Dss Form 273 PDF Details

When it comes to ensuring the security and appropriate access to Department of Defense (DoD) systems and information, the DSS Form 273 plays a crucial role. This System Access Request (SAR), outlined within the Enterprise Security System (ESS), is designed with a multi-faceted approach to validate the trustworthiness of individuals before granting them the necessary privileges. The form encompasses several critical details, including the necessity to record names, signatures, and Social Security Numbers under the advisement of the Privacy Act. It is instrumental in establishing a robust framework that enables a range of user access levels, from DoD military and civilian personnel to contractors and non-DoD individuals. Moreover, it addresses various request types such as account creation, name changes, and deletion of accounts among others. With provisions for user information, specific applications access, and distinct levels of permission requested, the form ensures a meticulous process before access is granted. This thorough vetting process is further reinforced by the nominating official’s certification, the user’s acknowledgment of responsibilities, and the validating official’s verification, which collectively solidify the integrity and security of the DoD's informational assets. Special attention is also given to the conditions under which these records may be disclosed to external entities, highlighting the form's critical role in both security and legal compliance. The instructions attached to the form serve as a comprehensive guide, ensuring clarity and ease of submission, which is pivotal for the timely and efficient processing of access requests to safeguard DoD's vital information systems.

QuestionAnswer
Form NameDss Form 273
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesSSO, dss form 273, 552a, DCII

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SYSTEM ACCESS REQUEST (SAR)

Enterprise Security System (ESS)

Phone: 888.282.7682

OMB No. Pending OMB approval expires

XXXXXXXXXXXXXXX

PRIVACY ACT ADVISEMENT:

AUTHORITY: Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act.

PRINCIPAL PURPOSE: 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. NOTE: Records may be maintained in both electronic and/or paper form.

ROUTINE USES: 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 DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: To a Federal, State, or local law enforcement agency when your agency becomes aware of a violation or possible violation of civil or criminal law; to the Department of Justice for the purposes of representing the DoD in pending or potential litigation to which the record is pertinent; to the Merit Systems Protection Board for the purpose of litigation or investigation of alleged or possible prohibited personnel practices; to a Federal agency when conducting an investigation or inquiry for security or audit reasons; or the General Services Administration in connection with its responsibilities for records management.

DISCLOSURE: Disclosure of this information (to include social security number) is voluntary; however, failure to provide the requested information will impede, delay or prevent further processing of this request.

1.TYPE OF USER

DoD (Military or Civilian)

DoD Contractor

Non-DoD NISP

Non-DoD

2.TYPE OF REQUEST:

Create an Account

Name Change (Last, First, Middle)

From:

Delete an Account

To:

Change User Level (JPAS Only)

3.USER INFORMATION (Must fill in completely; please type)

Last Name:

First Name:

 

Middle Name:

Social Security Number:

Date of Birth:

 

POB:

 

 

 

 

 

Job Title/Rank/Grade:

 

 

 

 

 

 

 

 

Organization Name:

 

 

Office Symbol:

CAGE Code (NISP Contractor Only):

 

 

 

 

Business/Duty Station Address (street, city, state, zip code):

 

Telephone Number:

 

Fax Number:

 

 

 

 

 

 

e-Mail Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

APPLICATIONS

 

 

 

 

Defense Central Index of Investigations (DCII)

 

OTHER

 

 

(Government Only)

 

 

 

Agency Site Administrator or Coordinator

 

Industrial Security Facilities Database (ISFD)

 

User :

 

 

Secure Web Fingerprint Transmission (SWFT)

 

 

 

 

Industry Site Administrator

 

Query

Agency Code__________

 

Industry User

 

Add

 

 

 

 

Delete

 

 

Other (Please Specify)

 

Update

 

 

_____________________________________

 

File Demand (Provide Accreditation Code):

 

_____________________________________

 

__________________________

 

_____________________________________

 

File Demand Print

 

 

 

 

 

 

 

 

 

 

 

 

5.

JCAVS

 

 

 

Type of Account Requested:

Account Manager

User

Permission Requested:

Initiate PSI

Review e-QIP

Override PSI

Approve e-QIP

Access Requested – Industry: (Must submit signed Letter of Appointment)

Level

2

Corporate Officer (SCI)

 

 

Level 3

Company FSO Officer/Manager (SCI)

 

 

 

Level

4

Corporate Officers Manager

 

 

Level 5

Company FSO Officers/Manager

 

 

 

Level

6

Unit Security Manager/Visitor Control

 

 

 

Level

7

Guard Entry Personnel

 

 

 

Level

8

Guard Entry Personnel (SCI)

Level 10

Visitor Management

Access Requested – Non-Industry:

Level 2 MACOM/Activity/HQ/Agency SSO

Level 3 Base/Post/Ship/etc. SSO

Level 4 MACOM Non-SCI Security Manager

Level 5 Base/Post/Ship/Non-SCI Security Mgr

Level 6 Unit Security Manager

Level 7 Collateral Entry Controller

Level 8 SCIF Entry Controller

Level 10 Visitor Management

DSS FORM 273, JUNE 2011

PREVIOUS EDITIONS ARE OBSOLETE

Page 1 of 3

User’s Last Name, First Initial: ________________________________________________

