Form TSA Form 1427 TSA Form 1427 TSA infoBoards

DEPARTMENT OF HOMELAND SECURITY

Transportation Security Administration

TSA infoBoards User Account Request/Renewal

INSTRUCTIONS: Applicants requesting access to a TSA Information Boards (TSA infoBoards) must complete all applicable fields of this form and submit by email or fax to the appropriate TSA point of contact (e.g., Sponsor, Representative, or Board Administrator). See TSA infoBoards User Account Request Instructions for additional details.
SECTION I. Requestor Information
Full Name (Last, First, MI):      				Job Title:      
Telephone Number:      				Fax Number:      
Employer Name:      				Email Address:      
Complete Work Address:      
U.S. Citizen (Required): Yes No				TSA Employee (Required): Yes No
Airport 3 – Letter Code (Optional):      				Carrier ID (Optional):
SECTION II. Requestor Type
General Aviation 12-5		Non-US Air Carrier			Authorized Representative
All Cargo TFSSP		Private Charter			US Airports (ACO200)
Full All Cargo		US Commercial Air Carriers (ACO500)			Other      
SECTION III. TSA infoBoards Boards (Per TSA MD 1400.X, each TSA infoBoards user shall be associated with at least one TSA infoBoards board.)
Name of infoBoards board(s) requesting access to (may select multiple):
AvOps Air Carrier Security (12-5) AvOps Air Carrier Security (ACO500) AvOps Air Carrier Security (Private Charter) AvOps Airport Security (ACO200) AvOps International AvOps Non-US Air Carrier Security AvOps TSA Employee Certified Cargo Screening Program (CCSP) DCA Access Standard Security Program (DASSP)			Full All-Cargo Program G7 Transportation Security Subgroup Industry Report International Working Group on Land Transport Security Non-US All Cargo Security Screening Partnership Program Trilateral Working Group Watchlist Other      
Details/Reasons for Request:      
SECTION IV. Requestor Acknowledgement (Requestor to read and sign)
I, the requestor, attest that I am familiar with and I will comply with the standards for access, dissemination, handling, and safeguarding of Sensitive Security Information (SSI) as cited in this request, and in accordance with 49 CFR Part 1520, Protection of Sensitive Security Information, as amended, and any supplementary guidance issued by an authorized official of the Department of Homeland Security (DHS). I understand that I will be accessing a U.S. Government system that is provided for U.S. Government-authorized use only. By using this information system, I understand and consent to the following: I have no reasonable expectation of privacy when I use this information system; this includes any communications or data transiting or stored on this information system. At any time, and for any lawful government purpose, the government may, without notice, monitor, intercept, search and seize any communication or data transiting or stored on this information system; The government may disclose or use any communications or data transiting or stored on this information system for any lawful government purpose, including but not limited to law enforcing purposes; I will comply with requests to be audited by DHS and TSA and will provide response within three business days; I am responsible for the security of TSA data otherwise stored or processed on the regulated entity’s computing system and will verify the regulated entity’s proof of eligibility for remote access connection to DHS/TSA networks is current; I am not authorized to process classified information on this system; I will comply with Sensitive Personally Identifiable Information (SPII) and PII handling and disposition requirements; I will complete IT Security Awareness, SSI, and privacy training and will complete refresher training annually; and I will sign and provide annually the DHS Non-Disclosure Agreement (NDA) 11000-6, TSA Form 1403 Computer Personal Electronic Device Agreement, and copy of contract with regulated entity for authorized user (if necessary). I understand that failure to comply with the above will result in immediate revocation of my access to the TSA infoBoards and may result in fines or other penalties. ________________________________________________ ________________________________ Signature Date
SECTION V. Acknowledgement (Requesting organization’s Security Coordinator to read and sign)
I, the requesting organization’s authorizing official, hereby acknowledge and concur with this request. I may also be held accountable for any violations of the infoBoards user agreement stated above. _________________________________________________ _______________________________________________ Print Name Title _________________________________________________ ________________ Signature Date
SECTION VI. TSA Sponsor Acknowledgement (TSA Sponsor to read and sign)
I, the TSA Sponsor, hereby acknowledge and grant this request. ________________________________________________ _______________________________________________ Print Name Title ________________________________________________ ________________ Signature Date
SECTION VIII. TSA Board Administrator (TSA Board Administrator to read and sign)
I, the Board Administrator, hereby acknowledge and grant this request. ________________________________________________ ________________________________________________ Print Name Title ________________________________________________ __________________ Signature Date
Internal Use Only – HSIN Account Administration
Nomination to HSIN: Yes No
Board/Role(s):      /     	     /     		     /     			     /     
Board Administrator Approval: ________________________________________________ __________________ Signature Date
HSIN Validation: Yes No
Board Administrator Approval: ________________________________________________ __________________ Signature Date
Non U.S. Citizens TSA Form 2816A Submitted and Approved: Yes No
Board Administrator Acknowledgement: ________________________________________________ __________________ Signature Date

PRIVACY ACT STATEMENT: Authority:  5 U.S.C. § 301; 49 U.S.C. § 114.  Principal Purpose(s):  All TSA-sponsored, eligible TSA infoBoards users who will be using TSA Information Technology systems are to complete this form signifying understanding and acceptance of applicable policy and legal requirements concerning the operation of computer equipment and access to network resources within the TSA.  Routine Use(s):  This information may be shared in connection with establishing an access account for an individual, or for routine uses identified in DHS/ALL-004 Department of Homeland Security General Information Technology Access Account Records (GITAARS) System of Records.  Disclosure:  Voluntary; failure to furnish the requested information may result in a loss of computer access privileges.

