Form TSA Form 1427 TSA Form 1427 TSA infoBoards

OMB 1652-0065
Exp: 02/29/2020

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):

Airport 3 – Letter Code (Optional):

Yes

No

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 1400.21, users shall be associated w ith 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
Surface Compliance
Third Party Canine-Cargo (3PK(-C) Program
Trilateral Working Group
Watchlist
Other

Details/Reasons for Request:
SECTION IV. Requestor Acknow ledgement (Requestor to read and sign)
I, the requestor, attest that I am familiar w ith and I w ill comply w ith the standards for access, dissemination, handling, and safeguarding
of Sensitive Security Information (SSI) as cited in this request, and in accordance w ith 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 w ill 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 follow ing:
•
I have no reasonable expectation of privacy w hen I use this information system; this includes any communications or data
transiting or stored on this information system. At any time, and for any law ful government purpose, the government may,
w ithout 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 law ful
government purpose, including but not limited to law enforcing purposes;
•
I w ill comply w ith requests to be audited by DHS and TSA and w ill provide response w ithin three business days;
•
I am responsible for the security of TSA data otherw ise stored or processed on the regulated entity’s computing system and
w ill verify the regulated entity’s proof of eligibility for remote access connection to DHS/TSA netw orks is current;
•
I am not authorized to process classified information on this system;
•
I w ill comply w ith Sensitive Personally Identifiable Information (SPII) and PII handling and disposition requirements;
•
I w ill complete IT Security Aw areness, SSI, and privacy training and w ill complete refresher training annually; and
w ill sign and provide annually the DHS Non-Disclosure Agreement (NDA) 11000-6, and TSA Form 1403 Computer and
Wireless Personal Device Agreement or TSA Form 1430 Computer Access Agreement (CAA) External Personnel Only.
I understand that failure to comply w ith the above w ill result in immediate revocation of my access to the TSA infoBoards and may
result in fines or other penalties.
________________________________________________
Signature
TSA Form 1427, 9/15 [File: 5000.26]

________________________________
Date

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Exp: 02/29/2020

SECTION V. Acknow ledgement (Requesting organization’s Security Coordinator to read and sign)
I, the requesting organization’s authorizing official, hereby acknow ledge and concur w ith 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 Acknow ledgement (TSA Sponsor to read and sign)
I, the TSA Sponsor, hereby acknow ledge and grant this request.
________________________________________________
Print Name
________________________________________________
Signature

_______________________________________________
Title
________________
Date

SECTION VII. TSA Board Adm inistrator (TSA Board Administrator to read and sign)
I, the Board Administrator, hereby acknow ledge and grant this request.
________________________________________________
Print Name
________________________________________________
Signature

________________________________________________
Title
__________________
Date

Internal Use Only – HSIN Account Adm inistration
Nomination to HSIN:
Board/Role(s):

Yes

No

/

/

/

Board Administrator Approval: ________________________________________________
Signature
HSIN Validation:

Yes

/
__________________
Date

No

Board Administrator Approval: ________________________________________________
Signature
Non U.S. Citizens TSA Form 2816A Submitted and Approved:

Yes

__________________
Date

No

Board Administrator Acknow ledgement: ________________________________________________
__________________
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 w ho w ill 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 netw ork resources w ithin the TSA. Routine Use(s): This information may be shared in connection w ith
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 w ish access to a TSA Information
Board. The total average burden per response associated w ith 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 1652-0065 w hich w ill expire on 02/29/2020.
Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this
burden to: TSA PRA Officer, TSA-11, 601 South 12th Street, Arlington, VA 20598. ATTN: PRA 1652-0065 TSA infoBoards.

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

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OMB 1652-0065
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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 w ith a need to know ”.
2.
Security Coordinator - A representative, such as an Aircraft Operator Security Coordinator (AOSC), from an organization
outside of TSA w ho 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 - Tw elve-Five Standard Security Program.
5.
TSA Sponsor - A front-line TSA employees w ho 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 w ith 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 Inform ation
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 w hom the requestor works
4.
Complete Work Address - Employee's physical w ork address. Include the street number, city, state, and zip code
5.
Job Title - Employee's current position
6.
Fax Number - Area code and number w here 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 w ith 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 Inform ation
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 follow ing infoBoards (may select multiple):
TSA InfoBoards Access Management
Location
HSIN
HSIN
HSIN
HSIN
HSIN
HSIN
HSIN
HSIN
HSIN
2.

Board Name
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)

Location
HSIN
HSIN
iShare

Board Name
Full All-Cargo Program
G7 Transportation Security
Subgroup
Industry Report

HSIN

International Working Group
on Land Transport Security
Non-US All Cargo Security
Screening Partnership
Program
Trilateral Working Group

HSIN

Watchlist

HSIN
HSIN
HSIN

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

Section IV – Requestor Acknow ledgment
1.
Subsection A: SSI Information - Read, sign, and date the SSI statement
Section V – Acknow ledgement
The Security Coordinator for the requesting individual’s organization must authorize the infoBoard request by printing and signing
their name, along w ith 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 Acknow ledgement
TSA Form 1427, 9/15 [File: 5000.26]

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The TSA Sponsor for the requesting individual’s organization must authorize the infoBoard request by printing and signing their
name, along w ith providing the title and date of signature. The TSA Sponsor w ill 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 Adm inistrator
The Board Administrator for the respective infoBoards board which the user is requesting access.

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

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