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Understanding the DSS 273 form is essential for anyone needing access to Department of Defense (DoD) systems and information. This form serves as a System Access Request (SAR) and plays a pivotal role in ensuring that only authorized individuals gain entry to sensitive environments. The primary purpose of the DSS 273 is to collect critical user information—including names, signatures, and Social Security Numbers—for the purpose of assessing the trustworthiness of applicants. This information must be filled out comprehensively, as incomplete submissions can lead to processing delays. Users can request various account types, such as a new account creation or changes to existing accounts, each requiring specific permissions based on the user's role within an organization. Employing a well-defined structure, the form features sections that necessitate endorsements from both the user and a nominating official, typically someone in a supervisory position. Moreover, the form is subject to privacy protections and is guided by several laws, including the Privacy Act and the Computer Fraud and Abuse Act. Understanding these aspects not only helps streamline the access request process but also emphasizes the importance of security and responsibility in handling sensitive materials.

Form Sample

SYSTEM ACCESS REQUEST (SAR)

Enterprise Security System (ESS)

Phone: 888.282.7682

OMB No. Pending OMB approval expires

XXXXXXXXXXXXXXX

PRIVACY ACT ADVISEMENT:

AUTHORITY: Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act.

PRINCIPAL PURPOSE: To record names, signatures, and Social Security Numbers for the purpose of validating the trustworthiness

of individuals requesting access to Department of Defense (DoD) systems and information. NOTE: Records may be maintained in both electronic and/or paper form.

ROUTINE USES: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: To a Federal, State, or local law enforcement agency when your agency becomes aware of a violation or possible violation of civil or criminal law; to the Department of Justice for the purposes of representing the DoD in pending or potential litigation to which the record is pertinent; to the Merit Systems Protection Board for the purpose of litigation or investigation of alleged or possible prohibited personnel practices; to a Federal agency when conducting an investigation or inquiry for security or audit reasons; or the General Services Administration in connection with its responsibilities for records management.

DISCLOSURE: Disclosure of this information (to include social security number) is voluntary; however, failure to provide the requested information will impede, delay or prevent further processing of this request.

1.TYPE OF USER

DoD (Military or Civilian)

DoD Contractor

Non-DoD NISP

Non-DoD

2.TYPE OF REQUEST:

Create an Account

Name Change (Last, First, Middle)

From:

Delete an Account

To:

Change User Level (JPAS Only)

3.USER INFORMATION (Must fill in completely; please type)

Last Name:

First Name:

 

Middle Name:

Social Security Number:

Date of Birth:

 

POB:

 

 

 

 

 

Job Title/Rank/Grade:

 

 

 

 

 

 

 

 

Organization Name:

 

 

Office Symbol:

CAGE Code (NISP Contractor Only):

 

 

 

 

Business/Duty Station Address (street, city, state, zip code):

 

Telephone Number:

 

Fax Number:

 

 

 

 

 

 

e-Mail Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

APPLICATIONS

 

 

 

 

Defense Central Index of Investigations (DCII)

 

OTHER

 

 

(Government Only)

 

 

 

Agency Site Administrator or Coordinator

 

Industrial Security Facilities Database (ISFD)

 

User :

 

 

Secure Web Fingerprint Transmission (SWFT)

 

 

 

 

Industry Site Administrator

 

Query

Agency Code__________

 

Industry User

 

Add

 

 

 

 

Delete

 

 

Other (Please Specify)

 

Update

 

 

_____________________________________

 

File Demand (Provide Accreditation Code):

 

_____________________________________

 

__________________________

 

_____________________________________

 

File Demand Print

 

 

 

 

 

 

 

 

 

 

 

 

5.

