A collection of most forms used by the NSA. Obtained, scanned, and posted by The Memory Hole. Agency: National Security Agency

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1 A collection of most forms used by the NSA. Obtained, scanned, and posted by The Memory Hole. Agency: National Security Agency Released: March 14, 2007 Posted on The Memory Hole: July 28, 2008 FOA: Released on paper in response to Freedom of nformation Act request 42877B, filed by Russ Kick, 28 May Note: The Memory Hole has divided this file into two parts to keep the file sizes manageable. This is the second half. The first half is here:

2 NATONAL SECURTY AGENCY CENTRAL SECURTY SERVCE FORT GEORGE G. MEADE:, MARYLAND ForA Case: 42877B 14 March 2007 Mr. Russ Kick PO Box Tucson, AZ Dear Mr. Kick: This responds to your Freedom of nformation Act (ForA) request dated 28 May 2003 for "One blank copy of each form on the unabridged list of forms used by the National Security Agency (this list was sent to me on 13 May 2003 as a response to FOA case 42754). This request includes those forms listed as cancelled". A copy of your request is enclosed. Your request has been processed under the FOA and some of the documents you requested are enclosed. Certain information, however, has been deleted from the enclosures and 24 documents (31 pages) have been withheld in their entirety. Some of the information deleted from the documents was found to be currently and properly classified in accordance with Executive Order 12958, as amended. This information meets the criteria for classification as set forth in Subparagraphs (c) and (g) of Section 1.4 and remains classified TOP SECRET, SECRET and CONFDENTAL as provided in Section 1.2 of the Executive Order. The information is classified because its disclosure could reasonably be expected to cause exceptionally grave damage to the national security. Because the information is currently and properly classified, it is exempt from disclosure pursuant to the first exemption of the ForA (5 U.S.C. Section 552(b)(1)). n addition, Subsection (b)(2) of the ForA exempts from disclosure matters related solely to the internal personnel rules and practices of an agency. This exemption has been held to apply to matters that are "predominantly internal," the release of which would "significantly risk circumvention of agency regulations or statutes." Crooker v. Bureau of Alcohol, Tobacco, and Firearms, 670 F.2d 1051, 1074 (D.C. Cir. 1981). The withheld information meets the criteria for exemption (b)(2) protection as that statutory provision has been interpreted and applied by the Federal,Judiciary. The information being protected under Subsection (b)(2) also contains a portion of a URL on a document that would reveal how NSA's information network is constructed. The release of such information could expose the network to unauthorized access. Further, this Agency is authorized by various statutes to protect certain information concerning its activities, as well as the names of its employees. We have determined that such information exists in these documents. Accordingly, those portions are exempt from disclosure pursuant to the third exemption of the FOA which provides for the withholding of information specifically protected from disclosure by statute. The specific statute applicable in this case is Section 6, Public Law (50 U.S. Code 402 note).

3 FOA Case: Since some of the documents were withheld in their entirety and information was withheld from the enclosures, you may construe this as a partial denial of your request. You are hereby advised of this Agency's appeal procedures. Any person denied access to information may file an appeal to the NSA/CSS Freedom of nformation Act Appeal Authority. The appeal must be postmarked no later than 60 calendar days from the date of the initial denial letter. The appeal shall be in writing addressed to the NSA/CSS FOA Appeal Authority (DC34), National Security Agency, 9800 Savage Road STE 6248, Fort George G. Meade, MD The appeal shall reference the initial denial of access and shall contain, in sufficient detail and particularity, the grounds upon which the requester believes release of the information is required. The NSA/CSS Appeal Authority will endeavor to respond to the appeal within 20 working days after receipt, absent any unusual circumstances. n addition, on 20 September 2004 we advised you that we had received your check for $762.00, which represented an estimate of hours of search and duplication of 1000 pages. The actual cost to process your case was $ This fee represents 16 hours of search (minus 2 hours free) and the duplication of 690 pages (minus 100 pages free). Costs were computed in accordance with DOD Regulation R. The search fee is computed at $44.00 an hour and duplication is computed at $.15 per page. A refund of $57.50 ($ $704.50) will be sent to you under separate cover. Please be advised that records responsive to your request include documents originating with another government agency. Because we are unable to make determinations as to the releasability of the other agency's information, the subject documents have been referred to the appropriate agency for review and direct response to you. Sincerely, Encls: a/s LOUS F. GLES Director of Policy

4 Russ Kick PO Box 1:U:3 Cookeville TN May 2003 Ms. Pamela N. PhiJips Chief, FOAPA Services National Security Agency Office oflnfonnation Policy, DC321 Ft. George G. Meade, MD Dear Ms. Phillips: This is a request under the Freedom oflnformation Act. hereby request one blank copy ofeach form on the unabridged list offorms used by the National Security Agency. (This list was sent to me on 13 May 2003 as a response to FOA case ) This request includes those forms listed as cancelled. am a freelance writer and journalist. am willing to pay for expenses that do not exceed $75. fthis request will be more than this amount, please notify me in advance. hope to hear from you within the 20-business-day statutory time period for responses to FOA requests. fyou decide to withhold any infurmation from release, would like a detailed explanation ofthe exemptions invoked. (fmaterial is withheld, am entitled under the law to be given any remaining "reasonably segregable portions" ofthese documents.) Thank you for your consideration ofmy request. Sincerely, :/.-a Russ Kick

5 DOCD: NAF EQUPMENT NVENTORY RECORD MOOEL URAl. VOLT AUPS PHASE.4-CO COSTVR OLD AGENCY 10 NUMBER ~ BAR CODE DATE LAST NVENTORY REMARKS DATE OlSf>OseO OF FORM P6748 JUL 93 NSN: 7S40-FM pproved for Release by NSA Q FOA Case #4287

6 DOClD: NAME CHANGE REPORT OF MARRAGE MARTAL STATUS CHANGE PRVACY ACT STATEMENT: Authority lor collecting information requested On 11s form i$ contained in '0 U.SC. Section 160,-,6H3; 50 U.S.C. section 402 0Q1e.; 50 U,S,C. Section : ExeetJtive Orders 10450, 10865, 12333, and 12968; "nd DC Directive No. 6/4, NSA's Blanket Routine Uses tound al 58 Fed, Reg. 10,531 (1993) as well as the SPl1!C.ifiC uses enumerated in GNSA01, GNSAOe, GNSA08, GNSA09, GNSA10. and GN$Al1 apply to this information. Auth 10f requesting SSN is EO The requested infolmation will be used to identity the individual; and to update and process medical, personnel, personnel security, and payroll records. Your disclosure of requested information, including SSN, is voluntary. However, failure to furnish lhe requested information may delay the updating or processing of your personal NSA record$ dentified above, and may affect your eligibility for access to Sensitive Compartmented nformation (SC). NSTRUCTONS 1, After completing this form, print outbqt pages and sign and date them. 2. Forward Copy 2 to your l(ltegrated Personnel Activity (i.e.. S2S1N. S2F, 821, 8200, S2.i. ate.) 3. f this change will affect the name on the badge, handcarry first copy to the n9ar9stvis~or Control Center in order to have the badge coneclad. 4. f change will HQ affectthe badge, forward first copy to S432t, FANX, Room FX1W28, Suite D D UPDATE MV RECORDS TO REFLECT CHANGE N ( have informed me MARTAL STATUS NAME Social Socurily Admin. 01 my name change.) PRESENT NAME (Last, First, MlddlelM) DMA. o MRS OMS o MSS FORMER NAME, F APPLCABLE (Last, First, MldalelM) OMR 0 MRS OMS. o MSS PRESENf ADDRESS (nclude ZP code) SECTON SOCAL SECURTY NUMBER REASON FOR CHANGE (e.g., marriage, divorce, court oldfjr) o MARRAGE 0 DiVORCE 0 OTHER PATE OF CHANGE PLACE OF CHANGE (ndicate court, ifapp/lcatie) NSA AFFLATON o EMPLOYEE o CONTRACTOR SECTON (To be completed only f change was due to marrlaga) o MLTARY o TENANT (List alt as shown. tf anyone listed is a naturalized citizen, under 'REMARKS', provide tha data, p(n1 of entry and naturalization carl,licate numbsr.) FULL NAME (Last, First, Middle) BRTH ClTtlEN- ~aturilt- EMPLOYER (List the maiden and former married ADPRESS SHP names, if any, of all marri"d fema/s5.) DATE PLACE (Country) f-!i1!,. (Nome and Acldress) Y N SPOUSE ~~ MOTHER-N-LAW FATHER-N'LAW REMARKS (f any) pproved for Release b'y NSA FOA Case #4287 SGNATURE OF PERSON CDMPLETNG FORM SECTON PATE FORM G1982 REV AUG 2OlO (Supersedes G9/J2 REV FEB 2000 wlic/j s o/)$oete) NSN, 7540 FM eopy 1 f badge change, goes to vce, All others to

7 DOClD: NAME CHANGE REPORT OF MARRAGE MARTAL STATUS CHANGE PRVACY ACT STATEMENT: Authority lor collecting information requf:sled on this form is contained in 10 U,S,C. section ; 50 US.C. Section 4020Q1e.: 50 V.S.C Section ; ExeclJ1ive Orders 10450, 10665, 12333, am 12968; and DC Directive No. 6/4. NSA's Blanket Routine Uses lound at 58 Fed. Reg. 10,531 (1993) as well as the specific uses enumeraled in GNSA01, GNSA06, GNSAOa. GNSA09, GNSA10, and GNSA11 apply to this information. Auth lor requesting SSN S EO 9397, The requested information will be.lsed to identity the individual: and to update and proce56 medical, personnel, personnel security, and payroll records, Your disclosure of requested information, including SSN, is voluntary, However, lailure to furnish the reql.lested infolma1ion may delay the updating or processing of your personal NSA reoords identified above, and may affect your eligibility for access to Sensitive Compartmented nformation (SC). NSTRUCTONS 1. After completing this form, print out.aartl pages and sign and date them. 2 Forward Copy 2 to your ntegrated Personnel Activity (i.e.. S2S1N, S2F, 521, 5200, 821, etc.) 3. f this change will affoctthe name on the badge, handcarry first copy to the nearest Visitor Control Center in order to have the badge corrocled, 4. f change will HQ1 atfec1 the badge, forward first copy , FANX, Room FX1W28. Suite D D UPDATE MY RECORDS TO REFLECT CHANGE N (f have informbd the MARTAL STATUS NAME Social SOCUf/iY Admin. of my name change.) PRESENT NAME (Last, First, MtddtolMl) OMR o MRS OMS OMSS FORMER NAME. F APPLCABLE (Lasl, First, Mlddle/M) OMA OMRS OMS 0 MSS PRESENT ADDRESS (nclude ZP code) SECTON SOCAL SECURTY NUMBER REASON FOR CHANGE (e.g., marriage. di\l'orr:tt, cow1 order) o MARRAGE 0 DVORCE 0 OTHER DATE OF CHANGE PLACE OF CHANGE (ndicatf court if app/icatll6) NSA AFFUATON o EMPLOYEE o CONTRACTOR o MLTARY o TENANT REMARKS (if any) SGNATURE OF PERSON COMPLETNG FORM SECTON! DATE FORM G19B2 REV AUG 2000 (Supersedes G982 REV FEB 2000 which is obsolete) NSN: 7540 FM.QOl 0367 COPY 2 To PA

8 DOClD: NATO ACCESS CERTFCATON Please Type or Print!! OAT. (yyyy.mm DD) PRVACY ACT STATEMENT: Auth: GNSATO, Pub.L , EO 12968; NSA's Blanket Routine Uses found at 58 Fed. Reg. 10,531 (1993) apply to this information. Authority for requesling SSN: E.O nfo will be used to positively identify the individual for briefing, rebrlefing, and debriefing for the handling of COSMC TOP SECRET, ATOMAL, NATO SECRET, and NATO CONFDENTAL material. Disclosure of the information. including the Social Security Number is voluntary. Effect on individual f information is not provided: nabilily to verify individual may delay clearance access. SECTON A GENERAL \JAME (Last) (First) (M) SD SSN OCV o Mil PHONE NUMBER (Secure) (f Mllirary. provide Rank) (Non Secure) ORGANZATON BULDNG ROOM NUMBER SECTON B BREFNG certify that have been briefed and fully undemtand the procedures for handling the below checked material and am aware of my responsbility for safeguarding such information and that am liable to prosecution under Sections 793 and 794 of Title 18, U.S.C., if either by inlenf or negligence allow t to pass into unauthorized hands. o COSMC 0 ATOMAl 0 NATOSECRET SECTON C ATOMAL REBREFNG certify that have been rebriefed and fully understand the procedures lor handling ATOMAL material and am aware of my responsibility to safeguard such information. SGNATURE DATE SGNATURE DATE D COSMC SECTON D REVALDATON D ATOMAL D NATOSECRET SGNATURE DATE SECTON E DEBREFNG have been debriefed for the below checked information and understand that must not disclose any classified information which have obtained in my assignment to this organization or in connection therewith. also understand that must not make any such classified information available to the public or to any person not lawfully entitled to that information. further understand that any unauthorized disclosure of such classified information. whether public or private, intentional or unintentional, will subject me to prosecution under applicable laws. o COSMC o ltomal o NTOSECRET SGNATURE DATE CONTROL OFFC.R SGNATUR. OAT. FORM G7192 REV OCT 2000 (Supersedes G7192 FEB 99 which is obsolete) pproved for Release by NSA FOA Case # 4287

9 D ---. ~"4'7?~ NCO COUNSELNG CHECKLST/RECORD For use or this form, see AR 623~205; the proponenl agency MLPERCEN NAME OF RATED NCD RANK DUTY POSTON UNT PURPOSE: The primery purpose of counseling s to mprove pertormance and to professionally develop the rafed NCO. The best counseling s always looking forward. t does not dwell on the past and on what was done. rather on the future and what can be done better. Counseling at the end of the rating period is too lata since there s not time to improve before evaluation, RULES: 1. Face-la-face performance oounseling is mandatory for a/l Noncommissioned Officers. 2. This form is for use along with a working copy of the NCQ..ER for conducting NCO performance counseling and recording counseling content and dates. ts use is mandatory for counseling all NCOs. CPL thru SFC/PSG, and is optional for counseling other senior NCDs. 3. Active Component nitial counseling must be conducted within the first 30 days of each rating period, and at least quarterly thereatter. Reserve Components. (AANG, USAF). Counseling must be conducted at least semiannually. There s no mandatory counseling at the end of the rating period. CHECKLST. FRST COUNSELNG SESSON AT THE BEGNNNG OF THE RATNG PEROD PREPARATON COUNSEUNG 1. Schedule counseling session, notify rated NCO. 1. Make sure rated NCO knows rating chain. 2. Get copy of last duty description used lor rate<l NCO's duty 2, Show rated NCO the draft duty description on your working copy of position, a blank copy of the NCO-ER, and the names of the new the NCQ ER. Explain all parts. f rated NCO performed in posi1ion rating chain. before, ask for any ideas to make duty description beuer, 3. Update duty description (see page 2.) 3. Discuss the meaning of each value/responsibility in Part V of NCO 4. Fill out rating chain and duty description on working copy of ER. Use the trigger words on the NCQ..ER, and the expanded definitions NCO ER. Parts and. on pages 3 and 4 of this form to help. 5, Read each of the values/responsibilities in Part V of NCc>-ER 4, E)(plaln how each value/responsibility appues to the specific duty and the Q)(panded definitions and examples on page 3 and 4 of this position by showing or telling your standards klr success (8 meets form. standards rating). Use examples on pages 3 and 4 of this form as B start 6. Think how each value and responsibility in Part V of NCO e:r point. Be specific so the rated NCO really knows whal's expected. applies to the rated NCO and his/her duty posilion. 5. When possible. give specllic examples of excellence that could Note: Lead8l'Ship and training may be more difficult to apply than the apply. This gives the rated NCO something special to strive for. other values/responsibilities when the rated NCO has no Remember that only a few achieve real excellence and that real subordinates. Leadership is simply influencing others in the excellence always includes specific results and often ncludes accomplishment at the mission and that can include peers and accomplishments of subon:llnates. superiors. t also can be applie<l directly to additional duties and ofher 6. Give raled NCO opportunity to ask questions and make areas of Army community life. ndividual training is the responsibility of suggestions, all NCO's whether or not there are subordinates. Every NCO knows somethng that can be taught to others and should be nvolved in some way in a training program. 7. Decide what you consider necessary tor success (a meets standards rating) for each valuelresponsibmly. Use the examples listed on pages 3 and 4 of this form as a guide in developing your own AFTER COUNSEUNG standard for success. Some may apply exactly, but you may have to 1. Record rated NCO's name and counseling date on this fol'ffi. change them at develop naw ones that apply to your situation. Be 2. Write key points made in counseling session on this form. specific so the raled NCO will know what is expected. 3. Show key points to rated NCO and get his initials. 8, Make notes in blank spaces in Part V of NCO ER to help when 4. save NCo-ER with this checklist for next counseling session. counseling. 9. Review counseling tips in FM CHECKLST LATER COUNSELNG SESSONS DURNG THE RATNG PEROD PREPARATON 6. Think about what the rated NCO has done so far during this rating 1. SChedule counseling session, notify rated NCO, and tell himlhef period (specifically, observed action, demonstrated behavior. and to come prepared to discuss what has been acoomplished in each results). value/responsibility. 7. For each value/responslbiljty area.. answer three questions: First, 2. Look at working copy of NCO EA you used during last what has happened in response to any discussion you had during the counseling session. last counseling session? Second, what has been done well?: and Third. 3, Read and update duty description. Especially note the area of what could be done better? special emphasis; the priorities may have changes. 8. Make notes n blank spaces n Part V of NCD-ER to help focus 4. Read again, each of the values/responsibilities n Part V of when counseling. (Use new NCQ.ER if old one is full trom last NCD-ER and the e,panded detinltions and e,amples on pages 3 and counseling session). 4 of thlslorm; then think again, about your standards lor success. 9. Review counseling tips in FM , Look over the notes you wrote down on page 2 of this form about the 18$t counseling session. DA FORM , AUG 87 NSA V1.00

10 DCiCD COUNSELNG 4. Ask rated NCO for ideas. examples and opinions on What has l. Go Over each part of the duty description with rated NCO. been done so far and what can be done better. (This step Clln be dona Discuss any changes, especially to the area of special emphasis, first or last). 2. Tell rated NCO how he/she: is doing. Use your success standards as a guide for the discusson (the examples on pages 3 AFTER COUNSELNG and 4 may helpl. First, for each value/responsibility, talk about what 1. Record counseling date on this form. has happened in response to any discussion you had during the 2. Write key points made in counsettng session on this form. last counseling session (remember, observed action, demonstrated 3. ShOW key points to rated NCO and get his initials. behavior and results). Second, talk about what was done well 4. SavE!' NCQ.-ER with this checklist for next counseling s&ssion. Third, talk about how to do better. The goal is to get all NCOs to be (Notes should make record NCQ ER preparation easy at end of rating successful and meet standards. period), 3. When possible, give examples of excellence that could apply. This gives the rated NCO something to strive for. REMEMBER. EXCELLENCE S SPECAL. ONLY A FEW ACHEVE T! Excellence includes resulls and often nvolves subordinates. COUNSELNG RECORO DATE OF RATED COUNSELNG NCO'. KEY PONTS MADE NTALS NTAL LATER LATER LATER DUlY DESCRPTON (PART 01 NCo-ERl The duty description is essential to performance counseling and 4. Area 01 Special Emphasis. This portion is most likely to change evalualion. t is used during the first counseling session to tell rated SOtl'l6What during the rating period. For this first counseling session, it NCO What the duties are and what needs to be emphasized. t may includes those items that require top priority effort at leest for the first change somewhat during the rating period. t is used at the end of the part of the upcoming rating period. At the end of the rating period. n rating period to record what was imporlant about the duties, Should include the most mportant nems that applied at any time during the rating period (examples are preparation for REFORGER The five elements of the duty description: deployment. combined arms drilled training for FTX. preparation for NTC rotauon, revision of battalion maintenance SOP, training for tank 1&2. Principal Duty Title and Duty MOS Code. Enter principal duty table qualification. TEP and company AMTP readineas. related tasl<s 1itle and OMOS that most accurately reflects actual duties pertormed. cross training, reserve components annual training support (AT) and SDPERS acceptance ratol, 3, Dally Duties and Scope.This portion should address the most 5. Appointed Dulle. This portion should include those duties that mponant routine duties and responsibilities. deally, this should are appointed and are not normally associated with the duty include number of people supervised, equipment, facilities, and description. dollars involved and any other routine duties and responsibilities critical 10 mission accomplishment. DA FORM , AUG 87 2 NSA Vl,OO

11 D C"'Tn. ~" 47"~ VALUESNCO RESPONSBLTES (PART V 01 NCQ-ER) VALUES: Values are what soldiers. as a profession, judge to be and courage to stand up for what is right; Developing a sense of right They are the moral, ethical, and professional attributes of obligation and support between those who Bre led, those who lead. character, They are the heart and soul of a great Army. Part Va of and those who serve alongside; Maintaining high standards of the NCQ EA includes some of the most important values, These personal conduct on and oll duly; And finally, demonstrating are: Putting the welfare of the nation, the assigned mission and obedience. total adherence to the spirtt and lettef of a lawful order, teamwork belora individual nterests; Exhibiting absolute honesty discipline, and ability to overcome fear despite difficulty or danger. Examples of standards for "YES" raungs: Exhibit pride in unil. be a team player. Put the Army, the mission and subordinates first before own personal interest. Meet challenges without compromising ntegrity. Personal conduct, both on and off duty, reflects favorably on NCO corps. Obey lawful orders and do what is right without orders. Choose the hard right over the easy wrong. Demonstrate respect for au soldiers regardless of race, creed, color, sex or national origin, COMPETENCE: The knowledge, skills and abilities nece.sary 10 be expert in the current duty assignment and to perform adequately in other assignments within the MOO when required, Competence is botj1 technical and tactical and include. reading, writing, speaking and basic mathematics. t also includes sound judgement, ability to weigh alternatives.lorm objective opinions and make good decisions. Closely allied with competence ia the constant desire to be better, to lif;ten and learn mare and to do each task completely to the best of one's ability. Learn, grow, set standards, and achieve them, create and innovate. taka prudent risks. never settle for lass than best. Committed to excellence. Examples of standards for "SuccessMeets Standard." n!t1ng: Master the knowledge, skills and abilities requited for performance in your duty position, Maet PMOS SaT standards tor your grade. requred by duty position. Constantly seek ways to learn, grow and improve. AccompliSh completely and promptly those tasks assigned or Enmples of "excellence": Picked as SSG to be a platoon sergeant over twelve other SSGs. Maintained SDPERS rating of 98% for six months. Scored 94% on last SQr. selected best truck master in annual battalion competition, Designated nstallation Drill sergeant of Quarter. Exceeded recruiting objectives two consectlve quarters, Awarded Expert nfantryman Badge (EB). PHYSCAL FTNESS AND MluTARY BEARNG: Physicai fitness is responsible for their own physical fitness and that of their subordinatos. the physical and mental ability to accomplish the mission combat Military Bearing consists of posture, dress, overall appearance, end reaainess. Total fitness includes weight control, diet and nutrition, manner of physical movement. Bearing also includes and outwerd smoking cessation, control of substance abuse. stress management. display of inner~feellngs, lears. and overall confidence and enlhu.siasm. and physical training. t covers strength, endurance, stamna, An inherent NCO responsibility is concern with the military bearing of flexibility. speed. agility. coordination and balance. NCOs are the individual soldier, to include on-tha-spot corrections. Examples of standards lor "SuccessMeeta Standards" rating: Maintain weight within Army limits for age and sex. Obtain passing score in APFT and participate in a regular exercise program, Maintain petsonal appearance and exhibit enthusiasm to the platoon. point of setting an axample for junior enlisted soidiers. Monitor and encourage improvement in the physical and military bearing of subordinates. DA FORM , AUG 87 3 Exampl.. ol_land_rd, 01 "ExceUence": Received Physical Fitness Badge for 292 score on APFT. Selected soldier of tj1e month/querter/year. Three of the last four soldiers of the month were from hislher As master Fitness Trainer, established battalion physical fitness program. His enijre squad was commended for scoring above 270 on APFT. NSA Vl.00

12 D('f'Tn. ~1147"~ LEADERSHP: nfluencing others to accomplish the mission. t consists of applying leadership attribules (Belle!s, Values, Ethics, Character, Knowtedge, and Skills). t includes setting tough, but achievable slandards and demanding that they be mel; Caring deeply and sincerely for subordinates and their families and welcoming the opjxjrtunity to serve them: Conducting counseling; Semng the example by word and actldeed; Cen be summarized by BE (Committed to the professional Army ethic and prof&gsional tmils); KNOW (The factors of leadership, yourself, human nature, your job, and your unit); 00 (PrOvide direction, implement, and motivate). nstill the spirit to achieve and win: nspire and dewiop excellence. A soldier cared lor today, leads tomorrow. Examples of standards for "Succ::esalMeets Standards" rating: Motivate subordinates to perform to the best of their ability as individuals and together as a disciplined cohesive team to accomplish the mission. Demonstrate that you care deeply and sincerely for soldiers and welcome the opportunity to serve them. nstill the spirit to achieve and win; nspire and develop excellence through counseling. Set the example: BE, KNOW, DO. Training: Preparing individuals, unlls and combined arms teams for duly performance; The teeching of skills and knowledge, NCOs contribute to team training, ara often responsible 'Ot unit (aining (Squads, Crows, Seclions), but individual reining is the most important, exclusive responsibuity of the NCO Corps. Quality traning bonds units: Leads directly to good discipline; Concentrates on Examples of standards for "Sl,.ccesslMeots Standillrds" raung: Make sure soldiersa, Can do identified common tasks. b. Are prepared tor SaT and Commander's Evaluation. c. Develop and practice skills lor duly position. d. Train as a squad/crew/section. dentify and recommend subordinates for profossional development courses. Participate in unit training program. Share knowtedge and experience with subordinates. RESPONSBLTY AND ACCOUNTABUTY: The proper care, maintenance, use, handling, and conservation of personnel, equipment, supplies, property, and funds. Maintenance 01 weapons, vehicles, equipment, conservaton of supplies, and funds s a SpEK:lal NCO responsbility because of its links to the success of all missions, especially those on the banlefield, t includes inspecting soldier's equipment often, using manual or checklist; Hotding soldiers responsible tor repairs and losses; learning how to use and maintain all the equipment soldiers use; Being among the first to operate new equipment Keeping up-to-date component lists; Setting aside time Examples 01 standards lor "SuccessMeel. Standards" rallng: Make sure your weapons, equipment, and vehicles are serviceable, maintained and ready lor accomplishing the mission. Stop waste of supples and limited funds. Be aware of those Ulings that impact on soldier readiness e.g., family effai"', SOT, cn, par, special duty, medical conditions, etc. Be responsible for your actions and those of your subordinates, Exomplos of "Excellence": Motivated entire squad to qualily axperl with M-16. Won last three platoon quad n:;;pections. selected for membership in Sergeant MOrales Club. nspired mechanics to mainta!'n operational readiness rating of 95% for two consecutive quarters". Led his squad through map orienteering course to win the battalion competition. Counseled two marginal soldiers ultimately selected for promotion, wartime missions; s tough and demanding without being reckless; s per10rmance oriented; Sticks to Army doctrine to standardize what is taught to fight, survive, and win, as small units when AirLand battle actions dictate. ~Good training means learning from mistakes and allowing plenty of room lor professional growth, Sharing knowledge and experience is the greatest legacy one can leave subordinates." Example. of "Excellence": Taught five common tasks resulting in 100% GO on Annual CTT for all soldiers in directorate, Trained best howitter section of the year in battalion. Coachad subordinates to win consecutive soldier of month competitions, Established company Expert Field Medical Badge program resulting n 85% of ail eligitje soldiers receiving EFMB. Dislinguished 1 tank and qualified 3 tanks n platoon on first run of tank table VU. Trained platoon to fire honor battery during annual service practice, for inventories; and Knowing the readiness status of weapons, vehicles, and other equipment. t includes knowing where each s~djer is during duly hours; Why he is going on sick call, where he lives, and his family situation; t involves reducing accidental manpower and monetary losses by providing a safe and healthful environment; t includes creating a cumste which enoourages young soldiers to learn and grow, and, to report serious problems without fear of repercussions. AJso, NOes must accept responsibility for their own actions and for those 01 their subordinates, Example. 01 "Excellence": His emphasis on safety resulted in four tractor trailer drivers logging 10,000 miles accident free. Rec~ved commendation 'rom CO for organizing post special olympics program. Won the installation award for Quarters of the Month, Commended tor no APes on deadline roport for six months, His learn and grow climate resulted in best platoon ARTEP resuhs n the battalion. OA FORM , AUG 87 4 NSA V1.00

13 !~~ LUATON REPORT SEE: PRVACY ACT STATEMENT For use 01 this Orm;""se~'::~ ; the proponent agency is DeSPER N AR APPENDEX E, PART ADMNSTRATVE DATA a NAME (Last, First, Middle/nitial) OON C nl'lf'll'\, UA ue RANK! e. emusu r t UNT. ORG" STATON. ZP CODE OA APQ, MAJOR COMMANO g. REASfN FOR SUBMSSON h PEROD COVERED i. RATED kn<j-"' k, NO. OF RATED NCO COpy (Check one and DatB; m.pse n,_c_~d MONTHS ATED ENCL &)6'i Date nitia.ls CODE FROM THRU CODES 1, Given to NCO yy MM yy MM 2. Forwarded to NCO a, NAME OF RATER (Last, First. Middle nitial) SSN PART - AUTHENTCATON SGNATURE RANK. PMOSClBRANCH. ORGANZATON, DUTY ASSGNMENT DATE b NAMt: V'" ~t:'or Rto t:t" (Last, First, Mlaa/e millal) loon 1" n" RANK, PMOSC/BRANCH, ORGANZATON, DUTY ASSGNMENT DATE c Aated NCO: understand my signature does not conr~t& aweement ~~e evaluations 9' SGNATURE DATE the raler and senior raler. Part, heigl1vweight and A ent es are veri'. have seen ths report complete<! through Part V. am aware of the appeals process (AR ). d. NAME OF REVEWER (Last, First, Middle /nitiaf) SSN SGNATURE RANK, PMOSCBRANCH, ORGANZATON, DUTY ASSGNMENT DATE e n CONCUR WTH RATER AND SENOR RATER EVALUATONS n NONOONCUR WTH RATER ANDOR SENOR RATER EVAL (S.."ffa<:/lO(f_menl.) a PRNCPAL DUTY TTLE PART - DUTY DESCRPTON (Rater) b DUTY MOSC c, DALY DUTES AND SCOPE (To include, as appropriale. people. equipmtjl'lt. facilities and dolaf$) d. AREAS OF SPECAL EMPHASS e APPONTED DUTES CounSeling dates from Cht!lCk/isVf8COtd NTAL LATER LATER LATER PART V VALUESNCO RESPONSBLTES (Rater) 8. Complete each que.tlon. (Commenr. art mandatory tor "No" tnllriuj opliona' (Of..y,...nrn..) YES NO V A L U ARMY ETHC Loyslfy Duty Selfless Service (nlegnry PERSONAL 1. Places dedicilliol1 and commitment to the goals and missions of the Army and nation above personal welfare. 1 Commitment 2 s committed to and shows a sense of pride in the unit works as a member of the team. 2 Competence 3. s disciplined and obedient to the spirit and letter of a lawful order, 3 Candor 4 s hones1 and lruthful in word anct deed. 4 CaVf1!l91!t E S 5 Maintains high standards 01 personal conduct 00 and off duly Has the courage of convictions and the! ab~ity to overcome fear. stands up for and does, what's right 6 7. SUP"""' EOEEO 7 Bullet comments OA FORM , SEP 87 REPLACES OA FORM OCT 81, WHCH S OBSOLETE ",AV100

14 as, rst, e nitial) SSN THRU DATE PART V (Rater) VALUESNCO RESPONSBLTES b. COMPETENCE o DulY proficiency: MOS competency o Technical &. tactical: knowledge, skills. and abilities o Sound judgement o Seeking self-mprovement; always learning o Accomplishing ta~s to the fullest capacity; committed to excellence EXCELLENCE SUCCESS NEEDS MPROVEMENT ([;xc98ds std) (Meets 51(3) (Some) (Much) c. PHYSCAL FTNESS & MLTARY BEARNG o Mental and physical toughness o Endurance and stamina to go the distance o Displaying confidence and enthusiasm; looks like a soldier APFT HE.GHTWEGHT EXCELLENCE (Exceeds sid) SUCCESS (MeerS std) NEEDS MPROVEMENT (SOm6) (Mucf'l) d. LEADERSHP o Mission first o Genuine concem for soldiers o nstilling the spirit to achieve and win o setting the example; Be, Know, Do EXCELLENCE (!Exceeds std) SUCCESS (Meets std) NEEDS MPROVEMENT (Some! (Much) e. TRANNG o ndividual a.nd team o Missk>n focused; performance oriented o Teaching soldiers how: common tasks, duly-related skills o Sharing knowledge and experience 10 fight. survfve and win excellence SUCCESS NEEDS MPROVEMENT (Exceeds sd) (Meets Sd) (SOme) (Much) f. RESPONSBLTY & ACCOUNTABLTY o Care and maintenance of aquipjfacillties o Soldier and equipment safety o Conservation of supplies and funds o EncouraQing soldiers to 18am and grow o ResponSible lor good. bad. right &wrong EXCEllENCE (Exceeds sd) SUCCESS (Meets stet) NEEDS MPROVEMENT (Some! (Much) PART V OVERALL PERFORMANCE AND POTENTAL a. RATER. Overall potentia' for promotion and! e. SENOR RATER BULLET COMMENTS or service in positions of greater responsibility. AMONG THE BEST FULLY CAPABLE MARGNAL b. RATER. LiSt 3 positions in whioh the rated NCO could best serve the Army at his/her current or next higher grade. c. SENOR RATER. Overall performance Successful d. SENOR RATER. Overall potential for promotion and/or service in 4 5 positions of greater responsibility. Fa.ir Poor 2 3 Soperior 4 5 Fair Poor NSA Vl.00

15 DOClD: SECURTY CLASSFCATON (if any) NEW EQUPMENT TAGGNG LOG EQUPMENT USER (Mandatory) NAME (Last) (Fitsf) (M) SD PHONE (S6Cure) (Non-Secure) ORGANZATON BULDNG ROOM NUMBER DEBT NUMBER PURCHASE REQUEST NUMBER CONTRACT NUMBER NSADTAG AECUAED? MANUFACTURER MODEL NUMBER DVES (Complete ll..k NOMENCLATURE fields) PRQJECT DATE RECEVED (YYYYMMODj... Does NQ meet Third Patty Equipment or Military (Shipping Voucher #) dollar thre,hold ($5,000) DNO Circuit Card or Used Shipped in 30 days or less under Shipping Voucher # (f 'WO", select ~ inside of equipment and send request to Directorate PAO) storage under storage voucner # Software.. 'L. >/'...,':;;', Other (Specify).:." NSAD SERAL NUMBER UNT COST COMMENTS (f Laptop, C/a,slfieatlon REQURED) FORM J7236 FEB 2002 SECURTY CLASSFCATON (il any) pproved for Release by NSA orl FOA Case#4287 V.

