Edit, Download, and Sign the Information System Access Authorization and Briefing Form

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How do I fill this out?

To fill out this form, you will need to provide your printed name and phone number. Confirm that you have the necessary clearance for the system. Agree to the security responsibilities listed in the form.

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How to fill out the Information System Access Authorization and Briefing Form?

  1. 1

    Provide your printed name and phone number.

  2. 2

    Confirm your clearance for the system.

  3. 3

    Acknowledge the security responsibilities.

  4. 4

    Provide your signature and date.

  5. 5

    Submit the form to the appropriate authority.

Who needs the Information System Access Authorization and Briefing Form?

  1. 1

    Employees requiring access to classified systems to perform their job duties.

  2. 2

    Contractors working with classified information systems.

  3. 3

    Visitors needing temporary access to classified systems.

  4. 4

    System administrators ensuring compliance with security protocols.

  5. 5

    Security managers overseeing information system access and protection.

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What are the instructions for submitting this form?

Submit the completed form to your ISSM or designee via email, fax, or in-person. Ensure all required fields are filled out and properly signed. Follow your organization's specific submission instructions and deadlines to avoid delays or loss of access.

What are the important dates for this form in 2024 and 2025?

The form should be submitted annually or when there are changes in system access requirements. Ensure to submit by the end of each fiscal year in 2024 and 2025.

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What is the purpose of this form?

The purpose of the Information System Access Authorization and Briefing Form is to ensure that all users accessing classified systems are properly authorized and aware of their responsibilities. It helps to prevent unauthorized disclosure, modification, or destruction of information by enforcing strict security measures. By signing this form, users acknowledge their understanding of the security protocols and agree to comply with them at all times.

formPurpose

Tell me about this form and its components and fields line-by-line.

The form includes various fields to capture user information and acknowledgments.
fields
  • 1. Printed Name: Your full printed name.
  • 2. Phone: Your contact phone number.
  • 3. System Name: The name of the classified system you are accessing.
  • 4. User Signature: Your signature to acknowledge the responsibilities.
  • 5. Date: The date when the form is signed.
  • 6. ISSM Signature: Signature of Information System Security Manager or designee.
  • 7. Employee/Visitor/Company: Indicate if you are an employee, visitor, or company representative.
  • 8. Clearance/Special Briefings: Details of your security clearance and any special briefings.
  • 9. Account Name: The account name assigned to you for the system.
  • 10. Date Added: The date when access was granted.
  • 11. Other Access/Privileges: Any additional access privileges or comments.

What happens if I fail to submit this form?

Failure to submit this form can lead to serious consequences.

  • Revocation of System Access: You may lose access to the classified system.
  • Disciplinary Action: Non-compliance may result in disciplinary measures.
  • Loss of Employment: Continued failure may lead to termination of employment.

How do I know when to use this form?

Use this form when you need access to a classified information system.
fields
  • 1. New Access Request: When you are requesting access for the first time.
  • 2. Annual Renewal: Submit this form annually to renew your access.
  • 3. Access Modification: When there's a change in your access requirements.
  • 4. Temporary Access: For visitors needing temporary system access.
  • 5. Transfer or Termination: When you are transferring or terminating your association with the system.

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