Incident Report Form/System

Police Center (RMS)

The notices below were drafted to be included on the first page of the system. To avoid additional costs to the government, these will be added once the OMB Control Number and Expiration date are known.

Privacy Act Statement

Authority: 5 U.S.C. 301, Departmental Regulations; 5 U.S.C. 303(b), Oath to Witnesses; 10 U.S.C. 133, Under Secretary of Defense for Acquisition and Technology. 10 U.S.C. 136, Under Secretary of Defense for Personnel and Readiness; Section 21 of the Internal Security Act of 1950 (50 U.S.C. 797); 18 U.S.C. 499, Military, Naval, or Official Passes; 18 U.S.C. 701, Official Badges, Identification Cards, Other Insignia; 18 U.S.C. 716, Police Badges; DOD Instruction 5200.8, Security of Military Installations and Resources; 10 U.S.C. 1580, Emergency Essential Personnel, designation; 10 U.S.C. 1585, Carrying of Firearms; DOD 5210.56, Use of Deadly Force and the Carrying of Firearms by DOD Personnel Engaged in Law Enforcement and Security Duties; CJCSI 3121.01B, Standing Rules of Engagement/Standing rules for the Use of Force for US Forces; 10 U.S.C. 1593, Uniform allowance: civilian employees. National Highway Safety Act of 1966 (23 U.S.C. 401, Highway Safety, et seq.); Section 21 of the Internal Security Act 1950 (50 U.S.C. 797, et seq.); DOD Instruction 5200.8, Security of DOD Installations and Resources; DOD Directive 5105.22; and E.O. 9397 (SSN), as amended.

Purpose: Information is collected to provide several existing functions of the DLA police force mission. This system serves as an enterprise wide system for the collection and storage of police records. The system will track criminal incident data at DLA Headquarters and the major DLA primary level field activities through information sharing to assist in crime prevention strategies, crime trends and criminal activities. The information gathered by the Police officers will be used for official police matters and record keeping purposes only.

Routine Uses: In addition to the DoD “Blanket Routine Uses” which apply to this system of records, the records may be released:

To Federal, state, and local agencies that administer programs or employ individuals involved in an incident or inquiry.

To medical and emergency personnel to make medical and safety determinations about individuals involved in accidents.

To the Department of Labor, Office of Workers' Compensation for the purpose of processing workers' compensation claims.

Disclosure: Voluntary; however, failure to provide the requested data may result in the inability to provide police-related services or benefits.

Rules of Use: Rules for collecting, using, retaining and safeguarding this information are contained in Defense Logistics Agency Notices, S500.30, “Incident Investigation/Police Inquiry Files”, S500.40, “DLA Security Force and Staff Records,” S500.41, “Vehicle/Traffic Incident Files,”, S500.42, “Seizure and Disposition of Property Records,” and S500.43, “Firearms Registration Records” located at http://dpclo.defense.gov/privacy/SORNs/component/dla/index.html.

AGENCY DISCLOSURE STATEMENT

The public reporting burden for this collection of information is estimated to average 30 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, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100 (XXXX-XXXX)[Insert OMB Control Number]. 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 RESPONSE TO THE ABOVE ADDRESS. SEND YOUR RESPONSES TO:

Security and Emergency Services

Law Enforcement Program Manager

8725 John J. Kingman Road, Suite 3533

Fort Belvoir, VA 22060-6220