JCAVS

 

 

 

Type of Account Requested:

Account Manager

User

Permission Requested:

Initiate PSI

Review e-QIP

Override PSI

Approve e-QIP

Access Requested – Industry: (Must submit signed Letter of Appointment)

Level

2

Corporate Officer (SCI)

 

 

Level 3

Company FSO Officer/Manager (SCI)

 

 

 

Level

4

Corporate Officers Manager

 

 

Level 5

Company FSO Officers/Manager

 

 

 

Level

6

Unit Security Manager/Visitor Control

 

 

 

Level

7

Guard Entry Personnel

 

 

 

Level

8

Guard Entry Personnel (SCI)

Level 10

Visitor Management

Access Requested – Non-Industry:

Level 2 MACOM/Activity/HQ/Agency SSO

Level 3 Base/Post/Ship/etc. SSO

Level 4 MACOM Non-SCI Security Manager

Level 5 Base/Post/Ship/Non-SCI Security Mgr

Level 6 Unit Security Manager

Level 7 Collateral Entry Controller

Level 8 SCIF Entry Controller

Level 10 Visitor Management

DSS FORM 273, JUNE 2011

PREVIOUS EDITIONS ARE OBSOLETE

Page 1 of 3

User’s Last Name, First Initial: ________________________________________________

6.JAMS USER ROLES (DoD/Non-Industry Only)

CAF:

CAF Team:

Employee Code:

Account Manager

Security Assistant

Pending User

Manager

Customer Support

Supervisor

Computer Analyst

Adjudicator

Mailroom

Case Assignment Personnel Management Support

Special Case User Can Handle:

CAF Employees

Presidential Support

GS-15/General Officer

Investigation Request Permissions:

Review PSQ

Approve e-QIP

User Permissions:

SAP Reports

Case Management Reassign to Other CAF

SCI

JCAVS

Update Case Component

Assign/Reassign Cases

TS FOIA/PA Assign CAF Cases Reassign from Other Employee

Secret

LAA

Review Required

7. NOMINATING OFFICIAL’S CERTIFICATION (Note 1)

I certify that the above named individual meets the requirements for access and account management privileges. Furthermore, I certify that the named user requires account/access as indicated above in order to perform assigned duties.

Nominating Official’s Printed Name

 

Nominating Official’s Signature and Date

 

 

 

Nominating Official’s Title

 

Nominating Official’s Telephone Number

8. USER’S CERTIFICATION

I hereby certify that I understand that by signing this System Access Request, I am solely responsible for the use and protection of the user ID and password that I will be provided. I also understand that I am not authorized to share my user ID and password 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.

User’s Printed NameUser’s Signature and Date

9. VALIDATING OFFICIAL’S VERIFICATION (Note 2)

I have verified with the appropriate security official/manager that minimum investigative requirements for the above user have been met.

Clearance Level: ____________________________

Type of Investigation: _______________________________

Clearance Granted Date: ______________________

Date Investigation Completed: ________________________

Clearance Issued By: _________________________

Investigation Conducted By:__________________________

Printed Name of DoD Security Services Center Representative or Security Official

Signature of DoD Security Services Center Representative or Security Official, and Date

10.ADDITIONAL SAR DIRECTIVES

The SAR must be signed by the Nominating Official and the User or it will not be processed.

Refer to page 3 of this form and JPAS, ISFD, DCII and SWFT Frequently Asked Questions (FAQs) at https://www.dss.mil or https://www.dmdc.osd.mil/psawebdocs, for additional SAR submission procedures pertaining to the respective systems (for example, please be advised that the DSS DoD Security Services Center does not process JCAVS access requests for military personnel; these requests should be submitted to the appropriate military agency approving authority).

SARs requiring DSS processing/approval should be submitted to the DoD Security Services Center via fax number 703.493.8965, e-mail address [email protected], or mailing address DoD Security Services Center, 10430 Furnace Road, Suite 101, Lorton, VA, 22079. Please allow at least three (3) business days for the SAR to be processed by the DoD Security Services Center. Notification of access will be sent to the User’s e-mail address. To ensure receipt of the access notification e-mail, add [email protected] to your e-mail contacts list.

