DD Form 2928 "Defense Civilian Pay System (Dcps) Payroll Office Access Form"

What Is DD Form 2928?

This is a form that was released by the U.S. Department of Defense (DoD) on January 1, 2014. The form, often mistakenly referred to as the DA Form 2928, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DoD.

Form Details:

  • A 2-page document available for download in PDF;
  • The latest version available from the Executive Services Directorate;
  • Editable, printable, and free to use;

Download an up-to-date fillable DD Form 2928 down below in PDF format or browse hundreds of other DoD Forms compiled in our online library.

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Download DD Form 2928 "Defense Civilian Pay System (Dcps) Payroll Office Access Form"

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DEFENSE CIVILIAN PAY SYSTEM (DCPS) PAYROLL OFFICE ACCESS FORM
PRIVACY ACT STATEMENT
AUTHORITY: Executive Orders 10450 and 9397 (SSN), Public Law 99-474, The Computer Fraud and Abuse Act (as amended), and 18 U.S.C. Section
1030 (as amended).
PRINCIPAL PURPOSE(S): To record names, signatures, and Social Security Numbers for the purpose of validating the trustworthiness of individuals
requesting access to Department of Defense (DoD) systems and information.
ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained
therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: The DoD "Blanket Routine Uses" set
forth at the beginning of DoD's compilation of systems of records notices apply to this system.
DISCLOSURE: Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay, or prevent further
processing of this request.
PART I. USER PERSONAL INFORMATION (To be completed by Requestor)
1. NAME (Last, First, Middle Initial)
2. EMPLOYEE ID
3. AGENCY/MAJOR CLAIMANT
(SSN/LN #/SOFA #)
MAJOR CLAIMANT
AGENCY CODE:
CODE:
4. AFFILIATION (If affiliation is Foreign National, provide country code)
CIVILIAN (C)
CONTRACTOR (R)
MILITARY (M)
FOREIGN NATIONAL (F)
COUNTRY CODE:
5. DCPS SECURITY AWARENESS ONLINE COURSE COMPLETION CERTIFICATION
(IMPORTANT: New users must complete this course before
requesting access)
I have completed the DCPS Security Awareness Online Course.
DATE (YYYY-MM-DD):
PART II. USER ACCESS INFORMATION (To be completed by the user or the user's supervisor/government sponsor.)
6. DATABASE DESIGNATOR
(X all that apply for a payroll office and enter designator(s) in column 9. A different form must be submitted for each payroll office.
CPI
OMA
ZFA
ZFR
ZKA
ZKE
ZPA
ZPV
ZGT
ZLO
ZPB
ZPD
ZPH
ZPM
a. HOME ACTIVITY CODE
b. SITE ACTIVITY CODE
c. SITE INDICATOR CODE
7. PRINTER ID FOR REPORTS
USER TYPE: N - Payroll Office (PRO) User
ACTION CODE
:
(Enter in Column 8)
AUTHORIZATION TYPE
:
(Enter in Column 10)
A - Add
B - PRO Debt Technician
P - PRO Tables Maintenance
C - Change
E - PRO PDS Reconciliation Technician
R - PRO Retirement Clerk
D - Delete
G - PRO TSP Technician
S - PRO Supervisor
AUTHORIZATION NUMBER
:
H - PRO Health Technician
T - PRO T&A Clerk
(Enter in Column 11)
If Column 10 is K, M, or T, enter user's 3-digit pay
K - PRO Technician (SF50 and non-SF50)
U - PRO Leave Buy Back Technician
block assignment. If any other codes, leave blank.
M - PRO MER Clerk (non-SF50)
V - PRO View
8. ACTION CODE
9. DATABASE 10. AUTH TYPE 11. AUTH NO.
8. ACTION CODE
9. DATABASE
10. AUTH TYPE
11. AUTH NO.
USER AGREEMENT
I accept the responsibility for the information and DoD system to which I am granted access and will not exceed my authorized level of system access.
I understand that my access may be revoked or terminated for non-compliance with DoD security policies. I accept responsibilities to safeguard the
information contained in these systems from unauthorized or inadvertent modification, disclosure, destruction, and use. I understand that my use of the
system may be monitored as part of managing the system, protecting against unauthorized access and verifying security problems. I will ensure system
media and output are properly marked, controlled, stored, transported and destroyed based on sensitivity and need-to-know. I will report all DCPS IA-
related suspicious threats and vulnerabilities to the appropriate organization. I have completed a U.S. Government background investigation equal with
the level of access granted. I will use strong passwords, protect workstation, and not leave my CAC card or other authentication device unattended. I will
keep my security training current. I agree to notify the appropriate organization that issued my account(s) when access is no longer required.
12. USER'S SIGNATURE
13. DATE
(YYYY-MM-DD)
14. SUPERVISOR APPROVAL (Completed by user's supervisor or government sponsor)
