Form DD Form 1540 DD Form 1540 Registration for Scientific and Technical Information Se

FOR OFFICIAL USE ONLY
OMB No. 0704-0264
OMB approval expires

REGISTRATION FOR SCIENTIFIC AND TECHNICAL INFORMATION SERVICES
(Read Privacy Act Statement and Instructions on back before completing this form.)

The public reporting burden for this collection of information is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0264). Respondents should be aware that notwithstanding any other provision of
law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. SEND YOUR COMPLETED FORM TO: DEFENSE TECHNICAL
INFORMATION CENTER, ATTN: DTIC-BC, 8725 JOHN J. KINGMAN ROAD, SUITE 0944, FORT BELVOIR, VA 22060-6218.
FOR DTIC USE ONLY
SECTION I - GENERAL INFORMATION (All applicants must complete Section I.)
2. SUBORGANIZATION NAME

1. ORGANIZATION NAME
3.a. CLASSIFIED/BUSINESS MAILING ADDRESS

b. CITY

DTIC USER CODE

c. STATE d. ZIP CODE

USER TYPE

ENTITY CODE

CHARGE CODE

4. ATTENTION
a. NAME (Last, First, Middle Initial)

b. SSN

c. POSITION/TITLE

d. OFFICE SYMBOL
SERVICE LEVEL SPONSOR

5. TELEPHONE NUMBER (Include area code)

6. FAX NUMBER (Include area code)

a. COMMERCIAL

a. COMMERCIAL

b. DSN

b. DSN

8.a. PRIME CONTRACT NUMBER
(Contractors only)

7. E-MAIL ADDRESS

10.a. MILITARILY CRITICAL TECHNICAL DATA AGREEMENT
CERTIFICATION NUMBER (Contractors only)

9. CURRENT OR FORMER DTIC
USER (X one)
YES (Enter DTIC user code)
NO

13. TYPE OF ACCESS REQUESTED (X as applicable)
a. UNCLASSIFIED:

FACILITY CLEARANCE

b. EXPIRATION DATE
(YYYYMMDD)

SECURITY CLEARANCE

b. EXPIRATION DATE
(YYYYMMDD)

11. CAGE CODE

TYPE

D R A F T

RD

CNWDI

NATO

12. DUNS NUMBER

c. SPECIAL ACCESSES:

UNCLASSIFIED/UNLIMITED (Public release)

RESTRICTED DATA

NATO UNCLASSIFIED

UNCLASSIFIED/LIMITED (Controlled distribution)

CNWDI

NATO CONFIDENTIAL

b. CLASSIFIED:

NATO SECRET

CONFIDENTIAL
SECRET

NATO DATE BRIEFED:

CNWDI DATE BRIEFED:

SECTION II - SECURITY OFFICER (Complete Section II if requesting access to classified data.)
14. SECURITY OFFICER CERTIFICATION

I certify that the organization listed in Section I may receive and store classified data at the access level indicated in Section I, and the
individual listed in Section I has been cleared and briefed for all requested special accesses.
a. NAME (Last, First, Middle Initial)

b. ORGANIZATION NAME

c. E-MAIL ADDRESS

d. SSN

e. TELEPHONE NUMBER (Include area code)
(1) COMMERCIAL

f. SIGNATURE

g. DATE SIGNED (YYYYMMDD)

(2) DSN

SECTION III - U.S. GOVERNMENT APPROVING OFFICIAL (DOD organizations requesting access to classified data, Non-DOD Government
organizations requesting access to unclassified, limited or classified data, and all contractors requesting either unclassified or classified data must
complete Section III. See Instructions for detailed explanation of Government Approving Official.)
15. APPROVING ORGANIZATION NAME

16.a. BUSINESS ADDRESS

17.a. APPROVING OFFICIAL NAME (Last, First, Middle Initial)

c. STATE

d. ZIP CODE

b. POSITION/TITLE

c. E-MAIL ADDRESS

d. SSN

e. TELEPHONE NUMBER (Include area code)
(1) COMMERCIAL

b. CITY

f. SIGNATURE

g. DATE SIGNED (YYYYMMDD)

(2) DSN

FOR DTIC USE ONLY

DD FORM 1540, 20070201 DRAFT

PREVIOUS EDITION IS OBSOLETE.

