SSN Justification Memo

GENADMIN DON CIO WASHINGTON DC 192101Z JUL 2010

SSN REDUCTION REVIEW

EMAIL
SUBMIT
Form Number:

FORM

Submission for (Check one):

Requiring Document: DoDI

5580/1

DATE COMPLETED:

IT SYSTEM

30 Oct 2015

5525.12

Form Revision Date:
SECTION 1
TO BE COMPLETED BY FORM ORIGINATOR/SPONSOR. Forms that collect and retrieve by SSN/PII must be covered by a System of Record
Notice (SORN), be call for within a requiring document, and have Privacy Act Officer approval for Privacy Act Statements. Return
completed packages that contain the SSN Reduction Review Form, Justification, and if need the DD 67 and the SSN Elimination Plan to the
cognizant forms manager. If SECNAV/OPNAV/NAVSO send to DON Forms Manager OPNAV. [email protected],
If NAVMC forms send to the USMC Forms Manager, [email protected]
1. Is the form covered by a System of Record Notice (SORN)?
a. If yes, what is the SORN number?
NM05580-2

YES

NO

(pending publication)

b. If no, contact the Privacy Act Officer for instructions.
2. Does the form contain a Privacy Act Statement (PAS)?
a. If yes, has the PAS been approved by a Privacy Act Officer?
b. If no, contact the Privacy Act Officer for instructions.
3. Is the SSN Field needed?

YES

NO

YES

NO

YES

NO

a. If no, complete DD67 to request revision of the form.
YES

NO

a. If yes, is the SSN field masked or truncated?

YES

NO

b. If no, could it be?

YES

NO

YES

NO

YES

NO

YES

NO

4. Is this form electronic?

5. Is this form part of an IT system?
a. If yes, what is the IT System name and DITPR DON ID?
b. If yes, does the IT System mask or truncate the display of the SSN on the form?
c. If no, Could it be?
6. Is Justification Memorandum for the Record attached?

YES

NO

7. Could an alternative to the SSN be used?

YES

NO

CONTACT INFORMATION - IT System Owner or Form Originator/Sponsor
Name, Code, Mailing Address

Office Telephone Number:

LtCol Durham, HQMC(PS), Pentagon, 4A324, Washington DC, 20350-3000

(703) 692-4249
E-mail Address

[email protected]
SECTION 2 TO BE COMPLETED BY PRIVACY ACT OFFICER
To verify information given in Section 1 is accurate, is in compliance with Privacy Act Regulations, and meets requirements of the
SSN Reduction Plan.
1. Is Privacy Act Statement (PAS) correct?

YES

NO

2. If there is not a PAS, is one needed?

YES

NO

3. If a PAS needed, what is the correct PAS? (Originator/owner of form/IT system will work with the Privacy Act Officer to draft a PAS if needed) (Field will expand
to fit typed data))

4. Is the System of Records Notice (SORN) number cited in Section 1 correct?

YES

NO

5. Does a SORN need to be initiated?

YES

NO

YES

NO

(Determination of need for SORN will be worked between the originator/owner of

form/IT system and Command Privacy Act Office)

6. Is use of SSN Justification Form complete and approved?
CONTAOI.TERI.DEBORAH
VANNEWKIRK.1176225200

APPROVED

Deborah Contaoi

DISAPPROVED

Privacy Act Officer Printed Name

Digitally signed by CONTAOI.TERI.DEBORAH VANNEWKIRK.1176225200
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USMC, cn=CONTAOI.TERI.DEBORAH
VANNEWKIRK.1176225200
Date: 2016.04.12 08:50:12 -04'00'

Privacy Act Officer Signature

12 Apr 2016
Date

SECTION 3 - COMMAND FORMS MANAGER
APPROVED

Ernest W. Williams

DISAPPROVED

Forms Manager Printed Name

WILLIAMS.ERNEST.WARREN.1243220595

Digitally signed by WILLIAMS.ERNEST.WARREN.1243220595
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USMC, cn=WILLIAMS.ERNEST.WARREN.1243220595
Date: 2017.02.23 09:24:43 -05'00'

Forms Manager Approval Signature

23 Feb 2017
Date:

NOTES:
(1) If Disapproved, sponsor/originator will need to provide a plan to include milestones and timeline of the elimination of the SSN usage.
(2) SSN Reduction Packages for forms will be kept by the cognizant form manager in the forms's history/case file.
(3) SSN Reduction Packages for IT Systems will be kept by the cognizant CIO office.

SECNAV 5213/1 (Jul 2010)

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GENADMIN DON CIO WASHINGTON DC 192101Z JUL 2010

22 Jan 2015
Date

MEMORANDUM FOR THE RECORD
Subj: JUSTIFICATON FOR THE USE OF THE SOCIAL SECURITY NUMBER (SSN)
TBD "DoN LEOSA Applicant Information Form"
(Form number and name or IT system name and DITPR DON ID number)

The National Defense Authorization Act (NDAA) of FY2013 amended Title 18 U.S.C. making Department of
Defense (DoD) Law Enforcement Officers (LEO) eligible to participate in the Law Enforcement Officers Safety
Act (LEOSA). The LEOSA grants qualified active, retired and separated law enforcement officers the authority
to carry a concealed privately owned firearm while in an off duty status. Guidance for the implementation of the
LEOSA within the DoD is articulated in DoD Instruction (DoDI) 5525.12. A key implementation measure within
DoDI 5525.12 is the requirement for DoD components to issue photographic identification to qualified, as
defined by Title 18 U.S.C. §926B (current) and §926C (retired/separated), law enforcement officers. Possession
of agency issued photographic identification is required of all LEOs choosing to exercise their LEOSA concealed
carry privileges.
With a command endorsement, active duty Military Police, Master at Arms and civilian police officers
currently performing law enforcement within the Department of the Navy (DoN) are considered qualified as a
consequence of their assigned duties and will be issued photographic identification accordingly. To determine
qualifications of retired/separated personnel the DoN established a standardized application process that
permits individuals to voluntarily submit personally identifiable information (PII) to substantiate eligibility to
participate. This information is used to determine an individual's compliance with Title 18 U.S.C., §926C
requirements; specifically, that they are not federally prohibited from possessing a firearm, they have a minimum
of ten years law enforcement experience and they have no misdemeanor domestic violence or felony
convictions. Information collected on the DoN LEOSA Application Form, which includes an individual's social
security number, is an instrumental component of this process. The social security number provides LEOSA
administrators with a unique, highly recognized, personal identifier that is common among all active, retired, and
separated personnel. The social security number provides the most accurate and efficient means of validating
criminal history, identity, and law enforcement experience. To use anything other than the social security
number increases opportunities for inappropriate issuance of law enforcement identification which violates the
law, tarnishes the reputation of the Naval Service, and creates potential risks to public safety.

Digitally signed by SMITH.RANDY.R.1171798120
c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USMC,
SMITH.RANDY.R.1171798120 DN:
cn=SMITH.RANDY.R.1171798120
Date: 2016.02.26 11:32:26 -05'00'

Signature (Flag, SES, or by direction)
Director, Security Division (PS)
Title and Code
HQMC, PP&O
Command

Note: Justification must include operational necessity, cost, etc. explanation and impact if SSN were to be eliminated)

SECNAV 5213/1 (Jul 2010)

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