Unclassified for Official Use Only

UNCLASSIFIED//FOR OFFICIAL USE ONLY FOR OFFICIAL USE ONLY DEPARTMENT OF THE ARMY OFFICE OF THE DEPUTY CHIEF OF STAFF, G-2 1000 ARMY PENTAGON WASHINGTON, DC 20310-1000

DAMI-CDS

MEMORANDUM FOR DIRECTOR, OFFICE OF THE DEPUTY CHIEF OF STAFF, G-2, HEADQUARTERS DEPARTMENT OF THE ARMY, SPECIAL SECURITY OFFICE ATTN: CHIEF, PERSONNEL SECURITY BRANCH

SUBJECT: Intelligence Community Badge Request

1. References:

a. Intelligence Community (IC) Badge Agreement between U.S. Army Intelligence & Security Command and HQ, Department of the Army, Deputy Chief of Staff, G-2, dated 13 Mar 07.

b. DoD 5105.21-M-1, Sensitive Compartmented Information (SCI) Administrative Security Manual, Chapter 6.B.1-2, dated 3 Aug 98.

2. Request below named individual be issued an IC Badge based on current operational requirements/ justification. Issuance of an IC Badge validates TS/SI/TK clearance/access only. Passing other accesses requires a PERM Cert message for non-Joint Personnel Adjudication System users.

Name: Rank/Grade: SSN: Clearance/Date: Investigation/Date: Access: Subject’s Agency/Organization/Job Title:

3. IC Badge Requirements: Strong Operational Justification addressing above named individual’s need for “staff-like” access to IC facilities in order to accomplish the intelligence mission of the Army. IC Badges are issued only to those U.S. government military and civilian personnel who possess a valid TS clearance and are indoctrinated for SI/TK. The issuance of the IC Badge to contractors and to personnel with interim TS SCI is prohibited.

* Requests for IC Badges must be approved by the Special Security Representative (SSR)/Security Manager (SM) and Office Director (O-6 or GG-15), validating the operational justification and compliance with referenced manual and agreement.

*This form is only a request to DAMI-CDS-SSO and WILL NOT be accepted by SSO INSCOM. IC Badge requests MUST be signed by the Special Security Officer or Deputy SSO.

This document contains information protected by the Privacy Act of 1974. Information is for internal use only and disclosure outside the Department of Defense is prohibited. This document is “FOR OFFICIAL USE ONLY” and will be afforded the protection prescribed by Chapter IV, AR 340-17. IC Badge Request Template Created 22 MAY 08 – All previous editions are obsolete.

FOR OFFICIAL USE ONLY

UNCLASSIFIED//FOR OFFICIAL USE ONLY UNCLASSIFIED//FOR OFFICIAL USE ONLY FOR OFFICIAL USE ONLY DAMI-CDS-SO SUBJECT: Intelligence Community Badge Request

4. Individual Responsibilities: The IC Badge is an accountable item and should be controlled as such. Lost, stolen or misplaced IC Badges must be reported immediately to the SSR/SM and HQDA Special Security Office. IC Badge will be returned prior to outprocessing.

Operational Justification (Specific to Above Named Individual):

IC facilities to be visited and frequency:

I understand and will comply with all IC Badge requirements and responsibilities as stipulated in this memo and the referenced agreement/manual.

______/ ______Printed Name/ Rank and Signature of IC Badge recipient Date

Individual meets all requirements as stipulated in this memo and referenced agreement/manual,

______/ ______Printed Name/ Rank and Signature of SSR/SM Date

I approve this IC badge request based on this memo’s stated requirements.

______/ ______Printed Name/ Rank, Title, and Signature of Approving Authority Date

This document contains information protected by the Privacy Act of 1974. Information is for internal use only and disclosure outside the Department of Defense is prohibited. This document is “FOR OFFICIAL USE ONLY” and will be afforded the protection prescribed by Chapter IV, AR 340-17. IC Badge Request Template Created 22 MAY 08 – All previous editions are obsolete.

FOR OFFICIAL USE ONLY

UNCLASSIFIED//FOR OFFICIAL USE ONLY