Agency Disclosure Notice/Privacy Act Statement

Office of the Provost Marshal General Army Provost Marshal Office Sex Offender Registration Information (Read Agency Disclosure Notice, Privacy Act Statement, and Instructions before completing form.)	OMB NO. 0702-0128 OMB approval expires MMM DD, YYYY
AGENCY DISCLOSURE NOTICE The public reporting burden for this collection of information, 0702-0128, is estimated to average 20 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. 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. Responses should be sent to the Office of the Provost Marshal General 2800 Army Pentagon, Washington D.C. 20310-2800 or your local Provost Marshal Office.
PRIVACY ACT STATEMENT AUTHORITY: Title 10 USC Section 301; title 5 USC Section 2951; E.O. 9397 dated November 22, 194 (SSN). PRINCIPLE PURPOSE: To provide commanders and law enforcement officials with means by which information may be accurately identified. ROUTINE USES: Your social security number is used as an additional/alternate means of identification to facilitate filing and retrieval. DISCLOSURE: Disclosure of your social security number is voluntary.
INSTRUCTIONS The sex offender produces either evidence of the qualifying conviction or the court ordered sex offender registration paperwork with the state in which the sex offender was convicted, date of conviction, and results of conviction, to include length of time required to register and any specific court ordered restrictions to the Installation Provost Marshal Office. Details of the court case, to include victim information, is not collected. The sex offender does not fill out a form or any paperwork to register as a sex offender on the installation, they must provide the court order or evidence of qualifying conviction to the Provost Marshal Office on the installation and the Army Law Enforcement Officer will use the supplied documentation to fill in and complete the Raw Data File completing the sex offender registration. The Raw Data File requires sex offenders to provide, among other things, certain personal information, such as name, grade/rank, address, date of birth, and SSN, which would be used in the course of a inputting their identifying information into ALERTS to assist in confirming the true identity of the individual. Justification for retention of the SSN is based on the Law Enforcement Use Case from DTM 07-015-USD(R&R).