16 DOClD FORM X818 AUG 53 pproved for Release by NSA ~q FOA Case #4287

17 DOMO~ S\JmEWORKSHEET a~ganzaton "ULDNG ROOM REPORT SERAL NUMBER SUPERVSOR PHONE NUMBER SURVEY DATE EMPLOYEE NAME PHONE NUMBER JOB TTLE eose EXPOSURE NFORMATON Number gxposed PPE (Type and effectiveness) Duration (Hours/Day): } Frequency (OaySJWeek): WEATHER CONOTONS o Nt. PHOTO DYESDNO TYPE OF OPERATON SOUND LEVEL METER DATA Time dba dbc location and Remarks. DOSMETER DATA Time On/Off Duration (OUR) Dose (BOd) Projected Dose (BOP) TWA (BA1) Peak Level (LP) FORM REV MAY 2000 {Supersedes FEB (;}s which is obsolete) (over) ~fproved for Release by NSA ~~ FOA Case # 4287,

18 DOClD: CALBRATON DATA DOSMETER (Manu(a.rur.r, Serla/ No,): PRE SURVEY POST SURVEY BATTERV CHECK LOCATON T & B,P BATTERY CHECK LOCATON / T & B.P. DYES o NO Dyes ONO CALBRATOR SN CALBRATOR SN '" '". Ui ' U) :; dba :; dba ::> ::> rr; dbc rr; dbc NTALS DATE f TME NlTlALS DATE TME UJ '" SOUNO.EVE. METER (M.nufactu"", Serial No,): PRE SURVEY POST-llURVEY BATTERV CHECK LOCATON / T & B P. BATERY CHECK LOCATON T & BP. DYES o NO DYES ONO CALBRATOR SN CALBAATOA SN '" SOD :; 'BA :; dba ::> iil U) rr; w w dbc C! dbc NTALS DATE TME NTALS OATE TME '" JOB DESCRPTON, OPERATON, WORK.OCATON(S), ENGNEERNG CONTRO.S continue on Page 3 NDUSTRAl. HYGENST /Signll"",) CATE FORM REV MAY 2000 Page 2-2-

19 DOCD: JOB DESCRPTON, OPERATON, WORK LOCATON(S), ENGNEERNG CONTROLS (Continued) FORM REV MAY Page 3-3 -

20 DOClD: NOMNATON FOR AWARD AWARD CATEGORY AWARD PEROD RANK/NAME OF NOMNEE (Last, First, Middle nitial) SSN DAFSC/oUTv TTLE MAJCOM TUNTOFFCe $YMBOVSTREET ADDRESS 6ASE/STATEZP CODE mltelephone (OSN & Commercial) RANK/NAME OF UNT COMMANDER (last First, Middle nitial) SPEC~C ACCOMPLSHMENTS (Use single-spaced, Dullet format) AF FORM 1206, APR 95 (EF-V) National Securty Agency (FtameMaker) PREVOUS EDTON S OBSOLETE.

21 DOCD: RANKJNAME OF NOMNEE (J..asr. First, Middle nifial) NOMNATON FOR AWARD (canlinuod) SPECFC ACCOMPLSHMENTS (Use sinafe-sp;jcftd, buller formar) (Continued) AF FORM 1206, APR 95 (REVERSE) (EP-V) Nallonal Sec"nly Agency (PrameMaker)

22 DOClD: NOMNATON FOR AWARD AWARD CATEGORY AWARD PEROD AirmaniNCO/SNCO fa Quarter NCO ApriJ- 30 June 1996 RANK/NAME OF NOMNEE (Last, First, Middle mtial) SSgr. Doe. John Q OAFSC/DUTy TillE DAFSClDuty title goes here MAJCOM UNT/OFFCE SYMBOL/STREET ADDRESS AlA 694 OSS/OSK 9829 Love Road Fort Meade. Maryland ASESTATEZP CODE TELEPHON(:: (D$N & commtfrciaf) Fort Meade. MD (301 ) RANK/NAME OF UNT COMMANDER (LaS!, FltSt. Middle nitial) Unit Commander goes here SPEC Fe ACCOMPLSHMENTS (Use singltf-spaced. bvllet format) LEADERSHP AND JOB PERFORMANCE N PRMARY DUTY: - A guess a key duty. tasks, and responsibility header goes here then the rest goes here. Part of the problem, perhaps most ofit, is related to temporary factors. Demand is growing more slowly in personal computers -- a $120 billion global market-- and in some other major areas such as cellular phones. -- But analysts say such trends are typical of the middle months of the year. and underlying growth rates remain robust. "Everybody is panicking," observed Michael Moritz, a partner in Sequoia Capital of Menlo Park. Calif.. one of the country's most successful venture-capital firms. "We are watching the lemmings fly out the window." SGNFCANT SELF MPROVEMENT: - Yesterday, the technology-laden Nasdaq Composite ndex plummeted points, or 3.05%, one of the sharpest drops on record, and the Dow Jones ndustrial Average swooned by points, or 1.48%. The main impetus was ominous news from two giants that have led the technology boom of the 1990s, Motorola nc. and Hewlett-Packard Co. On Wednesday, H-P said it had run into slowing demand for its computers. LEADERSHP QUALTES: - A guess a key duty. tasks, and responsibility header goes here then the rest goes here. Part of the problem, perhaps most of it, is related to temporary factors. Demand is growing more slowly in personal computers -- a $120 billion global market -- and in some other major areas such as cellular phones. -- But analysts say such trends are typical of the middle months of the year, and underlying growth rates remain robust. "Everybody is panicking," observed Michael Moritz, a partner in Sequoia Capital of Menlo Park, Calif. one of the country's most successful venture-capital firms. "We are watching the lemmings fly out the window." OTHER ACCOMPLSHMENTS: Yesterday, the technology laden Nasdaq Composite ndex plummeted points, or 3.05%, one of the sharpest drops on record. and the Dow Jones ndustrial Average swooned by points, or 1.48%. -- The main impetus was ominous news from two giants that have led the technology boom of the 19905, Motorola nc. and Hewlett-Packard Co. - On Wednesday, H-P said it had run into slowing demand for its computers. AR FORCE OR CVLAN AWARDS, PRZES, TTLES: - A guess a key duty, tasks, and responsibility header goes here then the rest goes here. - Part of the problem, perhaps most ofit, is related to temporary factors. Demand is growing more slowly in personal computers -- a $120 billion global market.- and in some other major areas such as cellular phones. But analysts say such trends are typical of the middle months of the year, and underlying growth rates remain robust. "Everybody is panicking," observed Michael Moritz, a partner in Sequoia Capital of Menlo Park, Calif., one of the country's most successful venture-capital firms. "We are watching the lemmings fly out the window." ARTCULATE AND POSTVE REPRESENTATVE OF THE AR FORCE Yesterday. the technology-laden Nasdaq Composite ndex plummeted points, or 3.05%, one of the sharpest drops on record, and the Dow Jones ndustrial Average swooned by 83.1 points, or 1.48%. The main impetus was ominous news from two giants that have led the technology boom of the 1990s, Motorola nc. and Hewlett-Packard Co. - On Wednesdav, H-P said it had run into slowing demand for its comouters. AF FORM 1206, APR 95 (EF V1) NoMno' Securoty Agency (Fram.M er) PREVOUS EDTON S OBSOLETE. 55N

23 DOCD: AANKNAME OF NOMNEE (Last. First, Middle nitial) SSg!. Doe, John Q. NOMNATON FOR AWARD (continued) SPECFC ACCOMPLSHMENTS (use single-spaced, but/st ormst) (Con/t'llJed) LEADERSHP AND JOB PERFORMANCE N PRMARY DUTY: - A guess a key duty, tasks, and responsibility header goes here then the rest goes here. - Part of the problem, perhaps most of it, is related to temporary factors, Demand is growing more slowly in personal computers n a $120 billion global market n and in some other major areas such as cellular phones. -- But analysts say such trends are typical of the middle months of the year, and underlying growth rates remain robust. "Everybody is panicking," observed Michael Moritz, a partner in Sequoia Capital of Menlo Park, Calif., one ofthe country's most successful venture-capital firms. "We are watching the lemmings fly out the window," SGNFCANT SELF MPROVEMENT: - Yesterday, the technology-laden Nasdaq Composite ndex plummeted 34,83 points, or 3,05%, one of the sharpest drops on record, and the Dow Jones ndustrial Average swooned by points, or 1.48%, n The main impetus was ominous news from two giants that have led the technology boom of the 990s, Motorola nc. and Hewlett-Packard Co. - On Wednesday, H-P said it had run into slowing demand for its computers. LEADERSDP QUALTES: - A guess a key duty, tasks, and responsibility header goes here then the rest goes here. - Part of the problem, perhaps most of it, is related to temporary factors. Demand is growing more slowly in personal computers n a $120 billion global market and in some other major areas such as cellular phones. n But analysts say such trends are typical of the middle months of the year, and underlying growth rates remain robust. "Everybody is panicking," observed Michael Moritz, a partner in Sequoia Capital of Menlo Park, Calif., one of the country's most successful venture-capital firms. "We are watching the lemmings fly out the window." OTHER ACCOMPLSHMENTS: - Yesterday, the technology-laden Nasdaq Composite ndex plummeted points, or 3.05%, one of the sharpest drops on record, and the Dow Jones ndustrial Average swooned by points, or 1.48%, -- The main impetus was ominous news from two giants that have led the technology boom of the 1990s, Motorola nc. and Hewlett-Packard Co, - On Wednesday, H-P said it had run into slowing demand for its computers. AR FORCE OR CVLAN AWARDS, PRZES, TTLES; - A guess a key duty, tasks, and responsibility header goes here then the rest goes here. - Part of the problem, perhaps most of it, is related to temporary factors. Demand is growing more slowly in personal computers -- a $120 billion global market-- and in some other major areas such as cellular phones. -- But analysts say such trends are typical of the middle months of the year, and underlying growth rates remain robust. "Everybody is panicking," observed Michael Moritz, a partner in Sequoia Capital of Menlo Park, Calif" one of the country's most successful venture-capital firms. "We are watching the lemmings fly out the window," ARTCULATE AND POSTVE REPRESENTATVE OF THE AR FORCE - Yesterday, the technology-laden Nasdaq Composite ndex plummeted 34,83 points, or 3.05%, one of the sharpest drops on record, and the Dow Jones ndustrial Average swooned by 83.1 points, or 1.48%. -- The main impetus was ominous news from two giants that have led the technology boom of the 1990s, Motorola nc. and Hewlett-Packard Co. - On Wednesday, H-P said it had run into slowing demand for its computers, AR FORCE OR CVLAN AWARDS, PRZES, TTLES: - A guess a key duty, tasks, and responsibility header goes here then the rest goes here. - Part of the problem, perhaps most of it, is related to temporary factors. Demand is growing more slowly in personal computers -- a $120 billion global market -- and in some other major areas such as cellular phones, -- But analysts say such trends are typical of the middle months of the year, and underlying growth rates remain robust. "Everybody is panicking," observed Michael Moritz, a partner in Sequoia Capital of Menlo Park, Calif., one of the country's most successful venture-capital firms. "We are watching the lemmings fly out the window," ARTCULATE AND POSTVE REPRESENTATVE OF THE AR FORCE AF FORM 1206, APR 95 (REVERSE) (EF V,) Nat.onal Securoly Agency (FrarneMa r)

24 DOClD: NOMNATON FOR TRANNG PROGRAM NAME PRVACY ACT STATEMENT: Auth for collecting inlo requested on this form is contained in 50 U.S,C, 402!llllll; 5 U,S,C, ; and Exseutlve Orders and NSA'g Blanket Routne Uses found at 58 Facl Reg, 10,531 (1993) and the spechic uses found n GNSA09 and GNSA12 apply to this information, Authority for requesting your SOCial security Number is executive Order 9397, nformation you provide will be used (primarily) to document the nomination of trainees, the completion of training, and to confirm your ktentity. Disclosure of requested information, ncl.jdlng your SSN, is voluntary, However, failure to furnish requested information, other than your SSN, may delay or prevent the Agency from processing you for training NAME (Last) (FilS') (M') GRADE SOCAL SECURTY NUMBER E-MAJL ADDRESS HOME ADDRESS OFFiCE PHONE (SllCUre) (Non S~re) CURRENT ORGANZATON POSTON TRE N UNCLASSiFED TERMS, BREFLY DESCRBE THE NOMNEE'S JOB RESPONSBtliTlES AND JUSTFY THE REOUESTED TRANNG BY SPECFYNG HOW THE TRANNG WLL BE APPLED ON RETURN, DENTFY THE PROPOSED ORGANZATON, POSTON AND RESPONSBLTES TO WHCH THE NOMNEE WLL RETURN: pproved for Release by NSA FOA Case #4287 NOMNEE w 0: :J CURRENT SUPERVSOR DATE (VYVY MM-OO) DATE (yyyy.mm-dd)!< z(!) PROPOSED SUPERVSOR DATE (yyyy.mm-dd) u; FORM E71 REV JUN 2001 (SupersedeS E71 ReV ocr2000 Whch S obsolete)

25 " DOCD: NONCOMPETTVE ACQUSTON JUSTFCATON ",'!'(i: i,'! A SUPPLES/SERVCES CAN BE OBTANED FROM ONLY ONE SOURCE BECAUSE: (NO1-complex requirement) THE TEM is A SPECFC TEM WHCH CAN BE OBTANED ONLY FROM THE MANUFACTURER; THERE ARE NO KNOWN DEALERS OR DSTRBUTORS (Does nor apply 10 services) SPECFC TEM~)iSOLE SOURCE CERTFCATON, WTH APPROPRATE SUPPORTNG DOCUMENTATON HAS BEEN FURNSH D BY THE REQURNG ELEMENT THE GOVERNMENTS MNMUM NEEDS CAN BE SATSFED ONLY BY TEMS OR SERVCES WHCH ARE UNOUE " ONLY KNOWN SOURCE WTH REQURED EXPERTSE TME S OF THE ESSENCE AND ONLY ONE KNOWN SOURCE CAN MEET THE GOVERNMENTS NEED WTHN THE REQURED TME FRAME DATA S UNAVALABLE FOR COMPETTVE SOLCTATON ONLY ONE SOURCE CAN PROVDE TEM(S)/SERVCES WHCH S/ARE interchangeable WTH EQUPMENT ANDOR SOFlWARE >U' ORDER(S) AGANST MANDATORY NONCOMPETTVE GSA CONTRACT OTHER (E,planetlon rsqulisd) B, SOLE PROPOSAL OBTANED AFTER SOLCTNG QUALFED SUPPLERS OF THE TEM(S)/SERVCES AND THERE S NO FURTHER SOLCTATON ANTCPATED BECAUSE THE PRCe HAS BEEN DETERMNED TO BE FAR AND REASONABLE AND: (Check sppropriate bloc«s)) ''ii,',.0:,::',,,"",,'b"f"" COMPLEXTY OF AWARD NVOLVED TME S OF THE ESSENCE AMOUNT OF MONEY NVOLVED OTHER (Explanelion /Squired) BASED ON THE ABOVE, T S DETERMNED TO NEGOTATE THS REQUREMENT ON A NON-COMPETTVE BASS, CONTRACTNG OFFCER SGNATURE DAfE FORM J2625A REV MAR 81 (SupJ,sedes J2625A JUN 76 which is obsolete) pproved for Release by NSA 0, FOA Case # 4287

26 DOClD: NON-COMMERCAL FACLTES RECEPT (Supplemental to TOSA TOSE FTA Claim) PrivacY Act Statement: AuthOrity Jof COllecting info recluested on ths term is contained n 50 U-5.C. 4021l12t1; 5 U.S,C. 5923; and EO 12333_ N$A's Blanket Routine Use$1ound at 58 Fed. R~, 10,531 (1993) and the specific uses fowld in GNSA08 and GNSA09 apply to thl$ inlotmation, Al,lth for requesting your SSN is EO nfo you provide will be used to verify your claim for reittibumement of expenses associated with noo-<.:ommerical lodging. Disd 01 requested info, including your SSN, is voluntary. HO'MMilr, lail\lre to furnish requested 1'110, other lhan SSN. may prevent Agency frorn P!'O<:essing your request for reimbursement f you decnne 10 pro\llde your SSN. there may be a dl!llay n prooessing your request for reimbursement. NOTE: The additional costs that your host incurs as a result of you and/or members of your family residing at their private residence are reimbursable to you provided that you are otherwise eligible for TQSE or FTA. tems considered as proper costs lor reimbursement include but are not limited 10 the lollowing: (1) ncreased utilities as a result of your stay. Reimbursement is only appropriate to the extent that the host's expenses are increased. (2) Hire of help that would not otherwise have been hired. (3) Rental costs 01 additional furniture. (4) ncreased cost of groceries the host incurred as a result of your Slay. (5) Value of extra work performed by host..e., preparation of ail meals. Each element 01 cost must be developed in a logical manner and a statement outlining that logic must be attached. Example; A. " reimbursed my host $150 for groceries prepared in their home during my 10 day slay. My average monthly grocery bill is $330/mo or$11day. Therefore, the reasonable cosl ofthe groceries consumed in 10 days was 10 x $1 lor$110." B. " reimbursed my host for increased utilities cost during my stay in April The utility bill for April 2000 was $120. The April 2001 bill was $150. While $15 resulted from increases in the cost of utilities, the remaining $15 reflects the increased use of utilities by my family and me during our stay." Expenses tor non-commercial facilities must meet criteria; (1) the costs must be reasonable and (2) this must reflect expenses actuaily received as a direct result of the employee's dependents' stay. EXPENSE RECEPT (To be completljd by Host) EMPLOYEE'S NAME (Last) (r:irsf) (411) AMOUNT RECEVEO HOST'S RESDENCE (AddreSS) $ PEROD (lnclljsive DattfS) ABOVE AMOUNT BASED UPON AMOUNT SGNATURE UTLTES FURNTURE RENTAL GROCERES OTHER (Specify) DATE TOTALS FORM FB550A REV JAN 2001 (Supers... F8500A REV OCT 90 wflich is obsol.t.) pproved for Release by NSA FOA Case # 4287

27 NSTRUCTONS Section 1353 oftitle 31, United States Code, permits non-federal sources, such as organizations. associations. or businesses, to pay the Government for the expenses of transportation, accommodations. and meals for Government employees (and accompanying spouse. as appropriate) to attend meetings and similar functions such as conferences in their official capacities. Before payments for travei may be accepted from a non-federal souroe. the employee's supervisor must make t1e following determinations: Payment s for attendance at meeting or.lmuer 'unction. Travel to V on.electlon boards or review panel., or to grid. exam, does not qualify. This regulation excludes events required to cerry out NSA' statutory and regulatory function., Uch ' inspections. audita, site vlslta, or negotiations. t also exclude. promotional vendor tr.lnlng or other meetings for the primary purpose of marketing the non Federal lauree', products or trvlc... Payment s fol' travel related to the employee's official dull.,.. (The omployee must be n B trat/el stjtut. The trawl. primarily to meet. Governmenl re.ponslbllily orotherwl"" for he ba""m Of /h. Governmen~no' h. Of/.nlz.tlonpayingfor.) Payment s frem s non-federal souo:>' that s not a conflicting source. whlell s on. that has nterests that may be substantially affected by the performance or non~rrformanceof the employee', duties. f the payment s from a conflicting source, contact the Standards of COn...cl Offle. (SOCO. Benefits in kind (e.g. piane tickets, prepaid hotel reservations) are preferred. Cash may NOr be accepted by NSA employees. f benefits are provided by reimbursement of expenses, checks must be made Oul by the non~eral source to the U.S. Treasury or NSA. NOT to the employee. Prior to your travel. you must complete Part of this form. acquire your superviso(s signature and relurn to SOCO to obtain approval for travel benefit acceptance. After the travel has been compleled, you must complete Part of this onm and return to SOCO. SOCO can be reached on s1(301) 681l-2752b n Room 2A0266, Ops 2A, Suite 6205 or at 'soco@nsa.' EMPLOYEE NAME (La,1) POST N TE PART - SUBMT FOR APPROVAL BEFORETRAVEL (First) (M) ORGANZATON PHONE (secure) (Non-Secure) EVENT (Name) TRAVEL DATES (YYYY MM DD) (Spon,Of) Eva;T LOCATON (Date: YYY -MM-OO) NON-FEDERAL SOUACE(S) OF TRAVEL BE:NEFJTS NATURE OF PARTCPATON N EVENT SPECFC EXPENSES TO BE PAD EMPLOYEE'S SGNATURE DATE (ryy'mm OD) SUPERVSOR'S APPROVAL Accept.nce of these travel banefils would not cause a reasonable parson wfth knowledge o(allthe relavant facts to qvestion thq integrity 0/ rhe NSA's progmm or opbmffon. heve considered.ny impact the performance or non~performance of the- DoD empfoyee's officie/ duties might have on the non-feder.'source. STANpARDS OF CONDUCT OFFCE APPBOVAL have reviewed the above information and appf'(j/fj acceptance of travel benefits /rom the non-fadem/source(s) namad above. PRNTED NAME (ust) SGNATURE SGNATURE (FitSt) (M) DATE (YYY -MM-DD) OATE (YYY'MM-OD) SPECFC EXPENSES PAD AND NATURE OF PAYMENT (Check orin kind paym""r) PART - SUBMT AmBTRAVEL HAS BEEN COMPLETED TOTAL VALUE OF BENEFTS RECEVED EMPLOYEE'S SGNATURE FORM K730S FEB 2001 pproved for Release by NSA a FOA Case#4287 DATE (YnY MM DD)

28 DO r"tn. ~114'7':l,4 NOTCE OF REVSiON (NOR) THS REVSON DESCRBED BE~OW HAS BEEN AlTHORZED FOR THE OOCUlENT ~STED.CATE (YYYYMMOO) Form Approved OMS No, 0704.()188 The public lepqrting burden lor this cqllection 01 inform.lion is estimallild 10 average 2 houra per response, including the time lot ~O 1n$Nl;liol1l sean;:hing e\listing OOia $Q,l!'Ce$, gathering am maintaining 2. PRc9C\AlNG thq dala nmded, and compltling 8/ld r8viltwing the COllection oj informatiall. send commonts fggarditlq this burden A V NO. estimate Qr any Oher aspect 01 this eoet'lion 01 in'ormation, including sugge&lion$ot redoclng thi' bufoln, to Dtpartmenl 01 De1ense. WahinglOl1 HeadqlJaMll$!HNlc.t, Or.aOl'lllO lot nformation C)per.l01'1' and Rf:iOns (0700t-0188) JeHermn Olvil Htt1hway. &lhe MlnG'Of'\, VA , RMPO"OOnlB at\ould be aware ltlalnotwilhstanding any otl1er pf'lwision of law, no ~ shall be $vbject 10 any penalty to( 1aillng to comply wjth a collection 01 inlqrrmj;tion it does Mt dl$play a currently lall(1 OMB control fll.under. Pl.EASE DO NOT RETURN YOUR COMPL.ETED FORM TO THS ADDRESS- RETURN COMPUTED FORM TO THE GOVERNMeNT SSUNG CONTRAC"NG 3,DODAAC OFFce FOR THE CONTRACT' PROCURNG ACTl'nTV NUMBeR LSTED N TEM 2 OF THS FORM, 4, ORGNATOR b. ADDRESS (Street, City, State, Zp Code) 5. CAllE CODE 6. NOR NO. a. TYPED NAME (First, Middle nitial, L.,~tJ 7. CAGE CODE 8. DOCUMENT NO. 9. TT~E OF DOCUMENT 10, REVSON ~ETTER 11. ECP NO. a. CURRENT bnew 12. CONFGURATON TEM (OR SYSTEMTO WHCH ECP APP~'S 13. DESCRPTON OF REVSON 14. THS SECTON FOR GOVERNMENT USE ONLY a. (X one) (1) Existing document supplemented by this NOR may be u&ed in manufacture. -- (2) RfWised document musl be received before manufacturer may incorporate this change -- (3) Custodian of master document shall make abo\te revision and furnish revised document. b, ACTVTY AUTHORZED TO APPROVE CHANGE FOR GOVERNMENT C TYPED NAME (1'1"'1, Mldd./nla, L'$ d TTLE e, SGNATURE f. DATE SGNED (YYYYMMOO 15.a. ACTVTY ACCOMPl..SHNG REVSON b. REVSON COMPLETED (Signature) c, DATE SGNED (YYYY/.MOOj DD FORM 1695, AUG 96 PREVOUS EDTON MAY BE USED,

29 DOCD: NATONAL SECURTY AGENCY Ft. George G. Meade, Maryland FORM A9S6SF JUL 97 NSN.754J-FM.()() pproved for Release by NSA FOA Case # 4287

30 DOCD: " ~. ~. o _ ~." _. ~. _. _ _ " _ _ " _. _ _. _ _ _: NSAlCSS ARCHVAL AREA LABEL ACCSN NO. DESCRPTON ,, FOAM 05970A DEC 79 NSN: 7540 FM<lOH 036 (PERMANENT STORAGE) 0 ',, pproved for Release by NSA FOA Case #4287

31 DOCD: NATONAL SECURTY AGENCY CENTRAL SECURTY SERVCE FORT GEORGE G. MEADE, MARYLAND NSA/CSS CR. NO. DATE: NSA/CSS CRCULAR pproved for Release by NSA FOA Case #4287 A95B5B.3-73

32 DOClD: NATONAL SECURTY AGENCY CENTRAL SECURTY SERVCE A9585A.3-79 pproved for Release by NSA FOA Case # 4287

33 DOClD: NATONAL SECURTY AGENCY CENTRAL SECURTY SERVCE FORT GEORGE G. MEADE, MARYLAND NSAlCSS DR. NO. DATE: NSA/CSS DRECTVE A9585D.3-73 pproved for Release by NSA FOA Case # 4287

34 DOClD: NATONAL SECURTY AGENCY CENTRAL SECURTY SERVCE FORT GEORGE G. MEADE, MARYLAND NSAlCSS REG. NO DATE: NSA/CSS REGULATON pproved for Release by NSA FOA, Case # 4287 A9585C,3-73

35 m. m._ DOCD: PRVACY ACT STATEMENT: AuUlOrity for col!e(1ng inf,:,rmation requested 00 this NATONAL SECURTY AGENCY POLCE NCDENT REPORT form is contained in 40 U,S.C. 318 ~nd 5Q us C, 402 notp.-. NSA's Blanket ROl,ltine Uses found alsa Fed. Reg. 10,531 (1993) as. well as the sper:.ific uses enumetaled in GNSA01. GNSA03, GNSA07 and GNSA10 apply to t!'lis information. The requesled information you pro...ide may be used for reporting purposj~, to A.~ncy organizations, the National Crime nformation Center, and other pohoo ~ncies, There is no current r~quirementorpenally for failing to provide the requesteo inf(lrmation OTHER REPORTS (Circlej TYPE OF NCOENT CASE N"UMBER CRME ANAL. ARREST PROPERTY CONTNUATON ACCDENT SPECAL OTHER LOCATON OF XXXXXXX LNKED CASE NUMBER DATE/TME OCCURRED XX/XX/XXXX XXXX DATE/TME REPORTED XXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXXX SUMMARY OF NCDENT XXXXXXXXXXXXXXXXXXXX PERSONS V -Victim W,Witness p. SPF R Reporting Person ~ nformanl Only CODE NAME (Last) (Filst) (Middle) RACE SEX DOB XX XXXXXXX XXXXXX XXXX X/XX/XX SA.CTY ~XTE i~xx HOME PHONE 4. LO XXXXXXXX XXXXXXXXXX (XXX) XXX-xxxx PLACe OF EMPLOYMENT XXX OTHER PHONE XXXXXXXXXXXXXXXXX (XXX) XXX-XXXX ouue NAME (LBst) ( irst) 1 M ""''') KAC" S"A WV" 5. XX «< N/A N CODE F NOT USED ADDRESS CTY STATE ZP PHONE 1. XXX 2, XXX 3. XXX XXX --- A AF/REST S. SUSPECT F FELD OBSERVATON ml.. MORE NAMES N DETALS? DYES D NO CODE NAME (Last) ---~-;;i)-' (Midd/&) RACE XX <<<N/A N CODE [' NOT USED FORM G4045 REV SEP 2001 (SupersedeS G4045 REV APR 89 WhiCh is obsolete) - Page 1 CTY STATE ZP PHONE SECURTY CLASSFCATON (f,ny) pproved for Release by t~sa 0 2-' FOA Case # SEX \"008 XXX 7. HEGHT WEGHT EYES HAR OTHER DESCRPTON, PHYSCAL APPEARANCEDESCRPTON OF WEAPON XXX VEHCLE S Stolen 1 lmpoun<l W - Wanted 8, R - RlKovered U - Unauthorized Use 0- Other NAME (Last) (First) (Middle) RACE DOB SEX OWNER - SA ADDRESS CTY STATE ZP PHONE 9. V XXX OWNER TME NSURANCE COMPANY DYES D NO DATE NOTFED? CODE YR MAN MAKE AND MODEL STYLE COLOR LCENSE NUMBER STATE!MONTH'YEAR 10. XX XXXX XXX XX XXXX XXXX XXXXXXXX XX EXP.DATE VN XXXXXXXXXXXXXXXX MLEAGE XXXXXXXXX VALUE 1 KEYS N GNTON? REMA.RKS XXXXXXXXXXXXXXXXXXXXX XXX -~ MAY VEHCLE 11. DYES NO DYES NO 0 BE RELEASED? _. ~- 000 F RECOVERED. CTY COUNTY STATE JURiSDCTON STOLEN FROM; TOWED BY LOCATON TOWED TO 12. XXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXX.. -~ 000 ~YES o DATE TME PANEL ROOM SDO DATE jtlme NO XX/XX/XXXX ' NOTFED? XXXX NOTFED? ~YES o NO XX/XXXXX XXXX CLERK 10 CASE POS' ZONE CONTNUED PAGE XXX (COM CTR.) c.c. EM.C. ~ YES NO D XX STAT. ON NEXT PAGE? OF XX.. REPORTNG OFFCER D APPROVAL OFFCER XXXXXXX XXXX LT. XXXXXXXX ~XXX.. -' ~

