Registration Form for Universal Data Repository for
U.S. Government DoD Sponsored Contractors

Please TYPE or PRINT CLEARLY then mail or fax this form to:

Mail:                                                                              FAX:
DLIS-VSM (UDR Access)                                            DSN 661-5925
Defense Logistics Information Service                        Commercial ( 269) 961-5925
74 Washington Ave N Ste 7
Battle Creek MI 49017-3084

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 DoD Contracting Officer Representative.

U.S. Government Sponsor Branch of Service: ______________________________
(Example: Army, Navy, Air Force, DLA, GSA, Marine Corps, FAA, VA, NASA).

Major Command: _____________________________________________________
(Example: Army Materiel Command, Air Force Materiel Command, Naval Supply Command, etc.)

Government Contract Officer Representative (COR). By signing this block, you agree that the contractor named in Block 3 needs access to UDR 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:______________________________________________

Contract End Date___________________________________________

Block 3. UDR User Information

This form requests that you provide your social security number. The U.S. Government is authorized to ask for this information under Executive Orders 9397, 10450 and 10577 sections 3301 and 3302 of title 5, U.S. Code and parts 4, 731 and 736 of Title 5, Code of Federal Regulations. Your social security number is needed to keep records accurate, because other people may have the same name. The primary use of the information on this form is for review by Government Officials to determine and verify that you have the appropriate security clearance to obtain access to the requested data. Disclosure is voluntary. However, failure to provide the requested information may result in denial of access.

As a user of UDR, 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 UDR, it is my responsibility to notify DLIS.

USER SIGNATURE______________________________________________

Printed Name:___________________________________________________

Social Security Number:______________________________

DLA Standard LOGON or User ID:__________________________________

Email:__________________________________________________________

Commercial Phone:________________________DSN:__________________

Personal Identification Information (This may be your favorite color, sports team, hobby or phrase.) _______________________________________________________

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.

DoD sponsored contractors must have a National Agency Check (NAC) ADP II or equivalent type of investigation performed.

Verification of Security for requester named in Block 3:

Employee Name:_____________________________________________

Type of Investigation: _____________ Completed on:_________________

ADP Level  ______________________

By (Agency):_________________________________________________

Signature of Security Representative: :______________________________

Block 5. Non-Disclosure Statement. This statement must be signed by each contractor requesting access to UDR. 

CONTRACTOR NON-DISCLOSURE AGREEMENT

 FOR UNIVERSAL DATA REPOSITORY (UDR) MEDICAL LOGISTICS INFORMATION ON THE WWW

 1.  To carry out the duties and functions of the United States (“ U.S.”), certain information may be disclosed to contractors and subcontractors that are authorized representatives of the U. S. for the purposes of the disclosure and this Contractor Non-Disclosure Agreement (“Agreement”).  This Agreement covers information, technical data, and trade secrets, access to which is under the control of the Department of Defense (“DoD”), and that are either associated with stock numbers codified by countries other than the U. S. or described at 18 U.S.C. 1905, 10 U.S.C. 2320(a)(2) or 5 U.S.C. 552(b)(4).  Such disclosure shall be considered authorized and not a disclosure to the public or outside the Government for the purposes of these statutes.  The disclosure is subject to and shall be in accordance with all conditions and limitations set forth herein.

 2.  This Agreement is entered into between _________________________

_____________________________________(“Agency” or “Sponsor” and

______________________________________________________________ (“Contractor”), parties to Contract No. ____________________ (“contract”), which was signed on ____________________ with an expected duration of ___________years.  The Contract requires the Contractor to assist in the performance of Governmental functions of the U.S.  Because of this requirement, the Contractor and any authorized subcontractors are considered to be authorized representatives of the U.S. for the purpose of this Agreement.

 3.  The Sponsor hereby determines that disclosure of information described in paragraphs 1 and 4 is necessary so that the Contractor or subcontractors may perform the work required by the Contract and is sponsoring access to such information on behalf of such contractors.

4.      The Sponsor hereby determines that the Contractor should receive access to medical logistics data at the following levels of information:

5.  DoD shall grant access to information described in paragraphs 1 and 4 until such time as the information is no longer required for the performance of work under the Contract, the Contract is completed or terminated, the Sponsor requests termination of access or DoD terminates access.

6.  Intending to be legally bound, the Contractor accepts the obligations contained in this Agreement in consideration of being granted access to the information described in paragraphs 1 and 4.  The Contractor acknowledges that all obligations imposed by this Agreement concerning use and disclosure of such information apply for the duration of the Contract and at all times thereafter.

