Registration Form for Use of the Input of Maintenance Requests to the
E-Cataloging

 U.S. Government Employee

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. Agency Information

U.S. Government Branch of Service or Agency:_______________________________
(Such as Army, Navy, Air Force, DLA, GSA, NASA, etc.)

Major Command:__________________________________________
(Such as Army Materiel Command, Air Force Materiel Command, Naval Supply Command, etc.)

Mailing Address.

Office Symbol, Code, Mail Stop:_________________________________

Organization:________________________________________________

Street/PO Box________________________________________________

City/State/Zip Code:___________________________________________

City/Country (if APO or FPO address:_____________________________

Commercial Phone:_____________ DSN:_________________________

E-Mail Address:_______________________________________________

FAX:_______________________________________________________

Block 2. 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 3. Security Verification

This block must be completed by the Command Security Office. Requests received without annotation and signature will be returned without further action.

Security Officer.  Access to this system requires the user to have a National Agency Check  (NACI) 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 2:

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:_____________________________________________________