NASA logo NASA Headquarters' Directives
HQPR 1630.1
Effective Date: February 25, 2016
Expiration Date: February 25, 2021
Responsible Office: LM032
Controlling NASA HQ National Security Systems (NSS) Reading Room
[<< back <<]

This document is uncontrolled when printed.
Check the NASA Online Directives Information System (NODIS) Library
to verify that this is the correct version before use.

Table of Contents | PREFACE | Chapter1 | Chapter2 | AppendixA | AppendixB

Appendix B

Request for Access to SIPRNET Reading Room

Date Access Requested: _________________________________________________________

Requestor Name:_______________________________________________________

NASA Office/Directorate/Code: ___________________________________________________

Requestor Work Phone Number: ___________________________________________________

Requestor Work Email Address: ____________________________________________________

Requestor NSS Emaial Address (if applicable): ____________________________________

Name of Sponsor: ____________________________________________________________

NASA Office/Directorate/Code: _____________________________________________________

Requestor Work Phone Number: _____________________________________________________

Requestor Work Email Address: ______________________________________________________

Requestor NSS Emaial Address (if applicable):

I have read and will abide by the "SIPRNET Standard Operating Procedure." I understand that access to the SIPRNET Reading Room will be immediately terminated if any of the following occur: my employment or contract t NASA is terminated; my security clearance is downgraded below SECRET; I violate applicable NASA security and/or information assurance directives or regulations; or I violate the Standard Operating Procedure.

Requestor Name (printed):

Signature: ___________________________________ Date: _________________________

For Official Use Only:

1st Endorsement, Personnel Security:

_____________________________ _____________________ _______________

Clearance Eligibility Investigation Type Investigation Date

______________________________ _____________________ ________________

Certifier Name

Signature Date

2nd Endorsment, Badging Office

Access Control System Update for Access to SIPRNET Reading Room

_________________________________ ______________________ _____________________

Date User Access Terminated:_________________________________________________

Reason for Termination:________________________________________________

Removed from Roster: ____________________ _________________

Date Initials

Removed from Access: ____________________ _________________

Date Initials


[<< back <<]