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pdfOMB NO. 0702-0135
OMB approval expires
MMM/DD/YYYY
TASS REQUEST FORM
Trusted Associate Sponsorship System (formerly CVS Contract Verification System)
This form must be submitted to Exchange EG-FP by the Exchange Contracting Officer only.
AF
PRIVACY ACT STATEMENT
T
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0702-0135, is estimated to average 30 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 whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. 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.
AUTHORITY: 10 U.S.C. §7103, “Secretary of the Army”; 10 U.S.C. §9013, “Secretary of the Air Force;” United
States Presidential Executive Order (E.O.) 13526, “Classified National Security;” E.O. 10450, “Security
Requirements for Government Employment;” Department of Defense Instruction (DoDI) 5200.01, “DoD
Information Security Program and Protection of Sensitive Compartmental Information;” DoDI 5200.02, “DoD
Personnel Security Program (PSP);” Army Regulation (AR) 380-67, “Personnel Security Program;” Air Force
Instruction (AFI) 31-501, “Personnel Security Program Management;” AFI 31-401, “Information Security
Program Management;” AR 215-8/AFI 34-211(i), “Army and Air Force Exchange Service Operations;” and E.O.
9397, (SSN), as amended.
R
PRINCIPAL PURPOSES: To assist in the processing of personnel security clearance actions; to record security
clearances issued or denied, and to verify for access to classified information or assignment to sensitive positions.
ROUTINE USES: Records may be disclosed outside of DoD pursuant to Title 5 U.S.C. §552a(b)(3) regarding DoD
“Blanket Routine Uses” published at http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx.
Information may be released to Federal agencies based on formal accreditation as specified in official directives;
regulations; to Federal, State, Local, and Foreign Law Enforcement, Intelligence, or Security agencies in
connection with a lawful investigation under their jurisdiction.
D
DISCLOSURE: Voluntary, however, failure to provide information may result in denial of a Common Access
Card; non-enrollment in the Defense Enrollment Eligibility Reporting System (DEERS); refusal to grant access to
DoD installations, buildings, facilities, computer systems and networks; and denial of DoD benefits if otherwise
authorized.
A copy of the Privacy Impact Assessment (PIA) for the collection of information may be located at https://
www.aafescom/about-exchange/public-affairs/FOIA/assessments.htm.
SYSTEM OF RECORDS NOTICE (SORN): 1703.03, “Personnel Security Clearance Case Files;” https://
dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/Army-Article-List/
EXCHANGE FORM 3900-002
TASS REQUEST FORM
Trusted Associate Sponsorship System (formerly CVS Contract Verification System)
This form must be submitted to Exchange EG-FP by the Exchange Contracting Officer only.
INSTRUCTIONS
1.
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3.
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6.
7.
8.
Before continuing, please read the Agency Disclosure Notice and the Privacy Act Statement on page one.
Information you provide will be used by an approved Exchange Trusted TASS Agency for input into the Defense Manpower
Data Center (DMDC) official electronic TASS system. The TASS system will provide you sponsorship into the Defense
Enrollment and Eligibility Reporting System (DEERS).
Provide personal information in Section I “Application Data”.
If you have been notified that a background investigation must be completed, submit the information in Section II. Your
Exchange Contract Official or local Services Business Manager (SMB) will provide directions on what attachments should be
included.
Information will be verified by your Contract Official or SBM.
The rest of the information on this form will be completed by your Contract Official or SBM.
Send the completed form to your Contract Official or SBM.
Your Contract Official or SBM will forward the completed form to the Exchange Force Protection for verification in the Joint
Personnel Adjudication System (JPAS).
Date of Request:
(ex: 25 Jul 2015)
* INFORMATION*
I. APPLICANT'S
(Full Name)
Last:
First:
Middle:
Gender:
Male
Female
Date of Birth:
Social Security # (or FIN - Foreign Information #):
(DD/MMM/YYYY)
Email Address:
Place of Birth:
(City, State) or (City, Country, overseas only)
Phone #:
Choose One:
Provide Military/Federal Agency/Federal Contractor (within 24 months)
No
Yes
From: (Month/Year)
To: (Month/Year)
II. REQUIRED DOCUMENT*
Must attach one of the following documents with this form (select document)
LOA (Letter of Authorization)
LOI (Letter of Intent)
These items are required only if a current investigation is needed.
OF 306
National Background Check
Fingerprints
III. EXCHANGE CONTRACTING OFFICIAL ONLY*
Exchange POC Name
Phone #
Facility #
Contractor's POC Name
Phone #
Email Address
Contractor's Company Name
Company Address
Contract #:
Contract End Date: (DD/MMM/YYYY)
Comments:
IV. EXCHANGE EG-FP ONLY*
In Process
JPAS Date Updated:
Investigation Type:
e-QIP Date Initiated:
TASS TA:
e-QIP OPM Submission Date
Out Process
JPAS Date Updated:
Comments:
*(Application will not be processed without the required documents.)
EXCHANGE FORM 3900-002 (JAN 19)
TASS TA:
File Type | application/pdf |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |