DD Form 2875 "System Authorization Access Request (SAAR)"

What Is DD Form 2875?

DD Form 2875, System Authorization Access Request is a form used for registering names, signatures and other identifying information of individuals looking to access the Department of Defense (DoD) systems and data. The purpose of gathering the information is to evaluate and assess the eligibility of the individual or individuals seeking access.

The latest edition of the form - often incorrectly referred to as the DA Form 2875 - was released by the DoD in August 2009 with all previous editions being obsolete. An up-to-date fillable DD form 2875 is available for online filing or download below.

The system authorization access request has to be filled before any access to DoD data is granted to the applicant. The request may be filed and submitted either digitally or physically.

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Download DD Form 2875 "System Authorization Access Request (SAAR)"

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SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)
PRIVACY ACT STATEMENT
Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act.
AUTHORITY:
PRINCIPAL PURPOSE:
To record names, signatures, and other identifiers for the purpose of validating the trustworthiness of individuals requesting
access to Department of Defense (DoD) systems and information. NOTE: Records may be maintained in both electronic
and/or paper form.
ROUTINE USES:
None.
Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or
DISCLOSURE:
prevent further processing of this request.
TYPE OF REQUEST
DATE (YYYYMMDD)
INITIAL
MODIFICATION
DEACTIVATE
USER ID
SYSTEM NAME (Platform or Applications)
LOCATION (Physical Location of System)
PART I (To be completed by Requestor)
1. NAME (Last, First, Middle Initial)
2. ORGANIZATION
3. OFFICE SYMBOL/DEPARTMENT
4. PHONE (DSN or Commercial)
5. OFFICIAL E-MAIL ADDRESS
6. JOB TITLE AND GRADE/RANK
7. OFFICIAL MAILING ADDRESS
8. CITIZENSHIP
9. DESIGNATION OF PERSON
MILITARY
CIVILIAN
US
FN
OTHER
CONTRACTOR
10. IA TRAINING AND AWARENESS CERTIFICATION REQUIREMENTS (Complete as required for user or functional level access.)
I have completed Annual Information Awareness Training.
DATE (YYYYMMDD)
12. DATE (YYYYMMDD)
11. USER SIGNATURE
PART II - ENDORSEMENT OF ACCESS BY INFORMATION OWNER, USER SUPERVISOR OR GOVERNMENT SPONSOR (If individual is a
contractor - provide company name, contract number, and date of contract expiration in Block 16.)
13. JUSTIFICATION FOR ACCESS
14. TYPE OF ACCESS REQUIRED:
AUTHORIZED
PRIVILEGED
15. USER REQUIRES ACCESS TO:
UNCLASSIFIED
CLASSIFIED (Specify category)
OTHER
16a. ACCESS EXPIRATION DATE (Contractors must specify Company Name,
16. VERIFICATION OF NEED TO KNOW
Contract Number, Expiration Date. Use Block 27 if needed.)
I certify that this user requires access as requested.
17. SUPERVISOR'S NAME (Print Name)
18. SUPERVISOR'S SIGNATURE
19. DATE (YYYYMMDD)
20b. PHON E NUMBER
20. SUPERVISOR'S ORGANIZATION/DEPARTMENT
20a. SUPERVISOR'S E-MAIL ADDRESS
21. SIGNATURE OF INFORMATION OWNER/OPR
21a. PHONE NUMBER
21b. DATE (YYYYMMDD)
22. SIGNATURE OF IAO OR APPOINTEE
23. ORGANIZATION/DEPARTMENT
24. PHONE NUMBER
25. DATE
(YYYYMMDD)
DD FORM 2875, AUG 2009
PREVIOUS EDITION IS OBSOLETE.
Adobe Designer 9.0
SYSTEM AUTHORIZATION ACCESS REQUEST (SAAR)
PRIVACY ACT STATEMENT
Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act.
AUTHORITY:
PRINCIPAL PURPOSE:
To record names, signatures, and other identifiers for the purpose of validating the trustworthiness of individuals requesting
access to Department of Defense (DoD) systems and information. NOTE: Records may be maintained in both electronic
and/or paper form.
ROUTINE USES:
None.
Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or
DISCLOSURE:
prevent further processing of this request.
TYPE OF REQUEST
DATE (YYYYMMDD)
INITIAL
MODIFICATION
DEACTIVATE
USER ID
SYSTEM NAME (Platform or Applications)
LOCATION (Physical Location of System)
PART I (To be completed by Requestor)
1. NAME (Last, First, Middle Initial)
2. ORGANIZATION
3. OFFICE SYMBOL/DEPARTMENT
4. PHONE (DSN or Commercial)
5. OFFICIAL E-MAIL ADDRESS
6. JOB TITLE AND GRADE/RANK
7. OFFICIAL MAILING ADDRESS
8. CITIZENSHIP
9. DESIGNATION OF PERSON
MILITARY
CIVILIAN
US
FN
OTHER
CONTRACTOR
10. IA TRAINING AND AWARENESS CERTIFICATION REQUIREMENTS (Complete as required for user or functional level access.)
I have completed Annual Information Awareness Training.
DATE (YYYYMMDD)
12. DATE (YYYYMMDD)
11. USER SIGNATURE
PART II - ENDORSEMENT OF ACCESS BY INFORMATION OWNER, USER SUPERVISOR OR GOVERNMENT SPONSOR (If individual is a
contractor - provide company name, contract number, and date of contract expiration in Block 16.)
13. JUSTIFICATION FOR ACCESS
14. TYPE OF ACCESS REQUIRED:
AUTHORIZED
PRIVILEGED
15. USER REQUIRES ACCESS TO:
UNCLASSIFIED
CLASSIFIED (Specify category)
OTHER
16a. ACCESS EXPIRATION DATE (Contractors must specify Company Name,
16. VERIFICATION OF NEED TO KNOW
Contract Number, Expiration Date. Use Block 27 if needed.)
I certify that this user requires access as requested.
17. SUPERVISOR'S NAME (Print Name)
18. SUPERVISOR'S SIGNATURE
19. DATE (YYYYMMDD)
20b. PHON E NUMBER
20. SUPERVISOR'S ORGANIZATION/DEPARTMENT
20a. SUPERVISOR'S E-MAIL ADDRESS
21. SIGNATURE OF INFORMATION OWNER/OPR
21a. PHONE NUMBER
21b. DATE (YYYYMMDD)
22. SIGNATURE OF IAO OR APPOINTEE
23. ORGANIZATION/DEPARTMENT
24. PHONE NUMBER
25. DATE
(YYYYMMDD)
DD FORM 2875, AUG 2009
PREVIOUS EDITION IS OBSOLETE.
Adobe Designer 9.0
26. NAME (Last, First, Middle Initial)
27. OPTIONAL INFORMATION (Additional information)
PART III - SECURITY MANAGER VALIDATES THE BACKGROUND INVESTIGATION OR CLEARANCE INFORMATION
28. TYPE OF INVESTIGATION
