Form Pssar PDF Details

The Pennsylvania System of School Assessment (Pssa) is a set of examinations that are administered to students in grades 3-8 and 11. The purpose of the Pssa is to measure student achievement in key subjects, including reading, writing, math, science, and social studies. In order to ensure that students are prepared for these important exams, it is important to understand the format and content of the Pssa. This blog post will provide an overview of the Pssa exam format and content, as well as helpful tips for preparing for the test. Stay tuned for our next blog post, which will offer strategies for how best to approach each section of the exam.

QuestionAnswer
Form NameForm Pssar
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesform 2962 form, dd2962v2, form security system access request, form pssar form

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NAME (LAST NAME, FIRST NAME, MIDDLE INITIAL) ________________________________

PERSONNEL SECURITY SYSTEM ACCESS REQUEST (PSSAR)

OMB No. 0704-0542

OMB approval expires

DEFENSE MANPOWER DATA CENTER (DMDC) - Version 1

20211031

 

 

 

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, Directives Division, 4800 Mark Center Drive, Alexandria,

VA 22350-3100 (0704-0542). 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/SORNsIndex/BlanketRoutineUses.aspx 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 (REQUIRED)

INITIAL

 

MODIFICATION

DATE (YYYYMMDD)

DEACTIVATE

USER ID (EXISTING ACCOUNTS) _________________

PART 1 - PERSONAL INFORMATION

1.

NAME (LAST, FIRST, MIDDLE INITIAL)

2.

ORGANIZATION

 

 

 

 

 

 

3.

OFFICE SYMBOL/DEPARTMENT

4.

TELEPHONE (DSN or COMMERCIAL)

 

 

 

 

 

5.

OFFICIAL E-MAIL ADDRESS

6.

JOB TITLE AND GRADE/RANK

 

 

 

 

 

 

7.

OFFICIAL MAILING ADDRESS

8.

CITIZENSHIP

9. DATE OF BIRTH (YYYYMMDD)

 

 

 

10. PLACE OF BIRTH (CITY & STATE/COUNTRY)

11. SOCIAL SECURITY NUMBER

12. CAGE CODE (CTR ONLY)

 

 

 

 

 

13. DESIGNATION OF APPLICANT

MILITARY

DoD CIVILIAN

INDUSTRY

NON-DoD

PART 2 - APPLICATIONS

14. DEFENSE CENTRAL INDEX OF INVESTIGATIONS (DCII) (GOVERNMENT ONLY)

a. DCII AGENCY CODE ______________________________________ OR

DCII AGENCY ACRONYM ______________________

b. USER PERMISSIONS

 

 

 

 

 

QUERY (SEARCH)

ADD

UPDATE

DELETE

AGENCY ADMINISTRATOR

EXECUTIVE ADMINISTRATOR

FILE DEMAND (PROVIDE ACCREDITATION CODE): ______________

FILE DEMAND PRINT

IA (ROOT ADMINISTRATOR)

15.SECURE WEB FINGERPRINT TRANSMISSION (SWFT) (GOVERNMENT/INDUSTRY) a. PERMISSIONS - FINGERPRINT SUBMISSION

USER

MULTI-SITE UPLOADER

SITE ADMINISTRATOR

ORGANIZATION/COMPANY ADMINISTRATOR

b. PERMISSIONS - FINGERPRINT ENROLLMENT

ENROLLER

TRANSACTION VIEWER

ENROLLER SITE ADMINISTRATOR

ENROLLER GROUP ADMINISTRATOR

 

c. ADDITIONAL CAGE/ORGANIZATION CODE(S): ___________________________

 

OTHER:

 

 

 

 

 

 

 

 

 

 

 

16. JOINT CLEARANCE ACCESS VERIFICATION SYSTEM (JCAVS) (GOVERNMENT/INDUSTRY)

 

 

 

 

 

 

 

 

 

 

a. TYPE OF ACCOUNT REQUESTED:

ACCOUNT MANAGER

 

 

 

 

 

 

 

 

 

 

 

b. ACCESS REQUESTED - INDUSTRY:

 

c. ACCESS REQUESTED - GOVERNMENT ONLY:

 

 

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

 

 

 

 

 

 

 

 

 

 

d. PERMISSION REQUESTED:

DD FORM 2962 V1, FEB 2020

INITIATE PSI

REVIEW e-QIP

OVERRIDE PSI

 

PREVIOUS EDITION IS OBSOLETE.