6.JAMS USER ROLES (DoD/Non-Industry Only)

CAF:

CAF Team:

Employee Code:

Account Manager

Security Assistant

Pending User

Manager

Customer Support

Supervisor

Computer Analyst

Adjudicator

Mailroom

Case Assignment Personnel Management Support

Special Case User Can Handle:

CAF Employees

Presidential Support

GS-15/General Officer

Investigation Request Permissions:

Review PSQ

Approve e-QIP

User Permissions:

SAP Reports

Case Management Reassign to Other CAF

SCI

JCAVS

Update Case Component

Assign/Reassign Cases

TS FOIA/PA Assign CAF Cases Reassign from Other Employee

Secret

LAA

Review Required

7. NOMINATING OFFICIAL’S CERTIFICATION (Note 1)

I certify that the above named individual meets the requirements for access and account management privileges. Furthermore, I certify that the named user requires account/access as indicated above in order to perform assigned duties.

Nominating Official’s Printed Name

 

Nominating Official’s Signature and Date

 

 

 

Nominating Official’s Title

 

Nominating Official’s Telephone Number

8. USER’S CERTIFICATION

I hereby certify that I understand that by signing this System Access Request, I am solely responsible for the use and protection of the user ID and password that I will be provided. I also understand that I am not authorized to share my user ID and password 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.

User’s Printed NameUser’s Signature and Date

9. VALIDATING OFFICIAL’S VERIFICATION (Note 2)

I have verified with the appropriate security official/manager that minimum investigative requirements for the above user have been met.

Clearance Level: ____________________________

Type of Investigation: _______________________________

Clearance Granted Date: ______________________

Date Investigation Completed: ________________________

Clearance Issued By: _________________________

Investigation Conducted By:__________________________

Printed Name of DoD Security Services Center Representative or Security Official

Signature of DoD Security Services Center Representative or Security Official, and Date

10.ADDITIONAL SAR DIRECTIVES

The SAR must be signed by the Nominating Official and the User or it will not be processed.

Refer to page 3 of this form and JPAS, ISFD, DCII and SWFT Frequently Asked Questions (FAQs) at https://www.dss.mil or https://www.dmdc.osd.mil/psawebdocs, for additional SAR submission procedures pertaining to the respective systems (for example, please be advised that the DSS DoD Security Services Center does not process JCAVS access requests for military personnel; these requests should be submitted to the appropriate military agency approving authority).

SARs requiring DSS processing/approval should be submitted to the DoD Security Services Center via fax number 703.493.8965, e-mail address account.request@dsshelp.org, or mailing address DoD Security Services Center, 10430 Furnace Road, Suite 101, Lorton, VA, 22079. Please allow at least three (3) business days for the SAR to be processed by the DoD Security Services Center. Notification of access will be sent to the User’s e-mail address. To ensure receipt of the access notification e-mail, add account.request@dsshelp.org to your e-mail contacts list.

The completed SAR must be maintained by the account manager for a minimum of six (6) months after the account is deleted.

Notes:

1.Nominating Official may be the Facility Security Officer, KMP, Security Manager, Information Systems Security Officer, Agency Administrator, etc. In most cases, the Nominating Official MUST be other than the User.

2.Validating Official is either a representative of the DoD Security Services Center, or if the SAR is staying within the organization, the appropriate security official. For non-DoD government agency requests, non-DoD government agency security officials must complete this section.

DSS FORM 273 (BACK), JUNE 2011

Page 2 of 3

SYSTEM ACCESS REQUEST (SAR) INSTRUCTIONS

Enterprise Security System (ESS)

SECTION

TITLE

INSTRUCTIONS

 

 

 

 

1

TYPE OF USER

Check the appropriate box for DoD (e.g., Military Branches, DoD Agencies), DoD

 

 

Contractor Companies, Non-DoD NISP Partners and Non-DoD affiliated.

 

 

 

 

 

2

TYPE OF REQUEST

Check the appropriate box indicating purpose for the SAR.

 

 

 

 

3

USER INFORMATION

Must completely fill in. If no middle name, enter NMN. Ensure e-mail address is accurate;

 

 

account access credentials are transmitted via e-mail.

 

 

 

 

 

4

APPLICATIONS

Check the application(s) and function(s) the user requires.

 

 

 

 

 

5

JCAVS

Check appropriate boxes. See definitions below.

 

 

 

NOTE: The appointment letter must be drafted on company letterhead, must name the

 

 

Primary Account Manager and must be signed by a corporate officer (KMP). The same

 

 

KMP must sign both the SAR (nominating official) and the letter.

