Form Cg 7421G – Fill Out and Use

8. Authorizing Official (Signature & Typed or printed name, Rank, Title (HSWL Product-Line Manager (PLM) (Field Office Supervisor)) & Phone Number):

I certify that the access I have authorized is based on an official need. I'm aware of the general functionality I have authorized and I'm aware of what this will allow this member to complete. If this is for a contractor, the Contracting Officer’s Technical Representative (COTR) signs as AO.

____________________________________________________________________________________________________________________

10 . Approving Official (Signature & Typed or printed name, Rank, Title (Headquarters Program Manager, Work-life Division Chief):

I certify that the access I have authorized is based on an official need. I'm aware of the general functionality I have authorized and I'm aware of what this will allow this member to complete. If this is for a contractor, the Contracting Officer’s Technical Representative (COTR) signs as AO.

____________________________________________________________________________________________________________________

Privacy Act Statement

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

PRINCIPAL PURPOSE: To record names, signatures, and other identifiers for the purpose of identifying individuals requesting access to U. S.

Acknowledgment: I understand that I am authorized to access the Direct Access system and that accessing it for purposes beyond the Scope of

Authorization is a violation of Federal law (18 U.S.C. 1030 et al) (Note: Refer to the Automated Information Systems (AIS) User Acknowledgement Form (CG-5500A), which is required for all U.S. Coast Guard AIS users, it contains the full Scope of Authorization and Acknowledgement.)

CG-7421G (Rev. May 2013) (Reverse)

Please “How to complete and route the User Access Form (CG-7421G)” at http://www.uscg.mil/ppc/wims/ for additional/updated information.

Block Instructions

1Enter the user’s last name, first name and middle initial.

2Enter the user’s Rank (e.g. “CAPT”) or Rate (e. g. “YN1”) or GS paygrade (e. g. “GS7”)

3Enter the user’s employee number. The employee ID number can be found on the unit roster. Any member of the command that already has access to Direct-Access can access the unit roster and locate the employee’s employee ID number. Follow these steps to access the unit roster:

•Select the following links on the Portal home page: Self Service for Commands > Use >

Command Information

•The department lookup page will display. The relationship type field will show "Own unit only" and the department field will show your sub-department ID number. Enter the department ID number for the unit in the department field.

•Click the Search button to continue.

•When the Airport Terminal displays click on the CG Dept Run tab.

•Choose “Civilian” from the drop-down menu in the Source field.

•Click the Execute button. The roster section will fill in with the information. Only the first five rows will be displayed. Click the View All link to see the remaining rows. The Employee ID number is shown in the second column.

4Enter the name of the unit the user is assigned, include the staff symbol if applicable.

5 Enter the user’s business phone number, including the area code 6 Enter the user’s business e-mail address.

7 Choose the appropriate user role from the list provided.

8The HSWL Regional Manager (RM) (Field Office Supervisor) will complete block 8.

9 Enter the date the form was signed by the authorizing official

10 Enter the Name, Rank, Title and Phone number of the approving official. (See “Requires Approval by” above)

11 Enter the date the form was signed by the authorizing official 12 User signs here.

13 Enter the date the form was signed by the user.

CG-7421G (Rev. May 2013) (Reverse)

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