The completed SAR must be maintained by the account manager for a minimum of six (6) months after the account is deleted.

Notes:

1.Nominating Official may be the Facility Security Officer, KMP, Security Manager, Information Systems Security Officer, Agency Administrator, etc. In most cases, the Nominating Official MUST be other than the User.

2.Validating Official is either a representative of the DoD Security Services Center, or if the SAR is staying within the organization, the appropriate security official. For non-DoD government agency requests, non-DoD government agency security officials must complete this section.

DSS FORM 273 (BACK), JUNE 2011

Page 2 of 3

SYSTEM ACCESS REQUEST (SAR) INSTRUCTIONS

Enterprise Security System (ESS)

SECTION

TITLE

INSTRUCTIONS

 

 

 

 

1

TYPE OF USER

Check the appropriate box for DoD (e.g., Military Branches, DoD Agencies), DoD

 

 

Contractor Companies, Non-DoD NISP Partners and Non-DoD affiliated.

 

 

 

 

 

2

TYPE OF REQUEST

Check the appropriate box indicating purpose for the SAR.

 

 

 

 

3

USER INFORMATION

Must completely fill in. If no middle name, enter NMN. Ensure e-mail address is accurate;

 

 

account access credentials are transmitted via e-mail.

 

 

 

 

 

4

APPLICATIONS

Check the application(s) and function(s) the user requires.

 

 

 

 

 

5

JCAVS

Check appropriate boxes. See definitions below.

 

 

 

NOTE: The appointment letter must be drafted on company letterhead, must name the

 

 

Primary Account Manager and must be signed by a corporate officer (KMP). The same

 

 

KMP must sign both the SAR (nominating official) and the letter.

 

 

 

 

5

ACCOUNT MANAGER

Account Managers will provide account maintenance on all user accounts created within

 

 

their company. Responsibilities include, but are not limited to, locking/unlocking accounts,

 

 

resetting passwords, logging off users, deleting accounts when no longer needed and

 

 

maintaining their Security Management Offices (SMO). Account managers will create any

 

 

additional accounts that are required.

 

 

 

 

5

USER

Depending on the level of access, users may verify clearances, update accesses, process

 

 

visit notifications, and handle all other functions within JCAVS.

 

 

 

 

 

5

ACCESS REQUESTED –

Check appropriate block, using the following guidance:

 

 

INDUSTRY

Level 2: SCI security personnel at Corporate level, with read and write access.

 

 

Level 3: SCI security personnel at echelons subordinate to Level 2 at a particular

 

 

geographic location, with read and write access.

 

 

 

Level 4: Non-SCI security personnel at Corporate level, with read and write access.

 

 

Level 5: Non-SCI security personnel immediately subordinate to Level 4, with read and

 

 

write access.

 

 

 

Level 6: Non-SCI security personnel immediately subordinate to Level 5, with read and

 

 

write access.

 

 

 

Level 7: Non-SCI security personnel who accomplish entry control (i.e., access to

 

 

installations, buildings, etc.), with read-only access.

 

 

 

Level 8: SCI security personnel who accomplish entry control, with read-only access.

 

 

Level 10: Non-SCI security personnel who accomplish visitor management, with read-only

 

 

access.

 

 

 

 

 

5

ACCESS REQUESTED –

Self-explanatory; check appropriate block.

 

 

DoD (NON-INDUSTRY)

 

 

 

 

 

N/A

TOP OF PAGE 2

Ensure User’s last name and first initial are entered at the top of the page in the space

 

 

provided.

 

 

 

 

6

JAMS USER ROLES

Provide information and check appropriate boxes for user functions, access, and

 

 

permissions. JAMS is only authorized for DoD CAFs.