PAPERWORK REDUCTION ACT: This is a mandatory collection of information if you wish access to a TSA Information Board. The total average burden per response associated with this collection is estimated to be approximately 1 hour. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The control number assigned to this collection is OMB 1652-NEW which will expire on MM/DD/YYYY.

InfoBoards User Account Request Instructions

Definitions:

1. Applicant (Requestor) - An individual requesting an account for an infoBoard and that has a need for access, as described in Title 49: Transportation, Part 1520 —Protection of Sensitive Security Information; Section 11 – “Persons with a need to know”.

2. Security Coordinator - A representative, such as an Aircraft Operator Security Coordinator (AOSC), from an organization outside of TSA who is responsible for confirming the authenticity and the need for access of an infoBoard applicant prior to submission to the TSA Sponsor.

3. SSI - Sensitive Security Information.

4. TFSSP - Twelve-Five Standard Security Program.

5. TSA Sponsor - A front-line TSA employees who are responsible for the approval of an infoBoard User Account Request. These individuals are typically a Principal Security Inspector (PSI), International Industry Representative (IIR), Transportation Security Inspector (TSI), Supervisory Transportation Security Inspector (STSI), or Assistant Federal Security Director for Inspections (AFSD-I).

6. 49 CFR part 1520, Sensitive Security Information - This Federal regulation outlines policies and procedures in how to share, safeguard, and identify sensitive transportation security information that is shared with transportation security stakeholders.

General Instructions:

1. All applicable sections of this form must be completed prior to submission.

2. All appropriate signatures must be obtained before the form is processed.

3. For Non-TSA employees, the individual’s organization’s Security Coordinator must sign and date the form prior to submission to the TSA Sponsor.

Section I – Requestor Information

1. Full Name - Last name, first name, middle initial

2. Telephone Number - Area code, office telephone number, and extension of the requestor

3. Employer Name - Name of company for whom the requestor works

4. Complete Work Address - Employee's physical work address. Include the street number, city, state, and zip code

5. Job Title - Employee's current position

6. Fax Number - Area code and number where the employee can send/receive a fax

7. E-mail Address - Work e-mail address

8. U.S. Citizen (Required) – Indicate if U.S. Citizen

9. TSA Employee (Required) – Indicate if TSA employee

10. Airport 3-Letter Code (Optional) – If affiliated with airport, enter 3-lettter code

11. Carrier ID (Optional) – If affiliated with airport, enter ID

Section II – Requestor Type

Please select the appropriate box that describes the requestor’s status.

Section III – Request Information

1. Name of infoBoards board Requesting Access to – Applicants may request access to more than one infoBoards board on a single infoBoards User Account Request form. Select from the following infoBoards (may select multiple):

TSA InfoBoards Access Management
Location	Board Name	Location	Board Name
HSIN	AvOps Air Carrier Security (12-5)	HSIN	Full All-Cargo Program
HSIN	AvOps Air Carrier Security (ACO500)	HSIN	G7 Transportation Security Subgroup
HSIN	AvOps Air Carrier Security (Private Charter)	iShare	Industry Report
HSIN	AvOps Airport Security (ACO200)	HSIN	International Working Group on Land Transport Security
HSIN	AvOps International	HSIN	Non-US All Cargo Security
HSIN	AvOps Non-US Air Carrier Security	HSIN	Screening Partnership Program
HSIN	AvOps TSA Employee	HSIN	Trilateral Working Group
HSIN	Certified Cargo Screening Program (CCSP)	HSIN	Watchlist
HSIN	DCA Access Standard Security Program (DASSP)

2. Details/Reason for Request – A summary of the requestor’s need for access.

Section IV – Requestor Acknowledgment

1. Subsection A: SSI Information - Read, sign, and date the SSI statement

Section V – Acknowledgement

The Security Coordinator for the requesting individual’s organization must authorize the infoBoard request by printing and signing their name, along with providing the title and date of signature. This section must be completed and signed prior to submission to the TSA Sponsor.

Section VI – TSA WebBoard Sponsor Acknowledgement

The TSA Sponsor for the requesting individual’s organization must authorize the infoBoard request by printing and signing their name, along with providing the title and date of signature. The TSA Sponsor will follow the standard operating procedures for providing access to the specific infoBoard. Foreign Nationals shall be vetted by DHS prior to receiving a HSIN account and access to TSA infoBoards.

Section VII – TSA Board Administrator

The Board Administrator for the respective infoBoards board which the user is requesting access.

TSA Form 1427, 9/15 [File: 5000.26] Page 4 of 4

1652-NEW; Exp: MM/DD/YYYY