Form SF 315 SF 315 TSP Request for Service Users

TELECOMMUNICATIONS SERVICE PRIORITY (TSP) SYSTEM
TSP REQUEST FOR SERVICE USERS

OMB No. 1670-0005

(See NCS Manual 3-1-1 for instructions before completion.)

Expires: 08/31/2011

The Public reporting burden for this collection of information is estimated to average 15 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 to any other aspect of this collection of information, including suggestions for reducing the burden, to DHS, NPPD/CS&C/NCS (Attn: TSP Program Office), 245
Murray Lane, M/S 0615, Washington, DC 20528-8500. 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.

1. ACTION REQUESTED (Enter applicable code) (If "C" or "D", complete Items 4, 9, 10, 11, and 12 at a minimum.)
A ASSIGN INITIAL PRIORITY FOR A SERVICE
C CHANGE TO A SERVICE, SERVICE PRIORITY, OR INFORMATION ABOUT A SERVICE
D DELETE/REVOKE A SERVICE'S PRIORITY
2. DATE SERVICE REQUIRED (MMDDYYYY)

3. SERVICE USER SERVICE ID

4. TSP AUTHORIZATION CODE (Complete below only if Action Requested in Item 1 is C or D.)

T

S

P

5. SERVICE PROFILE (List all profile elements that describe the user's level of support for the service.)

6. RESTORATION PRIORITY INFORMATION (Complete ONLY if requesting a restoration priority)

a. CATEGORY UNDER WHICH SERVICE QUALIFIES FOR PRIORITY TREATMENT (A, B, C or D)
b. CATEGORY CRITERIA UNDER WHICH SERVICE QUALIFIES
c. RESTORATION PRIORITY REQUESTED (5, 4, 3, 2, or 1)

d. PRIME VENDOR (Company Name)
7. PROVISIONING PRIORITY INFORMATION (Complete ONLY if requesting a provisioning priority)

a. CATEGORY UNDER WHICH SERVICE QUALIFIES FOR PRIORITY TREATMENT (A, B, C , D, or E)
b. CATEGORY CRITERIA UNDER WHICH SERVICE QUALIFIES
c. PROVISIONING PRIORITY REQUESTED (5, 4, 3, 2, 1, or E)
d. INVOCATION OFFICIAL'S NAME

e. INVOCATION OFFICIAL'S TITLE

f. TELEPHONE NUMBER (Area Code/Number/Extension)

g. HAS THE INVOCATION OFFICIAL AUTHORIZED
THIS ACTION? (Y or N)

h. SERVICE LOCATIONS (Street Address, Building Number, Room Number, etc.) AND 24-HOUR POINT OF CONTACT FOR EACH END
SERVICE LOCATION

i. PRIME VENDOR POINT-OF-CONTACT FOR PROVISIONING (Point of Contact Name, Telephone Number, and Company)

AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 315 (Revised 09/2010)

8. SUPPLEMENTAL INFORMATION (Provide: (1) circuit specification(s) for provisioning priority only; (2) justification for requested priority
level if higher than qualified for; or (3) justification for disapproval or priority level change in sponsorship disposition field (12e).)

9. SERVICE USER (Enter applicable code)
A FEDERAL GOVERNMENT
C LOCAL GOVERNMENT
B STATE GOVERNMENT
D PRIVATE SECTOR

E FOREIGN GOVERNMENT
F OTHER

G U.S. MILITARY

10. SERVICE USER ORGANIZATION (If Federal Dept/Agency, provide FIPS Code)
11. SERVICE USER POINT-OF-CONTACT (For correspondence regarding this service)
a. NAME AND TITLE

b. ORGANIZATION

c. (1) MAILING ADDRESS

(2) CITY

d. TELEPHONE NUMBER (Area Code/Number/Extension)

e. FACSIMILE NUMBER (Area Code/Number/Extension)

f. 24-HOUR TELEPHONE NUMBER (Area Code/Number/Extension)

g. ELECTRONIC MAILING ADDRESS

(3) STATE

(4) ZIP CODE

h. SIGNATURE AND DATE: I confirm this is a National Security and Emergency Preparedness (NS/EP) service.

12. SPONSORSHIP INFORMATION FOR NON-FEDERAL SERVICE (To be completed by sponsor)
a. FEDERAL SPONSORING AGENCY AND FIPS CODE
b. SPONSOR NAME
c. SPONSOR TITLE

d. TELEPHONE NUMBER (Area Code/Number/Extension)

e. RECOMMENDED DISPOSITION (X one)
APPROVE

DISAPPROVE

APPROVE WITH PRIORITY LEVEL CHANGE

f. SPONSOR SIGNATURE AND DATE: I confirm this is a National Security and Emergency Preparedness (NS/EP) service.

Non-Federal users: send form to your Federal Government sponsor.
Federal users or sponsors: send completed form to:
DHS, NPPD/CS&C/NCS
(Attn: TSP Program Office),
245 Murray Lane,
M/S 0615,
Washington, DC 20528-8500

Privacy Act Notice
Authority: This information collection is authorized by 5 U.S.C. §301 and 44 U.S.C. §3101.
Purpose: DHS will use this information to provide Telecommunications Service Priority (TSP) users and vendors
with information relating to TSP requests and to resolve specific cases of customer service.
Routine Uses: The information collected may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the
Privacy Act of 1974, as amended. This includes using the information, as necessary and authorized by the routine
uses published in DHS/ALL 002 Department of Homeland Security Mailing and Other Lists System.
Disclosure: Furnishing this information is voluntary; however, failure to furnish the requested information may delay
or prevent your registration or verification for continued use of service.
STANDARD FORM 315 (Revised 09/2010)(BACK)