36 MM m_...m.. mm... _.. _......m _ MM. DOCD: SECURTY CLASSFCATON (if any) DATE XX/XX/XXXX. WHERE D1SPATCHED?(LOCATON) 2. WHO WAS AT SCENE: SUSPECT OR PERSON THE REPORT S ABOUT, NAME, D.O.B., SOCAL SECURTY NUMBER, DRVERS LCENSE, NATONALTY F APPROPRATE. 3. VEHCLE DRVEN: DSCRPTON, TAG (AND EXPRATON DATE ON TAG STCKERS), V.N.. ( VEHCLE DENTFCATON NUMBER ). NAME OF PERSON WHO OWNS THE VEHCLE F NOT THE DRVER. 4. RUN N.C.LC ON PERSONNEL AND VEHCLE. 5. WHAT HAPPENED: DETALED DSCRPTON OF THE NCDENT ANSWER THESE OUESTONS; WHO, WHAT. WHERE. WHEN, HOW, AND WHY ap KNOWNl. WHAT ACTON WAS TAKEN. 6. WHO WAS A' THE SCENE, LST ALL SUPERVSORS,OFFCERS, M.P. PERSONNEL (RANK & NAMES), S.O.c., F.cc. PERSONNEL, AND SAR.U, ETC. 7. WHAT TME SECURED.( AT THE END OF THE NARATVE WRTE: END OF REPORT ). 8. F PHOTOGRAPHS ARE TAKEN: ON THE PHOTO WRTE THE NAME OF OFFCER 'TAKNG THE PHOTOGRAPH, THE DATE, TME, AND WHAT THE NCDET N CASE THE PHOTOS BECOME SEPARATED THEY CAN BE DENTFED AND REATTACHED TO THE REPORT). 9. USE SPELL CHECK AND MAKE SURE THE SPELLNG AND PUNCLJATON ARE CORRECT ATTACH ORGNAL OF N.C..C. ANDALL PERTNENT PAPERWORK TO ORGNAL ANDCOPES _..... (ORGNAL PLUS 2 COPES, ONE FOR OFFCE RECORDS AND ONE FOR SHFT RECORDS). ATTACH COPY OF YOUR WHCH YOU MADE AT THER SCENE OF THE NCDENT) TO THE SHFT COpy OF THE REPORT. YOU CAN NEVER HAVE TOO MUCH NFORMATON N THE REPORT. BE DETAED ON THE NFORMATON THAT S WRTTEN. WRTE T SO THE PERSON WHO S READNG THE REPORT CAN VSUALZE THE SCENE... til"" TME (Dispatched) XXXX (ATivM) xxxx REPORTNG OFFCER OFFCER XXXXXXXXXXX (SecUre dr xxxx (Returned to Dvty) XXXX D NUMBER XXXX NUMBER SPOs RESPONDED XX FORM G4045 REV SEP 2001 (Supersedes G4045 REV APR 89 whjoh is obsolete) - Page 2 S~CURTYCLASSFCATON (if a"y)

37 DOCD: PROTECTVE SERVCES DVSON PROPERTY RECEPT D EVDENCE D FOUND PROPERTY D CONFSCATED FOR SAFEKEEPNG RECEVED FROM (Please Print) RECEVED BY (Plea. Prlnl) NAME TELEPHONE NAME TELEPHONE ADDRESS! ORGANZATON AOORESSORQAN~nON OATET1ME OBTANED LOCATON FOUNOSEZED REASON rrem NO. 01 D2 03 D4 QUANTTY DESCRPTON OF PROPfRTY _." 13 he~ "ck~;jf6~ that the above list '3Pf6Srl,1$ all pi'. tty taken m my ~=Jono!ln that Nvs been olleied acopy of tills e hereby acknowjljdgb that the above listrepresents all property received by me in the offi<ial performance 01 my duties as a Security Protective 0f_ '. SGNATURE SQNATURE D' WTNESS ~lndfca/rjd) 10' CHAN OF CUS10DY lecevfd BY PURPOSE RECEVED DATE TME FORM G6817 JUN 94 NSN: 754Q FM !Atpproved for Release by NSA on OF FOA Case # 4287 PAGE

38 DOClD: NSA STAFF PROCESSNG FORM TO EXREO CONTROL NUMBER KCC CONTROL NUMBER THRU ACTON EXREO SUSPENSE SGNATURE o NFORMATON ----;<;,., APPROVAL SUBJECT DSmlBUTlON KCC SUSPENSE ELEMENT SUSPENSE COORDNATONAPPROVA~ OFFCE NAMEANO DATE SEC~.~.E OFFCE NAME AND DATE PHONE "~;;~~~ ORG. PHONE (secure) DATE PREPARED. - FOAM A6796 REV NOV 95 (&Jporsedes A6796 FEB 94 which is obsolete) NSN: 754D-FM-Q01 54S5 SECURllY CWSFlCATON Derived From: Declassify On: ~pproved for Release by NSA ~~ FOA Case # 4287

39 DOClD: HOW TO USE THE NSA STAFF PROCESSNG FORM Open the file A6796from the OA-Templates directory. The following tems are optional; use as appropriate. PURPOSE: Write a clear, brief statement of the purpose of the paper. t should not be "To obtain the Director's signature of the attached..., but rather "To respond to a request for information from...", or "To establish a position on... BACKGROUND: Layout how the action has developed to date; summarize key references and make sure they are attached and tabbed. Do not provide a chronological listing of events but do provide insight as to why events have occurred and their significance. DSCUSSON: Provide an analysis of the alternatives and issues; build a case for your recommendations. dentify unresolved nonconcurrences, or other agencies' positions, if any. and give consideration to the dissenting views. For complex matters, break them into parts and address them separately. RECOMMENDATON: Recommend what the decisionmaker should do and how it should be done. f decisions are required other than those that will be reflected by signature of the document, lay them out so that the reader need only indicate by an initial what he/she wants you to do. Focus on the substance, not the process. This form must accompany all written correspondence for the Directorate. You may use it in lieu of an internal memorandum. Restrict the summary to one page, if possible; if you can't, use plain bond paper for an additional page. Attach desk notes 2D.X if they reflect new nformation not found elsewhere in the package, or if they support a personal opinion/preference of senior management. Ensure that a Key Component Chief or Deputy approves all Form A6796's being forwarded to the Directorate. pproved for Release by NSA FOA Case # 4287

40 DOCD: S.CURTY CLASSFCATON (if any) NSA TV CENTER PROPOSAL WORKNG TTLE PROJECT NUMBER PN PRODUCER (Last) (First) (M) CUSTOMER (Lu) (First) (M) f. PROJECT OVERVEW (Descril.le me origin and eyolutlon ofthe requirement. State how v/de() will meet tile n88ds of tl'hij requirement.) 2. PURPOSE (Describ& tm go." of the production. nclude thlt "call to action") 3. DESCRBE AUDENCE (Primary, -e" NSA nternal Senior Le8d8f5hlp) (secondary, i." Congress. O/fiCa/s within the lnrbjigenc" CommuniTy) -:-=====-:-= 1_--,-- _ 4. DESCRBE HOW lhe SHOW WLL BE USED (Where will itbe seen and how ot8n it will be used?) 5. PRODUCTON DESCRPTON (Describe the vid60 "concept", i.6, dramatization, documentary. Cascom-oasfJd,.tc. nclude detail an requirements such i$ Tl»; professional talent, new $ets, etc, Proviae tmough detail to justily resources as well as satisfy the rtlquiremtfflt,) l:ltlu: Th. NSA TV elll'" witt rmt. em",..fjl.l'l WlNn ~ Q f;onform to th" orfglnlll...lgnment de.crll»d below. Any other ch",,.. COULD OfLAYPBODUCDQN."d willd:/j.'t. 1M mldft With.pprtJl.J of tfnf TV C.nt.r Chief.) 6. LENGTH (Approximately) 17. COMPLETON DATE (yyyy.mm-dd) P".E-PRODUCTON (Securing addt1 resources: 8. TMEUNE (R8searr;h) "tock """all<', graphics. etc.) (Draff SCripVtioalrnanl) (AnaU'" scrlptll"'atm"",) (ndicate n" 01 days required lor each hp'"r"'o'"o"'u"ctto"o"n----l l p"'o'"sl':;"'drd:ond-.u"cr;:;:;;,o;;n'-.j (Audio Mix) production activity) (ReYnotBS) rswdio) (Log Footage) (Edit) 9. SCHEDULE (At/ef completing SlfJPS ' 8. (i/scuss proposal with TV CentfH' Chief Chief Will rt1vi6w proposal and assigft rt!f$ojj~s. nclude proposed "ScheduA.,L" dams here.) 1O. WORK ROLESlRE$PONSBLTES (D8f1nt!1 the responsibilirias (producer and technical adisor!cuslom6f). Ass/on responsibjlities: paym"llr lor TOY$, negotiating wffh other offices, clearing unclassified vic1eos through PAO, submitting for classificatkm revew, etc,) 11. BUDGET JUSTFCATON (if requir6d) FORM H7308 MAR Page 1 SECURTY CLASSFCATON (/any) pproved for Release by NSA FOA Case #4287

41 DOCD: SECURTY CL.ASSFCATON (if aoy) NSA TV CENTER PROPOSAL (Continued) N$A TV CENT~A CHEF (Pn'nted Nam~) (Last) PROJECT NUMBER PN ACCEPTANCE OF PROPOSAL (The below signatures repf9sent acceptancti ofthese terms) (Pif$t) (M) DATE (YYYY.MM-DDJ PRODUCER (Printed Name) (Last) (First) (M) DATE (YYYY-MM DD FNAL APPROVNG AUTHORrrV (Printed Name) (Last) (First) (M) DATE (YYYY.MM DD) SCRPT APPROVALJPRODUCTON AUTHORZATON acknowledge have read and understand the scrjptltreatment, and hbrsby authoriil8 the NSA TeleVision Center to begin produclian, und8rstand that changes to this script during the production process could result in delays and ncreased costs. The NSA TV Center wm authorize only those changes it deems necessary 10 conform to the appravad script PANTED NAMe (Last) (FilSt) (M) ORG SGNATURE DATE (YYYY.MM DD) CUSTOMER ACCEPTANCE PRNTED NAME (Lasl) (First) M) t acknowledge that the telbyision producffon is complete and maets with my approval. Release ot this video external to NSA requires priorapproval from tile PAO in coord/nation --~ ~====_..,... _ with the NSA Television Center. Duplication of his video requir85 a saparate E.mail ORG DATE (YYYY-MM OOj request to iap9dupe@osa. Customer will purchase and supply blank tapes equal to or grbat9r than a quantity of four, have received a customsr survey form to be returned to.,s"g"'n"""':ru=a=e--...l the Chief, NSA Television Center. COMMENTS FORM H7308 MAR 2002 Page 2 SECURTY CLASSFCATON (il any)

42 DOClD: SECURTY CLASSFCATON (1'1 any) NSA VEHCLE HAND RECEPT As a hand receipt holder of an NSA vehicle, there are a number of items for which you are accountable that require readdressing and highlighting for your information and protection. t is your responsibility to ensure that the drivers of Agency vehicles assigned to your element are fully competent, licensed, and understand and comply with the rules as stated. 1. Keep a log of who is driving the vehicle at all times. This is required to determine who is responsible for the vehicle in case of an accident, parking ticket, etc. f this log is not kept and the responsible person cannot be determined, the hand receipt holder shall be held responsible. 2. The Equipment Daily Log (Form K4874) shall be completed daily and returned to the Motor Pooi on the first day of the month. 3. Perform daily maintenance by checking fluid levels, tires, etc. This is not only a safety feature but could prevent the deveiopment of major damage in vehicles. 4. Coordinate with the Motor Pool for scheduled maintenance and/or vehicle breakdown or deficiencies. Scheduled maintenance s normally done every six months or 7500 miles. 5. NSA vehicles are to be used only for official purposes at all times. The unauthorized use of an NSA owned, leased or otherwise controlled vehicle may result in adverse personnel actions. Furthermore, employees using or improperly authorizing home-to-work transportation shall be suspended, without pay, for at least one month, and when circumstances warrant, suspension will be for a longer period or the employee may be summarily removed from the office. A copy of the "Guide to the Use of NSA Vehicles" s available on the Transportation Home Page at: Any questions may be addressed to LL213, (b) or (s). Additionally, you are responsible for notifying LL213 prior to changing jobs or retiring. This action will remove you from accountability. You will also be asked to identify the person who will be assuming accountability for this vehicle (il known). VEHCLE NFORMATON VEHCLE YEAR MAJ<E MOOEL V.1.N NSA 10 NUMBER ADMN NUMBER TAG NUMBER acknowledge that understand the nformation provldad above, and have read and fully understand the "Guide to the Use of NSA Vehcles." RECEVED BY (Please Prin,! ORGANZATON PHONE NUMBER S"""",) (Non Secure) SGNATURE DATE FORM Kl346 REV FEB 2002 (Supersedes K346 REV FEB 2000 which is obsolete) SECURTY CLASSFCATON (ir eny)!a.pproved for Release by NSA o~ FOA Case #4287

43 DOC miu~llql\l.f.'j ",LY AND PERSO~AL HEALTH HSTORY QUESTONNARE PmVACY ACT STATEMENT: You.,. Jtltreby dv\e(i lnat authority lot reqlotpfulo Tlt(llct1 hl.tory, to nclude chemical and blologtc:' GltPMl.lnl and medlce.\ recocdl, " S U.S.C. Section 7901 and P.L This nlormltlon will be used to detltntllne WhetMr )'01.1 tlve ny 'tmlc111c occupltlcm.' hellth rtclulmnentf;...d whether you hive, need tor medica' 'lmvellllnce/$cr4llmlng. The dlgloture of nfonnilion "volun.lary. H4wtWlr, your f.l/ttej to p'o'ikse the ntormltlorl Wll,"ult n thelbove dotenn~lonsbatng made Wlthollt eomplet8 lnlonnltlon. The ntern of.-.c;ords n which these recordl Wll be mfolntlllined 'S N$A1C$$ 'Ytlllm Of Rtcorda Numbilf G. Hulttl, Medk:al and Sliety F... Routine Uut; of thl$ lnfonnltlon may ~ found at SO Fed. ~. 22,584 (1U4~ VOUl' slgmturtl below' ndkatea you t\aye... and undetstand tttel*bm/e. NSTRUCTONS Completion ofthis form will update the last history form that you completed for occupatjonal health purposes. Answer all question$ by checking "YES" or "NO" and give lpeclflc nformation when asked. PART - PERODC UPDATE NAME (lml) (FrM) (MliiiA1i"ib4J \.. o :-rsocal SE"",,"11, UMBER M.! :. ut' tllrth (V..."11, D) OM'L' FEMALE PERSONAL PHYSCAN OR HOSPTAL 00 CUNC (Nlmte Md AddrfH) TOOAY'S DATE""", ) QUESTON YES NO QUESTON YES NO 1. SNCE YOUR LAST H1S1'OFlY, DD YOUA JOJ CHANce, (F l:'es, USTHEW e. SNCE VOlJ LAST HSTORY. 010 VOUf'(OllR SPOl,lSE HAVE. A BABY? JOB nne, HEALTH HAZAADS EXPOSED TO ANO TY"F. OFPROTECTON (F YES, GVEMa./VEAR OFBRTH) WORN,) t.. ME 'fojyq~&rouse HCM PREGNANT? '0. STl'fCE YOOR LAST HSTORY, HAve YOUYOUR spouse TAEDTO HAve. "BABY SUT HAVE HeN UNABLE to? :1'. SNCE YOUR LAST HSTORY, H"~ YOU HAD A W(lRl(oAELATED LLNUS OR NJURY THAT RESULTED N MORE THAN ONe DAY Lost MOM weak? 11.'SNCE YOUR l.ast HSTORY. PlD ANY PREUNANCf Rt::MJLT N A MSCARRAGE OR SllllfJATH? (F YES, Gve AfOJY AR)? 3. SNCE YOUR LAST HSTORY, HAVE YOU RECEVED COMPENSATON FOR A WORK-RELAfiO U-NESS OR NJURY? 12. SNCE YOUR LAST H$TORY. HAS THERE BEEN A CHANGe N' YOUR TOBACCO SMOKNG (Sll.'JPSTARTJMOllKESS,? 4. SNCE YOUR LAST HSTORY. HAVE YOU aeen UMTED N YOUR WOflK 13. st«:e "tour LAST Hl$T()lllY, HASTt1eRE BUN A CttANO N VOUR FOfl HEALTH REASONS? ALCOHOUC BEVERAGES tstoplstarr.tlormessj1 TSiN'CeYOOiiwr H~~~HAVE.!!?,:,.HAD A WURK-H:Ult'ED EXPERENCE WHOH YOU BELEVE MAY HAVE AFFECTED YOUR HEALtH OR THE HEAlTH OF '!.,LOW WORKERs? 6. SNCE YOUR LAST HSTORY, HAVE YOU EXPERENCED DlfFCUl.TY WEARNG YOUR PROTECllVE ClOTHNG OR EQUlPlllJEtm 7. SNCE YOUR LAST HSTORY, HASMAVE YOUR H08UY~08BES CHANGet? (F YES, PLEASE LSTCURRENTHOBBES,) 1 SNC "lxlrldthstorv,_~.,':.~~ ~~~~~R BL' lmother, FAl'HER, S5TEA', BAOTHfit GRANDPARENT'S, AUNT, VNCLE, CHttOREN) OEvaOPEO A DlSe.A : Of\' CONDTON NOT PREV)Ol,SLY KNOWN? HEALTH CARE PAOYDEA COMMENTS (lju nmnjclt tecoumy) '1:Mf>l.CWEE'S SGNATURE HULtlt CARl!: PROVDER'S SfGHAfUFlE bfproved for Release by NSA ~~ FOA Case # 4287 KJHM SEP" NSN; 7540-FU OO1 S408

44 DOClD: OFFCAL COURER BREFNG NAME PRVACYAcSAM:edL~Elin~usc Section 402!J.2.1 and EO , 12958, and 12968, NSA's 81anket Aoutine UseSOund at 58 Fed. Reg, (1993) and 1he specllic uses lound n GNSA01, GNSA09, and GNSA10 apply to thl, inlo. AUlh for requelj;ting your SSN is E.O nlo you provide wjll be used to verity an individual'$ COl,lrier status lor security processing. Disci 01 requested info, including your SSN, is voluntary. However, failure to furnish requested il"lfo. other than your S$N, resull in deniallrallocalion ofcourier status. 55N ORGANZATON (Non-Secure) SPECFC DESTNATON (Contractor facility, field site, Government de~(lmtmt) HGHESl CLASSFCATON OF MATERAL CONFDENTAL SECRET TOP SECRET NON-SC SC MODE OF TRAVEL POV MLTARY ARCRAFT GOVERNMENT VEH CLE WTH CHAUFFEuR COMMERCAL ARCRAFT COMPANY ARCRAFT GOVERNMENT VEHCLE COMPANY VEHCLE OTHER (Specify) ACCOMPANED BY BREFNG DATE have received a courier briefing and fully understand the dldies and responsibilities for the malerial with which am entrusted. agree to abide by the procedures as provided to me in the briefing and the following points: 1. Each courier trip requires specific approval by the appropriate management level or designee within an Associate or Principal Directorate. 2. Couriers must be briefed once every two years. or if a chl:lnge lrt the method of transporting the materials occurs, 3. When acting as a courier in the local Baltimore, MOWashington, DC mellopolitan area. the transmitting office must be notified prior to departure and upon arrival. The Support Services Operation Center (SSOC). (301) , must be provided with the exact itinerary and noli/ied prior to departure and upon arrival when handcarrying materials outside 01 the local area, 4. f materials cannot be handcarried onto aircraft due to size and/or weighllimitatlons. prior arrangements should be made with lhe airline carrier. 5. A delailed inventory oj all matenal must be completed, A copy must be enclosed in the package and a copy retained in the lransmitting office. 6. The package must be wrapped in accordance with security requirements, Transmillal forms must accompany the package. 7. Couriers will travel directly lrom the sending facility 10 the destination. When there is a need to slore a package during transit. it must be stored n an approprialely secure facility in an approved secure container. Material is nollo be stored in a motel room, home, depot locker. holel safe. locked car or other such unapproved container or facility. B Couriers will maintain visual and physical possession of the material at all limes during transt t will not be left unattended at any time. 9. Couriers will not consume aicoholic beverages durin9 tt'je period of coulier duty. 10. Couriers must not allow the packa~e to be opened in ltansit under any circllmstances. 11 a problem develops with airport inspectors or cuf,iloms officials. the courier will follow the appropriate procedures provided in NSAlCSS Regulation 123 2, Handcarrylng Classified Material. Annex G, 1. The material must oe turned over only to the properly idenmied recipient and slored in an appropriately secure facility in an approved secure conlainer. The courier will obtain a receipl for the package if the classified material will remain at the site. 12. The Support SeNices Operation Center (SSOC) will be notified immedialely 01: A Any change 01 wnerary. 6. Any incidents related to the security of he material C. Loss ollhe material. 13 Overseas Courier" Prior planning must include a message exchange by which the courier obtains the name and telephone number 01 the individual at the receiving field ac1ivily to contnclln case of deltly Of emerg~ncy REMARKS SGNATURE Courior) Bciolor) FORM G6360 REV MAY 200' (Supersedes G6360 REV NOV 95 Which is obsole"', pproved for- Release by NSA FOA Case # 4287

45 DOClD: SPORT CVLAN WELFARE FUND OFFCAL TEAM MEMBERSHP ROSTER YEAR 1. Name. must be PRNTED. (Check CV or ML) 2. Manager's name On LNE 1. Assistant Manager's name on LNE Only players' names listed below are eligible to compete with this team... elv Mil PlAYER'S NAME TEAM NAME PHONE NON SECURE NUMBER SECURE FORMER TEAM 1-2 MANAGER ASSSTANT MANAGER 3, 4, 5. 6, , , 12, , TEAM NAME LEAGUE/DVSON FORM P5148 REN FEB 94 ~fproved for Release by NSA 9~ NSN: 7540 FM FOA Case #4287

46 D~bNiR~*CATON FOR FEDERAL EMPLOYMENT OF 612 GENERAL NFORMATON You may apply for most Federal job!! with a resume, the attached Optional Application for Federal Employment or other written format. f your resume or application does not provide all the information requested on this form and in the job vacancy announcement, you may lose consideration for a job, Type or print Clearly in dark ink. Help speed the selection process by keeping your application brief and sending only the requested information, f essential to attach additional pages, include your name and Social Security Number on each page. For information on ~ederal employment, including job Usts, alternative formats for persons with disabilities, and veterans' preference. call the U,S. Oftice of Personnel Management at 912~157~3000, TDO 912"744~2299, by computer modem 912~757"3100, Or via the nternet (Telnet only) at FJOB.MALOPM.GOV. f you served on active duty in the United States Mliltary and were separated under honorable conditions, you may be eligible for veterans' preference. To receive preference if your service! began after October 15, you must have a Campaign Badge, Expeditionary Medal, or a service-connected disability. Veterans' preference is not a factor tor Senior Executive Service jobs or when competition is limited to status candidates (clrrent or former career or career-conditional Federal employees). Most Federal jobsrequir9 United Slates citizenship and also that males over age 18 born after December 31, 1959, hava registered with the Selective Service System or have an exemption. The law prohibits public officials from appointing, promoting, or recommending their relatives. Federal annuital1ts (military and civlllan) may have their salaries or annuities reduced. All employees must pay any valid delinquent debts or the agency may garnish their salary. Send your application to the office announcing the vacancy, f you have questions, contact that office. THE FEDERAL GOVERNMENT S AN EQUAL OPPORTUNTY EMPLOYER PRVACY ACT AND PUBLC BURDEN STATEMENTS The Of1ice of Personnel Management and other Federal agencies fa1e applicants for Feqeral JODs under lhe authority of sections 1104, 1302, 3301, 3304, , 3393, and 3394 of title 5 of the United States Code We need the information requested in this lorm and in the asso(:iate<l vacancy annoum;ements to evaluate your qualificatio(ls, Other laws require us to ask Olboul Citizenship, military service, ele. We request your Social Security Number {SSN) under the authority of Ellecutive Order 9397 in order to keep your records straight; other people may have the same name As allowed by law or Presidential directive, we use your S$N 10 seek inlormation ijbou you trom employers, schools, banks, imd others who Know you Your SSN may also be used in studies and computer matching with other Government files, lor example, fifes on unpaid Siu<:fenlloans, f you do not give us your SSN or any ottler information requested, we cannot process your application, wl'lich is the lirs1 step in getting a job, Also. incomplete addresses am ZP Codes will slow processing, We may give inlormation from your records to training facilities; organizalions deciding claims for retirement, insurance, unemployment or ttealth benefits: oflleia's rn litigalion or administralive proceedings where the Gavemment is a party; law enlorcemenl agencies concerning violatons 01 law or regulation: Federai agencies tor statisticat reports and studies; ohicials of labor organizations recognized Dy law in connection with representing employees; Federal agencies or other sources requesting information for Federal agencies in connection with hiring Qt retaining, secvrity clearances, securi1y or suitability invesligaliofls, classifying jobs, contracting, or issuing iicenses, grants or other benefits: pubhc am private organizations including news media tlal grant or publicize employee recognrtion ano',1wqrds; and the Meri! Systems PrOlecfion Board, ttle Offic~ 01 SpeCial Counsel, the Equal E~loyment Opportunity Commission, the Federal Labor Relations Authority, the National Archives, lhe Federal Acquisition nstitute, and congressional offices n conl'lection with their ohiciallunclions. We may also give inlo(mation from your records to: prospective nonfederal employers concerning tenure of employment, civil service stalus, length of service, and date and nature of action tor separation as shown on personnel aclion forms of specificallv identified individual.s: requesting organizations o( individuals concerning the horne address and other rele\lant information on those who might have contracted an illness or been exposed to a health hazard; authorized Federal and nonlederal agencies tor use in computer matching; spooses or dependent children asking whettter the employee has changed rom serf,am family to seff-onry hearth benelits enrollment individual~ workng on a contract, $enice, grant. cooperative agrhment or Job for the Federal Government: non-agency members of an agency's performance or other panel; and agency-appointed representatives 01 eftl'lloyeels concerning information issued 10 the emplovee about 1itness for~ujy or agency-filed disability retirement procedures We estimate 1M public reporting burden tor this collection will vary rom 20 fo 240 minutes wi1h an average minutes per response, including lime for reviewing instructions, searching ekisting data source.s, gathering data, and completing and reviewing the inlormation. You may send comments regarding the burden estimate or any other aspect of toe collection 01 information, including suggestions for reducing this burden, to U.S, Office 01 PerSonnel Management, Reports and forms Management Officer, Washlngton, DC t. Send your <lppiicstton to the agency announcing lhe Jscancy

47 _ DOCD: OPTONAL APPLCATON FOR FEDERAL EMPLOYMENT OF 612 You may apply for most jobs with a resume, this form, or other written format. f your resume or application does not provide all the nformetion requested on this torm and n the job vacancy announcement, you may loae consideration for a job. 1" ~JOb title in" annou'ncement. ~ ~ ~ w ~ - ~ w w ~ ~ : 2 ~ Grade(S)"applying lor~ ~. ;":3.Announternent nomb-e; ~. ~.. ~... 4 Last name CitY St.i.. illlcixi<i.... : Daytime (.,w ~ ~ ~ ~ ~. 7 Phone numbers (include area code) E'Vening ( _ _ -". ~ - _ ~ - - ~ ~ - ~ ~ ~ -. - ~ ~ - ~. - _ ~ -'~. ~ ~ * ~ ~. _ WORK EXPERENCE Describe your paid and nonpaid work 8)(perience related to the job for which you are applying. Do not attach job descriptions. 1) Jobtltle~(ifFederaC include-s~eries~andgrade) n q. -. _ p _ _. u ~ w. " ~ ~ p". u ". 'From (M'MJYV)' ~ To (MMNYi SalarY per -:-Hours perw k.... ~.... Effi~pioyar 5 name and"address ~. ~ ~ "~ ~ ~ "~ "~ ~:~ supervisor's name"and phonlt numbe"r - -. Describe your duties and accomplishments 2) Job l~e (if Federal. include series and grade) 'Fro'''; {MMNYj'..... ~ To im,,;ivyi -.- Salary per :. HourS per ",;';'i" :. ~ ~ErripioYer'S ~ama iuid~b~ddress -.:~ S~Perv"j$or's name~and pho"na ~~rnbe-r "- " :101' --.. _.. -- NSN 754o.Q1:is':g17s.. -. _ Optionai'~;~e1 (S;Pt;~b.;1994i u.s. Offce of ~rsonnel Management

48 D(tC!1!'f>"t co~m'!l"'6 9'pervisor? YES [ ] NO[ ]... f we need to contact your current supervisor before making an offer, we wul contact you first. EDUCATON 10 Mark highest level completed. Some HS [ HSiGED [ ] AssOClate[ Bachelor [ Master [ Doctoral [ 11 Last high school (HS) or GED school. Give the school's nama, city, State, ZP Code (if known), and year diploma or GED received... N.';;".. '..,, "...,.... ~ 12 Colleges and universities attended. Do not attach a copy of your transcript unless requested. riital'c'rtidits!':arnea. :" SerTle$te~r ~ Ouarfer : 1) Gity "MajOr(S) : begr":""""' : (if any) Received 2) ~ ~., ~~'.~~~~'~~~.~~~~. ~w ~.J, 3) ~~.~~'~ ~.~ _~ ~W~~~~~~ ~. OTHER QUALFCATONS 13 Job-related training courses (give title and year}. Job-reJated skmslother languages, computer sohwarolhardware, tools, machinery, typing speed, etc.). Jobo-rel.ted certificates and licenses (current only), Job-related honors, awards, and special accomplishments (publications, memberships in professionallhonor societies, leadership activities, pubflc speaking, and performance awards). Give dates, but do notsend documents unless requested. GENERAL 14 Are you a u.s. citizen? ] t- Give the country of your citizenship. _ ~ _ ~ M YES NO [ ~ M. MM Do you claim veterans' preference? NO [ ] YES [ ]... Mark your claim of 5 Of 10 points below. 5 polnlst ).. Attach your DD 214 or other proof. 10 points [ ].. Attach an Application for fo-point Vetemns' Preference (SF 15) and proofrequrroo. Series. Grade. Ffllmlt,1MNy). TO(WNf\'J Were you ever a Federal civilian employee? " NO [ ) YES [ ).. For highest civilian grade give:. ~ :..:.. Are you eligible tor reinstatement based on career or career-conditional Federal status? NO [ ] YES [ ]"11 requasted, attach SF 50 proof. APPLCANT CERTFCATON 18 certify that. to the best of my knowledge and belief, all of the informalion on and ettached to his application s true, correct, complete and made in good faith. undersland that false or mudul.nt information On or attached to this application may be grounds for not hiring me or for firing me after begin work, and may be punishable by fine or imprisonment. undersland that any information give may be investigated. SGNATURE DATE SGNED

49 DOClD: NSA OH NAME Cl.AS6lfCAllON HOME ADORESS PHONn;jijMBER NliMBER OF TAPES ENCLOSURES DATE OF NTEFlVEW PLACE OF N11:.RVEW ''florvewer 1. TftAHSCRBED 2. EDTED " REVEWeD BY NTERVEWEE AND CORRECTeD 4, COPi:O 10 CO 5. FOA REaUEST DEED OF GfT? DyES DNO SCRPT REMOVED AND SENT TO ---_.- TAPE REMOVEO AND $NT TO SKU' ORAL HSTORY ENVELOPE --- 6, DECLASS SCRPT SENTrO MUSEUM U8RARY 1, TAPE(S) SENT TO SURe _ pproved for Release by NSA 0 ) FOA Case # 4287

50 DOell): -n~ Form Approved r=o FOR SUPPLES OR SERVCES OMS No- 0' (Contractor must submit four copies of invoice.) ExpilY'S Jun 30, 1997 PAGE 1OF PtJblic feporting burd9l110l' this c~loction 01 nlofl'l'llllionlli ll!1itimaled to averago i hour per '$SpOl'l$l, includinq the!imt 'lor relviewing instructl(,1('ls, Seatchhlq Qlo;j&lin9 dala GOU"CeS, \lalhering and ",'mla",ing the data nqfiloo;td, <ra compilltln\;l and rliylew,ng lh~ collacllon of U,lOffTl31o,,, Sa...d COrr\ments regarcl'''o thl$,wtden esill'l'lllie Qf,m~olller as~ ollhls CollfK:11Otl Of ntort1'la~on, 1nc,:ll"K,ji~~estiOns lorradud= burdel1. (0 Dtlpartmenl ot DelMSti. wast'linglon HeMquarters S&Nkes, Diractorate tollnlo"l'lll,on OP'lrt110t1S ttd Report!., 121 JGf6rson DlWs Highway. &.ute Arlington. VA -4302, ld to tn! of Man. aoeltwtnl am Budget Paoel"W rk Reduclion?ro/Ocl07Q4 0UFl. Wl's'ninglOfl, DC 20W3 PLEASE DO NOT RETURN YOUR FORM TO ETHER OF THESE ADDRESSES. SEND YOUR COMPLETED FORM TO THE PROCUREMENT OFFCAL DENTFED N TEM 6. 1 CU URDER NO 2 ORDER NO 4.V. 5. Pf<URil M.oJJM'5'D?RDER SSUED BY CODer 7, ADMNSTEREO BY (f oth6r than 6) CODE 8. DEUVE.RY FoB o DEST (SH Schfldt#6lf other) 9 CONTRACTOR CODer FACLTY CODE 'R,8f~YF!j..TD FOB PONT BY (Dale) 11 MARK F BUSNESS S (YYMMMDO) o SMALL 12 DSCOUNTTERMS o SMALL DSAD NAME AND VANTAGED ADDRESS 14"SHPTO CODEr 15. PAYMENT WLL 8E MADE BY CODE 13 MAL NVOCES TO o OTHER o WOMEN DWNED MAAKALL PACKAGES AND PAPERS WTH CON1RAC10R ORDER NUM8ER 18 DELVERY This delivery oraer is issued on anotller G(ll('mlMll agency or n axorll~ with lllld subjecllo lerms "w con<l!tions 0/ Bb<we numbered conlra:t TYPE l=:efetence your furnish the tallowlng on larms specified hem!]n. OF PURCHASE, n"'f BEEN OR S NOW MODFED. suawgr"~o" ~ir(if'\-he~e~1:s -;:'N'o'CO~DrTlONS SET FOATH, AND MlR~E1'TO PERFORM THE SAME ",,",n > MAT ~~..._L NAME OF CONTRACTOR SGNATURE TYPEO NAME AND ttle DATE silmeo 0 1/ this box is marked. SlJpplier mljslslgn Acceptance and relurn me following number of copies, (YYMMMDD) ['17 AND D'" ORDERED 2 O,,,, 22 Z3. TEM NO SCHEDULE OF SUPPLESSERVCES UNT PRCE AMOUNT ACCEPTED" fquantity accepted by the Government is same as 24. UNTED STA1.S OF AMERCA 25, TOTAL quantity ordered, mdcate by X. f different. enter 29. actual quantity aceeptfjd below quantify ordsred and encircle 8Y' CON1RAC'TNQORDERNCl OFFCER DFF.RENC.S 26 QUANTTY N COLUMN 20 HAS BEEN 27. SHP NO 28,0,0, VOUCHEf=fNO, 30, o NSP.C'.D 0 o ACCEPTED, AND CONFORMS TO TH. RECEVED NnALS CONTRAC, EXCEP'T AS NOTED 33, AMOUNT V.RFED CORRECT FOR o PARTl PAD BY o ANAL DATE SGNATURE OF AVHORZ'Eb GOVERNMENT REPRESENTATivE [3fl'AYMENT 34. CHECK NUM8ER 36 certi1y lhls account s correct and proper for payment. OCOMPLET< o PARTAL 35 BLL OF LADNG NO DATE SGNATURE AND TTLE ORCERTFYNG OFFCER o FNAL 37 R.C.V.O AT 38 RECEVED BY (Print) 39. DATE RECEVED 40, TOTAL CDNTAlN.RS 41 SR ACCOUNl NUMBER 42. SR VOUCHER NO (yymmmdo) DO FORM JUN 94 PREVOUS EDTON MAY BE USED

