0703-0061_Privacy Review and SSN Justification Form

SECNAV 5213-1 (Exp 11/31/2022)
SECNAVINST 5213.16

SSN REDUCTION REVIEW
DATE COMPLETED:

EMAIL
SUBMIT
Form Number:

Submission for (Check one):

FORM

IT SYSTEM

SECNAV 5512/1

Form Revision Date:

18 Sep 2020

SHARE DRIVE / WEB PORTAL

Requiring Document: SECNAVINST

5213.16

Oct 2020
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?
NM05512-2

and DMDC 16

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?

Biometric Automated Access Control System - 22557

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

DUSN (Security & Intelligence)
201 12th Street, Suite 701
Arlington, VA 22202

Office Telephone Number:

(571) 271-9346
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))

The following PRIVACY ACT STATEMENT printed on the SECNAV 5512/1 remains unchanged from the prior 2017 OMB
approval:
AUTHORITY: 10 U.S.C. 113, Secretary of Defense; DoD Directive 1000.25, DoD Personnel Identity Protection (PIP) Program;
DoD Instruction 5200.08, Security of DoD Installations and Resources and the DoD Physical Security Review Board (PSRB); DoD
5200.08-R, Physical Security Program; DoD Directive 5200.27, Acquisition of Information Concerning Persons and Organizations
not Affiliated with the Department of Defense (Exception to policy memos); Directive-Type Memorandum (DTM) 09-012, Interim
Policy Guidance for DoD Physical Access Control; DTM 14-005, DoD Identity Management Capability Enterprise Services
Application (IMESA) Access to FBI National Crime Information Center (NCIC) Files; and E.O. 9397 (SSN), as amended;
OPNAVINST 5530.14E, Navy Physical Security and Law Enforcement Program; Marine Corps Order P5530.14, Marine Corps
Physical Security Program Manual; SORN NM05512-2 Badge and Access Control System Records and DMDC 16, Identity
Management Engine for Security and Analysis (IMESA): http://dpcld.defense.gov/Privacy/SORNsIndex.
PURPOSE(S): To control physical access to Department of Defense (DoD), Department of the Navy (DON) or Marine Corps
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SECNAV 5213-1 (Exp 11/31/2022)
SECNAVINST 5213.16

installations/units, controlled information, installations, facilities, or areas over which DoD, DON, or Marine Corps has security
responsibilities by identifying or verifying an individual through the use of biometric databases and associated data processing/
information services for designated populations for purposes of protecting U.S./coalition/allied government/national security areas of
responsibility and information; to issue badges, replace lost badges, and retrieve passes upon separation; to maintain visitor statistics;
collect information to adjudicate access to facility; and track the entry/exit times of personnel.
ROUTINE USE(S): To designated contractors, federal agencies, and foreign governments for the purpose of granting Navy officials
access to their facility.
DISCLOSURE: Providing registration information is voluntary. Failure to provide requested information may result in denial of
access to benefits, privileges, and DoD installations, facilities and buildings. installations/units, controlled information, installations,
facilities, or areas over which DoD, DON, or Marine Corps has security responsibilities by identifying or verifying an individual
through the use of biometric databases and associated data processing/information services for designated populations for purposes
of protecting U.S./coalition/allied government/national security areas of responsibility and information; to issue badges, replace lost
badges, and retrieve passes upon separation; to maintain visitor statistics; collect information to adjudicate access to facility; and
track the entry/exit times of personnel.
ROUTINE USE(S): To designated contractors, federal agencies, and foreign governments for the purpose of granting Navy officials
access to their facility.
DISCLOSURE: Providing registration information is voluntary. Failure to provide requested information may result in denial of
access to benefits, privileges, and DoD installations, facilities and buildings.
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

PATTERSON.ROBIN.W.122932 Digitally signed by
PATTERSON.ROBIN.W.1229323403
3403
Date: 2020.10.22 16:55:10 -04'00'
Privacy Act Officer Signature

22 Oct 2020
Date

SECTION 3 - COMMAND FORMS MANAGER
APPROVED
DISAPPROVED
NOTES:

Forms Manager Printed Name

Forms Manager Approval Signature

Date:

(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.

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SECNAV 5213-1 (Exp 11/31/2022)
SECNAVINST 5213.16

SSN USE REVIEW AND JUSTIFICATION FOR FORMS

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 DEPARTMENT OF THE NAVY LOCAL POPULATION ID CARD/BASE ACCESS PASS
REGISTRATION, SECNAV 5512/1, is utilized by U.S. Navy and Marine Corps installations as an
authorized OMB collection instrument under OMB 0703-0061 and is required in support of Physical Access
Control and Physical Security missions. SECNAV 5512/1 is used to collect identity information from those
individual respondents requesting physical access who are not otherwise credentialed under DoD
Instruction 1000.13, "Identification (ID) Cards for Members of the Uniformed Services, Their Dependents,
and Other Eligible Individuals," December 5, 1997. The respondent voluntarily provides their identity
information on a SECNAV 5512/1 form, and submits it in person to the Navy/USMC registrar who is
required to enter specific identity information into criminal justice information systems, as required, to
perform a background check to determine the fitness of the respondent who is requesting access to DOD
or DON installations. If a background check results in a finding that the respondent is fit to access the
base, the Navy/USMC registrar is required to enter specific identity information including the SSN into the
Navy or USMC Physical Access Control System as required to issue a Local Population ID Card or Base
Access Pass to the respondent. The SSN is not printed or electronically encoded on the Local Population
ID Card or Base Access Pass.
2. Why is collection of the SSN necessary?

To control physical access to DoD, Department of the Navy (DON) or U.S. Marine Corps installations/units
controlled information, installations, facilities, or areas over which the DoD, DON or USMC has security
responsibilities by identifying or verifying an individual through the use of biometric databases and
associated data processing/ information services for designated populations for purposes of protecting
U.S./coalition/allied government/ national security areas of responsibility and information; to register DOD
identification cards and local population identification cards, replace lost ID cards and retrieve passes upon
separation; to maintain visitor statistics; collect fitness determination information to adjudicate access to
facility; and track the entry/exit times of personnel.
The SSN serves as primary identity information that is required to 1) establish identity; 2) determine fitness
for access; and 3) register in the DON installation’s Physical Access Control System in order to produce
and issue a DON Local Population Identity Card/Base Access Pass.
3. List the acceptable use criteria for the SSN (found at this link: http://www.doncio.navy.mil/ContentView.aspx?ID=1833)

Acceptable Use Criteria for Systems Collecting SSNs established by DON CIO Privacy Team - Published,
July 12, 2010.
Law Enforcement, National Security and Credentialing: Almost every law enforcement application must be
able to report and track individuals through the use of the SSN. This includes, but is not limited to, checks
of the National Crime Information Center, state criminal histories and Federal Bureau of Investigation
records checks.

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?

There is no planned or scheduled date for either the substitution or elimination of the SSN from the
SECNAV 5512/1 collection instrument. The DoD enterprise level authoritative data sources and the federal
law enforcement data sources utilize the SSN, and must first be addressed before the SECNAV 5512/1
form or the BAACS can be updated to align with any new identifier that may be used as a SSN substitute or
replacement at the DoD enterprise level.
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Commanding Officer

SECNAV 5213/1 (REV Oct 2020)

Command/Activity

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