a. CERTIFICATION OF NEED-TO-KNOW
I certify that this user requires access as requested in block 13 of the user's DD Form 2875.
c. SIGNATURE
b. SUPERVISOR/GOVERNMENT SPONSOR'S FULL NAME
d. DATE (YYYY-MM-DD)
IMPORTANT: Submit this form with the user's DD Form 2875, "System Authorization Access Request (SAAR)".
DD FORM 2928, JAN 2014
PREVIOUS EDITION IS OBSOLETE.
Adobe Designer 9.0
DEFENSE CIVILIAN PAY SYSTEM (DCPS) PAYROLL OFFICE ACCESS FORM
PRIVACY ACT STATEMENT
AUTHORITY: Executive Orders 10450 and 9397 (SSN), Public Law 99-474, The Computer Fraud and Abuse Act (as amended), and 18 U.S.C. Section
1030 (as amended).
PRINCIPAL PURPOSE(S): To record names, signatures, and Social Security Numbers for the purpose of validating the trustworthiness of individuals
requesting access to Department of Defense (DoD) systems and information.
ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained
therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: The DoD "Blanket Routine Uses" set
forth at the beginning of DoD's compilation of systems of records notices apply to this system.
DISCLOSURE: Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay, or prevent further
processing of this request.
PART I. USER PERSONAL INFORMATION (To be completed by Requestor)
1. NAME (Last, First, Middle Initial)
2. EMPLOYEE ID
3. AGENCY/MAJOR CLAIMANT
(SSN/LN #/SOFA #)
MAJOR CLAIMANT
AGENCY CODE:
CODE:
4. AFFILIATION (If affiliation is Foreign National, provide country code)
CIVILIAN (C)
CONTRACTOR (R)
MILITARY (M)
FOREIGN NATIONAL (F)
COUNTRY CODE:
5. DCPS SECURITY AWARENESS ONLINE COURSE COMPLETION CERTIFICATION
(IMPORTANT: New users must complete this course before
requesting access)
I have completed the DCPS Security Awareness Online Course.
DATE (YYYY-MM-DD):
PART II. USER ACCESS INFORMATION (To be completed by the user or the user's supervisor/government sponsor.)
6. DATABASE DESIGNATOR
(X all that apply for a payroll office and enter designator(s) in column 9. A different form must be submitted for each payroll office.
CPI
OMA
ZFA
ZFR
ZKA
ZKE
ZPA
ZPV
ZGT
ZLO
ZPB
ZPD
ZPH
ZPM
a. HOME ACTIVITY CODE
b. SITE ACTIVITY CODE
c. SITE INDICATOR CODE
7. PRINTER ID FOR REPORTS
USER TYPE: N - Payroll Office (PRO) User
ACTION CODE
:
(Enter in Column 8)
AUTHORIZATION TYPE
:
(Enter in Column 10)
A - Add
B - PRO Debt Technician
P - PRO Tables Maintenance
C - Change
E - PRO PDS Reconciliation Technician
R - PRO Retirement Clerk
D - Delete
G - PRO TSP Technician
S - PRO Supervisor
AUTHORIZATION NUMBER
:
H - PRO Health Technician
T - PRO T&A Clerk
(Enter in Column 11)
If Column 10 is K, M, or T, enter user's 3-digit pay
K - PRO Technician (SF50 and non-SF50)
U - PRO Leave Buy Back Technician
block assignment. If any other codes, leave blank.
M - PRO MER Clerk (non-SF50)
V - PRO View
8. ACTION CODE
9. DATABASE 10. AUTH TYPE 11. AUTH NO.
8. ACTION CODE
9. DATABASE
10. AUTH TYPE
11. AUTH NO.
USER AGREEMENT
I accept the responsibility for the information and DoD system to which I am granted access and will not exceed my authorized level of system access.
I understand that my access may be revoked or terminated for non-compliance with DoD security policies. I accept responsibilities to safeguard the
information contained in these systems from unauthorized or inadvertent modification, disclosure, destruction, and use. I understand that my use of the
system may be monitored as part of managing the system, protecting against unauthorized access and verifying security problems. I will ensure system
media and output are properly marked, controlled, stored, transported and destroyed based on sensitivity and need-to-know. I will report all DCPS IA-
related suspicious threats and vulnerabilities to the appropriate organization. I have completed a U.S. Government background investigation equal with
the level of access granted. I will use strong passwords, protect workstation, and not leave my CAC card or other authentication device unattended. I will
keep my security training current. I agree to notify the appropriate organization that issued my account(s) when access is no longer required.
12. USER'S SIGNATURE
13. DATE
(YYYY-MM-DD)
14. SUPERVISOR APPROVAL (Completed by user's supervisor or government sponsor)
a. CERTIFICATION OF NEED-TO-KNOW
I certify that this user requires access as requested in block 13 of the user's DD Form 2875.
c. SIGNATURE
b. SUPERVISOR/GOVERNMENT SPONSOR'S FULL NAME
d. DATE (YYYY-MM-DD)
IMPORTANT: Submit this form with the user's DD Form 2875, "System Authorization Access Request (SAAR)".
DD FORM 2928, JAN 2014
PREVIOUS EDITION IS OBSOLETE.
Adobe Designer 9.0
