTMENT, enter the employing department or office.

In Box 4, PHONE (DSN or Commercial), enter the telephone number of the applicant. Enter DSN or Commercial as appropriate.

In Box 5, OFFICIAL E-MAIL ADDRESS, enter the official e-mail address of the applicant to be used for account communication; in Box 6, JOB TITLE AND GRADE/RANK, enter the job title and pay grade or military rank of the applicant.

In Box 7, OFFICIAL MAILING ADDRESS, enter the official mailing address of the applicant.

In Box 8, CITIZENSHIP, enter the country of citizenship. If dual, enter both countries.

In Box 9, DATE OF BIRTH (YYYYMMDD), enter the date of birth of the applicant.

In Box 10, PLACE OF BIRTH (City & State/Country), enter the city and state, if born in the U.S. Otherwise, enter city and country.

Social Security Number (SSN) is required in Box 11, SOCIAL SECURITY NUMBER.

In Box 12, CAGE CODE (CTR Only), contractor only: enter the CAGE code of the applicant.

In Box 13, DESIGNATION OF APPLICANT, mark in the appropriate box for DOW (e.g., military branches, DOW agencies, DOW contractor companies), non-DOW NISP partner and non-DOW affiliated.

Under Part 2 - Applications, in Box 14, Defense Central Index of Investigations (DCII) (GOVERNMENT ONLY), complete a. DCII AGENCY CODE OR DCII AGENCY ACRONYM if requesting a DCII account.

Provide the DCII Agency Code/DCII Agency Acronym if previously assigned by DCII Administrator and known. Otherwise, contact DMDC Contact Center for assistance.

In b. USER PERMISSIONS, requested user permissions are restricted to those granted to the Agency. Elevated permissions for the Agency must be requested from DCII Program Manager.

In Box 15, Secure Web Fingerprint Transmission (SWFT), a. PERMISSIONS - FINGERPRINT SUBMISSION applies to SWFT users: indicate the requested user permission(s) by marking the appropriate box.

Only complete this section, b. PERMISSIONS - FINGERPRINT ENROLLMENT, if you have or request a SWFT account (Government Only) and are cleared to use the web-based fingerprint enrollment system. Indicate the requested user permission(s) by marking the appropriate box.

In c. ADDITIONAL CAGE/ORGANIZATION CODE(S), list only if different from box 12 of this form. Cannot add CAGE or Organization code(s) to account with Multi-Site Uploader permission.

The Nominating Official must have the authority to permit the use of the CAGE Code(s) by Applicant.

In Box 16, Defense Information System for Security - Joint Verification System (DISS-JVS), a. SMO NAME: ORGANIZATION/AGENCY CODE: is the Security Management Office name or Organization/Agency code.

In b. ROLE REQUESTED AND OPTIONAL PERMISSIONS (Mark All That Apply), indicate the requested user role(s) by marking the appropriate box, along with any optional permissions requested.

In a. APPLICATION LOCATION, enter the Organization Name, Division Name, Branch Name, Team Name.

In b. ROLE REQUESTED, indicate the requested user role(s) by marking the appropriate box.

In c. LIST ANY ELEVATED PERMISSIONS, list any Elevated Permission(s). This information is requested by the user.

Under Box 18, Defense Information System for Security - Appeals, a. APPLICATION LOCATION is the Organization Name, Division Name, Branch Name, Team Name.

Indicate requested user role(s) by marking the appropriate box, along with any optional permission requested.

In Box 19, National Background Investigation Services (NBIS), a. ROLE REQUESTED: is the user role being requested for system access.

In b. LIST ANY ELEVATED PERMISSIONS, list the optional permissions for requested roles.

Under PART 3 - TRAINING, in 20. CYBER AWARENESS TRAINING and 21. PERSONALLY IDENTIFIABLE INFORMATION TRAINING, mark in the box to certify training units completed and enter completion date (YYYYMMDD) for new accounts.

Certificates must be submitted with PSSAR within one year of training completion date.

Under PART 4, 22. APPLICANT'S SIGNATURE is the signature of the applicant acknowledging DOW and system policies, and 23. DATE (YYYYMMDD) is the date application signed by the applicant.

Applicant's certification: "I also understand that I am not authorized to share my account or logon credentials with any other individuals."

Applicant's certification: "I understand that if I violate any account management policy, security policy, U.S. laws or DOW regulations, my account will immediately be terminated, and may be subject to criminal charges and penalties."

In PART 5, 24. the Nominating Official certifies: "I certify that the individual named on this form meets the requirements for access, has the appropriate need-to-know, and if applicable, meets the requirements for account management privileges." Furthermore, the named applicant requires account access as indicated on this form in order to perform assigned duties.

In 25. NOMINATING OFFICIAL'S PRINTED NAME, enter the Last Name, First Name, and Middle Initial. If no middle initial, enter "NMN." In 26. NOMINATING OFFICIAL'S TITLE, enter the title of the Nominating Official.

In 27. NOMINATING OFFICIAL'S TELEPHONE NUMBER, enter the DSN or Commercial telephone number. The Nominating Official signs in 28. NOMINATING OFFICIAL'S SIGNATURE and enters the date in 29. NOMINATING OFFICIAL'S SIGNATURE DATE.

The Nominating Official is the individual who is authorizing that the Applicant should have the access requested. The Nominating Official must be a Key Management Personnel (KMP) listed in NISS, Facility Security Officer, or Security Officer/Manager. The Nominating Official CANNOT be the same as the Applicant unless it is a single person facility.

Do not complete PART 6 - VALIDATING OFFICIAL'S VERIFICATION if self-nominating/validating.

In 30. ELIGIBILITY/ACCESS LEVEL, enter the eligibility/access level of the applicant. See applicable System Account Management Policies/Access Request Procedures available from the respective DCSA website for minimum eligibility/access requirements.

In 31. TYPE OF INVESTIGATION, enter the type of investigation completed for the applicant.

In 32. ELIGIBILITY GRANTED DATE, enter the date clearance granted, indicating if interim. If not final, state date of interim. In 33. DATE INVESTIGATION COMPLETED, enter the date investigation completed.

In 34. ELIGIBILITY ISSUED BY, enter the organization that issued clearance. In 35. INVESTIGATION CONDUCTED BY, enter the investigating agency.

In 36. VALIDATING OFFICIAL'S PRINTED NAME, enter the Last Name, First Name, and Middle Initial. If no middle initial, enter "NMN." The Validating Official signature serves to affirm the information provided on the following lines (verify before signing): Eligibility/Access Level; Eligibility Issued By; Type of Investigation and Investigation Conducted By.

For non-DOW government agency requests, the Chief of Security or designee must complete this section. 38. VALIDATING OFFICIAL'S SIGNATURE DATE is the Validating Official's Signature Date.

Return completed form to the appropriate Account Manager or DCSA Contact Center, as indicated in the instructions.