Registration Form for Use of the Input of Maintenance Requests to
the
E-Cataloging
U.S. Government Sponsored Contractors
Please return this form to DLIS-VSM (E-Cataloging Access), Defense Logistics Information Service, 74 Washington Ave N STE 7, Battle Creek MI 49017-3084. FAX DSN: 661-5925, Commercial (269) 961-5925. PLEASE TYPE OR PRINT CLEARLY.
Instructions for completing this form
This is a Department of Defense (DoD) computer system. DOD computer systems are provided for the processing of official U.S. Government information only. All data contained on DoD computer systems is owned by the Department of Defense, may be monitored, intercepted, recorded, read, copied, or captured in any manner and disclosed in any manner, by authorized personnel. There is no right to privacy in this system. System personnel may give to law enforcement officials any potential evidence of crime found on DoD computer systems. Use of this system by any user, authorized or unauthorized, constitutes consent to this monitoring, interception, recording, reading, copying, or capturing and disclosure.
Block 1. Sponsor Information – This block must be completed and signed by the U.S. Government Contracting Officer Representative.
U.S. Government Sponsor Branch of Service:_______________________________
Major
Command:______________________________________________________
Government Contract Officer Representative (COR)
By signing this block, you agree that the contractor named in Block 3 needs
access to E-Cataloging in order to perform their contractual obligations at your
agency.
COR Signature:___________________________________________________
COR Name (print):________________________________________________
Office Symbol/Code/Mail Stop:______________________________________
Organization:___________________________________________________
Street/PO Box:__________________________________________________
City/State/ZIP Code:_____________________________________________
City/Country (If APO or FPO address):_______________________________
Commercial Phone:_____________________DSN:____________________
Email Address:____________________________________________
FAX:______________________________
Block 2. Contractor Information
POC Name:__________________________________________________
Company Name:______________________________________________
Street Address/PO Box:_________________________________________
City/State/ZIP Code:____________________________________________
City/Country:__________________________________________________
Commercial Phone:______________________DSN:__________________
FAX:_______________________Email:____________________________
Contract Number:______________________________________________
LENGTH OF CONTRACT:
End Date___________________________________________
Block 3. E-Cataloging User Information.
Social Security Number: This information is used by your Command Security Office to verify your employment status. The last six digits of your social security number will be used by DLIS to verify your identity when you need a password reset. We will destroy the first three numbers of your SSN after your security office has provided all the information needed in Block 3, or you may blacken out the first three numbers prior to sending the request to DLIS.
As a user of Input Maintenance Requests (E-Cataloging), I acknowledge my responsibility to conform to the following requirements and conditions as established by DLA:
I understand the need to protect my password. I will NOT share my password and/or account.
I understand that I am responsible for all actions taken under my account. I will NOT attempt to ‘hack" the network or any connected information system or network, or attempt to gain access to data for which I am not specifically authorized.
I acknowledge my responsibility to comply with all copyright laws both federal and state (where applicable).
I understand my use of DLA information systems is subject to monitoring to ensure proper functioning, to protect against improper or unauthorized use or access, and to verify the presence or performance of applicable security features or procedures. By using the information system I consent to such monitoring.
I acknowledge my responsibility to conform to the requirements stated above when using DLA information systems or networks. I also acknowledge that failure to comply with these requirements and conditions may constitute a security violation resulting in denial of access to DLA information systems, networks or facilities and that such violations will be reported to appropriate authorities for further action as deemed appropriate.
I understand the need to protect my password. I will NOT share my password/and/or user ID. If I no longer need access to the Input Maintenance Request Screen (E-Cataloging), it is my responsibility to notify DLIS.
USER SIGNATURE___________________________DATE:______________
Printed Name:___________________________________________________
Social Security Number:_____________________________________
DLA Standard LOGON:______________________________________
Email Address:_____________________________________________
Commercial Phone:___________________DSN:__________________
Personal Identification Information – (This may be your favorite color, sports team, hobby or phrase.)
1)_______________________________________________________
Block 4. Security Verification
If you are a DoD sponsored contractor you must have this block completed by your Contract Officer Representative/Security office. If received without annotation and signature, your form will be returned without further action.
Security Officer. Access to this system requires the user to have a National Agency Check (NAC) or equivalent type of Investigation. If this level of investigation has not been completed for this person, contact the Defense Security Service at http://www.dss.mil for assistance.
Verification of Security for requester named in Block 3:
Employee Name:_____________________________________________
Type of Investigation: _____________ Completed on:_________________
By (Agency):_________________________________________________
ADP Level:__________________________________________________
Signature of Security Representative: :______________________________
Typed Name of Security Printed Name:_____________________________
Title:__________________________________ Date:_________________
Commercial Phone:_______________________ DSN:________________
Block 4. Supervisory Approval
This block must be completed by your supervisor.
Signature of Approving Official:___________________________
Printed Name:______________________________________________
Title:_____________________________________________________
Commercial Phone:_____________________DSN:_________________