Having trouble downloading pdf files or with the pdf editor. Dd form 2923 download printable pdf or fill online privacy. Such uses include pornography, chain letters, unofficial advertising. Dd74 dependency statement child born out of wedlock under age 21 dd448 military interdepartmental purchase request dd397 claim certification and voucher for death gratuity payment dd462 bond of person designated to act on behalf of incompetent member or former dd410 telephone service, requisition for dd365 weight and balance personnel, record of dd460. Note that the documentation must be delivered directly to the intended recipient and not left with a third party. Ftsregnav adseps are submitted to pers832 for processing. Any misuse or unauthorized disclosure of this information may result in both criminal and civil penalties. The privacy act of 1974, 5 usc 552a, provides protection to individuals by ensuring that. The purpose of this website is to facilitate effective information flow about information managementinformation technology and cybersecurity issues and initiatives occuring within the department of the. Navy alcohol and other drug rehabilitation program personnel must take every precaution to protect confidential information as described in paragraph 4. This form is used to document a members request for verification of military service. Nm05002 program system authorization access request navy saarn privacy act statement management and locator system. Do not process, store, or transmit any personally identifiable information pii, unclassifiedfouo or classified information on.
In addition to their being used within the departments of the navy and defense for the purposes indicated above, patient files and records may be used by command officers to commence administrative processing of the patient, if necessary, under opnavinst 5350. The unauthorized disclosure may result from criminal and civil penalties. Secnav don cio navy pentagon washington, dc 20350. Executive order 10450, public law 99474, the computer fraud and abuse act. Privacy act statement health care records in the case of military personnel, the requested information is mandatory because of the need to document all active duty medical incidents in view of future rights and benefits. These may be completed by the clinic staff or the service member.
Attach the cover sheet to the front of all folders and. Issued by the epa chief information officer, pursuant to delegation 119, dated 772005 procedures for preparing. Service agreement is used as the contract between a military department army navy air force and an individual selected to enter the active duty health. Opnav 523914 rev 92011 replaces rev 72008, which is obsolete page 1 of 4for official use only when filledauthority. Ranktitle, first mi last name ranktitle, first mi last name signature date y m d da form 7433, apr 2009. In order to protect the confidentiality and rights, privacy, and reputation of all people involved in a commander, navy installations command cnic inspector. This all inclusive privacy act statement will apply to all requests for personal. Privacy act system of records notices united states navy. Privacy act of 1974 department of navy chief information. To officially report the facts and circumstances supporting the assessment of financial charges for the loss, damage, or destruction of dodcontrolled property. Navy websites, nor does it share the data obtained through such. There is nothing that will serve and protect the navys.
Requests for other documents should be sent directly to the department of the navy on the navy web site. Coast guard see coast guard aviation medicine manual, chapter 1. Privacy act statement form 2 free templates in pdf, word. Contents shall not be disclosed, discussed, or shared with individuals unless they.
I shall rule finally on all matters of procedure and evidence. Department of homeland security privacy act statement guidance. It is the policy ofthe department ofthe navy don to ensure a work environment for all employees that is free from discrimination and harassment both. How and when to write a privacy act statement don cio navy. The way to complete the online naval forms online on the internet. Provide an orderly means of discharge for enlisted personnel. Requests for personal information require a signature and cannot be processed through this.
The following links provide access to all department of defense sorns by dod agency, as well as direct links to navy and marine corps sorns. Co is an o4 or above, not under original mso, under initial eight year mso. Defense privacy and civil liberties office introduction to the privacy act 5 exceptions to the no disclosure to third parties without. The security accreditation level of this site is unclassified and below. If the information requested will not be included in a system of records, then a pas is not required. Do not submit the saarn package without having the following items. The template can be easily available on word and pdf files. The purpose of this website is to facilitate effective information flow about information managementinformation technology and cybersecurity issues and initiatives occuring within the department of the navy. When a suit is filed, the first document that is requested by both the attorneys representing the navy and attorneys on the other side is the jagman investigation. We bring you the letter of privacy act cover sheet template that includes the required information of the privacy act that must be read by any third person before forwarding the documents. There is nothing that will serve and protect the navy s.
Second, if you or your counsel have any objection to any matters introduced or to any proceedings of the board, you or your counsel may state your objection and the reasons for it. Dd form 2005, privacy act statement health care records. In the case of all other personnel beneficiaries, the requested information is. Naval forms online fill out and sign printable pdf template. To be used on all documents containing personal information. The advanced tools of the editor will guide you through the editable pdf template. Download free printable privacy act statement form samples in pdf, word and excel formats. In the case of military personnel, the requested information is mandatory because of the need to document all active duty medical incidents in view of future. Request navy, to ensure that all personnel using department of the navy don owned or leased automated data processing equipment, information systems and information data, hereafter called the oconus navy enterprise network onenet are correctly identified and. Please see the below table for the sorns associated with the. Transform passwords almost when there is a violation. Address commandant of the marine corps arsf headquarters us marine corps 3000 marine corps pentagon rm 2b289 washington, dc 203503000 usmc privacy program coordinator. Information pertinent to the following situations, however, must be reported via the chain of command to your commanding officer. I have a right to inspect and receive a copy of my own protected health information to be used or disclosed, in accordance.
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