51 Form Approved, OCD: 311~RFOR SUPPLES OR SERVCES OMB No ()187 (Contractor must submit lour COpiBS a/nvoice.) Expires Jun 30, 1997 'AuE 1 OF Publoe leporlil1~ burden for this collec~ol'l ot nlormallonis estimated 10 lverallfj 11'1our pet response, inchjdinq the lime ior ~iewing instruction$, $&tlttl'li~ existing data 5O\lrces, gathering l11d flinlainll14jl the data named, BOO completing and reviewing the eoilget'oo Of l(ltqr'(latlol'l. ~n(l QQmm8nll regard'!1\! ths tlurdet "~l'l'lita 01,n~ olhllr aspec1 Of thrill oou$clol'lof ntofl'l"lahon, noludln~ S=lior'lslOf redud~'&wrden, 10 Depan.1'\&t'1 O'l Defense, Washit'UJton HeadQuarters SeNlces, Direetoratelor nlqrmation Operallonll Nld Reports, 121 Jel1flrson O8VS HighWtly. S\,llte 1204, Arlington, VA al1d 10 the e 01 Man agement and Sudget Paperwork Redutiion Proje<:l (0704..o,a7l, Washington, DC ,vd UH~"HNU. PLEASE 00 NOT RETURN YOUR FORM TO ETHER OF THESE ADDRESSES. SEND YOUR COMPLETED FORM TO THE PROCUREMENT OFFCAL DENTFED N TEM 6. "".... UH~"H NU. M'aM"M'6D)H~.H 14 ""'-V'.','UN,"vRCH '",u o "'un,,, ' 6 SSUED BY CODE 7. ADMNSTERED BY (lfoth6r than 6) CODE MARYLAND PROCUREMENT OFFCE 8. DELVERV FOB 9800 Savase Road Fort George G. Meade. MD DDEST Buyer/SymboL ( J. DOTHER Pbone: 3011 (SH SChedule if other) 9 CONTRACTOR CODEt FACLTY CODE t 'M~J~'hm FOB PO"" BY /oate) 11 MARK F BUSNfSS S o SMALL 12. OSCOUNTl EHMS SMALL DSAD NAME AND VANTAGED ADDRESS o WOMEN-OWNEO 13 MAle NVU~E. ro ADDRESS SHOWN N BLOCK 15 14, SHP TO CODEj H PAYMENT WLL BE MADE BY COOE. H98230 MARK ALL. Trans. Officer, Sub- Trans. Office Purchases ~ Accounts Payable PACKAGES AND 9705 Samford Road. SAB 4. Door 3 Finance and Accounting Office PAPERS WTH F. George G. Meade. MD P.O. Box 1685 CONTRACTOR REF: MDA904 F. FeoTge G. Meade. MD ORDER NUM6EA (No Rod Siding Ava;(able) (301) DEUVERY This delivery order is is5ljl!d on another Gave.-nmeot agency or 1(1 accordaj"lce with and SlbJec1 10 lerms and col'ldltiom 01 above nllt't'lbered conlracl rype Reference your furnish the followino on terms specified herein. OF PURCHASE," MAY> r NAV' mn UH "1',-,,' ORDER MoOFEo.SUBl~~TCTO'AU. OF 11<E TEAMhW~tb~&'t\o'ilmT FOR11<. AND AGREeSrO PERFORM THE SAME NAME OF CONTRACTOR SGNATURE TYPED NAME AND TTLE DATE signed o f this box is marked, supplier must sign Acceptance and return the following number 01 copies (VYMMMDD) " 'ANU,.u~e TEM NO SCHEDULE OF SUPPLEs/SERVCES 20 ORDERED/ UNT «. UNT PRCE AMOUNT ACCEPTED SHPMENT WLL ONLY BE ACCEPTED ON WEEK DAYS (EXCLUDNG HOLDAYS) BETW EEN7:30AMA 02:3 PM. NOTE: FUl L TRALER LOADS WLL BE ACCEPTED BY APPONTMENT ONLY_ 24 HOURS ADVANCE NO nce REQURED. PHONE (30 ) FOR AN APPONTMENT. t quantity accepted by rhe Government is same as 24. UNTED STATES OF AMERCA 25. TOiAL quantity O«kNed. //ldicate by X. fdifferent, etller aclwl quantity accepted b8low Quantity ordered and 29 8f/C1rcle. BY CONTRACTNG/ORDERNG OFFCER DFFERENCES 26 QUANTTY N COLUMN 20 HAS BEEN 27. SHP NO ,0 VOUCHER NO. 30. o NSPECTEO 0 RECEVED oaccepted. AND CONFORMS TO THE NTALS CONTllACT EXCEPT Pl NOTED o PARTAL 32. PAD BY 33 AMOUNT VERJFED CORRECT FOR o FNAl DATe SGNATURE OF AUTHDRi1 O GO'EANMENT REPRE5l:NmwE 01. t'aymen, 34 CHECK NUMBER 36 1certify ths accqunlls correct and proper for payment. o COMPLETE o PARllAL OATE SGNATURE AND TTLE ORCERTFYNG OFFCER o FNAL 37. RECEVED AT3B. RECEVED BY (Print) 139 DATE RECEVED 40 lutal CONTANERS 41. SR ACCOUNT NUMBER 42 SR VOUCHER NO. {YYMMMOD} 35. BLL OF LADNG NO DO FORM 1155, JUN 94 PREVOUS EDTON MAY BE USED Overprint A REV SEP 90 NSN: 7540-FM

52 DOCD: SECURTY CLASSFCATON (if any) OSHRep ACCREDTATON PROGRAM APPLCATON NOTE: VermClJt/on of cours. completion m.y "" required. nclude ai/nformation that wllla lst 89penonneJ and KCSHOs n determining your nterest..nd.bllltle. for swvlng n At::redlted OSHRep. Return thl. compleled torm with.ny other n...ry nto,m.rlon to you, KCSHa. PRVACY ACT STATEMENT: Auth tor collecting the requested info is contained in 10 US-C, : 29 U.SC. 668; 50 US.C. 402 D.Q1e. and Executive Ot'der NSA's Blanket Routine Uses found at Fed. Fleg. 10,531 (1993)31"ld the specific useslound mgnsa06 apply 10 this information. Auth for requesting our SSN is EO ".The into provided will be ijsed (primarily) 10 evaluate the applicant's and program member's suitability '0( the OSHAep Accreditation Program. Oiscl of requested info, ncluding SSN, 1$ voluntary: However, failure to furnish inlo, other than you, SSN, may result in the delay or prec1u$ion of an applicant's or program member's oonsideral,on tor t\'le OSHRep Accreditation Program NAME (Last; (FitS!) (M) SSN JOB TTLE ORG/UNT PHONE ($SCUf.)(Non-5ecufe) COMPLETE MALNG ADORESSJBLOG DATE ASSGNED AS ROOM NO.lSUTE OSHRep (YYYY MM) E-MAL ADDRESS COURSE NUMBER SPECFC NCS COURSE(S) COMPLETED THAT RELATE TO SAFETY AND HEALTH (U.eReve,..,fn.._.ry) TTLE DATE COMPLETED HAVE YOU COMPLETED CD-l00? ( Yes. Oat. Completed) (YYYY-MM DD (Locot'm) ONO 0 YES 000 DYES N THE PAST YEAR: ~~=:i:~=---=-=,--:-:-:::--:--c--::-::::-:-:=:::c-----;:--:"..., HAVE YOU COMPLETED CD 200? (f YES: Date Comf)liJS(1) (YYYY MM DD) (Location) HAVE 'OU ATTENDED ANY QUARTERLY KCSHO MEETNGS? HAVE 'OU CONDUCTED ANY SAFETY NSPECTONS? ANY JOB HSTORY RELATED TO SA.FETY AND HEALTH SERVCES YES F YES: NO 1-=--r--:7:~::=':---:-:-:-:--:-::==:-:::::-- HOW MANY? WHEN? (Provide da,.,) (YYYY-MM DD) PFlOR SAFETY AND HEALTH TRANNG OUTSDE THE AGENCY (Please provide detailslspedfics of what, WhBfl, where, etc.: Use.reverse ifnocess ')'.) REMARKS (U$fi reverse if noc8ssary) KCSHO CONCURRENCE DATE (YYYY-MM DD) '" ::> a: SUPERVSOR CONCURRENCE: DATE (YYYY MMDD) '"!2 Z (/) APPLCANT DATE (YYYY-MMDD) FORM Pe895 REV APR 2001 (SUp'':S6'd6S P6895 REV NOV 2000 wflid!15 ()/)$O8tll' SECURTY CLASSFCATON (if any) ~fproved for Release by NSA ~~ FOA Case # 4287

53 DOCD: PACKNG AND CRATNG DALY REPORT DATE PRORTY 02 VOUCHER NUMBER Ul's LOCATON PECES WEGHT CUBC FEET VALUE TOTALS PRORTY OS VOUCHER NUMBER l/l'$ LOCATON PECES WEGHT CUBC FEET VALUE TOTALS PRORTY 12 VOUCHER NUMBER LJ'. LOCATON PECES WEGHT CUBC FEET VALUE PACKER'S SGNATURE TOTALS FORM J826' REV MAR 99 (SupersfK1(ts J8261 REV AUG 97 which is obsolete) NSN 7540 FM OO Approved for Release by NSA FOA Case #4287

54 DOCD: PARKNG PERMT APPLCATON D SENOR EXECUTVE D EXECUTVE Senior Executive Use ONLY ete USE ONLY ~SPACE NUMBER,-GATE 'BULDNG RETURN COMPLETED FORM TO, COMMUTERTRANSPDRTATONCENTERLOCATONS Ft Meade Office OPS 2A.VCC Room 101, (301) b FANX Office- FANX 3, Room Bl104, (410) b EXPRATON DATE Privacy Act Statement: Aulh: 50 U.S.C. 402 Jllllil: 50 US.C. 797; 41 CER ; and EO NSA'. Blanket Routine Use. found at 58 Fed. Reg, 10,531 (1993) and the specific uses found in GNSA07 apply to this info. nformation you provide will be used to identify vehicles parked at NSA facilities. to provide data necessary to manage and enforce parking regulations, and to assist in providing data for security, emergency, and other related matters. Disc of requested info, including your SSN, is vohmtary. However, failure to furnish requested info. other than your SSN, may result n the denial or suspension of parking privileges at NSA facilities and precjude notification of emergencies involving your vehk:le, PLEASE COMPLETE THE NFORMAnON BELOW ('&>nlor ExeCUl/ve Use ONLY) NAME (Last) (First) (M) PHONE (Secure) (Non-Secure) ORG SOCAL SECURTY NUMBER SD PARKNG LOCATON 'SULDNG 'CURRENT SPACE NO (ff appicalie) PROVDE TAG LCENSE PLATE NUMBER(S) OF ALL VEHCLES YOU PARK AT THE COMPLEX STATE VEHCLE TAG NUMBER STATE VEHCLE TAG NUMBER STATE VEHCLE TAG NUMBER CTCUSEONLY FORM P46756 REV JAN 2001 (Supersede. P4J758 REV MAY 92 and P4S750 MAY 92 otjlch are ObSole,e) pproved for Release by NSA FOA Case # 4287

55 DOClD: SECURTY CLASSFCATON (if any) PARTCPANT PLACEMENT REFERRAL TO FROM DATE (YYYYMMDD) 0 JUNOR 0 MDDLE OFFCER CRYPTOLOGC CAREER PANEL (H128) ENLSTED CRYPTOLOGC CAREER ADVANCEMENT PROGRAM PANEL PA~TC'PANrs NAME rlasf) (First) (M/) DESRED BEGiNNNG DATE LENGTH OF ASSGNMENT (YYYYMMDD) PANEL OBJECTiVES POR PARTCPANT PANEL EXECUTiVE SGNATURE PANEL SERVCE REPRESENTATVE (Signa'we) TO o PANEL servce REPRESENTATVE o PANEL EXECUTVE PROPOSED QUTES AND PROJECTS FROM OATE (YYYYMMDD) ORGANZATONAL DESiGNATOR MMEDATE SUPERVSOR (Lasl) (First) (M/) SPECAL CLEARANCES REOURED (Must be submitted by gainiflg elemi)flt) REMARKS pproved for Release by NSA FOA Case #4287 FORM P7724 REV SEP 2000 securty CLASSFCATON (if any)

56 DOClD: PAYMENT OF CASH AWARD TO: FNANCE AND ACCOUNTNG OFFCE, OF2213 o Civilian Personnel Military Personnel o RETREMENT SYSTEM: DATE o Social Security (FERS, FCA, Offsel) or Civil Service (CSRS) n accordance with NSNCSS Regulation 30-9, t s requested that the following check be issued: NAME OF AWARD RECPENT (L8St) (First) (Mf) GRADE OR RANK AND BRANCH OF SERVCE (if appicabllj) SOCAL SECURTY NUMBER ASSGNED ORGANZATON AMOUNT OF AWA.RO BASS FOA CASH AwARD ANS 0 SUGGESTON NO. SMA 0 SUPEROR MANAGEMENT AWARD swp 0 SUSTANED SUPEROR WORK PERFORMANCE STA SUPEROR TECHNCAL AWARD 0 SPC 0 SPECA~ PERFORMANCE CASH AWARD TVA TEACHER OF THE YEAR 0 SM 0 SPECAL ACT SERVCE STP 0 SC 0 SCENT/FC ACHEVEMENT - (Military Only) SRA 0 SOE RANK AWARDS A 0 NVENTON NO. CTA 0 CRYPTOLOGC LTERATURE ~F 0 NTERDEPARTMENTA~ SUGGESTON (Civilian) OTHER (Spacify rype of award) 0 ~FM 0 /NTERDEPARTMENTA~ SUGGESTON (Military) SENOR TECHNCAL ACHEVEMENT AWARDS NAME OF APPROVNG OFFCAL "'rtle OF A.PPROvNG OFFCAL FUNONG ORGANZATON COST CENTER COOE DSPOSTON OF" CHECK o Hold for pick.up by the below named individual: NAME (Last, First, M) PHONE NUMBER o Mail to: COMPL.ETED BY(Signature) TTLE PHONE NUMBER ORGANZATON cc: PAYROLL Orlglnal) ORGNATOR FOR EXTERNAL AWARD RECPENTS ADDRESS REQURED FOR W 2 PURPOSES ONLY: FORM P9S78 REV MAR 2001 (SupersedeS P9S78 REV SEP 98 which is obsolete) pproved for Release by NSf FOl\, Case #4287

57 DOCD: pes DEBREFNG QUESTONNARE Please Print or Type/! Use Reverse For Remarks Privacy Act Statement: Collecllon 01 information is authorized by PL and EO Tho principal purpose lor which this information is to be used is to identity security vulnerabilities, The completion of the questionnaire is voluntary and info contained therein will be used routinely to brief other individuals for similar assignments of the dangers iilvqlved, to develop countermeasures to the vulnerabilities identified, and in determinations whe!(e security considerations comprise a relevant and valid element ot the determination. Failure to comptete questionnaire may cause delays in security processing for additional TOY/pes. NAME (Last) (First) (Middle) GRADE OFFCE TO BE ASSGNED TELEPHONE (Secure) (Non-Secur6) A MESSAGE TO ARRVNG PERSONNEl NUMERCAL DESiGNATOR OF FiEUO ACTVTY PREVOUSLY ASSGNED On behalf of the Chier, Office 01 Security Services, we welcome you back to Headquarters. We ho~e your assignment was oparationally successful and personnally rawardlng. This questionnaire enables us to reestablish contact with you and provides you with a simple method to inform us of significant securily matlers you encountered during your field assignment. Please answer all questions completely and return quesfionnaire in a sealed envelope to MC43, Opsl, Room 1$079, Suite Questionnaire will remain in security channeis. NSTRUCTONS Mark the appropriate block. f your answer is "YES' to any question, please explain on reverse side. Classily complete form accordingly... YES NO ". 1. Are you aware of any physical security problem existing at the station 10 Which you were assigned which has not boon reported to station authorities? '.': :...,r'.::,,:'..,""':',':\"" ",,,,,,,,,,:,:..:"'P::::: "':,,,,",.,,'.',:::,....'",/.,i,,!i",h""'; 2. Are you aware Of any anonymity pro~.m not previously reported fo station authorities? 3, Were there security problems with personnel at the station that the authorities were not aware of? 4. Did you develop any associatons with foreign nationals outside the work environment which you consider close. continuing and characterized by tias of affection or obligation? ( yes, complete information below) 5. Do you recall any unusual inoidents which might have indicated an effort on the part of foregn ntelligence services to target, entrap, cultivate or subvert you or other U.S, personnel? e. As a result of your experiences. do you have any suggestions as to how the Office of security might improve the briefinqs provided to PCS and TOY personnel? 7, Would you prefer to answer these questions in private to a security officer? NAME CTZENSHP NATURE OF RELATONSHiP (Neighbor, C".Worl<er, Friend. etc.) NATURE/NTENT FOR PROBABLE FUTURE CONTACT (Correspondence, visits. etc) SGNATURE iaelurnee) SOCAL SECURTY NUMBER DATE OF RETURN FOAM G8922 AEV FEB 2001 (Supersedes GS922 REV AUG 2000 which is obsolele) SECURiTY CLASSFCATON NSN: 7540 FM OO1 1f:l86!A.pproved for Release by NSA ~~ b FOA Case#4287

58 DOClD: PCS PROCESSNG DATA PRVACY ACT STATEMENT: Auth; 5 USC , 10 USC 1605: 37 USC ; GNSA09; NSA" Blanket Routine Uses found at 58 Fed. Reg (1993) apply 10 this inlormatiofl. AuthOritV for requesting SSN: E.O nformation will be used primarily to collect information necessary to issue travel orders, galher inlormation 10 determine an employee's appropriate travel allowances/entitlements and to determine if any member ot the employee's family requires special assistance while trallejing. DiSClOsure 01 the information, including $odal Security Number, is voluntary. Failure 10 lurnil)h lhe reqvested inlormation may affect allowance disbursements and travel entitlements for the employee and employee's dependents or delay processing the permanent change of station NOMNEE'S NAME (Last! (First) M) SSN CURRENT ORG PHONE CURRENT SKLL COMMUNTYWORK ROLE PTC VACANCY NUMBER OR DRECT NOMNATON OVERSEAS ORG POSTON MSSON ELEMENT REPLACEMENT TOUR LENGTH DEPARTURE DATE SGNATURE =N=E=W=S=K=L=L=C=OM=M=U=N='TY=========="""=NEW==W=O=R=K=RC=LE===============N=EW=P=T=C======== OEPENOeNT NFORMATON NAME SSN RELATONSHP DATE OF BRTH CTZEN (Last) (Firs/) (M) YrYrMMDD) YES NO us LOCAL ADDRESS AND TELEPHONE NUMBEA ARE ANY DEPENDENTS, ACCOMPANYNG YOU, TYPE HANDCAP SPECAL SCHOOLNG REQURED F 1MFE PREGNANT, GVE PHYSCALLY HANDCAPPED? CONFNEMENT DATE o YES (f YES, (YYYYMMDOj DNa DYES (/1 YES, provide name(s)) DNO expa;n in Remarks below) N CASE OF EMERGENCY (Name, address, relationship and 19/ep/1one numb6t') f- U ~ 0 WH le ON LEAVE (Name, address and tfjlephona number) U TOY/DELAY ENROUTE (NvmberdayS) PLACE OUARTERS AUTHORZED SPONSOR BOX NUMBER DLQA D DoD Leased D Other PETS (f \1:jls, lisl type WEAPONS SPOUSAl ACCOMMODATONS D and number of D DNO YES pets in Remarks) NO DYES o NO 0 YES REMARKS FORM K392lJ REV OCT 2000 (Supersedes K3920 FEB 2000 which S /lbso/eiej ppmved for Release by NSA FOA Case # 4287

59 DOClD: PEDATRC MEDCAL HSTORY QUESTONNARE (Birth to 18 Months) Privacy Act Statement: Authority: 10 USC sec et.seq.: 50 USC sec, 831; 5 USC sec. 7901; ansa 06, NSA's blanket Routine Uses found al 58 Fed, Reg, 10,531 (1993). Purpose: TM inlqrmalion will be used to determine fitness for duty and eliqibility for medical surveillance/screenings, The disclosure of inlormauon including Social security Number S voluntary, Effect on diem if information is nol provided: Decisions regarding fitness for duty Of need lor medical screenings wlll be determined or processed without coft1)lete nformation CHLO'S NAME (lst) (First) (M/ddl.) DATE OF BRTH (YYYY..AfM OO) AG' SEX SOCAL SECUFlTY NUMBER Al,.lERGES r'none", f no sllgrgl.,) BRTH HSTORY WEGHT LENGTH WEEKS GESTATON MEDCATONS rwone", f np n'jedc8tfons} OM OF AGE SEX RELATON AGE SEX RELATON LST HOUSEHOLD DM DF DM DF MEMBERS DM DF DM DF DM DF DM DF PLEASE ANSWER THE FOLLOWNG QUESTONS YES NO EXPLANATON (f YES, explain) 1. Do you have any concerns about your child's health? 2. Are your Child'S Shots up 10 date?.- 3. Does you, child have any medlcll problems? 4. Has your child ever been admitted to the hospital? 5. Has your child ever hid surgery? 6. Does your child have frequenl crying spells? 7. coes your child have frequent ear inleelions? 8. Hu your child ever broken a bone? 9. Has your child ever had stitches? ,.. you, child have any feeding problems? DBreast DBottle 11. Does your child seem to have regutar boweljbladder habl1s? 12. Does your child follow a sleep schedule? 13. coes your child get regular medical check-ups? you consider your child to be developmentally appropriate'? 15. Are there any significant health problems in your immediate family? 18. Do you have any concerns regarllng your child's interaction with you or others? 17. Does your child require any specla'equlpment? (h rlng.ld, lube feeding. elc.) PARENT OR GUARDAN (Printlld Nom.) (Slgn.loro) FORM P7225 MAR page' Approved for Release by NSA FOA Case # 428T' DATE

60 DOClD: PEDATRC MEDCAL QUESTONNARE. Birth to 18 Months (Continued) b' <Th PERCENTLE LENGTH PERCENTLE HEAD CRCUMFERENCE PERCENTLE PULSE RESPRA ONS TYMPANOMETRY R-PDQ SCORE OTHER OEVELOPMENTAL ASSESSMENT R PHYSCAL EXAMNATON WNL ABN.. ':" ';''1/' DESCRBE ABNORMALTES AppearanceJJnteractlon GrowlhlNutrlUon Skin HeadlFace EyeslRed Refle. Cover TestlEye Muscles Earl NoseMoulhlDenla1 NeckNodes Lungs HeartlPulses ChestBreasls Abdomen Genitalia Musculoskeletal NeurolReflex8S Vision Assessment Hearing Assessment ANTCPATORY GUDANCE (Pleas. nlli.1 wh<h discussed) SAFETY NUTRTON LEAD POSONNG SOCALZATON DSCPLNE PROVDER'S PRNTED NAME PROVDER'S SGNATURE DATE FORM P7225 MAR 2001 ~ Page :2

61 DOClD: PEDATRC MEDCAL HSTORY QUESTONNARE (18 Months to 6 Years) Privacy Act St:a.tem&nt: Authority; 10 USC sec et.seq.: 50 USC sec. 831; S USC sec. 7901; GNSA 06, NSA's blanket Routine Uses round at 58 Fed. AlJQ. 10,531 (1993), Purpose: This information will be \,lead to determine fitness tor duly and ellqibhily lor medical a.urveillance/screeni!"lq$. lhe disclosure Of information including, Social Security Number is voluntary. Effect on client if nformation is not pro\lided: Decsions regarding litness tor duty or need tor medical screenings wll be derermu'o&d or processed without complete nformation CHLO'S NAME (l..st) (Fir'S') Mlddlfl} DATE OF BRTH (YYYY-MAf-DD) AGE SEX Olol OF SOciAL SECURT\' NUMBER ALLERGES (..Non... if no all.fj~') MEDCATONS ("N...", no "",_Uon.) AGE SEX RELATON AGE SEX RELATON LST HOUSEHOLD OM OF OM OF MEMBERS OM OF OM OF OM OF OM OF PLEASE ANSWER THE FOLLOWNG QUESTONS YES NO EXPLANATON (f YES. explain) 1. Do YOU have any concerns aboul your Child's heallh? 2. Are your child's shots up to date? 3. Does your Child have any medical problems? 4. Has your child ever been admitted 10 he hospital? 5. Has your child ever had surgery? 6, Does your child have freql.lent lar nfecton,? 7. Has your child ever broken a bone? S, Has your child ever had stitches? 9. Are there any slgnillcenl heallh problems n your mmedlale family? 10. Doe. your child get a yearly medical check up? 11. Does your child eat a balanced diet? 12. Do... your child have regular boweljbladder habits? 13. Doo. your child aloop wollal nlghl? 14. Do you consiller your Child 10 be developmentally appropriate? 15, a" yaur ChUg been dla8nosod with Attenllon Deficit '"Or or (AO or AOHO? Autlam. or Pervasive Developmental Disorder 16. Haa your child boon diagnosed wllh a learning disorder or mental retardation? 17. Do you have any concerna regarding your chlld'a nterattion with you or others? 18. Does your child have any special educational need.? 19. Does yol.if child require any special equipment? (hearing aid, walker, ec.) PARtNT OR GUARDAN (PrlnlJld N,m,) (Slgflllur') DATE FORM P7225A MAR 2001 P,gel ~fprovedfor Release by NSA ~~ FOACase#4287.

62 DOCD: PEDATRC MEDCAL QUESTONNARE -18 Months to 6 Years (Continued)...:.::'ifh)" Si~Th :BeC~iriplete ;ir,:""... :' ',.,_,;;. -',.,,. 1:'<"-:.;,:',: ~", ii" ",.,;;:'1" " ' HLO'S NAME (Lat) (First) (AfiddUl MEASUREMENTS WT HT VSON (D.ttlne. a-r. 5 yhr..nd aldtry BP (age 3.ndover) PU~SE (.a.nd avor) R L PHYSCAL EXAMNATON WNL ABN.. DESCRBE ABNORMALTES Appearance!lnteractlon GrowthlNutrltion Skin HeadFace EyeslCover TestlEye Muscles Ears Nose!Mo\,llhlOenlJil NeckNodes Lungs Heart/Pulses ChestJBre8Bts Abdomen Genllollo (teslhllabl.) Musculoskeletal NeurolReflexes Vision Assessment Hearing Assessment Developmental A.seaament ANTCPATORY GUDANCE {PlHse nltl.1 whmr dl.cw.edj SAFETy NUTRTON LEAD POSONNG SOCAL~T10N P~ E AN E A PROVDER'S PRNTED NAME PROVDER'S SGNATURE FORM P722SA MAR 2001 poge 2

63 DOCD: PEDATRC MEDCAL HSTORY QUESTONNARE (6 Years to 12 Years) Privacy Act Statement Authority: 10 USC sec et.s9l.].; 50 USC sec. 831;.s USC sec. 7901; GNSA 06, NSA's bl,anket Routine Uses found at 58 Fed. Reg, (1993) Purpose: This nformation will be useo to determine fitness tor duty and ehqibility for medica! surveillance/screemngs, The disclosure of inlor~tion includirlg; ~ Security Number is voluntaty, Effect on Client it information is nat provided: DeclSlOOS regarding fitness for duty or need tor medical screenings will be determned or processed without complete mlormatlon CHLO'S NAME (Last) (FTt) (14ddl.) OATE OF BRTH ( "''''"00) AGE SEX SOCAL SECURTY NUMBER ALLERGES ("Non... fno allorgl.s) MEDCATON5 ('''Non.'', f no msf.1fclltlmsj OM OF AGE SEX RELATON AGE SEX RELATON LST HOUSEHOLD OM OF OM OF MEMBERS OM OF OM OF OM OF OM OF PLEASE ANSWER THE FOLLOWNG QUESll0NS (f YES, t1xpla/n) ~ou have any concerns about your child', hea th? 2. Are your chlld's shots up to date? YES NO EXPLANAll0N 3. Does your child have any medical problems? 4. Ha. your child ever lleen admitted to the hospital? S. Has your chjld ever had s\argery? 6. Does your child have frequent ear nfections? 7. Has your child ever broken a bone? 6. Has your child ever had stltch.s? 9. Are there any slgnillcant health problems in your mmediate famllv? 10. Does your child get a yearly med1calche<:k-up? 11. Does your child eat a balanced diet? 12. s your chlld's weight in proportion to hlslher height? 13. Does your child have regular bowellbladder habits? 14. Does your child sleep well at night? 15. Do you r.ln~lder your child to be developmentally appropr ata 16. Ha$ your child boon dl.~no.~ with Attention Deficit Dlsoi'der (ADD or ADHD AUtiSm, or PervlSlve DevelOpmental Disorder. 1" '!~. your enllo D,".n,!..gn~""'1with. learning disorder or mental retardation? 18. Ha. ~Our child ever been evaluated or tr..ted_l~r ~r sslon, anxj.~ orl:init: disorder, an eatl"! disorder ftnorex Bul 18), or other psyc:holq leal dsorders 19. Do you have any concern. r~ardingyour child'. interaction with you or others. 20. OoH your child perform well at school? 21. Has your child had extended absence. from school? 22. Does your child have any special educational needs? 23. Doesln0ur c,hlld require any special equipment. (hell' n9 aid, walker, etc.) 24. s your ChUd nvolved n extra--cumcular activities? h,pproved for Release by NSA ~~- 25. FOR FEMALES ONLY: ~:. your child started her Derlod7 YES when? FOA Case # 4287 PARENT OR GUAROAN (Prinrad lame) OATE (Slpnal.ro) ~OAM P7225B MAR 2001 P,ge 1

64 DOCD: PEDATRC MEDCAL HSTORY QUESTONNARE 6 Years to 12 Years (Continued) 7i ~~~~"'F CHLD'S NAME (bstj (FllSt) HT VSON (D/.~net only) PUL COL A REEN o NORMAL L 0 DEFCENT PHYSCAL EXAMNATON WNL ABN,;.. DESCRBE ABNORMALTES Appearancellnteraction Skin Eyes/Ey. Muscl Eo.. Noso/MoulhlDontaJ NocklrhyroJdlNod Lungs HeartlPulses ChestJBreasta Abdomen G.nitalla (lesl.5) Dev.lopm.ntal A m.nt (ag.6-9) Tann.r Stag. (ag.lo.12) MUlculoskeletal N.urolR..x.. Hearng As.essment ANTCPATORY GUDANCE (P.."" nitial when discu5hd) SAFETV NUTRTON SOCALZATON DSCPLNE DENTAL PEER PRESSURE SUBSTANCE USE PHYSCAL ACTVTY PROVDER'S PRNTED NAME PROVDER'S SGNATURE DATE FORM P72258 MAR Page 2

