Pips Form 11 PDF Details

In the secure and regulated world of national defense, the management and communication of sensitive information are paramount. The PIPS Form 11, revised in October 2020, serves a crucial function within this ecosystem. Administered by the Defense Counterintelligence and Security Agency (DCSA), the form allows for the creation and amendment of a Security Office Identifier (SOI), a four-character code that uniquely identifies agency security offices. This identifier not only streamlines the process of returning investigative reports but also facilitates access to detailed investigative information for authorized individuals. The completion of the form requires specific information, including the name and social security numbers of authorized callers, an accurate office mailing address, and details of the most recent background investigations on these callers. The form's stringent guidelines ensure the secure handling of personal identifiable information (PII) and underscore the importance of maintaining operational integrity in handling national security information. It provides a structured method for agencies to request a new SOI or update their existing details, including addresses, phone numbers, financial information, and email addresses for communication related to security processes. By doing so, it ensures that the DCSA can efficiently and securely communicate with agency security offices, safeguarding the information flow within the defense community.

QuestionAnswer
Form NamePips Form 11
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespips 11, pips form 11, pips form download, opm pips 11

Form Preview Example

PIPS Form 11 (Revised October 2020)

Provide SOI (if amending):

Corresponding SOI(s) (if applicable):

Department of Defense Defense Counterintelligence and Security Agency

PO Box 618

Boyers, PA 16018-0618

Commercial 724 794-5612 Fax 724 738-0814

SECURITY OFFICE IDENTIFIER (SOI) CREATION AND AMENDMENT FORM

ATTENTION: SECURITY OFFICER

The Defense Counterintelligence and Security Agency (DCSA) authorizes each agency security office a 4-character identifier called the SOI. The SOI permits DCSA to return investigative reports to agency-approved addresses. The SOI also permits security offices to obtain detailed investigative information. The security office must provide DCSA following:

•Name and social security numbers for authorized callers

•An accurate mailing address for the security office

•Type and date of most recent background investigation completed on the authorized callers

To request an SOI or advise DCSA of SOI changes, legibly complete the necessary items on the form below. Submit the form via mail, fax, or messaging in the NP2 Portal to NBIB SON SOI. Do not submit PII through unsecure channels. For additional information and/or assistance, call DCSA at 724-794-5612 x4600

1.Check this block if requesting a new SOI:

2.Change/add agency name and/or address (include zip code):

Agency Name:

Address:

City:

State:

Zip Code:

3. Change/add security office telephone numbers (DCSA does not have DSN capabilities):

Commercial:

 

Extension:

 

Commercial:

 

Extension:

 

4.Change/add financial fields: Treasury Account Symbol (TAS):

Intra-Governmental Payment & Collection (IPAC):

 

Business Event Type Code (BETC):

5.Change/add security officer (Requires Favorable Adjudication T3 or higher):

Name:

SSN:

6.Add authorized callers (Requires T2 or higher):

Type/date of last investigation:

Name:

SSN:

Type/date of last investigation:

7.Delete authorized callers: Name:

Name:

Name:

SSN:

Type/date of last investigation:

SSN (last 4):

SSN (last 4):

8.Add email address (NOTE: Do not provide individual's email address):

Provide a group email address for form processing questions:

Provide a group email address for pending case questions/notifications:

Provide a group email address for continuous evaluation notifications:

SOI Security Officer Name:

Email Address:

Signature:

This form should be duplicated as needed.

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soi authorization completion process described (part 1)

2. After this array of fields is done, you should include the needed specifics in Changeadd security office, Extension, Commercial, Extension, Commercial, Changeadd financial fields, Treasury Account Symbol TAS, Business Event Type Code BETC, Changeadd security officer, Typedate of last investigation, Add authorized callers Requires T, Name SSN Typedate of last, Name SSN Typedate of last, Delete authorized callers, and Name Name in order to move forward to the next stage.

Commercial, Changeadd security office, and Treasury Account Symbol TAS of soi authorization

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Email Address, This form should be duplicated as, and Email Address of soi authorization

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