SSN Memo OPNAV 1770/3

SECNAV RCS 5213/1 (Effective 11/1/2016 through 11/31/2019)
GENADMIN DON CIO WASHINGTON DC 192101Z REV 10/2016

SSN REDUCTION REVIEW
DATE COMPLETED:

EMAIL
SUBMIT
Form Number:

Submission for (Check one):

FORM

IT SYSTEM

OPNAV 1770/3 Next of Kin Identification

Form Revision Date:

29 Mar 2019

SHARE DRIVE / WEB PORTAL

Requiring Document: OPNAVINST

1770.1A

New form
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 to the
cognizant forms manager.
1. Is the form covered by a System of Record Notice (SORN)?
a. If yes, what is the SORN number?
N04650-1

YES

NO

b. If no, contact the Privacy Act Officer for instructions.
YES

NO

YES

NO

b. If no, contact the Privacy Act Officer for instructions.
3. Is the SSN Field needed?

YES

NO

a. If no, complete DD67 to request revision of the form.
4. Could an alternative to the SSN be used?

YES

2. Does the form contain a Privacy Act Statement (PAS)?
a. If yes, has the PAS been approved by a Privacy Act Officer?

NO

a. If yes, 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

5. Is this form electronic?

6. Is this form part of an IT system?
a. If yes, what is the IT System name and DITPR DON ID?

N/A

b. If yes, does the IT System mask or truncate the display of the SSN on the form?
c. If no, Could it be?

YES

7. Is Justification Memorandum for the Record attached?

NO

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

Office Telephone Number:

NPC (PERS-1) Alan Gorski
5720 Integrity Dr
Millington, TN 38055

901-874-4559
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))

N/A

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?
APPROVED
DISAPPROVED

Robin Patterson
Privacy Act Officer Printed Name

signed by PATTERSON.ROBIN.W.1229323403
PATTERSON.ROBIN.W.122932 Digitally
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN,
cn=PATTERSON.ROBIN.W.1229323403
3403
Date: 2019.04.03 10:52:34 -04'00'
Privacy Act Officer Signature

03 Apr 2019
Date

SECTION 3 - COMMAND FORMS MANAGER
APPROVED
DISAPPROVED

Barbara L Figueroa DON FMO
Forms Manager Printed Name

SECNAV 5213/1 (REV 10/2016)

signed by FIGUEROA.BARBARA.LEE.1023334530
FIGUEROA.BARBARA.LEE.102 Digitally
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN,
cn=FIGUEROA.BARBARA.LEE.1023334530
3334530
Date: 2019.04.08 13:37:07 -04'00'
Forms Manager Approval Signature

08 Apr 2019
Date:
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SECNAV RCS 5213/1 (Effective 11/1/2016 through 11/31/2019)
GENADMIN DON CIO WASHINGTON DC 192101Z REV 10/2016
NOTES:

(1) For IT systems / applications, this completed SECNAV 5213/1 will be posted in the DOC tab of DITPR DON / DADMS respectively.
(2) For forms, post the date this SECNAV 5213/1 is approved in Naval Forms Online https://navalforms.documentservices.dla.mil/web/public/home.
and maintain the SECNAV 5213/1 in the form's history/case file.
(3) Approved share drive / web portal forms will be maintained locally by the share drive / web portal owner.

SECNAV 5213/1 (REV 10/2016)

Page 2 of 3

SECNAV RCS 5213/1 (Effective 11/1/2016 through 11/31/2019)
GENADMIN DON CIO WASHINGTON DC 192101Z REV 10/2016

SSN USE REVIEW AND JUSTIFICATION FOR FORMS

29 Mar 2019
Date

MEMORANDUM FOR THE RECORD
Subj: JUSTIFICATION FOR THE USE OF THE SOCIAL SECURITY NUMBER (SSN)
1. What is the purpose of this form?

Following the death of a Sailor, data is collected from designated beneficiaries to enable direct payment of
death gratuity, Unpaid Pay and Allowances, Servicemember's Group Life Insurance, Survivor Benefit Plan,
and others - as designated by the deceased Sailor.

2. Why is collection of the SSN necessary?

The SSN is critical when processing documents that enable the certification and award of financial benefits.
Because civilian Next of Kin have no EDIPI, the SSN is used to verify identification, to interface with
financial institutions, and submission to DFAS for payment processing.

3. List the acceptable use criteria for the SSN (found at this link: http://www.doncio.navy.mil/ContentView.aspx?ID=1833)

- Interactions with financial institutions
- Federal Taxpayer Identification Number (in certain circumstances)

4. If collection of the SSN is no longer necessary and a unique identifier can be substituted for the SSN or the SSN can be eliminated,
on what date will either the substitution or elimination occur?

Form collects data from non-military personnel; an alternative unique identifier is not anticipated.

MOODY.GREGORY.118
5043963

Digitally signed by
MOODY.GREGORY.1185043963
Date: 2019.04.08 10:32:42 -05'00'

Commanding Officer

SECNAV 5213/1 (REV 10/2016)

Navy Personnel Command
Command/Activity

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