65 DOClD: PEDATRC MEDCAL HSTORY QUESTONNARE (12 Years to 18 Years) Privacy Act Stateme.nt: Aulhodty. 10 USC sec et.seq., 50 USC sec. 831; 5 USC sec, 7901; GNSA 06. NSA's blanket Routine Uses found at 58 Fed. Reg. 10,531 (1993), Purpose: ThiS information will be used to determine moess for duty and eli~ibllity1q( medk;asljml:illance/screenings, The disclosure of nformation including Soctal Security Number is VOluntary, Effect on client if information is nol proliided: DecisOns teoardlng fitness tor duly or need for medical scree-rungs will be determined or processed withool complete nformation CHLD'S NAME (Lut) (Firs.) (Middle) DATE OF BRTH (YYYY Mo OO) AGE SEX SOCAL SECURTY NUMBER ALLERGES ("None", fno,1.rf11.s) MEDCATONS ("N()ttfl", it nomedlc,"ion.) OM OF AGE SEX RELATON AGE SEX RELATON UST HOUSEHOLD OM OF OM OF MEMBERS OM OF OM Of OM OF OM OF PLEASE ANSWER THE FOLLOWNG QUESTONS ( YES, explain) yo~nave any concerns adout your cnm;n health? 2, Are your child', sholl up to date? YES NO EXPLANATON 3, Does your child have any medical problems? 4. Has your child ever been admitted to the hospital? S, Hat your child ever had surgery? 6, Has your child ever broken a bone? 7 Has your child ever had stitches?. Areth~'eany significant health problem, n your family 9, Does your child geta yearly medical check up? 10. Does your child eat a balanced diet? 11, s your child'. weight n proportion to hlslhor height? 12. Does y:our child have regular bowellbladder habits? 13. Does your child sleep well at night?,how many houl1? 14, Do yoll consder your child to be developmentally appropriate? S,!:!~s ~r child been dla~nosj!".wlth!\tten.t!9n_deficit Diso er (ADD or ADHD? Autism, 0' Pervas,ve Developmental Disorder 16. Has your child ~n di8snosed with a learning dlsoreter or men" retar ation? 17.!l~. Your ch'!d eve,. ~_ ev':\1~!.~ or '!. ~'!'S..'!" depression anxl.~or ~nlc i.order, n eatng disorder AnOrexl ul mia), or olher plychologlcal disorders? 18. Does your child use tobacco, alcohol or drug.? 19. Do you have any concerns r~ardlng your child'. interaction with YOli or others 20. Does your child perform well at school? 21. Has your child had extended absences from school? 22, ' your child involved n extra<urrlcular activities? 23. DoBS your child have any special educational needs? ~requiteany special equipment? walker, etc,) 25, S_2NL.".: Has your child slarted (1/ YES, when?) PARENT OR GUARDAN (Printed filmo) (Slglllltuno) DATE FORM P7225C MAR 2001 Page 1 Approved for Release by ~~SA or FOA Case #42877

66 DocrD: PEDATRC MEDCAL HSTORY QUESTONNARE -12 Years to 18 Years (Continued) ~ WT HT VSON (D.fance only) " R l ll! naii'p, ;puwl"life !7'1'o;;'"loilirii'"ilisc"irii5e"'en.r-.j...-: W~" D NORMAL D DEFCENT _.. WNL ABN )':/,t,... PHYSCAL EXAMNATON DESCRBE ABNORMALTES AppearanceJnteraclJon Skin t'yes!fundi NoseMouthlDental Ntckl1'hyroldlNod... Lungs Heart/Pulses Ch t!br...t. Abdomen Mal. Genitalia, f appllcabl. Tanner Stage Mu.culoskeletal NeurolReflexe' Hearng Assessment ANTCPATORY GUDANCE (PNA nltl.1 when d/scus.ed) SAFETY NUTRTON PEER PRESSURE DENTAL us AN E PHY l ACTVTY SEXUAL PRACTCES PROVDER'S PRNTED NAME PROVDER'S SGNATURE FORM P7225C MAR 2001 Page 2

67 DOCD: r ~-~ , PENDNG MANTENANCE RECORD AO~NNO DATE _... FORM K7134 MAR 98 NSN: 754Q.FM-OOt./i617 L T,l..G NO BREF DESCRPTON OF PROBLEM.._. MAKE =EA$ON FOR DELAY FOR TFlANSPOFATlON SERVCES USE ONLY (00 nor remove from book).-.. MOOEL FU'lding SC~led Will NoBe ACTON TAKEN DATE OUllr Corrected ~-----~ SZE: 8-112" X 5-112" pprovedlorr-"iease by NSA FOA Case # 4287

68 ~----- DOCD: r ~ (oon/lnlj«l) DATE BREf DESCRPTON OF PROBLEM REASON FOR DELAY ~ FUl'Jdil'lg ~J:t!r 0"''' ACTON TAKEN DATE _.. _._no -_..._ _... FOAM K11$4 MAR ~. ReverM N$N: 7540-FM L.J SZE: " x 50112"

69 DOClD: PERFORMANCE EVALUATON (ARCHTECT-ENGNEER) 1. PROJECT NUMBER 2. CONTRACT NUM6ER MPORTANT: Be sure to complete Performance section on reverse. f additional space is necessary for any item, use Remarks section on reverse, 3, TYPE OF REPORT (Check one) COMPLE TON OF O 0 0 NTERM OR DESGN STUDY COMPLE TON OF CONSTRUC TON 4. REPORT NUMBER 5. DATE OF REPORT D TERM NATON 6. NAME AND ADDRESS OF CONTRACTOR 7, PROJECT DESCRPTON AND LOCATON 8 OFFCE RESPONSBLE FOR A, SELECTON OF CONTRACTOR S. NEGOTATON/AWARD OF CONTRACT C. ADMNSTRATON OF CONTRACT 9 CONTRACT DATA A TYPE OF WORK B. TYPE OF CONTRACT D FXED-PRCE COST-REMBURSEMENT C. PROJECT COMPLEXTY D. PROFESSONAL SERVCES CONTRACT 0 DFFCULT 0 D OTHER (Sp<JC''l') ROUTNE NTAL FEE AMENDMENTS CLAMS BY CONTRACTOR TOTAL FEE NO. l$...,ount NQ. AMOUN SMPLE $ $ $ E, DATE CONTRACT AWARDED F. CONTRACT COMPlETON DATE (ncluding G ACTUAL COMPLETON DATE OF CONTRACT extensions) 10 KEY CONSULTANT DATA A NAMES B ADDRESS C. SPECALTY 1,. CONSTRUCTON COSTS la$nltal ESTMATE B,AWARD C,ACTUAL $ $ 12. CONSTRUCTON CHANGES AND DEFCENCES NUMBER TOTAL A. CONSTRUCTON CHANGES $ B. CONSTRUCTON CHANGES RESULTNG FROM DEFCENCES N A E PERFORMANCE C DEFCENCES PAD FOR BY A-E $ D. DEFCENCES PAD FOR BY GOVE:RNMENi $ o 13 OVERALL RATNG 14. RECOMMENDED FOR FUTURE CONTRACTS? EXCELLENT 0 AVERAGE 0 POOR DYES 0 NO (f "NO~ e.xplain in REMARKS on rewrse) 15A NAME AND TTLE OF RATNG OFFCAL t6a NAME AND TTLE OF REEWNG OFFCAL $ 156 SGNATURE 15C DATE 16B. SGNATURE 16C. DATE NSN 754().OH STANDARD FORM 1421 (10,631 Ptescfibed tw GSA FAR (48 CFR) (d)

70 DOCD: CONCEPTS SCHEDULE (Mo., day, yr.) ACTUAL (Mo. day, yr.) PERFORMANCE RATNG FACTORSRATNGS W STAGES ill '" ~ 5,..,. RATEOBV CODE LEGEND- '" + EXCELLENT W,.. A AVERAGE 11,. z...,.. W ~ z,,~ z w W ~ 25 " z::> is,. ~ NA _Cl ::> tr,..w i2~ OF z ;;;; W W P POOR SERVCES 11' (As applicable) ~ 1C ' ~ FROM TO ARCH. STAUC. FROM TO M CH ELEC NOT APPLCABLE N NO NFORMATON '" (; 1l " 8., z 0 :±iii W<ll Z., U U ~ " "'"..., SGNATURE AND DATE SCHEDULE FROM TO ARCH TENTA (Mo., day, yr.) SlRUC. T1VES ACTUAL (Mo., day. yr.) FROM TO MECH. ElEC. SCHEDULE FRoM TO ARCH. WORKNG (Mo., day. yr.) S'rRUC ORAWNGS ACTUAL (Mo.. day. yr.) RuM Tv MECH. ELEe ESTMATES CRTCAL PATH METHOD V' WE PRE AWARD POST AWAAO POST CONSTRUCTON CONTRACT ~ SERVCES NSPECTON SOLCTATON DOCUMENTS REMARKS MAN UALS FELD OFFCE STANDARD FORM 1421 BACK (10-B3)

71 DOClD: "0" e...lejlll tis! 6NlY (WHEN COMPLETED) PERFORMANCE EVALUATON CONSTRUCTON CONTRACTS. 2. CONTRACTOR (Name, address and ZP code) 5 DESCRPTON AND LOCATON OF WORK PART L CONTRACT NUMBER GENERAL CONTRACT DATA A. ADV~RTSED 3. TYP~OF 8 NEGOTATED CONTRACT.. FRM (Chock) o CPFF 0 ~~,~~ o OTH~R (SpeCilyJ 4 COMPLEXTY OF WORK o DFFCULT o ROUTNE 6. A. AMOUNT OF BASC 8. TOTAL AMOUNT OF C. LQUDATED DAMAGES D. NET AMOUNT PAD FSCAL CONTRACT MODFCATON ASSESSED CONTRTACTOR DATA $ $ $ $ A. DATE OF AWARD B. ORGNAL CONTRACT C REVSED CONTRACT o DATE WORK ACCEPTED 7. SGNFCANT. OOMPLETON DATE COMPL~ON DATE DATES 6 TYPE AND EXTENT OF SUBCONTRACTNG PART PERFORMANCE EVALUATON OF CONTRACT (Check _" ""prj_t. box) 9 PERFORMANCE ELEMENTS OUTSTANDNG SATSFCATORY UNSATSFACTORY A. QUALTY OF WORK B. TMELY P~RFORMANC~ C. EFFECTV~NESS OF MANAGEMENT D. COMPLlANC~ WiTH LABOR STANDARDS E. COMPLANCE WTH SAFETY STANDARDS 10 OVERALL EVALUATON o OUTSTANDNG (Explain in tom 13. on,ova,.o) o SATSFACTORY o UNSATSFACTORY (Explain in tem 14. on 'eve'se) A. ORGAN2ATON (Type orprint) 11. EVALUATED BY 8 NAME AND TTLE: (Type or print) C SGNATURE o QATE A OAQANZATlON (Type or print) 12. EVALUATON REVEWED BY B NAME AND TTLE (Type orprint) C. SGNATURE O. DATE NSN H lion OPPiCAL USE vnly (WHEN COMPLETeD) STANDARD FORM 1420('O-ll3) Prescribed by GSA. FAR (45 CFR) 532:J6 ' (b)

72 DOCD: FOR OFFCAL USE ONLY (WHEN COMPLETED) 13 REMARKS ON OUTSTANDNG PERFORMANC:: - AS NDCATE::O BY THE CONTRACTOR'S PERFORMANCE ON THS CONTRACT, F YOU CONSDER THE CONTRACTOR TO ae OUTSTANDNG, SET FORTH FACTUAL DATA SUPPORTNG THS OBSERVATON, THESE DATA MUST Be: N SUFFCENT DETAL TO ASSST CONTACTNG OFFCERS N SELECTNG CONTRACTORS THAT HAVE DEMONSTRATED OVTSTANDNG QUALTY OF WORK AND RELABLTY. (Continue on separate sheet, fnhri8dj 14. EXPLANATON OF UNSATSFACTORY EVALUATONS FOR EACH UNSATSFACTORY ELEMENT. PROVDE FACTS CONCERNNG SPECFC EVENTS OR ACTONS TO JUSTFY THE EVALUATON (B.g., extent of Gowmmsnt nspection fequirtki, feworlc /WuirBd, Sut:Jcontracling, cooperation of contractor. qualify oj W.lrkmen and aoequacy of equlpmen,). THESE DATA MUST BE N SUFFCENT DETAL TO ASS1ST CONTRACTNG OFFCERS N OETERMNNG THE CONTRACTOR'S RESPONSBLTY, (Continuo on separate sheet, if needed,) FOR OFFCAL USE ONLY (WHEN COMPLETED) STANDARD FORM 1420 BACK (10,831

73 DOCD: GENERAL NFORMATON The success of your reinvestigation depends greatly on the information that you provide. Please ensure that your entries on the Questionnaire for National Security positions, Standard Form 86 (SF-86), are accurate, complete, and in accordance with the directions given. Failure to provide requested information may lead to unnecessary delays in your reinvestigation processing. Entries may be made directly on line on the FRAMEMAKER SF-86 package documents or the documents may be printed and entries made by typing or by legibly printing using a black ball point pen. When completing the SF-B6, follow the attached detailed instructions. A number of questions on the SF-B6 specify that your response be limited to the last 7 years. For reinvestigation purposes, you are requested to disregard this instruction and document all relevant information since the date of your last forms. Use SF-86A if additional space is required to list education, employment or residences. Use "Continuation Space", page 9, if additional space is required to answer other questions. Please do not indicate that certain information may be obtained from another source, i.e., birth, divorce, naturalization, or account data. Take the lime to obtain information not readily available. All questions on the SF-B6 must be answered. "no response is applicable, indicate this on the form (tor example, enter "None" or "Unknown''). Your reinvestigation includes a personal interview with a Security Officer. You will be contacted to arrange a mutually acceptable time and location for the interview. (Be sure your office black telephone number and present work loeation, i.e. OPS. OPS2B. FANX. APS 10 are provided in Section 11 ofthe SF-86.) THE COMPLETED ORGNAL SF-86, PLUS ONE COpy AND ORGNALS OF ALL OTHER FORMS, MUST BE SUBMTTED. THE COPY MUST NCLUDE DATES AND ORGNAL SGNATURES. WE RECOMMEND AN ADDTONAL COpy BE MADE FOR YOUR PERSONAL RECORDS. t you have any questions, please contact Reinvestigations, Q233, on (5), 41D-S (b). pproved for Release by NSA FOA Case # 4287

74 DOCD: DETALEP NSTRUCTONS FOR COMPLETNG THE QUESTONNARE FOR NATONAL SECURTY POSTONS (SF-D6) Before you proceed, insert your SSN in Question 4 and at the bottom of each page of the SF-86. This may be accomplished on-line by performing the following steps: 1. Click the left mouse button to get an insertion point in the following text box: 2. From the "Special" menu above, choose "Variable..:' 3. From the "Variables:" scroll list, choose "SSN", and then select the "Edit Definition..." button. 4. n the "Definition:" text area, replace " " with you Social Security Number, select the "Change" button, and then select the "Done" button. 5. Choose the "Update..." button, after which FrameMaker will pop up a window asking you if it is okay to update all system variables, to which you select the "OK" button. Question 1: Follow instructions on the form. Question 2: (Date of Birth) Numerically list the month, day and last two digits of the year. For example, January 15, 1960 should be entered as Questions 3 through 8: Follow instructions on the form. Question 9: (Where Vou Have lived) List in chronological order beginning with the most recent, but only those within the period of investigation. The telephone numbers provided for references should be current business numbers (if applicable). Otherwise, home numbers are acceptable. Question 10: (Where Vou Went to School) List in chronological order beginning with the most recent, but only those within the period of investigation. Exclude NSA sponsored training unless it has or may result in a degree from a college or university. Question 11: (Your Employment Activities) n block #1, indicate your current NSA assignment. Within the "Previous Periods" blocks you should document all other NSA assignments within the scope of the investigation. Utilize NSA organizational designators and your present work location (e.g. Ops 1, FANX, APS 10, etc.) and your current black telephone number. Also, any part-time employment(s) should be documented in blocks #2, #3, etc. f you require additional space, utilize the "Continuation Space" on page 9 or the appropriate section of SF-86A. Question 12: (People Who Know Vou Well) List non-relatives who are personally knowledgeable of your conduct, activities and background, particularly your unsupervised activities away from school and work. Their knowledge, collectively, should span the entire period of investigation. Avoid listing overseas references and military references unless they are in the United States and you have current location and telephone data. List only U.S. citizens. Question 13: Follow instructions on the form. Question 14: Follow instructions on the form.

75 DOCD: Question 15 and 16: Follow instructions on the form. Question 17: (Your Foreign Activities) These questions include any activities other than those related to officially sanctioned NSA business. Responses to Question 17(d) should cover the period of investigation only. Any "YES" answers must be explained in detail. Question 18: (Foreign Countries You Have Visited) Follow instructions on the form. Only indicate travel which occurred during the period of investigation. Questions 19 and 20: Follow instructions on the form. Question 21: (Your Medical Record) Follow instructions on the form. Question 22: (Your Employment Record) This should reflect only non-nsa employment within the period of investigation. Question 23: (Your Police Record) nclude any information related to incidents occurring within the period of investigation and any incidents not previously reported during NSA security processing. Question 24: (Your Use of llegal Drugs and Drug Activity) Document all drug involvement occurring during the period of investigation and any involvement not previously reported during NSA security processing. Question 25: (Your Use of Alcohol) Document all incidents occurring during the period of investigation. Question 26: (Your nvestigations Record) Check the ''YES'' block and (for NSA) enter the date that your investigation was completed (if you have that information). f not, use the date that you entered on duty (EOD). For Agency code, enter (1) and for Clearance code, enter (4). Question 27 and 28: (Your Financial Record and Financial Delinquencies) nclude all information related to events occurring during the period of investigation AND in the Continuation Space, page 9, (or on a separate sheet), LST ANY CASH TRANSACTON(S) OF $10,000,00 (PERSONAL OR OFFCAL) OR MORE not previously reported. Report the date of the transaction(s), institution(s) involved, location(s) of transaction(s) and institution(s) and explanation(s) for each transaction. Question 29: (Public Record Civil Court Actions) nclude only that information pertaining to the period of investigation. Question 30: Follow the instructions on the form. Complete the "Authorization for Release of nformation". Reproduce copy.

76 DOCD: ATTENTON: PLEASE READ PROR TO COMPLETON OF ANY FORMS PRVACY ACT OF 1974 NOTCE n accordance with the Privacy Act of 1974 (Public Law , 5 USC. 552a), you are hereby notified that: (1) Public Law 86-36, Public Law , Title 5 U.S.C.; Executive Order 10450, Executive Order 12356, and Executive Order 12333; Director of Central ntelligence Directive 1/14; NSAlCSS PMM Chapter 808 authorize the National Security Agency/Central Security Service to receive and maintain personal nformation on employees and others requiring continued access to classified intormation and NSAlCSS facilities. (2) The information is required to determine your eligibility for continued access to classified information and NSAlCSS facilities. (3) The information is to be used by officials of NSAlCSS and of other Federal Agencies charged with investigating and evaluating your eligibility for continued access to classified information and NSA CSS facilities. nformation provided by you including information on possible or actual violations of criminal laws, may be disseminated as appropriate to Federal, state and local authorities with law enforcement responsibilities. (4) Disclosure of the requested information is voluntary. Failure to provide the requested information may result in processing delays or the inability of the Agency to reach a final determination with respect to your continued access to classified information and NSAlCSS facilities and other related actions. (5) The request for your social security number is authorized by Executive Order t will be used to identify you during the investigations and evaluations referred to above. Providing it is voluntary. Failure to provide it may delay processing, impact security approvals and, ultimately, impact your eligibility for continued access to classified information. ~P"R""'N"'TE"'D""N""AM""E"' SGNATURE certify that have read and understand the above. DATE FORM P1613C JUN 97 NSN: 754o-FM OOl-5609 Attachment to NSAlCSS AeinvesUgalion Packet containing the following forms: Forms G3149, G6920 and G7017

77 DOCD: PERSONNEL SECURTY POLCY ADVSORY PRVACY ACT STATEMENT; Autt1 for requesting SSN: EO 9397: nfo will be used (F'rincipally) to idelntify indiv; (Routinely) None: Disci of SSN: Voluntary; Failure 10 provide info will delay processing. Your signature below indicates you have read and understand tf1e above, As a condition for receiving or retaining a security clearance with the National Security Agency, you are required to adhere to various personnel security policies, These policies are in effect to protect NSA affiliates from being targets of espionage and other hostile activities carried out by or on behalf of foreign intelligence entities. Three of these policies, the violation of which may result in the denial or loss of your security clearance, are described below, MPROPER USE OF DRUGS The improper use of drugs by NSA affiliates (e.g., NSA employees, military assignees or representatives, contractors, consultants, and experts) and applicants is strictly prohibited, mproper use ncludes the llegal use of controlled substances as well as the use, transfer, possession, sale or purchase of any drug for purposes other than their intended medical use, This polley may be reinforced through drug testing in accordance with Agency regulations, ASSOCATON WTH FOREGN NATONALS NSA affiliates and applicants must exercise common sense, good judgement, and discretion in their associations With non-u,s, citizens, Casual associations for foreign nationals are generally acceptable, Such associations must not, however, develop into "close and continuing" relationships: e,g.. those characterized by ties of kinship, obligation (including financial), affection. or other capacities to influence, Such relationships are not compatible with the security of NSA's sensitive mission, Affiliates who find themselves involved in such a relationship must mmediately seek guidance trom a security officer. Affiliates and applicants are also responsible for recognizing and subsequently reporting any activity which may be assessed as suspicious, provocative, or comprising. FOREGN TRAVEL Affiliates are required to submit foreign travel requests in advance for an approval decision by the Office of Security, Such determinations will be based on the particulars of each specific case, taking into consideration the most recent counterintelligence and threat data available to NSA at the time of the proposed travel. NSA may suspend andlor revoke the security clearance of any NSA affiliate who undertakes foreign travel without following proper procedures for requesting approval of the travel or who travels after his or her request is denied, Failure to observe the policies summarized above may constitute grounds for disqualification from initial or continued access to NSA information and facilities, Your signature below indicates your understanding and willingness to comply with these policies. PRNTED NAME SSN 'SGNATURE DATE FORM G3149 REV JUL 92 (Supersedes G3149 FEB 90 Which s obsolete) NSN: 7540 FM OO1 5175

78 DOCD: CONSENT FOR ACCESS TO RECORDS PRVACY ACT STATEMENT: Auth: Collection of into requested auttlofized under" 50 USC Section 436, Counlerintellig&f)ce and SecUrity Enhancement Act of 1994, and E.O 12968, Access 10 Classified nformation. nfo will be used (Principally) Pursuant to 50 USC Section 436 to obtain such financial records, other financial information, computer reporti$, '.nd foreign havel nformation all- may be fleceissary to conduct any authorized taw entot~ment anolar count~rintelligence investlgjtion or to determine your eligiblity for access 10 dassified 11'110. (Routinely) May be provided to financial institutions, holding companies. consumer reporting agencies, attler hnancial inlormation. computer reports, and foreign travel records pertaining to you. t may also be pro'ided to a congressional office in response 10 an inquiry made at your request; to the General Services Admin and the National Archives and Records Admin lor records management purposes; and to any agency of tl'le US, conducting an authorized law enforcement investigation, counlerintelligence inquiry, or 5ecurily determination where lhe requirements of 50 USC Seclion 436(a)(2)(8) are satisfied, Disc; FJarticipation is voluntary; however, under EO 12968, failure to furnish the requested into will result in you not being eligible lor new. or continued. access 10 classified information. PART AUTMORZATON FOR RELEASE OF NFORMATON (To be completed by 'he indivjdual) authorize any investigative agency of the Executive Branch of the United States Government to request. pursuant to Section 1.2 (e), Executive Order (E.O.) 12968, Access to Classified nformation, from any financial agency, financial institution, or holding company, or any consumer reporting, such financial records or other financial information, and consumer reports pertaining to me, 85 may be necessary in order to conduct any authorized law enforcement or counterintelligence investigation, or to determine my eligibility, or continuod eligibility, for access to classified information, hereby give the same authorization with respect to any records maintained by any commercial entity within the United States pertaining to travel by me outside the United States. understand that this release wlll not ba used unless the required conditions stipulated in The Counterintelligence and Security Enhancement Act of 1994 (50 U,S,C.Seclion 436[a)[2]) and E.O have been met and the certification attesting to that fact appearing below has been signed by an authorized United States Government ohiclel. direct each entity to which this request is presented to release the alorementioned records and nl'ormation, pursuant to 50 U.S.C. Section 436, upon request 01 the authorized recipient as described above, regardless 01 any agreement or direction may have previously made, also understand that, under 50 U.S.C. Section 436(b), the fact that a reque.t lor record. pertaining to me has been made will not be disclosed to me by any SuCh entity regardlesa of any agreement or direction may have made, or will make. have been advised the original of this authorization will be placed on tile with the sponsoring Federal agency. This authorzation expires three years after my current authorized access to classified information has terminated. PRNTED NAME (Last. Firsl, M) SSN SGNATURE DATE OF BRTH PART CERTFCATON (TO be completed by the certifying efflcial) have reviewed the facts of this case and certify:, 1 The person to whom the signed authorization above applies is, or was, a government employee as defined by 50 USC 436 at. seq. who has been required by the President in Executive Order to provide tha above consent as a condition of access to classffied information. The detinffion 01 employee in that slama includes any person Who received a salary or compensation of any kind from the United Statas Government, i$ a contractor of the United Slates Government or an employee thereof. is an unpaid consultanl of the United Statas Government, orotherwise acts for or on behalf of the United States Government. 2) This request for information andlor racords is being made pursuant to an authorized inquiry or investigation and is authori;!:ed under 50 USC Section 436(0)(2). 3) The employee, by hislher signature above, has previously agreed to make available the records of information requested by this certification. PANTED NAME OF CERTFYNG OFFCAL TTLE SGNATURE. DATE PART - STATEMENT OF RECORDS REQUESTED (71J be completed by the investlgativa entity lor each spaciflc request) THS REQUEST S DRECTED TO COVE~NG THE PEROD (From) (TO) A, FROM FNANCAL NSTTUTONS: B. FROM NVESTMENT NSTTUTONS: C FROM CREDT REPORTNG NSTTUTONS D. FROM HOLDERS OF TRAVEL RECORDS FORM G7017 JAN 97 NSN: 7540 FM ) Deposits. withdrawals, and account balances 2) Copies of checks and other negotiable instruments 4) Other, as specified: 1)Purchases of Slocks, bonds. or other securities with an aggregate value greater than S 1) Credit records 2) The identities of financial inslitutions where the employee mainlains accounts 1) Records 01 trips to and/or from locatiqrls outside lhe Un~ed Slates FOR THE FOLLOWNG RECORDS: 3) Funds transfers to or from financial institutions outside the Ul"ited States 2) Other, as specified: 3) Copies of correspondence relating to creditworthiness 4) Other. oils specified' 2) Other. as specified:

79 DOClD: SUPERVSOR SECURTY EVALUATON PLEAse NOTE: The supervisor WLL NOT review the employee's security forms. NSTRUCTONS: Supervisors are required to complete a Supervisor Security Evaluation (SSE) of subordinates as part of their reinvestigation. The subordinate will seal hislher completed security forms in a small envelope and provide this, a larger pre-addressed envelope and the SSE to hislher supervisor. After the supervisor completes the SSE, hefshe will place it and the small, sealed envelope in the larger envelope. The entire package will be forwarded to PERSONNEL SECURTY EVALUATON CRTERA a. Conduct which suggests possible involvement in espionage, sabotage, or subversion; b. ndications of disloyalty to the U.S. (this would include disloyalty to the U.S. on the part 01 a close relative 01 the employee or on the part 0/ an associate With whom the employee /s bound by affection orobl/getion); c. nvolvement in outside activities or employment which might create a potential conflict with the individual's responsibility to protect classified information trom unauthorized disclosure; d. ndications of poor judgement, indiscretion, unreliability, or untrustworthiness which suggests that the employee may be unsuitable for continued access to classified information or assignment to sensitive duties; e. Exploitable personal conduct fliteslyle Which might subject the employee to undue nfluence. duress. or blackmail; t. Unreported Unofllcial Foreign Travel; g. Unreported close and continuing associalion with a non-u.s. cllizen; h. Excessive indebtedness, financial irresponsibility, or unexplained aflluence (evidence olliv/ng beyond orrs's meens); i. Use involvement with controlled substances illegal drugs Since entering on duty; j. Alcohol abuse; k. Evidence of an emotional, mental, or nervous disorder (to nclude consultation with a psychologist. psychietrist, orcounselor lor such a problem);. nvolvement in criminal activity or a record of law Violations; m. Deliberate violations of security regulations and policies; n. Negligence or carelessness in performance of individual security responsibilities. o o AM../Q AWARE OF NFORMATON PERTANNG TO THE ABOVE CRTERA OR ANY OTHER NFORMATON WHCH MGHT AFFECT THS EMPLOYEE'S ABLTY TO PROTECT CLASSFED MATERAL. AM AWARE OF NFORMATON PERTANNG TO THE ABOVE CRTERA OR ANY OTHER NFORMATON WHCH MGHT AFFECT THS EMPLOYfE'S ABLTY TO PROTECT CLASSFED MATERAL. SUPERVSOR'S NAME (Print) TTLE SGNATURE DATE PHONE FORM G6920 REV APR 2002 (Supersedes RiV NOV 96 whch S obsolete)

80 DOCD: UNTED STATES OF AMERCA AUTHORZATON TO OBTAN CONSUMER (Credit) REPORT PRVACY ACT STATEMENT: Auth: GNSA06, GNSA10, Pub,L , and PlJb,L ; N$A's Blankel Floutine Uses fouoo at 58 Fect Reg. 10,531 (1993) apply to this information, Auth tor requesting SSN: EO principal Purpose: to obtain information which will a$$i$1 5eCUtity Setvices in teaching an inlormed decision regarding $Ui~bility lor a security clearance, Disclosure of the SSN is voluntary, Oiscklsure of all other information is mandatory, Failure to provide mandalofy intormation may result in an adverse suilability determination. Failure 10 ptovide SSN may delay processing thereby delay a determinatlofl of suitability, Carefully read this authorization for release ofnformation, then sign and date n nk. nstructions lor Completing this Release This release form authorizes the investigator to obtain a copy of your consumer (credit) report from a consumer reporting agency (credit bureau) pursuant to the provisions of the Fair Credit Reporting Act of 1970, as amended (15 U.S.C. Sec 1681 et seq.). The Federal agency or department receiving the report will use the consumer report to assist in its adjudication of whether you satisfy the criteria to receive access or continued access to classified national security information. Your signature is required before this release form becomes valid. AUTHORTY TO RELEASE NFORMATON hereby authorize any investigator, special agent, or other duly accredited representative of the authorized Federal agency or department conducting my background nvestigation, bearing this release or copy thereof that shows my signature, to obtain a copy of my consumer report as tha term is defined in the Fair Credit Reporting Act (FCRA) of 1970, as amended (15 US.c. Sac at seq.). understand that my consumer report will be used to assist in determining whether satisfy the criteria to receive access or continued access to classified national security information. Furthermore, understand that, if information in my consumer report leads to the Federal agency or department taking an action adverse to me as defined in the FCRA, that will be given an opportunity to appeal the action consistent with applicable law, executive order, and agency or department regulation. However, understand that may not receive advance notice of an adverse action based in part on the consumer report if the Federal agency or department has reason to believe that advance notification will result in endangering the life or physical safety of any person; flight from prosecution; destruction or tampering with evidence; intimidation of potential witnesses; compromise of classified information; or otherwise seriously jeopardize an investigation or official proceeding or unduly delay an ongoing official proceeding. PRNTED NAME ADDRESS (nclude street, apt. numb8r, city. state, and ZP cad.) SGNATURe: DATE SOCAL SECURTY' NUMBER TELEPHONE NUMBER FOAM G71 as FEB 98

81 DOCD: DATE: NATONAL SECURTY AGENCY CENTRAL SECURTY SERVCE MEMORANDUM REPLY TO ATTN OF: SUBJECT: Personnel Assignment nformation ChangelUpdate TO: D7P The following information is sllbmitted to effect an internal reassignment: NAME SSN RANK A, DUTY TTLE B. MLSPEC c ASSGNED ORG BLLET NUMBER D. DUTY ORGANZATON ROOM NUMBEA E, TELEPHONE NUMBERS (SECURE) (NON-SECURE) F_ RATER GRAOE NAME SSN DUTY TTLE G.NDORSl!R GRADE NAME 55N DUTV TTLE H REMARKS, EFFEcTVE DATE VERFYNG OFFCAL PRVACY ACT STATEMENT: AuthOrity loroollecting information requested on this form is contained in 50 U.S.C. Sec. 402 owe and Executive Order NSA's Blanket Routine Uses found at 58 Fed, R~. 10,531 (1993) as well as the specific uses enumerated n GNSA01 and GNSA09 apply to this information, Authority for requesting your Social Security Number (55 is Executive Order The requested informatton you provide will be used to update personnel actions for militaf.y personnel al NSA. Your disclosure ot requested nformalion, including SSN, s VOluntary, However. failure to furnish requested information, other than SSN, may result n the failure to complete your requested personnel action, FORM P5775 REV FEB 2002 (Supersedes P5775 REV NOV 97 which s obsolete) pproved for Release by NSA FOA Case # 4287

82 DOCD: SE.CURTY CLASSFCATON (if any) PERSONNEL EVALUATON PANEL DECSON DATE MR NAME (Last) (First) (M') SOCAL Sf.;CURTy NUMBER MRS MSS MS. APPLCANT t EMPLOYEE STE TO ORG FM ER SEC PSYCH HR CONTNUE PROCESSNG NOT SELECTED/DSCONTNUE PROCESSNG ENCOURAGE TO REAPPLY N NUMBER MONTHS NDCATED (Subject to availability of suitable vacancy) ACTONS MONTHS PROCESSNG EOO PG/RePG SECURTY NTERVEW NTATES PHYSCAL PROR TO EOD PSYCH/R.PSYCH SPECAL COUNSELNG BY (Org) Q w LETTER OF NTENT SPECAL COUNSELNG BY 10rg) PHYSCAL PROR TO EOD FOLLOW UP BY (Org) AFTER NO. MONTHS NTERVEW EMPLOYEE FOR PCS REMARKS COMPELLNG NEED STATEMENT REQURED ~ Q. FOLLOW UP BY (Org) AFTER NO MONTHS ll. ADMN/OPERATONAL ACCESS AND PCS NTERVEW «RETURN TO PANEL WHEN ACTON COMPLETED SGNATURE pproved for Release by NSA FOA Case #4287 FORM P8997 REV OCT 2001 (Suporsedes P8997 REN FEB 98 which is obsolete) NSN: 1540 FM SECURTY CLASSFCATON (if JY) PERSONNEL PRVLEGED NFORMATON

