INTEGRATED METADATA
REPOSITORY SYSTEM (IMRS) REGISTRATION
U.S. GOVERNMENT SPONSORED CONTRACTORS
Instructions for completing this form
Government Sponsor can fax or mail this form to us at:
Mail:
FAX:
DLIS-VSM
DSN 661-5925
Defense Logistics Information Service
Commercial (269) 961-5925
74 Washington Ave
N STE 7
Battle Creek MI 49017-3084
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 IMRS 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____________________________
LEVEL OF ACCESS (Please check the box that best describes your job duties)
_______ Data Provider (Provides data to the IMRS PMO or directly to IMRS)
_______ Integrator/Developer (Develops end user applications and/or integrated environments)
_______ Requirements Generator (generates requirements for shared data applications and/or integrated environments)
_______ Data Modeler (Develops and/or maintains models for data views)
_______ Data Administrator (Creates and maintains elements in the Data Element Registry)
Justification for other than read-only access: _________________________________________
_____________________________________________________________________________
Block 3. Security Verification
DoD sponsored contractors: have your Contract Officer Representative/Security office sign where indicated below; your form will be returned without further action if this section is not completed.
Verification of Security for requester named in Block 2:
Employee Name:_____________________________________________
Type of Investigation: _____________ Completed on:_________________
ADP Level ______________________
By (Agency):_________________________________________________
Signature of Security Representative: ______________________________
Block 4. IMRS User Information. This block must be signed by the contractor requesting access
As a user of IMRS, I acknowledge my responsibility to conform to the following requirements and conditions as established by Defense Logistics Agency:
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 Defense Logistics Agency 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 Defense Logistics Agency 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 Defense Logistics Agency 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 IMRS, it is my responsibility to notify DLIS.
USER SIGNATURE______________________________________________
Printed Name:___________________________________________________
Social Security Number (last six digits):______________________________
DLA Standard LOGON or User ID:__________________________________
(Complete only if you currently have access to other DLA systems and have been assigned this standard User ID)
Email:__________________________________________________________
Commercial Phone:________________________DSN:__________________
(See instruction sheet for Personal Password/Identification Information)
Personal Identification Information – (For example: favorite color, sports team, hobby or phrase.)
_________________________________________________________________