 

 

 

 

7

NOMINATING OFFICIAL’S

The Nominating Official is the individual who is authorizing that the User should have the

 

CERTIFICATION

requested accesses. The Nominating Official may be a Corporate Officer (KMP), Facility

 

 

Security Officer, Security Manager, Information Systems Security Officer, Agency

 

 

Administrator, etc. For JCAVS Industry Primary Account Managers, the SAR must be

 

 

signed by the same KMP that signed the Appointment Letter. The Nominating

 

 

Official CANNOT be the same as the User. Exceptions include the company President,

 

 

for JCAVS, and the FSO, for ISFD. NOTE: SARs submitted without the Nominating

 

 

Official’s signature included will not be processed.

 

 

 

 

 

8

USER’S CERTIFICATION

User must sign, acknowledging DoD/system policy.

 

 

 

 

9

VALIDATING OFFICIAL’S

The DoD Security Services Center (for industry only) or the Security Manager must verify

 

VERIFICATION

and indicate the following information on the following lines prior to signing: Clearance

 

 

Level; Clearance Granted Date; Clearance 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.

 

 

 

 

10

ADDITIONAL SAR

Provided to facilitate successful processing of the SAR.

 

 

DIRECTIVES

 

 

 

 

 

 

DSS FORM 273 (INSTRUCTIONS), JUNE 2011

Page 3 of 3

Document Specifications

Fact Name Details
Form Purpose The DSS 273 form is used to request access to Department of Defense (DoD) systems. It records essential information, including names, signatures, and Social Security Numbers.
Governing Authority This form operates under Executive Order 10450, Executive Order 9397, and Public Law 99-474, which includes the Computer Fraud and Abuse Act.
Privacy Practices While disclosure of the requested information is voluntary, failing to provide this data can delay or hinder the processing of access requests.
User Certification The user must certify their understanding of the responsibility for protecting their user ID and password upon signing the form.
Approval Process The completed form must be signed by a Nominating Official who certifies the user's need for access. It must also be verified by a validating official before submission for processing.

Steps to Filling Out Dss 273

Filling out the DSS 273 form is an important step in securing access to Department of Defense systems. Follow these simple steps to complete the form accurately. You'll enter your personal and organizational details, specify the type of request, and ensure that the necessary signatures are in place before submitting it for processing.

  1. Type of User: Check the appropriate box to indicate if you are a DoD (Military or Civilian), DoD Contractor, Non-DoD, or NISP.
  2. Type of Request: Select one of the options – Create, Name Change, Delete, or Change User Level.
  3. User Information: Fill in your last name, first name, middle name, social security number, date of birth, place of birth, job title/rank/grade, organization name, office symbol, and CAGE Code if applicable. Also, add your business address, telephone number, fax number, and email address.
  4. Applications: Indicate which applications you need access to by checking the relevant boxes.
  5. JCAVS Type of Account Requested: Select the account type and permission level you need. Remember: For Industry requests, submit a signed Letter of Appointment on company letterhead.
  6. JAMS User Roles: Fill in the necessary checkboxes for roles if you are a DoD/Non-Industry user.
  7. Nominating Official’s Certification: The Nominating Official must print their name, sign, and date the form. This individual cannot be the same person as the user.
  8. User’s Certification: Sign and date the form, confirming your understanding of the responsibilities attached to your user ID and password.
  9. Validating Official’s Verification: The designated verifying official must complete this section, providing their clearance level, type of investigation, and other required information.
  10. Submission: Ensure all required signatures are present. Submit the completed form to the DoD Security Services Center via fax, email, or postal mail. Allow three business days for processing.

More About Dss 273

What is the primary purpose of the DSS 273 form?

The DSS 273 form, also referred to as the System Access Request (SAR), is primarily used to document individuals who are requesting access to Department of Defense (DoD) systems and information. It aims to ensure the trustworthiness of these individuals by collecting critical information such as names, signatures, and Social Security Numbers. This information helps to validate the identity and integrity of users accessing sensitive systems.

Who needs to fill out the DSS 273 form?

The form must be filled out by anyone who wishes to gain access to DoD systems, including both military and civilian personnel, DoD contractors, and non-DoD affiliates. It is essential that all required fields are completed accurately to facilitate timely processing. Inaccurate or incomplete submissions may lead to delays or denials of access requests.