 

APPROVE e-QIP

NAME (LAST NAME, FIRST NAME, MIDDLE INITIAL) _______________________________________

17. JOINT ADJUDICATION MANAGEMENT SYSTEM (JAMS) (CAF ONLY)

a. USER ROLES

 

 

 

 

 

 

 

CAF:

 

CAF TEAM:

 

EMPLOYEE CODE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. ACCESS REQUESTED:

 

 

 

c. 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

 

 

 

 

 

 

 

d. SPECIAL CASE USER CAN HANDLE

 

CAF EMPLOYEES

PRESIDENTIAL SUPPORT

GS-15/GENERAL OFFICER

 

 

 

 

 

 

 

e. INVESTIGATION REQUEST PERMISSIONS

REVIEW PSQ

APPROVE e-QIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART 3 - TRAINING

 

 

 

 

 

 

I HAVE COMPLETED AND ATTACHED TRAINING CERTIFICATES FOR:

 

 

 

 

 

 

 

 

 

18.

CYBER AWARENESS TRAINING

 

 

 

DATE (YYYYMMDD) ________________

 

 

 

19.

PERSONALLY IDENTIFIABLE INFORMATION TRAINING

DATE (YYYYMMDD) ________________

 

 

20.

JPAS TRAINING REQUIREMENTS (IF REQUESTING A JPAS ACCOUNT) DATE (YYYYMMDD) _______________

PART 4 - 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.

21. APPLICANT'S SIGNATURE

22. 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:

23.

NOMINATING OFFICIAL'S PRINTED NAME (LAST, FIRST, MIDDLE

24.

NOMINATING OFFICIAL'S SIGNATURE AND DATE

 

INITIAL)

 

 

 

 

 

 

25.

NOMINATING OFFICIAL'S TITLE

26.

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.

27.

ELIGIBILITY/ACCESS LEVEL:

28.

TYPE OF INVESTIGATION:

 

 

 

 

29.

ELIGIBILITY GRANTED DATE:

30.

DATE INVESTIGATION COMPLETED:

 

 

 

31. ELIGIBILITY ISSUED BY:

32.

INVESTIGATION CONDUCTED BY:

 

 

 

 

33.

VALIDATING OFFICIAL'S PRINTED NAME (LAST, FIRST, MIDDLE

34.

VALIDATING OFFICIAL'S SIGNATURE AND DATE

 

INITIAL)

 

 

 

 

 

 

DD FORM 2962 V1 (BACK), FEB 2020

PERSONNEL SECURITY SYSTEM ACCESS REQUEST (PSSAR) INSTRUCTIONS

Please see the respective System Access Request Procedures available from the DMDC PSA website for supplemental guidance on completing and submitting this form.

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.Telephone. 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 born in the U.S. Otherwise, enter country and city.

11.Social Security Number. SSN of Applicant.

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

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

Part 2 - Applications.

14.Defense Central Index of Investigations (DCII). Government applicants only.

14.a. DCII Agency Code/DCII Agency Acronym. Complete 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

14.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.

15.Secure Web Fingerprint Transmission (SWFT). For Government and Industry applicants.

15.a. Permissions - Fingerprint Submission. Applies to SWFT users. Indicate the requested user permission(s) by marking the appropriate checkbox, or list in item 15.c. on line "Other.

15.b. Permissions - Fingerprint Enrollment. Indicate the requested user permission(s) by marking the appropriate checkbox. Only complete this section if you possess or requested a SWFT account (Government only) and are cleared to use the web-based fingerprint enrollment system.

15.c. Additional CAGE Code(s). List only if different from item 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.

16.Joint Clearance and Access Verification System (JCAVS). For Government and Industry applicants.

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

16.b. Access Requested - Industry. Select appropriate permission(s).

16.c. Access Requested - Government Only. Select appropriate permission(s).

16.d. Permissions Requested. Select appropriate permission(s).

17. Joint Adjudication Management System (JAMS). CAF only.

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

17.b. Access Requested. JAMS access requested. 17.c. User Permissions. JAMS user permission(s).

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

17.e. Investigation Request Permissions. Select Investigation Request

permissions for JAMS user.

Part 3 - Training.

18.- 20. 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. Certificates must be submitted with

PSSAR.

Part 4 - Applicant's Certification.

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

22.Date. Date application signed by Applicant.

Part 5 - Nominating Official's Certification.

