DCS, G-2 Letterhead
[pic]
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.
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): |
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|IC facilities to be visited and frequency: |
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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
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