83 DOCD: r ~-~., SECURTY CLASSFCATON (if "fly) ; Auth for coll9cdllq into reql,lelsled on form is coolaimd in 50 US.C. SecliOl'lS 631, U,S,C" sections and EO 1~333 and, ound al 58 Fed Reg. 10,531 (1993) as "'"" M the &peti(w;:, 10 llf1d 12 apply 10 info, AlJ\h lor requ8sling, SSN is EO (printipal1y) 10 dbl1t1fy ndn Skill held, klr submitting cluat'll/'lco\\ to looomal si16s, tor procoosino lr81l'lh'lq requests, and for emtl'q6t'lcy conlae1 purposes, Ywr di$c1 Of $5111,1$ VOUW,ry. HowWilf.!allure to lumi$l'l requ8$led illlo. other \tan requested info, 11'C1~Olng PERSONNEL NFORMATON RECORD SSN mayan.cl!hi ofice's abillll\' to Pro\llde me requested stlryl(i$ NAME (Last) (Fit$f) (1'1) SSN SD OAG DATE (Assigned to Orgj (Assigned 10 Agency) (Agency Release) ORG. TRANSFERRED TO/DATE (YYYYMMOOJ GRADE OR RANK/SERVCE DATE OF GRADE/RANK PRMARY (Mlitary!2t/LY) DUTY (Military!2t/LY) WOAKAOLE SKLL FELD MOS AFSC SUJCO MOS AFSC SUJCO HOME ADDRESS (Street) (Apt. No.) (C<ty) (State) (ZPCodej HOME TELEPHONE (nc1vd9 Aretf Code) DATE OF BRTH (YYYYMMDD) PLACE OF BRTH 10 CARD NUM8ER (Civihim Qf:JjJ SPOUSE'S NAME (La5() (First) REMARKS SGNATURE DATE (YYYYMMOD) FORM P1335B REV APR 2002 (Supersedes pt3358 JUN 85 which is obsoj"te) SECURTY CLASSFCATON (f 'ry) L -1 Size: 5" x 8" Printed on Lightweight White Cardstock Stocked in Hard Copy Via Stock System pproved for Release bv NSA 0 J FOA Case # 4287

84 DOCD: PERSONNEL SECURTY POLCY ADVSORY PRVACY ACT STATEMENT: Auth fqr requesting SSN: EO 9397: nto will b<l used (Principally) to dentify ndiv: (Routinely) None; Disc of SSN: Voluntary; Failure to provide info will delay processing. Your signature below indicates you have read and understand the above. As a condition for receiving or retaining a security clearance with the National Security Agency, you are required to adhere to various personnel security policies. These policies are in effect to protect NSA atfiliates from being targets ot espionage and other hostile activities carried out by or on behalf of foreign intelligence entities. Three of these policies, the violation of which may result in the denial or loss of your security clearance, are described below. MPRQPER USE OF DRUGS The mproper use of drugs by NSA affiliates (e.g., NSA employees, military assignees or representatives, contractors, consultants. and experts) and applicants is strictly prohibited. mproper use includes the illegal use of controlled substances as well as the use, transfer, possession, sale or purchase of any drug for purposes other than their intended medical use. This policy may be reinforced through drug testing in accordance with Agency regulations. ASSOCATON WTH FOREGN NATONALS NSA affiliates and applicants must exercise common sense, good judgement, and discretion in their associations with non-u.s. citizens. Casual associations for foreign nationals are generally acceptable. Such associations must not, however, develop nto "close and continuing" relationships; e.g.. those characterized by ties ot kinship, Obligation (including financial), affection, or other capacities to influence, Such relationships are not compatible with the security of NSA's sensitive mission, Affiliates who find themselves involved in such a relationship must immediately seek guidance from a security officer. Affiliates and applicants are also responsible for recognizing and subsequently reporting any activity which may be assessed as suspicious, provocative, or comprising, FOREGN TRAVEL Affiliates are required to submit foreign travel requests in advance for an approval decision by the Office of Security. Such determinations will be based on the particulars of each specific case, taking into consideration the most recent counterintelligence and threat data available to NSA at the time of the proposed travel. NSA may suspend andlor revoke the security clearance of any NSA affiliate who undertakes foreign travel without following proper procedures for requesting approval of the travel or who travels after his or her request is denied. Failure to observe the policies summarized above may constitute grounds for disqualification from initial or continued access to NSA information and facilities, Your signature below indicates your understanding and Willingness to comply with these policies, P~NTEO NAME SSN 'SGNATURE DATE FORM G3149 REV JUL 92 (Supersedes G3149 FEB 90 which is o/)sojete) NSN: 7540 FM pproved for Release by NSA FOA Case # 4287

85 DOCD: SECURTY CLASSFCATON PHYSCAL HEALTH STATEMENT NAME (Last) (First) (M) PSyCHOLOGCAL CL~ARANCE (Date) -;-;,;,;=;;-==~:;:-:-- L _ MEOCAL CLEARANCE (oale) ~~===:----_- MEDCAL DOCTOR SGNATURE -, PATEN1"S SGNATURE ( heretjy sttlte that there has been flo slgmficant cnange mmy physical health since completing DATE TRP DATE my last SF 93 or Form P5556 for Ovt'rseas travel) FORM P6563 REV AUG 2000 (Supersedes P8583 REV AUG 91 which is obsolele) SECURTY CLASSFCATON ~?proved for Release by NSA ~~ FOA Case # 4287

86 DOCD: PHYSCAL RESTRCTON ASSGNMENT REPORT SSN NAME DATE ORG cooe! oescrpton CDDe; oescrpton CODe DESCRPTON SPEECH NONPARAlY'lC ORTHOPEOC MPARMENTl OTHER MPARMENTS HEARNG.5 10M, OR aoth FE!!T HSART DSEAse WJTH RESTRCTON OA 81 LMTATON OF ACTVTY ~ARD OF HE:A~NG.. lone OR BOTH ARMS 15 (Hft41fng in om, Hror az EPl.EPSY hhm'r sid tequffed).1 ONE OR 80'lln.E"S 83 Bl.OOO OSeAse (S:'r:ilYJ 18 1NO USABLE NEAANG,8 HP OR PELVS a. DABETES 17 NO USABLE HEARm1lPEECH AAlFUNCTKJH,. aac~'nec)( 88 RESPRJ,mRY C1SCACE:t (Spflctfy) VSON 57 ANY COUSNA-:iON OF::Z C~!ORE lacy P.J,R":'S 13 NORMAL HEARNGiSPEECH MALFUNCl10N,. r ONE; OR BOTH HANOS ao HeART DiSEASe. W1rri NO RESTRCTON OR UMlTATlON OF ACTVTY ABLTY TO REAO ORDNARY SZ! PRNT 22 WTH GLAsses, eutwth LOSS OF PARTAL PARALYSS 88 KONE':, OY$FUNC":":CNNG!?'E~P"'ERAl VSON i NA6!Llr'( TO Re."C OR01NA~':' size PRNT. 51 J ens ~ANO a9 CANCSR. C:::MP~.= ::U;coVeRY 2', NOT C:RRe :~Aal.= 9Y Gl..ASSE5 C;'NC=:R UNC:.=!'::;C:J\;G :SL'~GjC.;L. ;'NCiC~ 8. j C;\E.:..R:l.l..\N'i' J:.:..RT '0 ME:::::C)l" ",e,.;., i:l.'e~jr 2' aline N ONE :':'E 8~ j., CNE :.5'3. ANY ',:)..RT ME."l:T'\L ~:~ARc.:. -::CN.-., : BUNt:! N BOTH eyes (Na 1/$.Cf vs/en) 6" i 6crri HANOS s: ime~lal. CR =~.'Cr:C~':'L :~~E5S ::S [ C:)LOR :!!.!NO., SCTh!.!H~S. ANV?>\Ri S2'Je,=;e ~1$':"Cr;:,:,":c~ CF i,.,!mes AoNC!CFt S~'Ne MSSNG EXTRE:MT1E.S 88 BeTh ARMS, ANY!='.,l,RT,. " '" DS- Gt.:R'-'JEN-...,;: - C~ JoA~ CS ""R F-~-! J"': e.....' ~..., l. ~ :::: 27 ONEHANO 8; C 'JE SiCS ::F seer, rnc:':':c;ng ':>Ne,l,R~t 93 l t.s.~rnng :MF:",~~.la~li,:liNe L.:'::J.8 t C,'Je~RM j ThA=: '~R :\ler: ~~':CR ".\"-:';') :;r: -r::e '5 ce:,t:i!.4se::' ~::"::Nii:\o'E, 88 2' 1eNE.:"CCT i accv.<ltms.1':'; i!';sj,,, J. i ONE LE'.J COAtPLfTE PARALYSS J3 : acih r,~ncs CR ARMS 70 i J" i acth F;;Si JFi L..e~s 71 lone rtanc OR ARM AND ONE =OOT OR Je.,. f';;;s '. CNE!'iANC 05! C7He~ BC':'H HANes ONE'!~RM,. j ONE. HAND OR ARM ANO BOTH F!.1!T OR 73, ecrnarms LE':;S,. SOTH HANOS Cl't ARMS AND BOTl1 Fait 15 OR LS"::;S 3; aoth HANes OR ARMS...NO en! POOT 74, ONE!.!oJ OR :.egs SOTH L;:;GS 75 Lcwe.=: HALF OF aoov, NC:'UONO ',-='3S 77 CNE $OE -;;;F SOC'!'. NC:':.JONG ONe ~RM ANt:' OfiE ;"e-:; THRoE OR ~CRE \\AJOR PARTS OF THE Bcoy (arm~ ojijl1 ~J " PHYSCA~ ReSTRiCTONS - ma:..imum and ocl;.,'1sionalty lifting al'lc1lcr r--.. Wth frequent limng and/or ~rrylng 01 carrymg Suett amells as dod<.els. led ers Ob,ee:.s weighing up tc:l 10 pounds. Even 1. Sedent:try Wortc. Lifting 10 pound$ 2. Ugtlt Work. L:l'bng 20 pounds maximum 8 NSDE OUTV ONLY and,mall too". Although a SEden,ary jot,s lhougn \tie weight ~ftecl may be only defined as one wfllch nvolves Ung, a NO e:<posure TO HGH PLACES. HGH VOLTAOE OR: negligible amount. if JOb n lhls QllSOry 8 certam areoum of walktng ana standing S MOVNG MACHNE,,:l:tV often necessary m c::arryl(l9 01,11 lob dutlss l'eqi,:lres waiklng or standing 10, NO ORVNG OF GOVSRNMSNT VEHCLES JCDS are Sedenlary f walklllg and slandll1g : s'g"lfic,jfl1 :.lr'llree or t nllcl"es Sr.<ng are reql.lred only occa$lon81ly,and ot'ler mos cflfte lime wl[h a degree of pusnlmq 10 NOAR'TR.WE;,. seoemaly Cflena are me!. and pulling of.arm andlor leg contr'ols. 11 NO TOY NO pes 3. Ught Medium Work. Llftlng 30 pounas. 4. Medium Wone Lfting 50 pouoos 12 F,~C:LJTY (l"rr: - s:, acoll:'~o1l' maxmum wlln frequem lifting andfor H 'TalUl'l'um With frequent lttlng and/or C carrying of oblects w1:t19hll19 vp c:arrvlng Of OD,ects W!llgmng up DATEEXPlRcD SGNATURE o TEMPORARY poun... i /)Ound$ erj ~ OTHE.q PERMANENT FORfl.l PS '5 REV NOV 96 (Supersedes PS TS Rev OC NSN 75J.Q.FM.001.(lS91-97 wt'lco'j S "asotetel pproved for Release by NSA FOA Case #4287.~EjUrv NO TOY pes exce?t io AREAS OF MEOC",l,. 20 E:~eMPT FRCM USiNG "::::NF'iflM ""'

87 DOClD: NATONAL S":CliRTYAGENCY CENTRALSECURTYSERVJCE Offic.' of Security YOUR PERSONAl.DENTFCATlON NUMBER S: GPO; 2001-Sl>-4S2. Qi. J pproved for Release by NSA FOA Case #4287

88 n... -position DESCRPTON 2 Reason lor Submission h~ervice (Please Read nstructions on the Back) 1. Agency Position No, 4. Employing Office location 5, Duty Station a QPM Certilication No. BRedescription BNew Hdqtrs, nfield Reestablishment Otner 7, Fair LabOr Standards Ac1 e, Financial Statements Required 9. Subject to A Action Explanation (Show any POSil/OflS rsplacoo) h Exempt n Nonexempt h Executive Personnel, rl ~mplo~rnentand hves nno Financial DisclOsure FinanClallnterests 10 position Stalus 11. Position is: 12, sensitivity 13. Competitive Level Cockl f- ~ Competitive f-- Supervisory :J 1 Non D3.Critical Sensitive Sensitive 14. Ageney Use - Excepted (Sri in Remarks) - Managerial il(!' Noncriticaln 4 Special SES (Genl SES (CA) Neither Sensitive sensitive 15, ClassifledlGraded by Oflicial Tille of PoStion Pay Plan Occupational Code Grade nitials Date a U.S Olhce of Per sonne Management b Department. Agency or Establishment c Secono Lev!!1 Review._,- d. First level Review e Recommended by Supervsor or rutiatln'1 nffl''''' 16 Organizational Title 01 Position (if different from official/it/e) 17. Name ot Employee (if vacant, specify) 1e. Department, Agency, or Establishment c, Third Subdivision a First SubdivSion d. Fourth SUbdivision 0 Second SUbdivision e, Filth SubdiVision. 19 Employee Review - ThiS is an accurate description at the major dulies and responslbihlle!s 01 my position : Signature 01 EmploYee (optloflsl) 20 Supervisory Certlllcation, certify thai this is an accurate statement ofthe ledge that this infotmation is to be used for statutory purposes relating to ap. rna/or aullos and responsibilities of this posilion and ts organil:arional mla. p:lintment and payment ofpublic funds. and that fals8 or misleading state tionships, and trlat me position is necessai'}' to carry out Government tunc- monts may constitute violations of such statutes Qf their implementing fions for which am responsible, This certification is made wir/l the know- regulations 'c; Type-dO Name anlftille-o((mmediate'supeiv1sor~'"-tt ~ _ Tb~ YyPEiifNamearK{Tiilo ofhig"tier:cevel SuperViiOr'or Manager COPtOtiaij"' ~ ~~ Signalure,., _ ~ ~ _. ~ '. _. _. _ _. _. _.~._ _. *_ ~~.w """'" _ ** ~_." wwww~**"w : Dale :Signature : Date,,,,, 21 ClassifieatJonlJob Grlllding Certification. certify tlar this position has been classified 22. position Classilication Slandards Used in Classifying/Grading Position graded as required by Ti/65, US, Code, in COflformance wifh standards publishedby the US Office 01 Personnel Management or, if no put>/ishbd standards apply directly, ~~~~~::~tr ~~(~_t~~t ~~: ~~lica~!.~~~/~~~~~ ~~~~~~~~... _ Typed Name and Tille 01 Official Taking Ac1ion ~ ~~-~ Sl~:inalure - -~ ~-... ~.. _ _.,,- : oaie ' nform.llontor Employees. The standards, ancj nformation on their application, are available in lhe personnel office The classjfication ot the posjtion may be reviewed ana corrected by the agency or the U,S, Office of Personnel Management nformation on classilicationljob grading appeals, and complaints on el(emption from FLSA, is available, from the personnel office Of the U.S. Office ot Peroonnel Management. 23. Position Review nitials : Date nitials : Date nitials : Oate nitials Date nitials : 0<11. a Employee (Optional),,, b SuperwiOr :,, _., c Classilltn 24 Remark;s 25, Descripllon 01 Major Duties and Responsibilities (See Attached) PREVOUS EDTON USABLE EXCEPTON TO OF 8 APPROVED BY GSA/RMA 8 91 OF B(Rev. 1 85) U.S. Office 01 Personnel ManagefOel"rt FPM Chapler 295

89 nstructions for Completing Optional Form 8 POSTON DESCRPTON n order to comply with tho requirements of FPM Chapter 295, subchapter 3, and other provisions of the FPM, agencies must complete the items marked by an asterisk. Agencies may determine what other tems are to be used, '1, Enter position number used by the agency for control purposes. See FPM Chapler 312, Subchapter 3. "2. Check one.. ~Redescriptjon~ means the duties and/or responsibilities of an existing position are being changed. ~New~ means the position has not previously existed... "Reestablishment" means the position previously existed, blj had been cancelled... "Other" covers such things as change in title oroccupalional series wthout a Change in duties or responsibilities, The "Explanation" section should be used to show the reason jf "Other" is che<:ked, as well as any po$ition(s) replaced by position number, title, pay plan, occupational code, and grade, 3. Check one. '4. Enter geographicallocauon by city and State (or if position is in a for, eign country. by city and country). '5. Enter geographical location if different from that of #4, 6. To be completed by OPM when certifying positions, (See tem 15lor date of OPM certification.) For SES and GS~16/18 positions and equivalent. show the position number used on OPM Form 1390 (e.g. OAES0012) *7. Check one to show whether the incumbent is elxempt Or nonexempt from the minimum wage and over1ime provisions at the Fair Labor Standards Act. See FPM Chapter Check box if statement s required. See FPM Chapter 734 for the Executive Personnel Financial Disclosure Report, SF 278. See FPM Chapter 735, Subchapter 4, for the Employment and Flnanclallntar~ esls Statement. 9 Check one to show whether dentical Additional positions are permit ted. See FPM Chapter 312, Subchapter 4. Agencies may show the number 01 such positions authorized and/or established after the ~Yes" block. 10.Check olie. See FPM Chapter 212 for information on the competitive service and FPM Chapter 213 for the excepted service, For a position in he exceptecl service, enter authority for the exception, e,g" ~Schedule A (d)" for Attorney positions excepted under Schedule A of the Civil Service Regulations. SES (Gen) stands for a General position in the Senior Executive Service, and SES (CR) stands for a Career Reserved position 11 (!;heck one A ~Supervisory" posiuon is one that meets the requirements for a supervsory title as set forth n current OPM classification and lob~ grading guidance, AgenCies may designate first~'evel supervisory positions by placing ~1" or ~1st" alter "Supervisory." A "Managerial" position is one that meets the requirements for such a designation as set forth in current OPM classlfication guid ance. 12. Check one to show whether the position is non~sensitive, noncritical sensitive, critical sensitive, or special sensitive for security purposes, lh,s is an ADP position. write the letter "C" beside the sensitivity. 13. Enter competitive level code for use in reduction~ln~force actions. See FPM Chapter , Agencies may use lhis block tor any additional coding requirement, 15. Enter c1assificatlon~ob grading action. For Official Title of Position," see the applicable classification or job grading standard, For positions not covered by a published standard l see the General ntroduction to "Position Classification Standards," Section ll, for GS positions, or FPM Supplement 512~1. ~Job Grading System for Trades and labor Occupatlons,~ Part 1, Section ll. For WPay Plan" code, see FPM Suppl~ment 292-1, ~Personn91 Data Standards," Book ll. For ~Occupalional Code," see the applicable standard: or, where no standard has been published, see the "Handbook of Occupational Groups and Series of Classes" for GS positions, or FPM Supplement 512-1, Part 3, for trades and labor positions. for an potitions n scientific end engineering occupe1l0n., enter the two~digit functional classification code n parentheses lmmedlataly following the occupational code, a,g., "0$ 1310(14)," The codes are listed and discussed n the Generallntroduclion to '''Position Classification Standards," Section V. 16. Enter the organizational, functional, orworking title if it differs from the official title. 17. Enter the nama of the incumbent f there is no incumbent, enter"va~ caney." *18. Enter the organizational location of thel position, starting with the name of the department Or agency and working down from there. 19. f the position is occupied, have the incumbent read the attached de~ scription of duties and responsibilities, The employee's signature is optional, *20, This statement normally should be certified by the immediate super. visor of the position. At its option, an agency may also have a higher-level supenisor or manager certify the statement *21, This statement should be certified by the agency official who makes the classiflcation1ob grading decision. Depending on agency regu~ lations. this official may be a personnel office representative, or a manager or supervisor delegated classificationljob grading authori~ ty. 22. Enter the position classificatiotljob grading standard(s) used and the dale of issuance, e.g. ~Mail and File, GS~305, May 1977." 23, Agencies arb encouraged to review periodically each established position to determine whether the position is Slillll8Cessary and, it so, whether the position description is adequate and classification! job grading is proper. See FPM Leiter (to be incorporated 1nto FPM Chapter 536). This section may be used as part of the review process. The employee's initials are optional. The initials by the su~ pervisor and classifier represent recertiflcauons of the statements n items #20 and #21 respectively. 24. This section may be used by the agency for additional coding re~ qui(ements or tor any appropriate remarks. *25. Type the description on plain bond paper and at1ach to the form. The agency position number should be shown on the attachment. See appropriate instructions for format of the description and for any requirements for evaluation documentation, e.g., ~lnstruetjons for the Factor Evaluation System," in the Generallntroduetion to "Posi

90 DOCD: PRE ENTRY SURVEY (Complete for Permit and Non Permit Spaces) Mail completed form to: OCcupational Health, Environmental, & Safety services Confined Space Program Manager OPS1 Suite 6404 DATE (YYYYMMDO) EMPLOYEE COMPLETNG FORM (Last) (First) (M) N'AME OF SPACE ORGANZATON LOCATON (BuildingiAtea) PURPose OF ENTRy CONTRACTOR NAME (la,,) (First) (M) COR NAME (last) (First) (M) F YOU ANSWER YEll TO THE FOLLOWNG THREE QUESTONS, THE SPACE MEETS THE CRTERA FOR A CONFNED SPACE. 1 S THE SPACE LARGE ENOUGH AND SO CONFGURED THAT AN EMPLOYEE CAN BODLY ENTER AND PEAFORM ASSGNED WORK? 2, DOES THE SPACE HAVE LMTED OR RESTRCTED MEANS FOR ENTRY OR EXT? 3 1$ THE SPACE MQ DESGNED FOR CONTNUOUS OCCUPANCY? YES NO F YOU ANSWER YEll TO ANY OF THE FOLLOWNG QUESTONS, THE SPACE S A PERMT REQURED CONFNED SPACE. A CONFNED SPACE ENTRY PERMT MUST BE COMPLETED PROR TO ENTRY UNLESS TJ-jE SPACE CAN BE MADE SAFE FOR ENTRY WTHOUT ENTERNG THE SPACE E., LOCKNG OUT HAZARDOUS ENERGY SOURCES VENTLATNG ETC. YES NO 1 DOES THE SPACE CONTAN OR HAVE THE POTeNTAL TO CONTAN A HAZARDOUS ATMOSPHERE? 2, DOES THE SPACE CONTAN A MATERAL WTH THE POTENTiAl FOR ENGUL.FMENT? 3 S THE SPACE CONFGURED SUCH THAT AN ENTRANT COULD BE TRAPPED BY NWARDLY CONVERGNG WALLS OR AFLOOR THAT SLOPES DOWNWARD AND TAPERS TO A SMALLER CROSS-SECTON" 4 DOES SPACE HAVE ANY OTHER RECOGNZEO SEROUS SAFETY OR HEALTH HAZARD? 1 WHAT DD THE SPACE LAST CONTAN? CHARACTERSTCS OF THE SPACE 2 A A v H ARDS POSED BY RESiDUE? o YES ONO 4. ARE NTEROA SURFACES POTENTALLY SLPPERY? o YES 3. DOES THE CONFGURATON POSE ANY UNUSUAL PROBLEMS? DYES 6, HOW LARGE S THE ENTRY portal? WHERE S rt LOCATED? ONO 5 ARE THERE ANY PROJECTONS OR OBJECTS THAT COULD CAUSE CUTS. BUMPS, OR ABRASONS? o YES ONO 1 DOES THE SPACF CONTAN ANY MECHANCAL EQUPMENT? 2 ARE THERE ANY FLUD LNES ATACHED? 3 WLL ANV HAZARDS 8E POSED BV PORTABLE EQUPMENT TAKEN NTO THE SPACE? 4. 1$ THERE A POTENTAL FOR ENGULFMENT? PHYSCAL HAZARDS., '.' YES NO 5, ARE THERE ANV EXTERNAL HAZARDS SUCH AS EXPOSED ELECTRCAL COMPONENTS, MECHANCAL EQUPMENT. OR VEHCULAR TRAFFC? t Will ANY NOSE PRODUCNG OPERATONS BE PERFORMED? OTHER CONSDERATONS, ~ "'" YES NO 2. ARE THERE ANY POTENTAL RADATON HAZAROS POSED 6Y THCKNESS GAGE SOURCES OR X RAY EQUPMENT? 3 S THERE ANY POTENTAL FOR VERMN OR POSONOUS ANMALS SUCH AS SPDERS AND SNAl<ES? FORM D7150 REV APR 2001 (Supersed6S 071$0 NOV 2000 which S ODSoiets) - Page 1 Page 1 pproved for Release by NSA FOA Case #4287

91 DOCD: , COULD THE ATMOSPHERE BE DEFCENT N OXYGEN? :: COULD THE ATMOSPHERE BE OXYGEN ENRCHED? ATMOSPHERC HAZARDS, '" ' YES NO 3 WHAT AR CONTA.MNANTS MGHT THE SPACE CONTAN? ' " 4 WilL AR CONTAMNANTS BE NTRODuceo NTO THE SPACE 8Y PROCESSES LKE WELDNG. SPRAY PANTNG OR SOLVENT CLEANNG? 5_ COULD THE ATMOSPHERE BE FLAMMABLE? 6, DOES THE ATMOSPHERE HAVE THE POTENTAL FOR BECOMNG FLAMMABLE? TESTNG LOG OXyGEN COMBUSTBLES CARBON MONOXDE (00) HYDROGEN SULFDE (HzS) OTHeR (Specify) 19,5 23.5% <10% L.EL <25 ppm do ppm TME RESULTS NTAL TME RESULTS NTAL TME RESULTS NTAL TME RESULTS NTAL TME RESULTS NTAL FORM D7150 REV APR Page:2 Page 2

92 DOCD: MARYLAND PROCUREMENT OFFCE 9800 SAVAGE ROAD FORT GEORGE G. MEADE, MD PRE-SOllCTATON/PRE-AWARD CONTRACT/MODFCATON CHECKLST PR, PR o CERTFED VEARTYPE FUNDS $ o SUBJECTTO 0 NCREMENTALLY' FUNDED PRODUCT/SERVCE o COMPETTVE FOLLOW ON TO COMPETTON? 0 FULLY FUNDED o SOLE SOURCE DYES DNo RFP NUMBER CONTRACT TYPE o COMPLETON NEG o TERM CO (Brancl'l) PRMARY COR 10rg) (Secure Phone) SOURCES CONTRACTOR CONTRACT/MOD NO ADDRESS PONT OF CONTACT PHONE BASS OF AWARD CONTRACT AMOUNT Sa,ic) TOTAL CONTRACT VALUE TO DATE OPTON # OPTON. $ $ $ $ $ $ $ $.,,":- OPTON' PRE SOLCTATON REVEW PRE-AWARD REVEW NEG DATE NEG DATE CO DATE CO DATE 2ND REV DATE 2ND Rf::V. DATE LEGAL REVEW DATE LEGAL REVEW DATE NEG 'CO PRE SOLCTATON NOTES 1, Minutes from the 8SM (> $1 M) 2. Highest Classification on File Folder 3. Mission mpacvur~j(~r~jstatement (MPOAS (1) 92) 4. TAB A (Provided by Technical Element) 5. COR Certifications (MPOAS 342_203-92(b)) 6. Evaluators Certifications (MPOAS 315,305-90) 7. PP (Provided by Technical Element) 8. CORLs (DO 1423s and DO 1884s) (Provided by Technical Element) 9. Approved DO 254 (Provided by Technical Eismenl) 10. GCE (Non Commerical > ~1M) f':\pproved for Release by NSA o~ (MPOAS (a)(3)(90 ) FOA Case #42871 FORM C2698 REV JUL 2001 (Supersedes C2698 Rf:rv SEP 2000 which is ObSolete) 'LEGEND: X"" Complete and Correct; 0.. Missing: '" ncomplete: NfA ;; Nol APPlicablel

93 DOCD NEG CO PRE SOLCTATON NOTES.,,. SOW/PO/Other Specifications (Provided by Technical Element) 12. Performance Based Acquisition 13. Evaluation Plan (FAA ) 14. Evalua.tion criteria/relative weightslsi~nificanoestatement (FAA , OFARS , MPO S ) 15. Award Fee Plan (FAR , OFAR$ ) 16, Foreign Buy Justification (ProVlaed by Technical element) 17, AC~UjSjtjon Brief to ChieflDA3 (>$5M) (M OAS ) 1a, Milestone Letter (MPOA$ ) 19. GFE Technical Memo (Provided by Technical E/omont (MPOAS 345) 20. Just. Non-Dole~ation of ~roperty Admin (MPOA$ Table 42.3) 21. Justification for Special QA Tech Memo (FAR ) 22. Personnel Qualifications 23, Use of Technical Assistance KR 24. 8(a) Offer and Acceptance Lettor 25. Technical CCA/Sole Source Justification (Provided by Technical Element) 26. Source Selecfion nformation (File Stamp) (MPOAS ) 27. SF 9~ W~Deter'jNot tor Construction) (FAR 2.1,MPO S ) 28, Union Notification for Recompetition [FAR (8)J 29. EEO Clearance Requesf Letter (>~10M) (FAR ) 30. Y2000 Clauses (T/HW/SW/FW) 31. Section 508 Compliance (FAR 39) 32. Contains All Proper Clauses 33. Past Perlormance ssues Addressed (FAR 15.3) 34. Solicitation contain~ ~qfp with appropriate clauses (MPOAS , )) 35. DA3 CCA (MPOAS ) Approval (MPOAS ) 36. Advisory and Assistance Services (MPOAS 337) 37. GFE" DA3 Memo (MPOAS ) 38. Small Business Review ~DD 257~ (DFARS (9)(8), ) 39. Davis - Bacon Act~Constructio~ (FAR M OAS ) 40. Non-1PJ."icabili~ Justification for SCA (FAR b)(4)(iii)(a)) 41. Justification for Use 01 Pre~Sol Cont. (MPOAS (h)) 42. D&F for Oral Solicitation (MPOAS (f)(91)) 43. D&F for Foreign Buy (MPOAS ) 44. proxi~ O&F ~ KTftt:.ocatlon Approval (MPO (90)) 45. D&F O~anizationai Conllict Of nterest (MPOA ) 46. CO's Determination to nclude Options (MPOAS ) 47. CO's Determination to Not Evaluate Options (MPOAS (b)), 48. D&F Contract Type (MPOAS 316.6) FORM C2698 REV JUL Page 2 'LEGEND: X:;; Complete and Correct; 0 4 MiSSing; 1 ncomplete; NlA '" Not Applicable

94 DOClD NEG 'CO PRE-AWARD NOTES 4". },L'1:l:.,;;ersona', \,,\lryjc.l" (FAR , MPOAS (c)4(ii)) 50. Multiyear D&F Be Present Value Analyss (FAR 17.1, OFARS 217.1, MPOAS 3 7.1) 51. Justification of rade off 52. ~~royaj to Eliminate to One Offeror ( OAS (c)(5)) 53, Technical Evaluation (FAA ) 54. EEO Clearance (FAR 22.8, MPOA (a)(2)) 55. DOL Wage DeterminalionlC6A (MPOAS ) 56. Small Business Sot Aside Pre-Award Notification (FAR (0)(2)) 57. Section K Certifications Addressed 58. Ade~uat9 Accounting System (FAR 16104(h)) 59. SUbconlrac1in~ Plan Reviewed (MPOAS , , >$SOOK - Laroe Business) 60. Bid Bond Reviewed (Construction) (FAR 28, 101) 61. Certified Currenl Cosl & Pricing Data (FAR ) 62. Copy of DCAA AudlVDesk Audit 63. Wetted Guidelines JDD 1547) (Of, RS PriC Ne~tiation Memorandum (MPb ) 65. Final Proposal ReviSionJC/DA3 Approval 2nd or more) (MPOAS (e)(i)(b) 66. Confirmaton of Negotiations Letter 67. Ap~rovai to Modify UCA (1.1 OAS (c), Table317-2) 68. CO's Reasonablene.s of Frlce (MPOAS 315.4) 69. Negofiator', Memorandum (MPOAS HlO) 70. Approval of Award (MPOA5301.6O-2-1) 71. CongreSSional Notlflcalion 1$5M Pius) (MP AS ) 72. GCE Dov. of 30% (+1-) Documenled (MPOAS (a)(3 (90)(0) 73. :if~roval for Use Of~~~Hontract Costs ( OAS D&F Fixed Price LOE > $l00k (FAR ) 75.1YPCral for Use of Overtime Premiums ( AS ) NEG 'CO CONTRACT NOTES 76. UN"::S.~p:(AWard 0 0. without discussions} Yes No f Yes. Frace'!ures fallo~oo. (DA3 One~Step Eval. Procurement Handbook) ~~rle:j~(~ppra~e<11 (MPOAS lem 77, page ) 77, ~ovt~ t:.inanoiat ~ slstanoe (FAR 32, MPOAS 332 (Progress Paymenls; etc,) 78. nvoices - Copy to COR (MPOAS ) 79. UCA (DA3 ApprovallUrgency Statemenf) (MPOAS ) 80. Approval lor Use of Notice of Award 81. Letter of Delegation 10 DCMC (MPOAS ) 82. Nan-Dele8:tion to DCMC Justification (MPOAS ) 83_ GFP Listed in Contract (MPOAS 345)! - FORM C2698 REV JUL Page 3 'LEGEND X.. Complete and COrrect; 0 = MiSSing:.. ncomplete; N/A ;;;: Not Applicable

