S pacific fleet inspector general hotline complaint form please answer all questions below, use block 9 for additional information or additional sheets if the blocks are not large. Employees who violate security regulations or make unauthorized use of dod interest. Privacy act statement national oceanic and atmospheric. Code, section 301 and executive order 9397 of 22 nov 43, information regarding personal identification including, but not limited to, name, address, telephone number, social security number, next of kin, etc. The information provided on is for general and educational purposes only and is not a substitute for professional advice. All information is provided in good faith, however, we make no representation or warranty of any kind regarding its accuracy, validity, reliability, or completeness. Regular active service member active guard active reserve air force army navy reserves national guard civilian marine corps coast guard h. Notwithstanding the above, using this is does not constitute consent to pm, le or ci investigative searching or monitoring of the content of privileged communications, or work product, related to personal representation or services by attorneys, psychotherapists, or clergy, and their assistants. To restrict disclosure of personally identifiable records maintained by agencies. Introduction to the privacy act defense privacy and civil liberties. Dd form 2005, privacy act statement health care records. Providing information to the epa suspension and debarment program is voluntary.
A record in this system of records may be disclosed to the department of justice to determine whether disclosure is required by the freedom of information act foia. No agency shall disclose any record which is contained in a system of records by any means of communication to any person, or to another agency, except pursuant to a written request by, or with the prior written consent of, the individual to whom the record pertains, unless disclosure of the record would be. This could be a person designated by the service member, a courtappointed guardian, or a personal representative in accordance with dod 6025. This must include measurable objectives, milestones and performance metrics to evaluate progress. Other dod personnel, such as authorized alcohol and other drug screening, counseling, treatment, or other medical personnel who have a need to know.
The american innovation and competitiveness act also requires that noaa to maintain a comprehensive system to evaluate the outcomes of its educational programs, not merely the number of activities and participants. Dd form 2923 download printable pdf or fill online privacy. This statement serves to inform you of the purpose for collecting personal information required by tricare and health net federal services, llc hnfs and how it will be used. Depending on the nature of your application, supplemental authorities include federal statutes, state statutes pursuant to pub.
The information may be disclosed to the agency contractors, grantees, experts, consultants, or volunteers who have been engaged by the agency to assist in the performance of a service. Contents shall not be disclosed, discussed, or shared with individuals unless they. Information about the privacy act statement and security. Articles army corps launches alternate care facility construction building health care facilities isnt a new task for usace, which has years of experience designing and building hospitals and clinics for the military health system. Ranktitle, first mi last name ranktitle, first mi last name signature date y m d da form 7433, apr 2009. Tournament dates month day, year b name of state park, marina, or concession i agree that the tournament may be held as scheduled at this location. To provide such data as is requested by the recruiter to contact, process, and enlist prospects fro army service. Privacy act statement and advisories allow the individual to make an informed decision about providing their data. The security accreditation level of this site is unclassified and below. The fipps help serve as a useful framework for the department to analyze how to handle pii, comply with its continuing responsibilities under the numerous legal obligations that apply, as well as adhere to its. The fbis acquisition, preservation, and exchange of fingerprints and. To grant individuals increased rights of access to agency records maintained on themselves.
All proceeds from the operation of this site are donated to veteran and other charities. This statement serves to inform you of the purpose for collecting personal information required by health net federal services, llc hnfs, on behalf of the tricare program, and how it will be used. Attach copy yes no duty position yymmdd please circle. The access right cannot be delegated below the level of executive officer and is subject to the limitations on disciplinary and administrative action contained in other parts of this statement. Guardians agreement to care for a soldiers children in his or her absence. Date signature of the individual social security no. Information collected will be used to expedite the selection process of recruiter applicants.
Sep, 2010 secnav don cio navy pentagon washington, dc 20350. Collection of this information is authorized by 10 usc, sections 503 and 30. The purpose of collecting this information is to conduct background checks on visitors to army facilities and installations. To provide commanders and law enforcement officials with means by which information may be accurately identified. To provide detailed information necessary for army officials and commanders to discharge their responsibilities for maintaining discipline, law and order through investigation of complaints and incidents and possible criminal prosecution, civil court action, or regulatory order. Army records, regardless of media, aremaintained from creation through final disposition in a manner that protects the rights and interests of individuals and the federal. Ssn and personal information in hisher leaders book with the understanding that this information will. Collection of the information request by the recruiter and recorded on this form is authorized by title 10 u. Do not process, store, or transmit any personally identifiable information pii, unclassifiedfouo or classified information on this system. A record from this system of records may be disclosed, as a routine use, in the course of.
Do not process, store, or transmit any personally identifiable information pii, unclassifiedfouo or classified information on. This privacy act statement is located on the back of the fd258 fingerprint card. The privacy act of 1974, 5 usc 552a, provides protection to individuals by ensuring that personal information collected by federal. Records from this system of records may be disclosed to the national archives and records administration or to the general services administration for records management inspections conducted under 44 usc 2904 and 2906. The specific federal statute or executive order that authorizes collection of the requested information. This data is used to provide human resource management and succession planning for the army s senior military leaders. The privacy act of 1974, 5 usc 552a, provides protection to individuals by ensuring that personal information collected by federal agencies is limited to that which. In the case of military personnel, the requested information is mandatory because of the need to. Total army personnel command, reserve component counterparts, and other agencies that have an input to training missions, the vehicle to manage individuals and training course seatsquotas through the training base of officers and skill level 2 and above. Unauthorized attempts to upload information andor change information on this website are strictly prohibited and are subject to prosecution under the computer fraud and abuse act of 1986 and title 18 u. To grant individuals the right to seek amendment of agency records maintained on themselves upon a showing that the records are not accurate, relevant, timely or complete. See privacy act statement on reverse yymmdd required for asisqi producing courses military training request the proponent of this form is the directorate of plans, training, mobililization and security previous form is obsolete rankgrade profile. Criteria, dod minimum antiterrorism standards for buildings. Issued by the epa chief information officer, pursuant to delegation 119, dated 772005 procedures for preparing.
Army regulation 190, the army physical security program. The pa statement process should accomplish one goal. Tracking the provisions of the act itself, the overview provides reference to and legal analysis of court decisions interpreting the acts provisions. The army privacy program army publishing directorate. The army maintains records during the conduct of army business. The data provided will be used to update your military personnel record. Secnav don cio navy pentagon washington, dc 20350.
Navy website dod resource locator 45376 sponsored by the department of the navy chief information officer don cio. Leaders guide to protecting personally identifiable information. If monitoring of this or any other dod interest computer system reveals a possible violation of criminal statutes, this evidence and any other related information, including identification information about the user, may be provided to law enforcement officials. Used by recruiter selection teams when interviewing recruiter applicants. The overview is not intended to provide policy guidance, as that role statutorily rests with the office of management and budget omb, 5 u. A person designated to make scaadl decisions for the service member. To be used on all documents containing personal information. No agency shall disclose any record which is contained in a system of records by any means of communication to any person, or to another agency, except pursuant to a written request by, or with the prior written consent of, the individual to whom the record pertains, unless disclosure of.
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