DA Form 7765 Army Disaster Personnel Accountability Assessment System, Command Officer Representative Access Request

DA Form 7765 - also known as the "Army Disaster Personnel Accountability Assessment System, Command Officer Representative Access Request" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 7765 - was last revised on February 1, 2017. Download an up-to-date fillable PDF version of the DA 7765 below or request a copy through the chain of command.

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ARMY DISASTER PERSONNEL ACCOUNTABILITY AND ASSESSMENT
SYSTEM, COMMAND OFFICER REPRESENTATIVE ACCESS REQUEST
For use of this form, see AR 600-86; the proponent agency is DCS G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
10 USC 136, Under Secretary of Defense for Personnel and Readiness; 10 USC 3013, Secretary of the Army; 10 USC
AUTHORITY:
5013, Secretary of the Navy; 10 USC 8013, Secretary of the Air Force; DoD Instruction 3001.02, Personnel Accountability
in Conjunction with Natural or Manmade Disasters; Air Force Instruction 10-218, Personnel Accountability in conjunction
with Natural Disasters or National Emergencies; Army Regulation 500-3, US Army Continuity of Operations Program
Policy and Planning.
To accomplish personnel accountability for DoD affiliated personnel in a natural or manmade disaster or when directed by
PRINCIPAL PURPOSE:
the Secretary of Defense. This system will document the individuals check-in data. The Military Departments may also
collect information about Service members and their dependents for needs assessment as a result of the natural or
manmade disaster. The DoD Components may also use accountability data for accountability and assessment reporting
exercises.
In addition to those disclosures generally permitted under 5 USC 552a(b) of the Privacy Act of 1974, these records may
ROUTINE USES:
specifically be disclosed outside DoD as a routine use pursuant to 5 USC 552a(b)(3) as follows:
To Federal, state, or local governments during actual emergencies, exercises or continuity of operations tests for the
purpose of responding to emergency situations or to allow emergency service personnel to locate the individual(s).
To Federal Emergency Management Agency to facilitate recovery efforts when natural or manmade disasters occur.
The DoD Blanket Routine Uses also apply to this system of records.
DISCLOSURE:
Voluntary; however, failure to provide identifying information may impede processing of this application.
This form is used for requesting Disaster Personnel Accountability Program Manager (DPAPM)/Command Representative (COR) access to ADPAAS in
order to perform personnel accountability requirements for their command/organization, before, during or after a disaster event. All DPAPMs should be
appointed by Commanders, Directors, and Managers to act on their behalf.
All requests should be sent to USARMY.PENTAGON-E.HQDA.MBX.ADPAAS@MAIL.MIL or call (703) 697-4246 to speak to an ADPAAS team
member.
1. WHAT UIC(S) ARE YOU REQUESTING ACCESS FOR? (Use additional attachments as needed):
UIC
UNIT NAME
2. DESIGNATED DPAPM/COR
GRADE/RANK NAME (Last, First, Middle Initial)
PHONE NUMBER
EMAIL ADDRESS
DPAPM/COR SIGNATURE
DATE
Once granted access, DPAPMs will have the ability to mange their UIC Hierarchy down to the lowest level. This includes, adding and removing CORs,
managing personnel, and updating statuses during an accountability event. The DPAPM will be allowed access to specific personal information and
data for this purpose only. The ADPAAS system is committed to protecting personal privacy. Therefore, the use and implementation of the information
within are covered under the ADPAAS Privacy and Security Notice. Please review the ADPAAS Privacy and Security Notice on the ADPAAS Web site
at https://adpaas.army.mil. Care and protection of Privacy Act Information must be adhered to at all times accordance with DOD 5400.11 dated 8 May
2007.
3. APPROVING AUTHORITY (Commander/Director/Manager)
GRADE/RANK NAME (Last, First, Middle Initial)
PHONE NUMBER
EMAIL ADDRESS
APPROVING AUTHORITY SIGNATURE
DATE
APD LC v1.00ES
DA FORM 7765, FEB 2017
ARMY DISASTER PERSONNEL ACCOUNTABILITY AND ASSESSMENT
SYSTEM, COMMAND OFFICER REPRESENTATIVE ACCESS REQUEST
For use of this form, see AR 600-86; the proponent agency is DCS G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
10 USC 136, Under Secretary of Defense for Personnel and Readiness; 10 USC 3013, Secretary of the Army; 10 USC
AUTHORITY:
5013, Secretary of the Navy; 10 USC 8013, Secretary of the Air Force; DoD Instruction 3001.02, Personnel Accountability
in Conjunction with Natural or Manmade Disasters; Air Force Instruction 10-218, Personnel Accountability in conjunction
with Natural Disasters or National Emergencies; Army Regulation 500-3, US Army Continuity of Operations Program
Policy and Planning.
To accomplish personnel accountability for DoD affiliated personnel in a natural or manmade disaster or when directed by
PRINCIPAL PURPOSE:
the Secretary of Defense. This system will document the individuals check-in data. The Military Departments may also
collect information about Service members and their dependents for needs assessment as a result of the natural or
manmade disaster. The DoD Components may also use accountability data for accountability and assessment reporting
exercises.
In addition to those disclosures generally permitted under 5 USC 552a(b) of the Privacy Act of 1974, these records may
ROUTINE USES:
specifically be disclosed outside DoD as a routine use pursuant to 5 USC 552a(b)(3) as follows:
To Federal, state, or local governments during actual emergencies, exercises or continuity of operations tests for the
purpose of responding to emergency situations or to allow emergency service personnel to locate the individual(s).
To Federal Emergency Management Agency to facilitate recovery efforts when natural or manmade disasters occur.
The DoD Blanket Routine Uses also apply to this system of records.
DISCLOSURE:
Voluntary; however, failure to provide identifying information may impede processing of this application.
This form is used for requesting Disaster Personnel Accountability Program Manager (DPAPM)/Command Representative (COR) access to ADPAAS in
order to perform personnel accountability requirements for their command/organization, before, during or after a disaster event. All DPAPMs should be
appointed by Commanders, Directors, and Managers to act on their behalf.
All requests should be sent to USARMY.PENTAGON-E.HQDA.MBX.ADPAAS@MAIL.MIL or call (703) 697-4246 to speak to an ADPAAS team
member.
1. WHAT UIC(S) ARE YOU REQUESTING ACCESS FOR? (Use additional attachments as needed):
UIC
UNIT NAME
2. DESIGNATED DPAPM/COR
GRADE/RANK NAME (Last, First, Middle Initial)
PHONE NUMBER
EMAIL ADDRESS
DPAPM/COR SIGNATURE
DATE
Once granted access, DPAPMs will have the ability to mange their UIC Hierarchy down to the lowest level. This includes, adding and removing CORs,
managing personnel, and updating statuses during an accountability event. The DPAPM will be allowed access to specific personal information and
data for this purpose only. The ADPAAS system is committed to protecting personal privacy. Therefore, the use and implementation of the information
within are covered under the ADPAAS Privacy and Security Notice. Please review the ADPAAS Privacy and Security Notice on the ADPAAS Web site
at https://adpaas.army.mil. Care and protection of Privacy Act Information must be adhered to at all times accordance with DOD 5400.11 dated 8 May
2007.
3. APPROVING AUTHORITY (Commander/Director/Manager)
GRADE/RANK NAME (Last, First, Middle Initial)
PHONE NUMBER
EMAIL ADDRESS
APPROVING AUTHORITY SIGNATURE
DATE
APD LC v1.00ES
DA FORM 7765, FEB 2017

Download DA Form 7765 Army Disaster Personnel Accountability Assessment System, Command Officer Representative Access Request

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