28a. DATE OF INVESTIGATION (YYYYMMDD)
28c. IT LEVEL DESIGNATION
28b. CLEARANCE LEVEL
LEVEL I
LEVEL II
LEVEL III
30. SECURITY MANAGER
29. VERIFIED BY (Print name)
32. DATE (YYYYMMDD)
31. SECURITY MANAGER SIGNATURE
TELEPHONE NUMBER
PART IV - COMPLETION BY AUTHORIZED STAFF PREPARING ACCOUNT INFORMATION
TITLE:
SYSTEM
ACCOUNT CODE
DOMAIN
SERVER
APPLICATION
DIRECTORIES
FILES
DATASETS
DATE PROCESS ED
PROCESSED BY (Print name and sign)
DATE (YYYYMMDD)
(YYYYMMDD)
DATE REVALIDATED
REVALIDATED BY (Print name and sign)
DATE (YYYYMMDD)
(YYYYMMDD)
DD FORM 2875 (BACK), AUG 2009
INSTRUCTIONS
The prescribing document is as issued by using DoD Component.
A. PART I: The following information is provided by the user when
(21) Signature of Information Owner/OPR. Signature of the functional
establishing or modifying their USER ID.
appointee responsible for approving access to the system being
requested.
(1) Name. The last name, first name, and middle initial of the user.
(21a) Phone Number. Functional appointee telephone number.
(2) Organization. The user's current organization (i.e. DISA, SDI, DoD
and government agency or commercial firm).
(21b) Date. The date the functional appointee signs the DD Form
2875.
(3) Office Symbol/Department. The office symbol within the current
organization (i.e. SDI).
(22) Signature of Information Assurance Officer (IAO) or Appointee.
(4) Telephone Number/DSN. The Defense Switching Network (DSN)
Signature of the IAO or Appointee of the office responsible for
phone number of the user. If DSN is unavailable, indicate commercial
approving access to the system being requested.
number.
(23) Organization/Department. IAO's organization and department.
(5)Official E-mail Address. The user's official e-mail address.
(24) Phone Number. IAO's telephone number.
(6) Job Title/Grade/Rank. The civilian job title (Example: Systems
Analyst, GS-14, Pay Clerk, GS-5)/military rank (COL, United States
Army, CMSgt, USAF) or "CONT" if user is a contractor.
(25) Date. The date IAO signs the DD Form 2875.
(7) Official Mailing Address. The user's official mailing address.
(27) Optional Information. This item is intended to add additional
information, as required.
(8) Citizenship (US, Foreign National, or Other).
C. PART III: Certification of Background Investigation or Clearance.
(9) Designation of Person (Military, Civilian, Contractor).
(28) Type of Investigation. The user's last type of background
(10) IA Training and Awareness Certification Requirements. User must
investigation (i.e., NAC, NACI, or SSBI).
indicate if he/she has completed the Annual Information Awareness
Training and the date.
(28a) Date of Investigation. Date of last investigation.
(11) User's Signature. User must sign the DD Form 2875 with the
understanding that they are responsible and accountable for their
(28b) Clearance Level. The user's current security clearance level
password and access to the system(s).
(Secret or Top Secret).
(12) Date. The date that the user signs the form.
(28c) IT Level Designation. The user's IT designation (Level I, Level II,
or Level III).
B. PART II: The information below requires the endorsement from the
user's Supervisor or the Government Sponsor.
(29) Verified By. The Security Manager or representative prints his/her
(13). Justification for Access. A brief statement is required to justify
name to indicate that the above clearance and investigation
establishment of an initial USER ID. Provide appropriate information if
information has been verified.
the USER ID or access to the current USER ID is modified.
(30) Security Manager Telephone Number. The telephone number of
(14) Type of Access Required: Place an "X" in the appropriate box.
the Security Manager or his/her representative.
(Authorized - Individual with normal access. Privileged - Those with
privilege to amend or change system configuration, parameters, or
(31) Security Manager Signature. The Security Manager or his/her
settings.)
representative indicates that the above clearance and investigation
(15) User Requires Access To: Place an "X" in the appropriate box.
information has been verified.
Specify category.
(32) Date. The date that the form was signed by the Security Manager
(16) Verification of Need to Know. To verify that the user requires
or his/her representative.
access as requested.
D. PART IV: This information is site specific and can be customized
(16a) Expiration Date for Access. The user must specify expiration
by either the DoD, functional activity, or the customer with approval of
date if less than 1 year.
the DoD. This information will specifically identify the access required
(17) Supervisor's Name (Print Name). The supervisor or representative
by the user.
prints his/her name to indicate that the above information has been
verified and that access is required.
E. DISPOSITION OF FORM:
(18) Supervisor's Signature. Supervisor's signature is required by the
TRANSMISSION: Form may be electronically transmitted, faxed, or
endorser or his/her representative.
mailed. Adding a password to this form makes it a minimum of "FOR
OFFICIAL USE ONLY" and must be protected as such.
(19) Date. Date supervisor signs the form.
FILING: Original SAAR, with original signatures in Parts I, II, and III,
(20) Supervisor's Organization/Department. Supervisor's organization
and department.
must be maintained on file for one year after termination of user's
account. File may be maintained by the DoD or by the Customer's
(20a) E-mail Address. Supervisor's e-mail address.
IAO. Recommend file be maintained by IAO adding the user to the
system.
(20b) Phone Number. Supervisor's telephone number.
DD FORM 2875 INSTRUCTIONS, AUG 2009
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DD Form 2875 Instructions

