Msfc Form 383 1 PDF Details

Ensuring the orderly transition of contractor employees who depart their roles, the MSFC Form 383-1 serves a crucial function within the operational frameworks of organizations working in concert with governmental bodies. As a comprehensive Contractor Employee Clearance Document, this form meticulously outlines all necessary steps and items requiring attention before an employee's departure can be finalized—ranging from personal identification and property issues to more sensitive matters involving classified information and proprietary materials. The form stipulates categories that need to be cleared, such as electronic and hardcopy files, registered documents, classified materials, and even security keys and respiratory equipment, among others. Instruction detailed for completing the form emphasizes the significance of controlled items, including data storage devices and any property assigned that could, if mishandled, pose security risks or create compromising situations for government operations. Additionally, the procedure for handling government-issued items upon departure is outlined, ensuring that all such materials are accounted for or adjustments are made. This careful delineation of responsibilities both of the departing employee and the authorities within an organization underscores the form's role in safeguarding the integrity of operational processes and sensitive information. With privacy considerations under the Privacy Act of 1974 also highlighted, the MSFC Form 383-1 embodies a crucial administrative tool in managing transitions in the contractor workforce efficiently and securely.

QuestionAnswer
Form NameMsfc Form 383 1
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesContractorEmplo yeeClearance clearance form 383

Form Preview Example

 

 

UUPIC LOOKUP

CONTRACTOR EMPLOYEE CLEARANCE DOCUMENT

OITM/ITM LOOKUP

 

 

 

 

 

 

(See Instructions)

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF INDIVIDUAL:

 

 

BADGE NUMBER:

UUPIC NUMBER:

 

EFFECTIVE DATE:

LAST DAY ON DUTY:

 

 

 

 

 

 

 

 

 

 

 

OTHER NAME USED:

 

 

 

 

 

REASON FOR LEAVING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resignation

 

Reduction in Force

 

Sick Leave/Long-Term Disability

CONTRACTOR ORGANIZATION AND ADDRESS:

 

 

Retirement

 

Termination

 

Term/Contract Expired

 

 

 

 

 

 

Transfer

 

Suspension

 

Deceased

 

 

 

 

 

 

Military

 

LWOP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM CLEARED

 

 

TO BE CLEARED WITH

 

SIGNATURE OR NAME OF RESP.

 

SIGNATURE OF

 

 

 

 

 

CLEARING AUTHORITY

COMPANY REPRESENTATIVE

 

 

 

 

 

 

 

 

 

 

Disposition of Electronic and Hardcopy Files

 

 

 

 

 

 

 

 

 

 

 

Disposition of Registered Documents and

 

 

 

 

 

 

 

 

 

1.

 

Classified Materials

 

Supervisor

 

 

 

 

 

Employee Must Clear

 

 

Disposition of Official Records

 

 

 

 

 

 

 

 

 

 

 

Disposition of Chemicals

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Redstone Scientific Information Center

 

 

 

 

2.

 

RSIC Technical Documents

 

Bldg 4484, 3rd Floor

 

 

 

 

 

 

 

 

 

 

256-876-5181

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSFC Respirator Services

 

 

 

 

 

 

3.

 

Respiratory Equipment

 

Bldg 4646, 256-544-4483 or

 

 

 

 

 

 

 

 

 

 

256-544-4484

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Small Tool Control System

 

Machining and Assembly Branch

 

 

 

 

 

 

 

Bldg 4705

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disposition of ODIN Seats (MAMs)

 

 

 

 

 

 

 

 

 

5.

 

Disposition of Non-ODIN Property

ITM/OITM

 

 

 

 

 

Employee Must Clear

 

(Use button at top right for list)

 

 

 

 

 

 

 

ODIN Cell Phones, Pagers, PDAs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Computer Access

 

 

 

 

 

 

 

 

 

 

 

 

Devices to be turned in here

 

Office of the CIO, IS01

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employee Must Clear

6.