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

24.Nominating Official's Signature and Date. The Nominating Official is the individual who is authorizing that the Applicant should have the access requested. For Industry, the Nominating Official must be listed in ISFD as a Key Management Personnel (KMP) in connection with the Facility Clearance, and if an Appointment Letter is needed, it must be signed by the same KMP. The Nominating Official CANNOT be the same as the Applicant unless it is a single person facility. For Government/Civilian, the Nominating Official must be the Security Officer/ Manager.

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

25.Nominating Official's Title. Title of Nominating Official.

26.Nominating Official's Telephone Number. DSN or Commercial telephone number of Nominating Official.

Part 6 - Validating Official's Verification. Do not complete if self- nominating/validating.

27.Eligibility/Access Level. Eligibility/Access level of Applicant. See applicable System Account Management Policies/Access Request Procedures available from the respective DMDC PSA system website for minimum eligibility/ access requirements.

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

29.Eligibility Granted Date. Date eligibility granted. If not final, state date of interim.

30.Date Investigation Completed. Date investigation completed.

31.Eligibility Issued By. Organization that issued eligibility.

32.Investigation Conducted By. Investigating agency.

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

34.Validating Official's Signature and Date. The Validating Official signature serves to affirm the information provided on the following lines (verify before signing): Eligibility/Access Level; Eligibility Granted Date; Eligibility 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 V1 (INSTRUCTIONS), FEB 2020

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If you want to complete this PDF form, make certain you type in the right information in each field:

1. Start completing your form 2962 form with a group of necessary fields. Collect all the information you need and ensure there's nothing left out!

Stage no. 1 for filling in 2020 dd 2962 form

2. Once the last segment is completed, you should include the necessary details in OFFICE SYMBOLDEPARTMENT, TELEPHONE DSN or COMMERCIAL, OFFICIAL EMAIL ADDRESS, JOB TITLE AND GRADERANK, OFFICIAL MAILING ADDRESS, CITIZENSHIP, DATE OF BIRTH YYYYMMDD, PLACE OF BIRTH CITY STATECOUNTRY, SOCIAL SECURITY NUMBER, CAGE CODE CTR ONLY, DESIGNATION OF APPLICANT, MILITARY, DoD CIVILIAN, INDUSTRY, and NONDoD so you can move forward to the third stage.

SOCIAL SECURITY NUMBER, JOB TITLE AND GRADERANK, and DESIGNATION OF APPLICANT inside 2020 dd 2962 form

3. The third step is hassle-free - fill in all of the fields in c ADDITIONAL CAGEORGANIZATION, OTHER, a TYPE OF ACCOUNT REQUESTED, ACCOUNT MANAGER, b ACCESS REQUESTED INDUSTRY, c ACCESS REQUESTED GOVERNMENT ONLY, LEVEL, LEVEL, LEVEL, LEVEL, LEVEL, LEVEL, LEVEL, CORPORATE OFFICER SCI, and COMPANY FSO OFFICERMANAGER SCI to conclude the current step.

Step no. 3 in filling out 2020 dd 2962 form

4. To move forward, the next form section requires typing in a handful of empty form fields. Examples of these are NAME LAST NAME FIRST NAME MIDDLE, a USER ROLES, CAF, CAF TEAM, EMPLOYEE CODE, b ACCESS REQUESTED, c USER PERMISSIONS, ACCOUNT MANAGER, CUSTOMER SUPPORT, ADJUDICATOR, MANAGEMENT SUPPORT, SAP, SCI, CASE MANAGEMENT, and UPDATE CASE COMPONENT, which you'll find key to going forward with this particular document.

Filling out part 4 of 2020 dd 2962 form

5. As you draw near to the completion of your form, you'll find just a few more requirements that need to be satisfied. Notably, PERSONALLY IDENTIFIABLE, JPAS TRAINING REQUIREMENTS IF, PART APPLICANTS CERTIFICATION, I hereby certify that I understand, APPLICANTS SIGNATURE, DATE YYYYMMDD, PART NOMINATING OFFICIALS, I certify that the above named, NOMINATING OFFICIALS PRINTED NAME, NOMINATING OFFICIALS SIGNATURE, NOMINATING OFFICIALS TITLE, and NOMINATING OFFICIALS TELEPHONE must be done.

NOMINATING OFFICIALS TELEPHONE, I hereby certify that I understand, and PART APPLICANTS CERTIFICATION inside 2020 dd 2962 form

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