95 DOCD: NEG 'CO CONTRACT NOTES 84. ~FP Del~tion LtflNon+Oelegation Just11ication MPOAS 2.202) 85. Mu't~'e Fund Cites/Allocation of Contract Costs (MP AS , ,91) 86. All Award Fee Clauses ncluded (MPOAS S 90(d), FAR ) 81, Contract Clauses are Appropriate 88, Data Ba$e Feeder ReportkDD 350) (MPOAS "ARS ) 69 Abstract of Offers (FAR ) 90. PR Funds DiS~osition Sheet (Over$100K) (MPOAS (4)) 91. Contract Distribution List 92 Payment & Perlormance aoods (FAR ) 93. COR Letters (MPOAS ) 94. Notices to Unsuccessful Offerors (MPOAS ) 95, Contractor nsurances as Required (MPOAS , FAR 26.3) FORM C2698 REV JUL 2001 Page 4 'LEGEND: X'" Complete and Correct; 0 '" Missing; -ncomplete; NlA '" Not Applicable

96 DOCD: PRCNG REQUEST TO FROM DATE m. PR NUM8ER CONTRACT OR RFP NUMBER PRAMOUNT CONlf"J,ACTOR PROGRAM NAME Cl.ASSFCATON (Cost) Technical) CONTRACT TYPE o SOLE SOURCE o COMPETTVE (Copy 01 PP and Cost Eva/ual/on criteria attached) ACTON TO BE REVEWED PR FUNDNG BY YEAR AND TYPE BASC $ GFY FUNDNG OPTON # 1 $ BASC $ OPTON.2 $ OPTON' 1 $ OPTON' 3 $ OPTON.2 _.. $ OPTON #4 $ OPTON # 3 $ TOTAL $ TOTAL $.- MAJOR SUBCONTRACTORS AMOUNT TECH El.eMENT $ PONT OF CONTACT $ PHONE(Securej (Non-Secure) $ [ ---_..- This 0 s 0 is not anticipated to be an unpriced action with a ceiling price of _$ _ Award date of o A Technical Evaluation has been requested and will be forwarded upon receipt. o This is an ncentive Contract and the technical element is 10 address technical risk issues so as 10 derive incentive range, D This is a follow on to Contract No. AODTONAL NFORMATON FOR THE cosr ANALYST Please advise the undersigned of the N15 pomt ofcontact for this requirement. CONTRACTNG SPECALST (Nl) PHONE; FA)( N15 USE ONLY DATE RECEVED NEGOTATED AMOUNT AUDT REOUESTED FEE/PROFT % D & B RATNG ASSGNED TO SAVNGS AMOUNT AUDT RECEVED COMPLETON DATE (Negotiations) (PNM senfto CO) FoRM J2377 Rev NOV 97 (Supersedes J2377 JAN 76 which is obsolete) "1<:.':f.l?"d.rU::~A.M1.N~l'l [Approved for Release by NSA ~~ b FOA Case #4287

97 D Red JACKET NO, (Assi(1'ed at GPO) DOCJ?lt-lT~8 "~G REQUSTON SF 1To the PUBLC PRNTER Please furnish the followina: D """ mom (Deportment Of Governmonll;.stobltshmenl) (B\Jre<:l\,l or OrflCG) """ REQU$liOl\l NO AF'Pr.OPR\110N CJ-lAAGEABlE/APPllCABLE LAW ~LJNG ADDRESS CODf (8.AC ) AUTHORZED BV Tlr~f QUALlTV! VEL FORM NO Q\.JAJ'H,TY (UrHs of ~),sh&d products) FNlfrjEQ PRODt.,CT (CheCkOne) C.A5SlFCATON o ~~~~el> o rs:~fs!ts 0 o POdiO Sets 0 01"'" TObll'1ts ($pecltv) H., U<U:~ Rt.,;t:J (wepelrtmen1) (lo/equi~itlon No) (Joclt;Qt No,) STRAP Wl1H ReQJSTON NO, " "" Text S~ "'0 a:;z Cover ~" if OTHER'(SPe<;ty) tll(:ll L..HOh...E(",rode. COlO(, OM basi! W61Qnt) 1~.V"U...HVf\...t ( any) COLO~S)OF NK FURNSHED (Magl"etc topel) (Negoli",,,) (Camero l..opy) ~;Vi\Jnu&Cllp,) \.,. 00 ptln,<:l'v <';<;1-"! PREVOUS JACKET/REQ { r6pfll'lt) 15 o )'.ecl )"vl'il o Cth9' " lex! lype (f>o;nt, Face. leaded/solid) DSPLAY TYPE (Face) ~n;~~ Boc~fLaft lop QMt tol, LT ~ -"" ~ 0,YP PAGE >N10fM NO. of Col. (PiCO!) " PPN, ~G~~MU:; S~~~~o< ;:fn:~~s~:h{rrw:n6& llusmatons (TotO/) PCk UP mom Jlckil No. """.No RE$TOFlEm f1a.d AEPROOlCf6LES (Sp«;tfJ (Mrg.r., typf,1llq._ bollomtoiol JACKET WeekS Co" 1 Width ORGrNAL ONE SDE HEAD TO rt AO TO (PrlnlOf on O 1'1'1'1' EM""" R~.~~~ PERFORATE SCORf Position NUMtltlot V'CUSl~) Color of ink ONLY HEAD FOOT 8lr,dery) TO!:: SZE HAT (''''CM5) (OLD TO SZE TRMMED PAGES foldng/n9;?ts Ul FORMS, S:15. PADS (nches) PAGE ll~hel;l 0 x x BOOKSPAMF'HLETS x?; LOOSEUAF WRE smch '~':""! ~~~~Vt '" 0 ($oe) (SoddO) (No.) ON FOLD BOUND 1(5911) f(separate) ~w CASE (tjotertal ood COlor) STAMP TTLE (Bindery) Cover Spine Geld m.gol:l nk (colot) " {$e$ln (Sheefs {\~~~ &11 Sf '~DCORNERS ~ ~~:) (Sliter) (?o~.) ft..stp~f jjh~h/ (Shope) ~~~5~' (Fb, ) a:.. GATHER Pod) inset) (Dio-n) '10 Center> (No,) (PoS11or) (E"Kplo,n) CARllOO (Bleed) UP DVDeRS NTERlEAVE '~,,' (Tob) (-~ Up) R "QuESTED PRco>' DATE "(Galley) (Page) 1~~oll~0LU«~o~W ffiool's JO 'rj~?s'\\"'1 0 Z,. f,le<;::tu~sl DDEUVE?Y OA"E ~AF 1i~NK lt\~u N SUTABLE OTHER PACKAGNG (Sp~lfy) OOANTTV N cf'h)( N ~SHEO <J>W "'" AP ""<AGE CAlf""" i!i~ [)~UVmlO [~ -.J ADD!lob:N~A~'''''''r'''o:'l'~M~A'::''O~N:: (f:ls l FOR ADDnONAllNFORMATON CONTACT (Nome Or'\ClleleotTone Number) BilLNG ADDRESS (ir BAC has '101 be9"l m$lqr'led) c:ermy ha~ this work is Ou!hofiled by low and nec6:ls0ry,0 the conduct of the busness of lhe obove mentiof"'ied government es10blisl'1r'm1'\1, STANDARD ~ORM) (Rev July 1979) Presclibed by GpO Jie 44 of the us, Code CorlrO NO 1,110 (Authorilif1g S;onollJre) NSH 75dlJ..0M34<3Qftj (litre) PREVi(XJS EDTON NOT USABLE

98 DOCD: SECURTV CLASSFCATON (if any) PRVACY ACT NFORMATON REQUEST PleBS8 PRNT or TYPE!! Submit two (2) caples. NOTE: False statements subject to criminal penalties. See Public Law , BB stat (5 U.S.C. 552a()) Privacy Act Statement: Authority for collecting information requested on this form is contained in 5 U.S.C. 552(a); 50 U.s.C. 402!lQllt and Executive Order NSA's Blanket Rouline Uses found at 58 Fed, Reg (1993) and the specific uses found in GNSA06, 03, 09, 10 and GNSA17 appiy to this informalion. Authority for requesting your Social Security Number is Executive Order The information provided will be used (primarily) to identify the individual requesting Agency records and 10 identify the record(s) requesled, Disclosure of requested information, including your SSN, is voluntary, However, failure to furnish requested information, other than your SSN, may result in the delay or denial of the processing of your request REQUESTER NAME (Last) SECTON REQUESTER AND RECORD DENTFCATON (Mandatory) (First) (M) SOCAL SECURTY NUMeeR ORGANZATON HOME ADDRESS (Street) (City) (Stars) (ZP Code) PHONE NUMBER (Secure) (Non-Secure include Ares C0d8) (HOme include Area Code) RECORDls) REQUESTED FOR o REVEW 0 COpy SGNATURE (Only required if roqu(.tsted record(s) for yourself) DATE (YYYY MM DD) DESCRPTON OF REQUESTED RECORD(s) (Please be specific) NDVDUAL WHOSE RECORD S BENG SOUGHT F OTHER THAN REQUESTER NAME (Last) (First) (M) HOME PHONE NUMBER (n<:fude Area COO,,) HOME ADDr:lESS (Slr""O (City) (State) (ZP Code) SOCAL SECURTV NO. DELVERY OF RECORD(s) D MAL TO MV HOME ADDRESS o give pe"nlssio" lor the individual listed above as the "REQUESTER", to relriave these rbcords on my behalf. SGNATURE REPRESENTAtVE'S LEGAL CAPACTY (Copy ofauthonz.mg document must be artachecj, e,g., court's guardianship ordtjr, power of anomey, etc,) (Printed Name) (Signature) (TtlB) DATE REMARKS SECTON FOR AGENCY USE ONLY OFFCAL:S SGNATURE OFFCAt:$ TTLE DATE FORM REV AUG 2001 (Supersedes REV JUL 2001 which is ObSolete) SECURTY CLASSFCATON (il any) ~pproved for Release by NSA ~~ FOA Case #4287

99 DOCD: ATTENTON: PLEASE READ PROR TO COMPLETON OF ANY FORMS PRVACY ACT OF 1974 NOTCE n accordance with the Privacy Act of 1974 (Public Law ,5 U.S.C. 552a), you are hereby notified that: (1) Public Law 86 36, Public Law , Title 5 U.S.C.; Executive Order 10450, Executive Order 12958, and Executive Order 12333; Director of Central ntelligence Directive 1/14; NSAlCSS PMM Chapter BOB authorize the National Security Agency/Central Security Service to receive and maintain personal information on applicants and employees. (2) The information is required to determine and assess your qualifications and suitability for NSAlCSS employment and for access to sensitive cryptologic information and NSAlCSS facilities. (3) The information is to be furnished to officials of NSAlCSS and of other Federal Agencies charged with investigating and evaluating the applicant's qualifications and suitability. nformation provided by you, including information on possible or actual violations of criminal laws, will be disseminated as appropriate to Federal, state and local authorities with law enforcement responsibilities. NSA's Blanket Routine Uses, found at 58 Fed. Reg. 10,531 (1993) apply. (4) Disclosure of the requested information is voluntary. f you do not provide the requested information, this may result in processing delays or the inability of the Agency to reach a final determination with respect to employment, clearance, and access to NSAlCSS spaces and information. The request for your social security number is authorized by Executive Order Providing it is voluntary. t will be used to identify you during the investigations and evaluations referred to above. Failure to provide it will delay your processing. A COpy OF THS NOTCE S AVALABLE FOR VOUR RETENTON UPON YOUR REQUEST C&ffily that / have rea.d and understand the above. SGNATURE DATE FORM P1613A REV NOV 98 (Supersedes P1613A REfNNoV9J which is obsolete) NSN: 7540 FM FOR USE WTH FORM FD 2S8, FNGERPRNT CARD, ONLY pproved for Release by NSA FOA Case # 4287

100 DOClD: PROCUREMENT REQUEST SOURCE SEL.ECTON NFORMATON see FAR OAT~13 PA/AMEND 4. DESREO/REOURED \5. PRiORTY 6. PLANT EQUPMENT AMENO NUMBER DYES DNo o WORK N PROCESS? TO 8. THRU -19, FROM 10. PROGRAM /TASK 11 ORGNATOR OF REQUEST (N<1me. organizl;1tion phone no.) 12, PREPAREO BY (TYf)tld name. signature, phofle no.) 13 SHP TO MARK FOR,14, NTERNAL DELVERY NSTRUCTONS (org, buhl.1iflg, room no. recipient. pllone flo) 15, SUGGESTED SOURCES (Name, address, xip code, ptlone no,) A 16, NSPECTON AND ACCEPTANCE A 16. NSPECTON AND ACCEPTANCE NO ORGN f-_d_ca_s -+_-+_-jl-0_e_st_'n_a_t_'o_n_by_pr_o_j_e_ct_en_g_'_n_ee_r R_E_P_R_ES_E_N_T_AT_'V_E _ BY PROJECT ENGNEEA REPRESENTAT1V~ SEe ATlACHMENTS DESCRPTON OF SUPPLES SERVCES QUANTTY UNT T TEM NO. A (nclude manufacfurer's name amparr l1um~r if available) UNT TOTA TEMPEST SAFEGUARDS NECESSARY: YES NO NOT APPLCABLE The PR is authorized to deviate by % of he total amour.t cited without returning to originating organization. 18. ACCOUNTNG CLASSFCATON (Start typing 6xtreme Jeft margin and type o,,~ line for each Fund Cit6) 21 FOR ORGNATNG ORGANZATON'S USE 22. SPECFC TEM CERTFCATON D TEMS REQUESTED HEREN ARE THE ONLY MATERALS WHCH WLL SATSfOY THS lgchncal REQUREMENT O~ THE OFGNATNG OFFCE AND EOUVALENT TEMS ARE NOT ACCEPTABLE, 23 FOR PLANT EQUPMENT ORGNATOR HAS SCREENED rue MASTER PEAS LSTNG FOR A.Ll CPO ACCOUNTS LOCATED AT TlE FORT MEADE FANX COMPLEXES O ANO THS TEM S NOT AVAlLABLl1 FROM EXSTNG RESOURCES on APPROVAL OF REQUREMENT (Typed name, tilffj, sl'gnarut9, date) 25, ASSGNED TO 26 L1 USE NAME DATE OATE FEDERAL SOURCE SCREENNG COMPLETEO, REASON FOR NON,FEDERAL ACOUSTON (OELVERY) (COST) (NAME OATE) NON-AVALABLTY O 21, CERTFCATE OF AVALABLTY GerMy thai lunds ded ~ereln are a",ailallie and are comrni1tecl. Ol;.gations flgl,m&d putsuajll to 1his lutn,mty lihall not exceed the dollar value l>tlllea hl1rooo wnhou 8$lProva or llf amendml,llll 10 this ault1orily. SGNATURE k=--~==--f--+ L4 USE DATE NTALS OATE rhe,art ltlls the FORM J135 REV AUG 92 (Supersedes J135 REV AUG 89 which is obsolete) NSN: '1540-FM..Q SOURCE SELECTON NFORMAT;.;O:.:.N:.:.-:.:.S=EE::.:..:FA.;.R.,.:3:.:.,1..:,04"-;..,--~,,,,"",,---, Approved for Release by NSA FOA Case#4287

101 ~~Mitli14BUiJEST (Continuation Sheet) mom NUMBER SOURCE SELECTON NFORMATON,. PAGE PAGES 2. PR NUMBER "SEE FAR OF DESCRF'TON OF supples SERVCES (nclude manufacturer's name and part number jf available) QUANTTY UNT UNT AMEND TOTAL NUMBER pproved for Release by NSA o~ FOA CElse # FORM J135c REV AUG 89 (Supersede. J35c REV MAY 88 wh,ch may be "sed unf,1 dspl.(ed) NSN FM SOURCE SELECTON NFORMATON" SEE FAR 3.104

102 DOCD: SECURTY CLASS1F1CATlON PRODUCT PUBLCATON REQUEST 1. Prepare this form in triplicate and forward those copies, along With your report to Y197. Y197 will complete Job Number and Date Distributed fields and will return one copy to the originating office and one copy to P "SPEC'AL~ distributions require prior P0513 approval. Please bring your proposed "SPECAL b distribution to P0513 at 2C099, or call 963~5906s for approval. Please be aware that cenaln organizations have different addresses for electrical and hard copy product Y197 JOB NUMBER DATE OF REPORT DATE DSTRBUTED REPORT TTLE DSTRBUTON (nclude Distribution Symbol andany Plus, "L6$$", and/or MicrOtChe Addressees. For dspec1al~, list alladdressees). ORGNATOR'S NAME ORGANZATON SECURE PHONE RELEASNG AUTHORTY DATE RELEASED PRNnNG REQUREMENTS -NO-.-O-F-MA-S-r-ER-S [ COPES. PRNTNG NSTRUCTiONS FORM A2345 REV MAY 95 (SUpe'Sed8S A2345 REV NOV 92 which is obsahjkt) NSN: 754lJ.FM OO pproved for Release by NSA FOA Case # 4287

103 DOCD: PROGRAM ACCESS LOG Please maintain this listing by Program with inclusive access dates and the access authority (COR approval). Access level shouid be indicated by unclassified digraphs or trigraphs. Return this log with the Debriefing Statement and Access Letter when the individual no longer requires access on NSAlCSS Programs. NAME (Lt1$t) if's/) (Middfe) SSN PROGRAM NAME DATE ACCESS LEVEL AUTHORTY DATE PROGRAM ACCESS CEASED ~fproyed for Release by NSA ~~ FOA Case #42871 FORM G,052 REV DEC 2000 (Supersedes G3052 REN NOV 98 which s obsojele)

104 DOClD: PROGRESS PAYMENT APPROVAL TO FAOM DATE CONTAACT PROGRESS PAVMENT 1, Attached is one (1) copy of subject contractor's request for Progress Payment. 2, Please review said request and advise the Contracting OHicer whether or not the contractor's technical progress of the work under the contract is commensurate with the amount billed on the SF Paragraph "C" ot the Progress Payment clause (FAR ) lists a number of adverse conditions, as defined in FAR , including failure to make progress and unsatisfactory financial conditions which may be cause for suspension or reduction of Progress Payments or an increase in the rate of liquidation, f any of these conditions are found to exist they will be referred immediately to the Contracting Officer. The Contracting OHicer, after appropriate collaboration with N15, N411 and your office, will make a decision whether to suspend or reduce Progress Payments or revise the liquidation rate until the problem(s) are resolved with the contractor. 4. t is further requested that this office be notified in writing, of your findings NO LATER THAN the date indicated. DUE DATE CONTAAcnNGlPAOCUREMENT OfFCER TO THRU FAOM COMMENT NO.2 o APPROVED 0 DSAPPROVED (Specify below} PROGRESS PAVMENT NUMBER NAME TTLE REMARKS pproved for Release by NSA FOA Case # 4287 FORM J0001 REV MAY 94 (Supersedes Jl0001 APR 84 which s obsolete) NSN: 7S40-FM-OOl-3396

105 DOCD: PROGRESS PAYMENT RECORD 1. Progress payments are authorized not to exceed % of the total amount of this contract. 2. Recoupment of progress will be made at %. DATE DOC. REF OBLGATON DOLLAR VALUE OF TEMS PROGRESS NVOCED UNNVOCEO PAYMENT LMT PAYMENTS LQUDATONS UNLQ. BALANCE -~. hpproved for Release by NSA ~~ FOA Case # ACCOUNTNG CLASSiFCATON CONTRACT NUMBER TEM NUMBER FORM F5196 REN MAR 99 NSN 7540 FM

106 _mn_m DOCD : sec3,~;b,a;d;1n,,"~'="')~ PROPERTY ACCOUNTNG HAND RECEPT USE'R'S NAME NSA BAR CODE NO EQUP, TYPE (i,e., PC, W,Sla. Laptop) \ SD 'ped P 0!'table ComplJting Device ORO ROOM PHONE TEM RETuRNED TO PROPERTY OFFCER. USeR S RELEASEO FROM RESPONSlfUUTY. MODEL SERAL Nl)MaER "'G clnslticallon '(PCD) COMMENTS OATE PO SGNATURE....- _ _-- BE$po~$'Blurv STATEMENT acknowledge receipt of the equipment listed above. ull(er-sfano that the equrpmentls the Propc;Jrty of the National SecUflty Aaency (NSA) and!.t& United States Government and must be mlurned to the above organization upon reassignment. retirement, resignation, or termination. also understand thai NSA may require the retum of the above eqlllpment al any lime and agree to return it promptly upon demand. agree nollo transfer any of the above equipment to l' vendor, other organization, or other il'ldlvidual without first consulting with the Division Property Accounting Officer. n accordance with the procedures set forth in the NSAlCSS RMM 111 ~5, understand hat may be lound finarlclally liable for loss, damage or destruction of equipment resulting ftom my OroS neolioence, willful misconduct Or' dljtliberale unauthorjzed use. USER SGNATURE PROPERTY OFFCER For~M J124AA REV OCT 2001 ($upelt;&de's J244A REVMAY 2001 wtj/c1l ilj ob$olefej.. _... DATE SECUR~i~~~:a~~r~~~:1~:~~:~

107 DOCD: PROSPECTVE CHLD CARE EMPLOYEE CRMNAL HSTORY BACKGROUND NVESTGATON CONSENT PRVACY ACT STATEMENT AUTHORTY FOR REQUESTNG NFORMATON: Public Law ; GNSA09 and GNSA10. AUTHORTY FOR REQUESTNG SOCAL SECURTY NUMBER: Executive Order 9397, PRNCPAL PURPOSE(S) FOR WHCH NFORMATON WLL BE USED: To conduct a criminal history background investigation to determine eligibility for a position involving the provision of child care services, ROUTNE USES(S) OF NFORMATON: Certification as to your eligibility for a position involving the provision of child care services at an NSA facility or a facility operated under contract with NSA will be provided to Children's World, nc, NSA's Blanket Routine Uses, found at 50 Fed. Reg. 22,584 (1985) also apply, DSCLOSURE OF NFORMATON: Mandatory. EFFECT ON NDVDUAL F REQUESTED NFORMATON S NOT PROVDED: Will render you ineligible for a position involving the provision of child care services at an NSA facility or a facility operated under contract with NSA, Failure to provide your SSN may delay the processing of your background investigation. As an employee or prospective employee of Children's World nc,. you are, or will be,in a position which involves the provision of child care services to children under the age of 18 at a facility operated under contract with NSA. Public Law requires that a criminal history investigation be conducted on all individuals either currently in or applying for such position. Therefore, by law, the National Security Agency is required to conduct a criminal history background investigation on you. The information provided on the attached security forms and your employment application with Children's World, will be reviewed solely to determine your eligibility to provide child care services in accordance with P.L, and implementing regulations, You are not being sponsored for, nor will you receive, a security clearance for access to classified information, Disclosure of the information is mandatory; failure to provide the information will render you ineligible to provide child care services at an NSA facility or facility operated under contract with NSA, Your signature below acknowledges that you are aware that consent to this records check is a condition of employment at an NSA facility or facility operated under contract With NSA. Your signature also acknowledges that you have a right to obtain a copy of the criminal history reports made available to NSA and the right to challenge the accuracy and completeness of any information contained in the reports in accordance with the provisions of the Privacy Act. certify' have read and understand the above. Typed or Printed Name (Last, First, M Signature Date Date rorm G6747 JUL 93 pproved for Release by NSA FOA Case # 4287

108 DOCD: PS AFTER HOURS CHECK SOCiAl SECURTY NU~BER ORG. (il llppjicsbl9) SPONSOR (,Yacp/K::MJ6) DATE (YYYYMMDD) TME LOCATON OF NDV WHEN CHECKED CHECKEOBV REMARKS SZE 5" x 3" FORM AVALABLE ON LGHTWEGHT CARDSTOCK THROUGH THE AGENCY STOCK SYSTEM pproved for Release bjt NSA FOA Case #4287

109 DOCD: SECURTY CLASSFCATON (if.any) EMPLOYEE SELECTON PROGRAM PSYCHOLOGCAL EVALUATON REPORT NAME (Las') (First) (Mi) SOCAL SECUf':!TY NUMSER 1. PSYCHOLOGCALiASSESSMENTBATERY.ADM'NSTFlATON OBSERVAnONS o COMPLETED QU\CKLY MNUTES TECt-tNCAN DATE (YYYYMMDD) 2. PSYCHOLOGCAL ASSESSMENT BATTERY REVEW PSYCHOLOGST DATE (YYYYMMDO) NTERVEW FOCUS o WTHN NORMAl LMTSMMP Z o ESSENTALLY NEGATVE PERSONAL HSTORY KEY FNDNGS ~. CLNCAL NTERVEW o NO SGNFCANT HSTORY/SSUES PSYCHOLOGST DATE (VYYYMMOD) RSK RATNG: o LOW o MODERATE o HGH O 4. PSYCHOLOGCAL EVALUATON REVEW CONCLUSONS o No indication of vulnerability to poor judgement, unreliable behavior or significantly impaired functioning D No indication of substantial risk for poor judgement, unreliable behavior or significantly impaired functioning RECOMMEND DSCUSSON AT PERSONNEL EVALUATON PANEL (PEP) PSYCHOLOGST DATE (YYYYMMDD) RSK RATNG: o LOW o MODERATE o HGH o REFER FOR DSCUSSON AT PEP.. 5. PERSONNEL EVALUA'10NPANE!L REPRESENTATVE DATE (YYYYMMDD) FNAL RSK RATNG: 0 LOW 0 MODERATE 0 HGH 0 PSYCHOLOGCAL RSK COUNSELNG FNAL PEP DECSON: 0 Continue Processing 0 Discontinue Processing 0 No Decision 0 Return to Panelafte, 811RePGRePsych FORM PMOS REN MAR 2002 SECURTY CLASSFCATON i/any) pproved for Release by \lsa FOA Case # 4287

110 DOCD: (Pirsr) (M) AGE Privacy U.S.C. SSN is Statement: P.Jth for collecting inb is cootaintld n 50 u.s.c. 402 l1qj2; 50 3(C)(6) and EO 10450, 10865, 12333, 12958, and 12968, AlAn lor collechng NSA's et Routine Us.. found at sa ~, Reg, 10,531 (1993) llruj 10 ajll)ly 10 lhili infq. Tho r&q. 11'110 wlll be used SECURTY CLASSFCATON (if any) "".'.' :3.~::.,,,,\;;0 ':f~i~:art~r makino a tlworable decisiot'1, Or'...v Oec:iSiOl1 allll" PSYCHOLOGCAL SERVCES' REASSGNMENT QUESTONNARE Use Page 6 for Additional Comments NAME (lasti SSN tdinq y()1.r MaUl nmenl. TOOAY'5 DATE (YYYY-MM-OO) o MALE o FEMALE D CVLAN 0 MLTARY 0 pes 0 TOY DSPEC'ALOlJTY FOR AGENCY AFFLATES ONLY Joe TTLE RANK OR GS LEVEL (if appl<;alj18j EOUCATON (Highesf grade O( degree)martal STATUS FOR ALL TO COMPLETE o 51NGeE 0 ENGAGED D MARREO o DVORCED o WDOWf::L.l D REMARRED CHLDREN NAMES CHECK APPLCABLE COLUMN WLL ACCOMPANY YOU? AGE (Lastj (First) (MJ BOLOGCAL ADOPTED STEPCHLD YES NO Please respond truthfully to the followmg questons, Fat/ure to rio so can negatvely affect your selecton. Your responses are considered confidential psychologica/lnformation, and handled accordingly. For YES" responses, please provide comments, FAMLY OF ORGN: YES NO COMMENTS 1- Were you raised by your biological parents? (f NOT, who raised you?) WAS THER';: 2. Any abuse in your household? 3. Naglect of you and/or your siblings? 4. A serious rift in your relationship with a parent or sibling? 5. AlCOhol or drug abuse? 6 Criminal behavior by a family member? 7 A major psychiatric disorder (e.g. manic-depressiv8 inesslbipolar disorder, schizophrena, clinics depression) on the part of a family member? 8. An attempted or actual suicde by a family member? 9. A psychiatric hospitalization of a family member? 10. Accidental or violent death of a Jamily mamber? FOAM P18178 OCT Paye 1 SECURTY CLASSFCATON (f any) Approved for Release by NSA o~ FOA Case # 4287

111 DOClD: SECURTY CLASSFCATON (if any) Use Page 6 for Additional Comments WORK: YES NO COMMENTS N THE LAST 3 YEARS, HAVE YOU AT WORK? 11. Been counseled lor performance problems 12. Had conflicts with managers or co-workers 13, Been the subject of an investigation or complaint 1. Been the subject of an adminstrative action (formal counseling, suspension, etc.) 15. Been involuntarily transferred or removed from your position 16. Had your security clearance suspended or revoked (Milit.ry ON/,..Yj 17, Received a lener of counseling, Article 15, Captain's mast, atc. MARRAGE: YES NO COMMENTS HAVE YOU ANOOR YOUR SPOUSE (or intimate partn.r) EVER: 18. Been unfaithful? '9, Separated aua to conflict? 20. Had physical altercations? 21. Had marriage or couples counseling? 22, nitiated a Jegal separation? 23. Oivorced? FORM Pl 6176 OCT 2001 Page 2 SECURTY CLASSFCATON (if any)

112 DOCD: SECURTY CLASSFCATON (if any) Use Page 6 for Additional Comments HAS ANY OF YOUR CHLDREN: 24. Had dsciplinary problems n school? CHLDREN: YES NO COMMENTS 25. Been suspended or expelled from school? 26, Failed out of school? 27. Had a learning disability? 2B. Been diagnosed with Attention Deficit Disorder (ADD or ADHD)? 29 Been diagnosed with conduct disorder or oppositional defiant disorder? 30. Been prescribed medication, e.g. Rttalln, Adderall, Dexedrine for ADD/ADHD? 31. Had a speech problem requiring speech therapy? 32. Had a physical disability that could affect his or her learning? 33, Been diagnosed as mentally retarded? 34. Been diagnosed as having pervasive developmental dismder? 35. Had an EP (ndividual Educational Plan)? 36. Baan on medication for anxiety, depression, or other psychological disorder? 37 Been diagnose<j with bipolar disorder or schizophrenia? 3B. Been hospitalized for a psychiatric condition? 39. Been in psychiatric or psychologicallreatment? 40. Abused alcohol or drugs? NAME AND AGES OF CHLDREN WTH ANY SSUES PERTANNG TO au.stons Will this child/lhese children accompany you On the assignment? 42. f so, do you have a plan for follow-up care for the assignment? FORM P1B17S OCT 2001 Page 3 SECURTY CLASSFCATON (ilany)

113 DOCD: SECURTY CLASSFCATON (il any) Use Page 6 for Additional Comments PSYCHOLOGCAL SSUES: YES NO COMMENTS N THE LAST YEAR, HAVE YOU, FOR A WEEK OR MORE: 43. Folt sad, blue, moody, ~down in the dumps"? 44. Had difficulty concentrating, remembering? 45. Had difficulty falling asle~p or staying asleep? 46. Had fatigue or low energy? 47. Been very irritable? 48, Constantly worried, feared the worst? 49 Crie<l easily? 50, Felt hopeless, pessimistic about the future'? 51. Had very low self 9steem and confidence'? 52. Felt restless, unable to sit still? 53, Had unusual energy and required little sleep'? 54, Had extreme mood swings? 55, Often felt angry? 56. Been worried that you might lose control? HAVE YOU EvER: 57. Had a serious head injury/concussion? 58. Had a learning disability? 59. Been the vic1im of violence? 60 aeen traumatized? 61. Been severely depressed, so that t interfered with your normal activities? 62, ntentionally hurt yourself? 63 AssaUlted or intentionally harmed anyone? 64. Had urges or impulses you were unable to control? 65 Been evaluated for a psychological or psychiatric problem? 66, Been given a psychiatric diagnosis? FORM P18178 OCT 200' Page 4 SECURTY CLASSFCATiON (il any)

114 DOCD: Use Page 6 for Additional Comments PSYCHOLOGCAL SSUES: (Continued) YES NO COMMENTS HAVE YOU EVER: 67 Seen treated by 8 mental health professional? 68. Been hospitalized for a psychiatric problem? 69. Taken medication tor a psychological or psychiatric condition? (For Women ONLY) 70. Had postpar1um depression or other psychiatric problems after glvjng birth? 71 Had premenstrual dysphoric disorder (PMDO) or premenstrual syndrome (PMS)? SUBSTANCE USE: YES NO COMMENTS 72 Have you ever been addicted 10 a legal or illegal f $0, to what. and when? drug? How of1en'? How many drinks per occasion? 73. Do you drink alcoholic beverages? When were you last intoxicated? How many drinks do you allow youself if you have to drive? 74. Have YOu had any problems (including medical ones) or incidents which have resulted from drinking? 75. Do you believe any of your biological relatives were Or are alcoholics'? 76, Are you a smoker? f so, how many cigarettes per day? 77. s overeating a problem for you? 7B. Have you ever been diagnosed with an eating disorder (anorexk:l, bulimia),? LAW ENFORCEMENT: YES NO COMMENTS 79. Have you aver been arrested or detained by civilian or military authorities? so, When, for Whal, and what was the outcome? FNANCES: YES NO COMMENTS BQ Have you ever dedared bankruptcy? so, wh$n and what were the circumstances? 81. Have you ever had your wages garnisheed? Circumstances? HAVE YOU HAD FNANCAL PROBLEMS AS A RESULT OF: 82. Gambling? Circumstances? 83. Overspending? Circumstances? FORM P1817B OCT 2001 Page 5 SECURTY CLASSFCATON (if any)

