SSN Memo - NSTC 1533 -158

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

NSTC 1533/158

Form Revision Date:

20 Nov 2019

SHARE DRIVE / WEB PORTAL

Requiring Document:

11/2019
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?
N01131-1

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?
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:

Naval Service Training Command
2601 A Paul Jones St.
Great Lakes, IL 60088

(847) 688-3400 ext 107
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?
APPROVED
DISAPPROVED

Privacy Act Officer Printed Name

Privacy Act Officer Signature

Date

SECTION 3 - COMMAND FORMS MANAGER
APPROVED
DISAPPROVED

LT DAVID A. TEJEDA, USN
Forms Manager Printed Name

SECNAV 5213/1 (REV 10/2016)

TEJEDA.DAVID.ALEXANDER. Digitally signed by
TEJEDA.DAVID.ALEXANDER.1242546594
1242546594
Date: 2019.12.05 15:40:34 -06'00'
Forms Manager Approval Signature

05 Dec 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)

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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

SSN USE REVIEW AND JUSTIFICATION FOR FORMS

20 Nov 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?

The purpose of this form is obtain an evaluation of the NROTC scholarship applicant by a school official.

2. Why is collection of the SSN necessary?

The collection of the social security number on the subject form is necessary to assure that the information
presented by each applicant is correctly filed with the applicant's file as there are often applicants with the
same or similar names.

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

Other cases- to avoid misfiling information as a result of the same or similar names.

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?

Not applicable

Commanding Officer

SECNAV 5213/1 (REV 10/2016)

Command/Activity

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