  1. Select the type of your request: initial, modification, deactivate. If you don't have a current MDR/SCE user account or user id, choose initial as your option. Date the form. Fill in the system name, location and the date of the request.
  2. Part I of the form is to be filled by the individual requesting access to the data. It requires their personal and contact information: their name, organization, department, phone number, job title, rank or grade and an official mailing address.
    The requestor must also indicate their citizenship and military status. If the requested information requires the person seeking the access to have completed certain training, the requestor must indicate whether they meet the given requirements. Certify Part I of the form by signing it in the provided box.
  3. Part II of the form is for the administrative agency or sponsoring party. This part consists of the following:
    • The justification for access, which is a brief explanation of reasons for granting access to the Department's data.
    • The type of access and the category of required information (classified, unclassified or other)
    • Access expiration date;
    • Personal information of the supervisor.
  4. Part III is filled by the security manager in cases when additional security matters are needed to provide access. This part provides details on the type and date of investigation, clearance level, IT-level designation, name and phone number of the security manager and the date of filing. The security must certify Part III with their signature.
  5. Part IV is completed by the authorized staff in charge of preparing account information.

After the DD 2875 is completed by the authorized parties, the form is to be submitted to the approval authority. The requestor should keep the record of the form for further reference if any additional authorization requests will take place in the future.

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