What happens if I do not provide my Social Security Number?

While providing your Social Security Number is voluntary, not supplying this information may hinder your request's progress. The lack of a Social Security Number can impede, delay, or even prevent the processing of your access request. It is recommended to include it to avoid unnecessary complications.

How is the information on the DSS 273 form protected?

The information collected on the DSS 273 form is protected under the Privacy Act. This means that it will be used only for the intended purpose of validating access to DoD systems. Furthermore, the records may only be disclosed in restricted circumstances, such as complying with law enforcement requests or for litigation purposes related to DoD operations.

What are the responsibilities of a Nominating Official?

The Nominating Official plays a crucial role in the process by certifying the need for access. This individual must be a designated official such as a Facility Security Officer or a senior manager, and cannot be the user themselves. The Nominating Official verifies that the individual meets the required access criteria to perform their duties effectively. If discrepancies occur, the request may be rejected.

How long should the completed DSS 273 form be kept?

Once the access request has been processed and the account is deleted, the completed DSS 273 form should be retained by the account manager for a minimum of six months. This retention period allows for the potential review of the account’s activity and ensures compliance with security protocols.

Common mistakes

  1. Incomplete User Information: Ensuring that all fields, such as last name, first name, and Social Security Number, are completely filled out is essential. Leaving even a single field blank may result in delays or rejection of the application.

  2. Incorrect Email Address: The email address provided must be accurate. Since account access credentials are sent via email, an incorrect address can prevent the user from receiving vital information.

  3. Missing Signatures: Both the Nominating Official and the User must sign the form. A form submitted without these signatures will not be processed, leading to frustrations and additional wait times.

  4. Neglecting the Type of Request: Failing to check the appropriate box that indicates the type of request being made can lead to confusion and further processing issues. It is crucial to specify whether you are creating an account, changing details, or deleting an account.

  5. Failure to Select Applications: Neglecting to check the relevant applications and functions required can significantly hinder the user's ability to access necessary information. Review this section carefully to ensure all applicable boxes are marked.

Documents used along the form

When submitting a DSS 273 form, there are several other related forms and documents that may be necessary to support the request for system access. Each of these documents serves a specific purpose and helps ensure that all necessary information is provided for a smooth processing experience. Here’s a brief overview of these forms and documents:

  • Letter of Appointment: This document is signed by a corporate officer and designates a Primary Account Manager. It must be presented alongside the DSS 273 form for certain access levels.
  • Security Clearance Verification: This form confirms that the individual has undergone the necessary background checks and received the appropriate security clearance level that aligns with their requested access.
  • Privacy Act Statement: This statement outlines the individual's rights regarding their personal information as collected by the Department. It explains how their data will be used and protected.
  • Account Management Policy: This document provides guidelines that outline the responsibilities associated with user accounts, including how account information is handled and what security measures are necessary.
  • Access Request Form: This is sometimes used to specify other types of access not covered by the DSS 273. It details specific applications or systems the user needs access to.
  • Emergency Contact Form: This form gathers information about individuals to contact in case of an emergency related to the user’s access or security issues.
  • FISMA Compliance Document: This verifies that systems are in compliance with the Federal Information Security Modernization Act, ensuring that security measures are properly implemented and maintained.

Each of these documents contributes to a comprehensive understanding of the access request and ensures that the user is fully compliant with the various requirements set forth by the Department of Defense. Having them prepared can facilitate a quicker and more efficient review process.

Similar forms

The DSS 273 form shares similarities with the SF-85 form, which is the Questionnaire for Non-Sensitive Positions. Both documents collect personal information for the purpose of determining an individual’s eligibility for access to specific systems or positions. The SF-85 captures names, Social Security Numbers, and other identifying details to evaluate trustworthiness, much like the DSS 273. Each form also contains certifications from the individual completing it, underscoring the importance of accuracy and honesty in the submission process.