Adobe Professional 7.0

INSTRUCTIONS FOR COMPLETING DD FORM 1540,
REGISTRATION FOR SCIENTIFIC AND TECHNICAL INFORMATION SERVICES
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301; E.O. 9397.
PRINCIPAL PURPOSE(S): To register for scientific and technical information services provided by Defense Technical Information Center (DTIC).
DoD individuals must be verified through Defense Manpower Data Center (DMDC). This verification process is used to validate an individual's
required affiliation with a DoD organization.
ROUTINE USE(S): None.

D R A F T

DISCLOSURE: Voluntary; however, failure to provide the requested personal information will result in the individual not being registered for
scientific and technical information services.
A. WHO IS ELIGIBLE
- Department of Defense (DoD) members and employees
- U.S. Government employees
- Government contractors
B. WHERE TO FILE
Mail completed DD Form 1540 to:
Defense Technical Information Center
DTIC-BC, (Registration)
8725 John J. Kingman Road, Suite 0944
Fort Belvoir, VA 22060-6218
Telephone: (703) 767-8273
Fax:
(703) 767-9459
E-mail: [email protected]
C. GENERAL INSTRUCTIONS
1. DoD Members/Employees.
a. Section I - General Information. For Unclassified/Limited data
complete Section I only.
b. Section II - Security Officer. Your Facility Security Officers' (FSO)
signature is required in block 14.f. in order for DTIC to grant access to
classified data. Signature is confirmation that you are eligible to
receive, and have the capability to store, the classified data at the
access level requested in Section I (block 13, "Type of Access
Desired").
(1) Security officer must enter date(s) briefed for access to: CNWDI
and NATO in block 13.
c. Section III - U.S. Government Approving Official. Sign block 17.f. if
access to classified data is requested.
NOTE: The Government Approving Official is a government employee
in a supervisory or managerial position, who is knowledgeable of your
eligibility to perform the official duties of your position, has official
control and responsibility over you and the position you occupy.
2. U.S. Government Employees.
A current SF-50, or comparable personnel document, for the
applicant, security officer and/or government approving official, is
required for employment verification. Please send with the completed
DD Form 1540.
a. Section I - General Information. For Unclassified/Unlimited (public
release) data complete Section I only.
b. Section II - Security Officer. Your Facility Security Officers' (FSO)
signature is required in block 14.f. in order for DTIC to grant access to
classified data. Signature is confirmation that you are eligible to
receive, and have the capability to store, the classified data at the
access level requested in Section I (block 13, "Type of Access
Desired").
(1) Security officer must enter date(s) briefed for access to: CNWDI
and NATO in block 13.

DD FORM 1540 (BACK), 20070201 DRAFT

c. Section III - U.S. Government Approving Official. Signature required
if access to Unclassified/Limited (controlled distribution) or classified
data is requested.
NOTE: The Government Approving Official is a government employee
in a supervisory or managerial position, who is knowledgeable of your
eligibility to perform the official duties of your position, has official
control and responsibility over you and the position you occupy.
3. Contractors, Subcontractors, Potential Contractors, CRDA
Partners, and Grantees
a. Section I - General Information. Contractors complete Section I.
Enter the contract number and expiration date in blocks 8.a. and b.
(1) Submit a certified copy of your DD Form 2345, "Militarily Critical
Technical Data Agreement", to DTIC for access to export controlled
data.
(2) Enter the CAGE code in block 11 and DUNS number in block 12.
Contact your security officer if you need assistance in obtaining this
information.
b. Section II - Security Officer. Your Facility Security Officers' (FSO)
signature is required in block 14.f. in order for DTIC to grant access to
classified data. Signature is confirmation that you are eligible to
receive, and have the capability to store, the classified data at the
access level requested in Section I (block 13, "Type of Access
Desired").
(1) Security officer must enter date(s) briefed for access to: CNWDI
and NATO in block 13.
c. Section III -- U.S. Government Approving Official. Complete Section
III. Signature of Government Approving Official is required.
The government approving official must be one of the following:
- Primary Contracting Officer (PCO)
- Administrative Contracting Officer (ACO), when designated in
writing by the PCO, to DTIC
- Contracting Officer's Technical Representative (COTR)
- Contracting Officer's Representative (COR)
- Program Manager
- Project Manager
D. AFTER REGISTRATION
1. DTIC will email a numeric user code to the user upon approval.
2. Registered DTIC users must notify DTIC, in writing, of any changes
to their current DD Form 1540. Please send an e-mail with changes to
[email protected].
3. Registered users will receive a notice from DTIC 60 days prior to the
scheduled expiration date of their service.
E. ADDITIONAL INFORMATION
Visit DTIC's web site for information on registering for online
services. The URL is www.dtic.mil.