DEFENSE CIVILIAN PAY SYSTEM (DCPS) PAYROLL OFFICE ACCESS FORM
INSTRUCTIONS FOR REQUESTING INITIAL ACCESS RIGHTS
IMPORTANT: Make sure this form is submitted with the user's DD Form 2875, "System Authorization Access Request (SAAR)".
PART I. USER PERSONAL INFORMATION
BLOCK 1. Enter user's last name, first name, middle initial, and suffix (if applicable).
BLOCK 2. Enter user's Social Security Number (SSN), local national (LN) number, or Status of Forces Agreement (SOFA) number.
Foreign nationals MUST provide the number assigned to them to work on the base.
BLOCK 3. Enter user's agency code and major claimant code. (Section H1 of DCPS User Manual contains a list of agency and
major claimant codes.)
BLOCK 4. Enter an X in the box to the left of user's affiliation. If affiliation is "Foreign National", you MUST enter user's 2-character
country code in the space provided. (Section G of DCPS User Manual contains a list of country codes.)
PART II. USER ACCESS INFORMATION
BLOCK 5. Place an X in the box to the left of statement and then enter the date the new user completed the DCPS Security
Awareness Online Course.
BLOCK 6. Place an X in the box to the left of each database within a payroll office that the new user will be accessing.
(IMPORTANT: A separate DCPS Payroll Office Access Form must be submitted for each payroll office for which the new user will
provide service.)
BLOCK 7. Enter identification number of printer where requested or automatically generated DCPS reports will print.
BLOCK 8. Enter A to add authorization type and authorization number within a database for accounts the new user will access.
(Repeat for each database and for each authorization type and number.)
BLOCK 9. Enter appropriate database designator.
BLOCK 10. Enter one of the following authorization types: (Repeat for each database and for each authorization type and
authorization number.)
B - PRO Debt Technician. Accesses Main Menu: Employee Data Menu (non-SF50), Pay Adjustments Menu, On-Line Inquiries Menu (non-SF50),
W-2 Main Menu, Debt Collection Menu.
E - PRO PDS Reconciliation Technician. Accesses Main Menu: Employee Data Menu - Personnel (SF50), Employee Data Menu (non-SF50),
On-Line Inquiries Menu, Debt Collection Menu.
G - PRO TSP Technician. Accesses Main Menu: Employee Data Menu - Personnel (SF50), Employee Data Menu (non-SF50), Pay Adjustments
Menu, On-Line Inquiries Menu, W-2 Main Menu, Debt Collection Menu.
H - PRO Health Technician. Accesses Main Menu: Employee Data Menu - Personnel (SF50), On-Line Inquiries Menu, Debt Collection Menu.
K - PRO Technician (SF50 and non-SF50). Accesses Main Menu: Employee Data Menu - Personnel (SF50), Employee Data Menu (non-SF50),
Time and Attendance Menu, Pay Adjustments Menu, Leave Menu, On-Line Inquiries Menu, As-Required Reports Menu, W-2 Main Menu,
Debt Collection Menu.
M - PRO MER Clerk (non-SF50). Accesses Main Menu: Employee Data Menu (non-SF50), Time and Attendance Menu, Pay Adjustments Menu,
Leave Menu, On-Line Inquiries Menu, Debt Collection Menu.
P - PRO Tables Maintenance. Accesses Main Menu: On-Line Inquiries Menu, Payroll Office Tables Maintenance Menu, Payroll Office Tables
Reports Menu.
R - PRO Retirement Clerk. Accesses Main Menu: Pay Adjustments Menu, On-Line Inquiries Menu, As-Required Reports Menu, Retirement Menu,
Debt Collection Menu.
S - PRO Supervisor. Accesses all Main Menu options.
T - PRO T&A Clerk. Accesses Main Menu: Time and Attendance Menu, On-Line Inquiries Menu, Debt Collection Menu.
U - PRO Leave Buy Back Technician. Accesses Main Menu: Time and Attendance Menu, On-Line Inquiries Menu, Debt Collection Menu.
V - PRO View. Accesses Main Menu: On-Line Inquiries Menu.
BLOCK 11. Enter user's 3-digit pay block assignment if authorization type is K, M, and/or T; otherwise, leave blank. NOTE: User
may not have K, M and/or T authorization types for the same pay block number. (Repeat for each database and for each
authorization type and authorization number.)
BLOCKS 12 and 13. Sign and date the form.
BLOCKS 14a through 14d. User's supervisor or government point of contact should place an X in the box to the left of the statement,
print his or her name, and then sign and date the form.
INSTRUCTIONS FOR REQUESTING MODIFICATION TO ACCESS RIGHTS
BLOCKS 1 through 7 and 12 through 14. Complete as directed in the Instructions for Requesting Initial Access Rights section above.
BLOCKS 8 through 11. Add, change, and delete authorization types and numbers as required (See Instructions for Requesting Initial
Access Rights section above for assistance in completing these blocks.)
DD FORM 2928 (BACK), JAN 2014
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