7.  The Contractor agrees that it shall use information described in paragraphs 1 and 4 only for the logistics purposes of the work required by the Contract and shall not use such data for commercial purposes.

8.  The Contractor agrees that it shall not disclose or provide access to information described in paragraphs 1 and 4 to anyone unless it has verified that the recipient has been properly authorized to receive such information, e.g., employees of the Contractor or subcontractors who have signed Employee/Subcontractor Non-Disclosure Agreements pursuant to this Agreement, U.S. employees, and employees of a foreign Government to which disclosure has been determined to be in the interest of the U.S., such as Canada, who are working in the logistics area.

9.  The Contractor agrees to adopt operating procedures and physical security measures to properly safeguard such information from unauthorized use and from disclosure or release to unauthorized third parties and to provide documentation to DoD for review.

10.  The Contractor agrees to return to DoD or the Sponsor all copies of any limited rights, foreign country, or other restricted data, and any abstracts or extracts therefrom, of which it has possession pursuant to this Agreement, upon request by the Sponsor or DoD, when the information is no longer required for the performance of work  under the Contract or upon completion or termination of the Contract, whichever comes first.

11.  The Contractor agrees to obtain a written agreement to honor the terms of the Contract and this Agreement from each subcontractor, consultant and employee of the Contractor or subcontractor who will have access to such information before the subcontractor, consultant or employee is allowed such access.  The format of the agreement is attached hereto as Exhibit A.  The Contractor agrees to submit the signed agreements to DoD.

12.  The Contractor hereby acknowledges that no subcontractor, consultant or employee who will have access to such information is debarred, suspended or otherwise ineligible to perform on a U.S. Government contract.

13.  The Contractor hereby acknowledges that any violation or breach of this Agreement on the part of the Contractor, subcontractor, consultant or any employee of the Contractor or subcontractor shall constitute grounds for suspension and/or debarment of the Contractor, or such subcontractor or employee; termination of access to such information; termination of the Contract; suit for damages; suit to enforce the Agreement, including but not limited to, application for a court order prohibiting disclosure or use of information in violation or breach of this Agreement; and/or suit for civil fines and penalties.  The Contractor further acknowledges that the unauthorized use, disclosure or retention of the information may constitute a violation of the U.S. criminal laws, including provisions of sections 641, 793, 794, and 1905, Title 18 U.S. Code, and that nothing in this Agreement constitutes a waiver by the U.S. of the right to prosecute for any statutory violation.

14.  The Contractor hereby acknowledges and agrees that the provisions concerning the use and disclosure of information described in paragraphs 1 and 4 are for the benefit of, and shall be enforceable by, the Sponsor, DoD or any affected entity having an interest in the information that was disclosed under this Agreement.  Such an entity and DoD are third party beneficiaries of this Agreement and shall have the right of direct action against the Contractor or subcontractor to enforce the Agreement or to seek such damages that may result from any breach of the Agreement.

15.  The Contractor agrees to indemnify the U.S., its agents and employees from all liability arising out of, or in any way related to, the misuse or unauthorized disclosure of information described in paragraphs 1 and 4 by the Contractor, subcontractors or their employees or agents.  The Contractor shall hold the U.S., its agents and employees harmless against any claim or liability, including attorneys fees, costs and expenses, arising out of the misuse or unauthorized disclosure of such information.

16.  The Contractor hereby assigns to the U.S. Government all royalties, remunerations and emoluments that have resulted, will result or may result from any disclosure or use of information that is described in paragraphs 1 and 4 of, and that is provided to the Contractor pursuant to, this Agreement.  The Contractor makes no assignment as to funds received from the disclosure or use of such information that is obtained from a source other than this Agreement.

17.  Each provision of this Agreement is severable.  If a court should find any provision of this Agreement to be unenforceable, all other provisions of this Agreement shall remain in full force and effect.

CONTRACTOR

Date_______________

Name:_____________________________________________

               (Typed or Printed)

*Signature:_______________________________________

Title:____________________________________________

Address:__________________________________________

__________________________________________________

Last Six Digits Social Security:__________________

SPONSOR

Date______________

Name:_____________________________________________

Signature:________________________________________

Title:____________________________________________

Organization:_____________________________________

* This Agreement must be signed by an authorized representative of the Contractor who has the authority to bind the Contractor.

Authority to solicit Social Security Number (SSN) is Executive Order 9397.  The SSN is routinely used to precisely identify the individual when necessary to certify access to logistics information or to determine that access to such information has terminated.  Although disclosure if your SSN is not mandatory, your failure to do so may delay certification and possibly prevent access to logistics information.