Another comparable document is the SF-86 form, known as the Questionnaire for National Security Positions. This form is used for positions requiring security clearances and requires detailed information regarding an individual's background, including financial history and foreign contacts. Similar to the DSS 273, the SF-86 aims to assess overall suitability and trustworthiness for access to sensitive information. Both forms involve a verification process by a designated official, ensuring that necessary checks and balances are in place.

The Standard Form 312 (SF-312), which is the Classified Information Nondisclosure Agreement, also aligns closely with the DSS 273 form. While the SF-312 focuses on the signing of a non-disclosure agreement for individuals granted access to classified information, it too requires affirmations from the user about the use and protection of sensitive information. Like the DSS 273, both forms enforce the necessity of safeguarding information and emphasize the obligations placed upon the individual regarding the confidentiality of information accessed.

Finally, the OPM Form 1203-FX, the Federal Employment Application, is another document that is similar to the DSS 273. This application collects personal data required to assess an individual's qualifications for potential employment with the government. Like the DSS 273, it requires a complete and accurate submission of personal information, including contact details and employment history. Both forms ultimately serve the purpose of validating the fitness of an individual to access or work within specific governmental roles or systems.

Dos and Don'ts

When filling out the DSS 273 form, here are six key do's and don'ts:

  • Do: Ensure that all sections of the form are completely filled out. Missing information can lead to delays.
  • Do: Double-check the accuracy of your email address. Access notifications are sent via email.
  • Do: Have the form signed by the appropriate nominating official to ensure it is processed.
  • Do: Keep a copy of the completed form for your records, especially if you are managing an account.
  • Don't: Provide inaccurate information, especially for your Social Security number or identifying details.
  • Don't: Submit the form without verifying that the nominating official’s signature is included; it won’t be processed without it.

Misconceptions

Here are six common misconceptions about the DSS 273 form, also known as the System Access Request (SAR) form, along with explanations to clarify these misunderstandings.

  • Only military personnel need to fill out the DSS 273 form. Many people believe that this form is solely for military users. In reality, both civilian employees and contractors who require access to Department of Defense systems must complete this form.
  • Providing personal information is optional. While the form states that disclosure is voluntary, failing to provide the necessary information can significantly delay or even prevent the processing of the request. It is essential for users to understand the significance of the information requested.
  • Once the DSS 273 form is submitted, access is guaranteed. Some individuals might mistakenly think that submitting the form automatically grants them access to the systems they requested. Access is contingent upon approval from the appropriate officials and verification that the individual meets security requirements.
  • The Nominating Official can be the same as the User. It is a common misconception that the Nominating Official, who certifies the necessity of access for the user, can also be the user themselves. However, to prevent conflicts of interest, the Nominating Official must be someone other than the user, except under specific circumstances.
  • The form can be processed without a signature from the validating official. Some may think that the form can be submitted without all necessary signatures. This is incorrect. The validating official's signature is required to ensure that security protocols have been properly followed before access is granted.
  • The DSS 273 form is the same for all agencies and uses. Another misconception is that this form is standardized across all government agencies. In fact, different agencies may have specific requirements or versions of the form to address their unique security needs, which should be recognized and followed accordingly.

Key takeaways

1. User Type Matters: When filling out the DSS 273 form, it's essential to accurately select the appropriate type of user, such as DoD military or civilian, DoD contractor, or non-DoD. This classification helps determine the correct processing path for your request.

2. Complete User Information: Ensure that all user information fields are completely filled out. If there is no middle name, write “NMN.” An accurate email address is crucial because your access credentials will be sent there.

3. Nominating and Validating Officials: Remember that the Nominating Official must not be the same as the User. This individual certifies that the user meets the requirements for access. Additionally, a validating official must verify the user's information before submission.

4. Signature Requirements: Both the Nominating Official and the User must sign the SAR. Without these signatures, the form cannot be processed. Be sure to check this detail to avoid delays.