 

 

 

 

5

ACCOUNT MANAGER

Account Managers will provide account maintenance on all user accounts created within

 

 

their company. Responsibilities include, but are not limited to, locking/unlocking accounts,

 

 

resetting passwords, logging off users, deleting accounts when no longer needed and

 

 

maintaining their Security Management Offices (SMO). Account managers will create any

 

 

additional accounts that are required.

 

 

 

 

5

USER

Depending on the level of access, users may verify clearances, update accesses, process

 

 

visit notifications, and handle all other functions within JCAVS.

 

 

 

 

 

5

ACCESS REQUESTED –

Check appropriate block, using the following guidance:

 

 

INDUSTRY

Level 2: SCI security personnel at Corporate level, with read and write access.

 

 

Level 3: SCI security personnel at echelons subordinate to Level 2 at a particular

 

 

geographic location, with read and write access.

 

 

 

Level 4: Non-SCI security personnel at Corporate level, with read and write access.

 

 

Level 5: Non-SCI security personnel immediately subordinate to Level 4, with read and

 

 

write access.

 

 

 

Level 6: Non-SCI security personnel immediately subordinate to Level 5, with read and

 

 

write access.

 

 

 

Level 7: Non-SCI security personnel who accomplish entry control (i.e., access to

 

 

installations, buildings, etc.), with read-only access.

 

 

 

Level 8: SCI security personnel who accomplish entry control, with read-only access.

 

 

Level 10: Non-SCI security personnel who accomplish visitor management, with read-only

 

 

access.

 

 

 

 

 

5

ACCESS REQUESTED –

Self-explanatory; check appropriate block.

 

 

DoD (NON-INDUSTRY)

 

 

 

 

 

N/A

TOP OF PAGE 2

Ensure User’s last name and first initial are entered at the top of the page in the space

 

 

provided.

 

 

 

 

6

JAMS USER ROLES

Provide information and check appropriate boxes for user functions, access, and

 

 

permissions. JAMS is only authorized for DoD CAFs.

 

 

 

 

7

NOMINATING OFFICIAL’S

The Nominating Official is the individual who is authorizing that the User should have the

 

CERTIFICATION

requested accesses. The Nominating Official may be a Corporate Officer (KMP), Facility

 

 

Security Officer, Security Manager, Information Systems Security Officer, Agency

 

 

Administrator, etc. For JCAVS Industry Primary Account Managers, the SAR must be

 

 

signed by the same KMP that signed the Appointment Letter. The Nominating

 

 

Official CANNOT be the same as the User. Exceptions include the company President,

 

 

for JCAVS, and the FSO, for ISFD. NOTE: SARs submitted without the Nominating

 

 

Official’s signature included will not be processed.

 

 

 

 

 

8

USER’S CERTIFICATION

User must sign, acknowledging DoD/system policy.

 

 

 

 

9

VALIDATING OFFICIAL’S

The DoD Security Services Center (for industry only) or the Security Manager must verify

 

VERIFICATION

and indicate the following information on the following lines prior to 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.

 

 

 

 

10

ADDITIONAL SAR

Provided to facilitate successful processing of the SAR.

 

 

DIRECTIVES

 

 

 

 

 

 

DSS FORM 273 (INSTRUCTIONS), JUNE 2011

Page 3 of 3

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entering details in e-QIP part 1

Feel free to submit the Query Agency Code Add Delete, File Demand Print, JCAVS Type of Account Requested, Initiate PSI, Account Manager, Level Level Level Level Level, Corporate Officer SCI Company FSO, Other Please Specify, User, Access Requested NonIndustry, Level Level Level Level Level, MACOMActivityHQAgency SSO, Review eQIP, Override PSI, and Approve eQIP box with the essential particulars.

step 2 to finishing e-QIP

Write the fundamental particulars when you are within the Users Last Name First Initial, JAMS USER ROLES DoDNonIndustry, CAF, Account Manager Security Assistant, CAF Team, Manager Customer Support Supervisor, Special Case User Can Handle, Employee Code, Computer Analyst Adjudicator, Case Assignment Personnel, CAF Employees, Presidential Support, GSGeneral Officer, Investigation Request Permissions, and Review PSQ User Permissions part.

e-QIP Users Last Name First Initial, JAMS USER ROLES DoDNonIndustry, CAF, Account Manager Security Assistant, CAF Team, Manager Customer Support Supervisor, Special Case User Can Handle, Employee Code, Computer Analyst Adjudicator, Case Assignment Personnel, CAF Employees, Presidential Support, GSGeneral Officer, Investigation Request Permissions, and Review PSQ User Permissions fields to fill

The I hereby certify that I understand, Users Printed Name, Users Signature and Date, VALIDATING OFFICIALS VERIFICATION, I have verified with the, Clearance Level Clearance Granted, Type of Investigation Date, Printed Name of DoD Security, Signature of DoD Security Services, ADDITIONAL SAR DIRECTIVES, The SAR must be signed by the, SARs requiring DSS, email address, The completed SAR must be, and Notes Nominating Official may be box is where all parties can indicate their rights and responsibilities.

Entering details in e-QIP part 4

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