 

Secure ID Token

 

Bldg 4200, Rm 522A or Rm 526

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long Distance Calling Cards

256-544-2847 or 256-544-5532

 

 

 

 

 

 

 

 

Telephone Listing Data (MSFC Form 2683)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

Property Management/Government Property

Bldg 4200, Rm 410

 

 

 

 

 

Employee Must Clear

 

256-544-2293

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

MSFC Medical Center

 

MSFC Medical Center

 

 

 

 

 

Employee Must Clear

 

 

Bldg 4249, 256-544-2390

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

Security Keys

 

Organizational Lock and

 

 

 

 

 

Employee Must Clear

 

 

Key Coordinator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Security

 

Protective Services Department, AS50

 

 

 

 

 

 

 

Badge

KeyCard

 

 

 

 

10.

 

256-544-2090, Bldg 4312

 

 

 

 

 

Employee Must Clear

 

 

 

 

 

 

 

 

 

 

Vehicle Decal

PKI/Entrust

(See Instructions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPANY USE

 

 

 

12.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that all Government property issued to me has been turned in, accounted for, or

 

SIGNATURE OF EMPLOYEE:

 

 

adjustment made; that all funds advanced to me have been returned, repaid, or adjustment

 

 

 

 

 

made; that obligated service agreements have been completed or a waiver has been

 

 

 

 

 

 

approved; that all computer materials and programs or copies have been turned in; and

 

 

 

 

 

 

that I have no Government property or materials in my possession.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSFC Form 383-1 (March 2012)

PREVIOUS VERSIONS OBSOLETE

INSTRUCTIONS FOR COMPLETING

MSFC FORM 383-1

CONTRACTOR EMPLOYEE CLEARANCE DOCUMENT

The Contractor Employee Clearance Document (MSFC Form 383-1) must be completed for contractor employees who leave the employment of their company for more than 30 days.

Controlled items are: (1) keys, property, classified documents, and other items that must be signed for by an individual; or (2) ADP programs, documentation, tapes, data in machine-readable form, magnetic disks or diskettes, proprietary software, tape cassettes,CDs, DVDs, flash drives, hard drives, or any other medium containing classified, sensitive, or proprietary data and other ADP hardware and software used by specified individuals and (3) those items which if lost, allowed to be used by or made available to nonauthorized personnel could cause embarrassment to or create a compromising situation with a Government function or operation.

Item 1. Your supervisor must sign as clearing official. By signing this block, the supervisor and administrative officer are certifying that any records the employee had (or was responsible for, etc.) were properly transferred to another appointed employee, or to their supervisor to reassign, retire, etc. This includes records that may be in hardcopy (files) or electronic (on electronic equipment such as PDAs, laptops/desktops, servers, etc., or offline storage such as CDs/DVDs, thumb drives, hard drives, etc.). It is understood that the ID(s) of the departing user will be deleted upon transfer or termination, in accordance with MPR 2810.1. Your supervisor must clear Disposition of all Registered Documents, Classified Materials, Official Records, and Chemicals.

Item 5. You are responsible to ensure all property assigned to you in N-PROP and MAMs has been dispositioned. Your Organizational IT Manager (OITM) must sign as the clearing official. By signing this block, the OITM and your Supervisor (in ITEM 1) are certifying that any records the employee had (or was responsible for, etc.) were properly transferred to another appointed employee or to their supervisor and all data that remains can be removed from the assigned equipment. All ODIN and non-ODIN property has been transferred to another appointed employee or an excess request has been submitted. This includes PDAs, pagers, laptops/desktops, peripherals, servers, network drops, etc.

Item 7. If charged with property, you are responsible that it is turned in, transferred to another person, or appropriate adjustments are made with the Logistics Services Department and with your organizational property manager when changed to a position no longer requiring the property or prior to leaving the Center. Employees must provide their badge number when clearing in Building 4200.

Item 9. Each laboratory/program/project office has a Lock and Key Coordinator. Contractors must clear with the Lock and Key Coordinator for the organization they support.

Item 10. When leaving the Center, you must personally turn in your NASA identification badge and car decal(s) to the Protective Services Identification and Registration Office (I&R), Building 4312. Remove decals from all of your vehicles and have them with you when you check out. If you do not know how many decals have been charged to you, call the I&R office at 256-544-2090. If you have Entrust/PKI, submit request through IDMAX

<https://idmax.nasa.gov/ > to modify PKI application and request revocation.

WHEN INFORMATION ENTERED

SUBJECT TO PRIVACY ACT OF 1974

When not under the continuing control and supervision of a person authorized access to

this material, it must be as a minimum, maintained under locked conditions.

Page 2 of MSFC Form 383-1 (March 2012)