115 DOCD: SECURTY CLASSFCATON (if any) ADDTONAL COMMENTS (preaae ",f.rence tem Number with each comment) FORM P1817Bocr 2001 Page 6 SeCURTY CLASSFCATON (i/any)

116 DOClD: PSYCHOLOGCAL TESTNG ORDER OA.TE ORDERED (Y 'r"y.mm DD) PSYCHOLOGST RECEVNG TECHNCAN NAME (Last) (First) (M) 55N D MLTARY D EMPLOYEE D CONTRACTOR DOS (YYYY-MM-OOJ TEST (YYYY.MM OD) (Time HH:MM)..' YEARS OF EDUCATON D 12-HGH SCHOOL D 14-ASSOCATE'S DEGREE D 16-BACHELOR'S D la-master's D 20-Ph.D. MARTAL STATUS D NEVER D D D MARRED MARRED CO-HABTATNG SEPARATED DOVORCED DW'OOWEO TEST COMMENTS AU BA BD 2 DRAWNGS MCM MMP A MMP-2 SAVVY RECRUTER SENTENCE COMPLETON SHPLEY WONDERLC 16PF FOAM P70SS REV JAN 2002 (Supersedes P7066 ReV DEC 2000 which is obsolete) ~pro;;;ed for Release by NSA ~~ FOA Case # 4287

117 Df\ "Y~!~~~~"'.L 6:1: 'U~ VOUCHER NO PUBLC VOUCHER FOR PURCHASES AND ~TPFM'~.~~1 the lreasury SERVCES OTHER THAN PERSONAL ' US DEPARTMENT, BUREAU, OR ESTABLSHMENT AND LOCATON CATE VOUCHER PREPAREO SCHEDULE NO CONTRACT NUMBER AND DATE PAD BY REQUSTON NUMat:R AND CATE " PAYEE'S NAME AND ADDRESS DATE NVOCE RECEVED DSCOLJNi TERMS L.J PAYEE'S ACCOUNT NUMBER SHPPED FROM TO WEGHT GOVERNMENT BL NUMBER NUMBER DATE OF AR'rCLES OR SERVCES UNT PRCE AMOUNT AND DATE DELVERY (Enu,r descripli"n, /lem numberofcqfltrwct or Fede,.,1 supply OUAN OF ORDER OR SERVCE schedulo,.ndother nfcum.tfon deemed necessary) TTY COST PER (1) (Use continuation sheei(s) if necessary) (Payee must NOT use the space below) TOTAL PAYMENT: APPROVED FOR EXCHANGE RArE PROVSONAL.$ 4UlO COMPLETE BY 2 PARTAL FNAL TTLE PROGRESS o ADVANCE Pursuant to authority vested in me, certify thai this voucher is correct and proper lor pay~nl. DFFERENCES Amount verified; correct for (Signature or initiaj$) (Dale) (Authorized Certifying O/fit9A (fitl&) ACCOUN11NG CLASSFCATON CHECK NUMBER ON ACCOUNT OF US.TREASURY CHECK NUMBER ON (N;Jme of bank) >- Q if CASH DATE PAYEE 3 $ 1 When slated in foreign Cl"lrrencYi insert name of currency, PER 2 the ability to certlly and au hortly 108f,prove are combined n one person. one signature only is necessary; otherwise the approving officer will sign n he space provided, over his Offlcllildle, 3 When a voucher S receipted in the name of 3 company or corporation, the name 01 the person writing the company or corporate name, as well as the capacity in whktj ~:v ~ign5, must appear. For example: John Doe Company, per TTLE ~John Smith Secretary" or "Treasurer~ as the case m be. Previous edition usable PRVACY ACT STATEMENT The lnlormalion requested on this form is required under the provisions of 31 US,C 82b and B2c,lor the purpose 01 disbursi~ The intormallon requested is to identify 1t1e partioular creditor and the amounls to be paid. Failure 10 turnish this information wi of theoavmenl obllqation, Federal money. hinder discharge NSN: l-9{lO 22:l4

118 DC~:,~14! 02 PUBLC VOUCHER FOR PURCHASES AND SERVCES OTHER THAN PERSONAL VOUCHER NO Depar11'1lent ollh$ Treasur)' 1 TFM U.S. DE.PARiMENl, BUREAU, OR ESTABLSHMENT AND LOCATON DATE VOUCHER PREPARED SCHEOULE NO. CONTRACT NUMBER AND DATE PAD BY REDUSTON NUMSEA AND DATE PAYEE'S NAME AND ADDRESS r DATE NVOCE RECEVED DSCOUNT TEAMS L.J PAYEE'S ACCOUNT NUMBER SHPPED FROM TO WEGHT GOVERNMENT BL NUMBER NUMBER DATE OF ARTCLES OR SERVCES AND DATE DELVERY (Erlt., ducrlptfon. tem number of canrlwt or Few,.,1 supply OUAN- UNT PRCE OFOROER OR SERVCE SChedU.,,,,(1 othtr flrotmlf/ofl dhm,d f1fc*lury) TTY COST PER AMOUNT (Use continuation Sheel(S) jf necessaryi (Payee musl NOT use he space below) TOTAL PAYMENT: DFFERENCES PROVSONAL COMPLETE PARTAL FNAL Amount verified; :Orrect rot PROGRESS (Signaturs or initials) o ADvANCE MEMORANDUM ACCOUNTNG CLASSFCATON CHECK NUMBER ON ACCOUNT OF U.S.TREASURY CHECK NUMBER ON (Name ofl.lsnkj > 0 CASH DATE if $ PRVACY ACT STATEMENT The information requested on th.ls form is required under the provsions of 31 U.S,C. 82b and 82c, for the pur~ose of disbursi~ Federal money. The ~~~rmalion r~uaesled is 10 dentify tne particular creditor and the amounts to be paid F'ailure to furnish t is information wi hinder discharge of the lavmenl obli.lilian

119 TTLE OF BOOK CALL NO, BOAROwErfS NAME ORO SECURE PHONE DATE BORROWED NEED (HOW long?) r=orm H3593 REN MA.R 95 NSN 7S40 FM OO1 38a7 pproved for Release by NSA FOA Case # 4287

120 DQCDL 3]] TO: 0 Y192, Room 22, SAe 2, (secure) (non-secure) Y192, Room C1W44, Cps 3, /2565 (SSClJrt) (flofl'$e/cvrl1) REOUESTED COMPLETON DATE Y196, Room 2C105. Cps 1, (secure), (non-secure) o Yl96, Room A1332, FANX 11, 96B 7325 (secure), 859'~10 (n~~s9curh!. _..._._ m'_'_ REQUESTER (Naml! of responsible p.!rsan) SD ORG LOCATON Pt'lONE (StlCiJre:NOl-Secure) PUBLCATON/REPRODUCTON REQUSTON AECPE;NT S'O ORG LOCATON f>hone: (StlCl.lfelN $oo.mtj DESCRPTON OF ORGNAL MATERAL (~otoocumcnt.ele) o DSTRiBUTON CLASSFCATtON NUMBER OF ORGNALS COPES EACH SZE OF REPRODUCTON 0 sc CON',em"'''''M"'..~ _ MAil BACK o PCKUP TSC TS SECAET UNCl BNl:)ERV (Chttcl( a" 'Ppllc6ble blocks) Collale S1f,l,\lleStilctl Copy No Sphl Bind.. m._ Pertect B11ld Shlpl" J'unl11 Tape Bind CERTFCATON M1CROFO"lM CONTROL NUtJ6ER - (i1app/icablt1) cenify fhilllamautltorizr!d ro fl!qvw hme semce5 WhiCh ar/l ~ry '0 conclljct GO\lfNl'lmeM buslntlm., tfle request complies \Vtl illl G<wt!mmentana ~JCy RfJglJfatiorn- SGNATURE (Cenifylr'/{J aijl101'iy) RECEVED ORGNAlS" REPROOlJCTONS DATE FORM 1161 REV MA!"'l97 (Supersedes H61 REVNOV 96 Wflich is ~ete) NSN 1 FORM SZE 5" X8" pprov8d for Release by NSA FOA Ca,, ijj287

121 DO<P:Ululcm~o CONSENT RECORD understand thera is a videotape being taken of me pertaining to the program and on the date indicated below. My consent indicates that hereby assign and authorize the producer all rights, including the right to reproduce, copy, exhibit, publish or distribute the resulting videotapes or still photographs, PROGRAM DATE (YYYY MM DD) HAVE YOU HAD A SENSTVE TOY DATE (YYYY MM OO) ORGANZATON(,) OR pes ASSGNMENT DURNG THE FROM TO LAST FVE YEARS? o YES (provide details).. ONO 0 do 0 do nor consent to publication in an UNCLASSFED forum. ALL FELDS.M.U.S BE COMPLETED My signature indicates that understand that my appearance in a publicly released unclassified or FOUO video may impact future assignments involving anonymity. NOTE: A CLASSFED video wfll NOT mpact future assignments nvolving anonymity. NAME (Last) (First) (MJ) SGNATURE ORGANZATON PHONE (S6CUr&) (Non-Secure) DATE YYYY MM-DD) RETURN TO (Check appropriate block) O D Office 01 CDrpDrate Communications Suite 6577 Ops 3, Room C2B49 FORM P7321A NOV 2000 NSA Television Center 0 NSA Broadcasl Network O Sulle6813 Suit FANX 2, A2A035 Ops, RDom 3E047 WHETHER OR NOT YOU GVE YOUR CONSENT FeR effleh'l l:j9e enlv RETURN NlT DATE (YYYY MM OD) SZE 8 1/2" x 5 1/2" pproved for Release by NS,A FOl\, Case # 4287

122 DOClD: PURCHASE REQUEST WORKSHEET DATE OF REQUEST (YYYY MM DD) REQUEST NO ~ROJECT NO.1 NAME TO THAU FROM (Div., Sr., or Staff) ORGNATOR (1..851) (First) (M) PHONE (Secure) (Non Secure) YES, check appllcable block o MMEDATE 0 URGENT DATE DESRED (Contractor QUOf9 & CONTRACTOR QUOTED DELVERY TME EMERGENCY (Check ~pp(()prjat" t.>ock f HYES", justify on Page 3) Admin. laadhmej (YYYY-MM-DD) AFTER RECE~T OF AWARD eyes o NO SOURCE DATA SOURCE/5) OF SUPPLV (Company, complete address, zip code and /8/epfronfJ no.) DSUGGESTED SPECFC TEM (Justify on Page 3) o SNGLE (Justify on Page 3) S TECHNCAL DOCUMENTATON REQURED? THE PAOCUREMENT ACTVTY S AUTHORZED TO DEVATE BY o (f ~Yes': msks an item entry YES below in "Description ofmafefiar) o NO % OF THE TOTA, AMOUNT CTED BY THS ~R NSPECTON AND ACCEPTANCE PERFORMANCE (etlock ONE only) SHP TO. (Check appropriate b/(jck) OORSSY ROAO WAREHOUSE o AT ORGN BY DCAS DORSEY ROAD DOORS 1, 2, & 3 HANOVER, MO MlF AT ORGJN BY PROJECT ENGNEER OR REPRESENTATVE o AT DESTNATON BY PROJECT ENGNEER OR REPRESENTATVE 0 OTHER (Give lull addfbsf;) AS FOLLOWS TtM NO DESCRPTON OF MATERAL (include Mfg('s Name and Part No,. Model or Type) PURCHASE! QrY UNT RENTAL TOTAL UNTP~C' poe NAME (Last) (First) M) PHONE (Sew",) (Non $ecu",) GRANDTOTAL DELVER TO: ORG, BULDNG ROOM FOAM J461. REN OCT 2000 Page 1 pproved for Release by NSA FOA Case #4287

123 DOCD: TEM NO DESCRPTON OF MATERAL (/nclljde Mfgr's Name and Part No" MOdel or Type) Qty UNT PURCHASE! RENTAL TOTAL UNT PRCE FORM J4<14 REN 0Ct 2000.pag.2

124 DOCD: JUSTFCATON FOR PURCHASE SPECFC TEM OR SNGLE SOURCE JUSTFCATON (Fm PR's on specific items that exceed $250 but do not exceed $2500, For PR's on specific items that exceed $2500, attach S6f)Srafe detai/ea justiffcation.) EMERGENCY JUSTFCATON! REMARKS FORM J4614 OCT 2000 Page 3

125 DOCD: OCCUPATONAL HEALTH, ENVRONMENTAL, AND SAFETY SERVCES QUALTY ASSURANCE DOCUMENT PERFORMANCE ASSESSMENT PEROD COVERED: FROM UNSATSFACTORV AREAS OF ASSESSMENT (Check appropriate box. SATSFACTORY GOOD EXCELLENT (Does Not Moor (Exceeds (GrsatJy Exceeds Qualifying statements may be made under COMMENTS below.) (Meet$ StanoardS) Standards) Standards) Standards},. BaSC clinical knowledge displayed 2 Clinical Judgment 3 Clinical performanco a. Outpatient ambulatory care/occupational health b. Psychological Services 4. Communication skills 5. Rapport witli patients 6. Relationship with colleagues 7. Cooperation with clinic personnel 8. Appearance 9. Emotional stability 10 Apparent physical health 11, Professional conduct 12. Ethical conduct 13, Leadership capability 14. auality and timeliness of medical/psychological record documentation 15. PartiCipation/attendance at staff committee meetings ano professional CME activities TO 16. a. This Practitioner has a current unrestricted state license, DYES D NO 16. b, This Practitioner is presently certified in: D ecls/cpr D ACLS D ATLS 16. c. Results of Quality Management activities considered were:.16. d. Practitioners PAF and PCF ware reviewed: DYES, 6. e. COMMENTS (Unsatisfactory areas will be fully addressed and recommendations made for corrective action by assessed 17 a. ASSESSED NDViDUAL NAME 17.. CURRENT POSTON 17. c. GRADE 17. d, COPY OF EVALUATON FURNSHED HCP: DYES DNo 18 a TYPED SUPERVSOR NAME 18. b. DVSON 18. c. SGNATURE FORM P6749 REV AUG 99 (Supersede. P6749 AUG 93 which s obsole'e) NSN: 7540 FM OO pproved for Release by NSA FOA Case # 4287

126 DOCD: General nstructions for the FrameMaker SF 86 Before you proceed, perform the following steps: 1. Click the left mouse button to get an insertion point in the following text box: 2. From the "Special" menu above, choose "Variable..." 3. From the "Variables:" scroll list, choose "SSN.", and then select the "Edit Definition..." button. 4. n the "Definition:" text area, replace " " with your Social Security Number, select the "Change" button, and then select the "Done" button. 5. Choose the "Update..:' button, after which FrameMaker will pop up a window asking you if it is okay to update all system variables, to which you select the "OK" button. You have just told FrameMaker to enter your Social Security Number in appropriate places, so that you do not have to enter it again on the form. While designing the FrameMaker version of the SF86, an attempt was made to link "like" fields together. You can simply hit the "return" key to move from text box to text box. Use the "backspace" key to reverse the process. All text boxes, however, are not linked together, so you may need to use the mouse to place an insertion point in a text box in a new section of the form. You are now ready to begin. Place an insertion point in the LAST NAME text box of Section 1. By ENTERNG (using the return key), you will automatically tab to the next text box within the section. This will help ensure you do not omit any requested information. Usually you will have to place an insertion point in the first text box of each section. You will also have to place an insertion point in the appropriate text box on multiple choice questions (Section 8 and 13) and in the appropriate text box on YESNO questions. Rule of thumb. f using the return key does not move you to the next text box, use the mouse to place an insertion point in the desired text box.

127 ~frm8(i evlse eptem'15er 'ftj9'b u.s. Office of Personnel Management 5 CFR Parts 731,732, and 736 Questionnaire for National Security Positions Form approved OM.B. No NSN Follow instructions fully or we cannot process your form. Be sure to sign and date the certifioation statement on page 9 and the release on page 10. f you have any questions. oallthe offioe that gave you the form, Purpose of this Form The U.S. Government conducts background investigations and reinvestigations to establish that military personnel, applicants for or incumbents in national security positions, either employed by the Government or working for Government contractors. licensees, certificate holders, and grantees, are eligible for a required security clearance, nformation from this form is used primarily as the basis for investigation for aocess to classified nformation or special nuclear information or material. Complete this form only after a conditional offer of employment has been made for a position requiring a security clearance. Giving us the information we ask for is voluntary. However, we may not be able to complete your investigation, or complete it in a timely manner, if you don't give us each item of information we request This may affect your placement or security clearance prospects. Authority to Request this nformation Depending upon the purpose of your investigation, the U.S. Government is authorized to ask for this information under Executive Orders B65, 12333, and 12356; sections 3301 and 9101 of title 5, U.S. Code; sections 2165 and 2201 of title 42, U.S. Code: sections 7B1 to 887 of title 50, U.S. Code; and parts 5, 732, and 736 of Title 5, Code of Federal RegUlations. Your Social Security number is needed to keep records accurate, because other people may have the same name and birth date. Executive Order 9397 also asks Federal agencies to use this number to help identify individuals in agency records. The nvestigative Process Background investigations for national security positions are conducted to develop information to show whether you are reliable, trustworthy, of good conduct and Character, and loyal to the United States. The information that you provide on this form is confirmed during the investigation. nvestigation may extend beyond the time covered by this form when necessary to resolve issues. Your current employer must be contacted as part of the investigation, even if you have previously indicated on applications or other forms that you do not want this. n addition to the questions on this form, inquiry also is made about e person's adherence to security requirements, honesty and integrity, vulnerability to exploitation or coercion, falsification, misrepresentation, and any other behavior, activities, or associations that tend to show the person is not reliable, trustworthy, or loyal. Your Personal nterview Some investigations will include an interview with you as a normal part of the investigative process. This provides you the opportunity to update, clarify, and explain information on your form more completeiy, which often helps to complete your investigation faster t is important that the interview be conducted as soon as possible after you are contacted. Postponements will delay the processing of your investigation, and declining to be interviewed may result in your investigation being delayed or canceled. You will be asked to bring dentification with your picture on it, such as a valid Slate driver's license, to the interview. There are other documents you may be asked to bring to verify your identity as well. These include documentation of any legal name change, Social Security card, andlor birth certificate. You may also be asked to bring documents about information you provided on the form or other matters requiring specific attention. These matters include allen registration, delinquent loans or taxes, bankruptcy. judgments, liens, or other financial obligations, agreements nvolving child custody or support, alimony or property settlements, arrests, convictions, probation, andlor parole. Organization of this Form This form has two parts. Part 1 asks for background informalion, including where you have lived, gone to school, and worked. Part 2 asks about your activities and such matters as firings from a job, criminal history record, use of illegal drugs, and abuse of alcohol. n answering all questions on this form, keep in mind that your answers are considered together with the information obtained in the nvestigation to reach an appropriate adjudication. nstructions for Completing this Form 1. Follow the instruotions given to you by the person who gave you the form and any other ciarifying instructions furnished by that person to assist you in completion of the form. Find out how many copies of the form you are to turn in. You must sign and date, in black ink, the original and each copy you submit. You should retain a copy of the completed form for your records. 2. Type or legibly print your answers in black ink (if your form is not legible. it will not be accepted). You may also be asked to submit your form in an approved electronic format. 3. All questions on this form must be answered. f no response is necessary or applicable, ndicate this on the form (for example, enter "None" or "N/A"l. f you find that you cannot report an exacl date, approximate or estimate the date to the best of your ability and indicate this by marking "APPROX." or "EST." 4. Any changes that you make to this form aiter you sign it must be initialed and dated by you. Under certain limited Circumstances, agencies may modify the form consistent With your intent 5. You must use the State codes (abbreviations) listed on the back of this page when you fill out this form. Do not abbreviate the names of cities or foreign countries, 6. The 5 digit postal ZP codes are needed to speed the processing of your investigation. The office that provided the form will assist you in completing the Z P codes. 7. All telephone numbers must include area codes. B. All dates provided on this form must be in Month/DaylYear or MonthlYear format Use numbers (1-12) to indicate months. For example, June 8, 197B, should be shown as 6/B Whenever "Cily (Country)" s shown in an address block, also provide in that block the name of the country when the address is outside the United States. 1O. f you need additional space to ilst your residences or employments/self-employmentslunemployments of education, you should use a continuation sheet, SF B6A. f additional space is needed to answer other items, use a blank piece of paper. Each blank piece of paper you use must contain your name and Social Security Number at the top of the page.

128 DOOm:acrmiBilMfUb&- Eligibility Final determination on your eligibility for access to classified information is the responsibility of the Federal agency that requested your investigation. You may be provided the opportunity personally to explain, refule, or clarify any nformation before a final decision is made. Penalties for naccurate of False Statements The U.S. Criminal Code (title 18, section 1001) provides that knowingly falsifying or concealing a material fact is a felony which may result in fines of up to $10,000, andlor 5 years imprisonment, or both. n addition, Federal agencies generally fire, do not grant a security clearance, or disqualify individuals who have materially and deliberately falsified these forms, and this rema,ns a part of the permanenl record for future placements. Because the position for which you are being consdered is a sensitive one, your trustworthiness is a vary mportant consideration in deciding your eligibility for a security clearance. Your prospects 01 placement or security clearance are better if you answer all questions truthfully and completely. You will have adequate opportunity to explain any information you give us on the form and to make your comments part of the record. Disclosure of nformation The intormation you give us is for the purpose of investigating you for a national security position; we will protect it from unauthorized disclosure. The collection, maintenance, and disclosure of background nvestigative information is governed by the Privacy Act. The agency which requested the investigalion and the agency which conducted the investigation have published notices in the Federal Register describing the systems of records in which your records will be maintained. You may obtain copies of the relevant notices from the person who gave you this form. The information on this form, and information we collect during an investigation may be disclosed without your consent as permitted by he Privacy Act (5 USC 552a (b») and as follows: PRVACY ACT ROUTNE USES 1, To the Department of Justice when: (alihe' agency or any componenllhereof. or (bl any employee of the agency in his or t'ler Official capacity; or (C) any employee 01 the agency m his or her inoividual capacity where the Department of Justice ha$ agreed to represent the employee; or (d) the United States Government, is a party to litigation or hali interest in such litigation, and by carefuj review, the agency determines thal the recl:lr(ts are both relevant and necessary 10 the litigation and the use 01 such records by the Department 01 Justice s therefore deemed by the agency to be lor a Qurpose tha is compatible with the purpose for which he agency collected the records 2. To a court of adjudicative body in a proceeding when: (a) the agency or any component thereat; or (bl any employee at the agency n his or her official capacity; or (C) any employee of the agenc~ in his or her individual capacity where the Department ot JuSlice has agreed to represent the employee: or (d) the United States Government, is a party 10 litigation or has interest in SUCh litigation, and by careful review, the agency determines that the records are both relevant and necessary to the litigation and the use 01 such records is therefore deemed by lhe ag$noy to be for a purpose thai is compatible with the purpose tor which the agency cohected the records. 3. El(cept as noted in Question 24, when a re<:ord on its lace, or in conjunction with other records. indicates a violation or potential violation of law. whether civil, criminal. or regulatory in natljre, and whether arising by general statute. particljlar program statute, regulation. rule, or order issued pursuant thereto. the relevant records may be disclosed to lhe appropriate Federal. Oreign. State, GC&. tribal, or other public authority responsible lor enforcing, investigating or prosecuting such violation or charged with enforcing or implementiflg he statute. rule, regulalion, or oreter, 4, To any source or potential source from which information is requested in tne course of an jnyesligalion concerning the hinnq or retention of an employee or oth~r personnel action, or lhe issuing or retention of a security clearance, contract, grant, license, or other tlenetit, to the ex1ent necessary to identify the individual, inform the source 01 the nature and purpose of the investigation, and to identify the type 01 information requested. 5. To a Federal, State, local, foreign, tribal, or olher public authority the fact that this system 01 record!!; contains information relevant to ttle retention of an employee. or the retention of a security clearance, contract, license, grant, or other benefit The other agency or licensing organization may then make a request supported by written consenl of the individual for the entir8 record it it so chooses. No disclosure will be made unless the information has been determined to be sufficiently reliable to support a referral to anolher ottice witllin the agency or to another Federal agency for criminal, eivil, administrative, personnel, or regulatory action. 6, To contractors, grantees, experts, consultants, or volunteers when n$ce!lssary to per1qrm a funcilon or service related to this record for which they have been engaged. Such rl!lcipiertts shall be required to comply with the Privacy Act , as amenden. 7, To the news media or the general public. factual information he disclo$ure 01 which would be in the public interest and WhiCh wo~ld not constitute an l,jnwarranted invasion 01 personal privacy_ 8. To a Federal, Slate, or local agency, or other appropriate entities or individuals, or through established liaison channels 10 s&lected loreign governments, in order 10 enal'jle an ntelligence agency to carry oot its responsibilities under the: National Security Act of 1947 as amended, the CA Act of 1949 as amended, Executive Order or any successor order. applicable national S8ClJrilY dil'eetives, or Classified implementing procedures approved by the Attorney General and promulgated pursuant 10 such statutes. orders or directives. 9. To a Member 01 Congress or to a CongressiOnal staff member in response to an inquiry of the Congressional office made at the written request of tt'le constituent about WhOm the record is maintained. 10, To the National Archives and Records Administration for records management inspections COnducted under 44 USC 2904 and , To the Office of ManagemerJt and Budget when necessary to the review of private reliellegislation. STATE CODES (ABBREVATONS) Alabama AL Hawaii H Massachusetts MA New Mexico NM South Dakota so Alaska AK daho 10 Mictligan M New York NY Tennessee TN Arizona AZ llinois L Minnesota MN North Carolina NC r~xas TX Arkansas AR ndiana N Mississippi MS North Dakota NO Ulah UT California CA owa A Missouri MO Ohio OH Vermont VT Colorado eo Kansas KS Montana MT Oklahoma OK Virginia VA Conn&C1icut cr Kentucky KY Nebraska NE Oregon OR Washington WA Delaware DE Louisiana LA Nevada NV Pennsylvania PA Wast Virginia wv Florida FL Maine ME New Hampshire NH Ahode sland A Wisconsin W Georgia GA Maryland MD New Jersey NJ South Carolina se Wyomil19 WY American Samoa AS Oisl. of Columbia DC Guam GU Northern Marianas CM Puerto Rico PA Trust Territory T Virgin slands V PUBLC BURDEN NFORMATON PUblic burden reporting for this collection of nformation is estimated to average 90 minutes per response, including time for reviewing instructions, se~rching existing data sources, gathering and maintaining the data needm, and completing and reviewing l1e collection of nformation. Send comments regardng tna burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Reports and Forms Management Officer, U.S. Office of Personnel Management E Street, N.W., Room CHP-500, Washington, D.C Do not senet your completed form to this address.

129 D~lt~1i1l'9 0a u.s. Office of Personnel Management QUESTONNARE FOR NATONAL SECURTY POSTONS Form approlled. O.M.B, No ()()07 N5N 7540.()Q CFR Parts 731,~7~3~2~,a~n~d~7~3~e~~~.,.~~ ~~~~ _ G J SON L so, N P Nama 1f'd Tille K ~i~='~~~n~i' Foloer M ~~~~iv Foldfp N''''' NPRC A SON None Al Sol NP' l914phoru Nurooer ( loate lp Code Code FULL f you ha...e only initials in your Mme, use them and slats (10), NAME f you halle no middle name, enter ~NMW t you are a "Jr,," ~Sr. ~ "," elc" enler this in the box after your middle name.. DATEOF BRTH las! Name First Name Middle Name (, f, ele. Month Dav Year PLACE OF BRTH Use the two ener code for the Stale. :.:SOCAL SECURTY NUMBER City,,-,ounty Stale Country (if ndt itt the United :;;tatfts) OTHER NAMES USED Gille other names you used and the period 01 time you used them (for example" your maiden name, name{s] bya former marriage. former name{sl. alias{esj, or nickname[s}). 11 the other name is your m.iden name, put "TlM~ in lront 01 il Name MonthYear MonthlVear Name MonthYear MontWYear.1 t3 To To Name MonthYear MOnlhlYeat Name MonthVear MonthfVeat '2.4 To To. lher Height (feet ana inches) Weight (poljnds) Hair COlor Eye Color sell: (marlt Olle b<»c) DENTFYNG NFORMATON TELEPHONE Work (inclurhl Area COde and extension) Home (include Area Code) 'i ) eny eny ( NUMBERS ) Night ( ) ( ) Night CrnZENSHP 1am a U.s. citium or national by birlh in tile U.S. or U,S, territory/possession, Answer items b.nd d Mark the box at the right e that reflects your current am a. U.S. citizen, bull was NCT born in the U.S Ctizenship Slatus., and Jam nol a U.S. citizen, Answer items b, c,.nd d, An'lJHer items b.net (!) Your Mother's Maiden Name GUNTED STATES CmZENSHP f you are a U.S Citizen, but were 1'101 born in the US.. provide information about one or more of the following proo1s of your citizenship. Naturalization cenifleate (Where Wflt1!' you n.tufllized1) Court City State certificate Number MonthiDaylYear ssued Citizenship certifioate (Wh"'" was the certificate l$'uf(j?) City Stale Certifica1e Number Month' ay ar ssued State Department Form Rtport of Birth Abroad of a Citizen 01 the United Stat Give the da.le me torm was prepared and give an explanation if needed MonlhtOayNeBr Explanation u.s. Passport This may tie either a cutrent or previous U.S. Passport. Passport Number MontlVOaylVear ssued (9 OUAL CTZENSHP f you are (or were) a dual citizen Of the \Jnited Stales and another country, provide the name of that country n lhe space to the right. Country G ALEN yoll are ali alien, Pl'O\ide the following information: Place You City Entered the United Stales: Alien Reglstrat On Number Country(ieS) 01 CitizenShip Page 1

130 ~D. Ust the places where you have lived, beginning with the masl recent (#1 J and working back 7 years. Nl periods must be accounted for in your list. Be sure 10 indicate the actual physical location of your residence: do not use a pos.t office box a.s an address, do not Ust a permanent address when you wers actually living at a school address. etc. Be sura to specjty your location as closely as possible: for example, do not list only your base or Ship, list your barracks n(.lmber or home port. You may omit temporary military duty locations under 90 days (list your permanent address instead), and you should use your APO/FPO address t you lived overseas. For any address in the last 5 years, list a person who knew you at that address, and who preferably still lives in that area (do not list people for residences completely outside this 5-year period. lind do not list your spouse. former spouses, or other relatives). Also for addresses in the last five year$, if the address is "General Delivery," a Rural or Star Aoute. or may be difficult to locate, provde directions for locating the residence on an attached continuation sheet MonthlYear MonttVYear Streot Adoross \jlt. ""ty ",ounlryj ~tate ~ (;000 '1 To Present Name of Person Who Knows You Street Addre.. Apt. # City (Country) ~ate ZP Code Telephone Number ( ) MonthlYoar MonthlYearStreet Address Apt. # City (Country) State ZP Code #2 To Name of Person Who Knew You Street Address Apt. # City (Country) State ZP Code Telephone Number ( ) MonthlY..r MonthYear Street Address Apt. # City (Country) Stats ZP Code #3 To Name of Person Who Knew You Street Address Apt. City (Country) ZP Code Telephone Number Statol ( ) MonthYear MonthlYear Street Address Apt # City (Country) State ZP Code #4 To Name of Person Who Knew You Street Address Apt # City (Country) ZP Code Slato/ MonthlVesr MonthlYearStreet Address Apt. City (Countryl State #5 To Name of Person Who Knew You Street Address Apt. # City (Country) Slate Telephooe Number ( ) ZP Code ZP Code Telephone Number ( ) G WHERE YOU WENT TO SCHOOL List the schools you have atlended, beyond Junior High SChool, beginning w"h the most recent (#1) and working back 7 yea... List COllege or University degrees and the dates they were received. f all at your education occurred more than 7 years ago, Ust your most reicent education beyond high school, no maner when that education occurred. Use one of the followng codes in the "Code" block: 1 High School 2 CollegelUniversity/Military College 3 VocatlonalfTechnical/Trade School For schools you attended n the past 3 years. list a person who knew you at school (an instructor, student, etc.). Do not Ust people for educatton completely outside this 3-year period. For correspondence schools and extension classes, provide the address where the records are maintained. MootntYear MOnWYear <;ooe Name of ScMO DegrOOlUlplOmaiumer MOn1tllYear Awarded #1 To Street Address and City (Country) of Scl100l Slats "PCode Name of Person Who Knew You Street AddresS Apt.# City (Country) Stat. ZP cc e,telepnone Number ( ) MonlntYear MonthlYear Code Name 01 SChool Degree/Diploma! Jther MonthlYOer Awarded #2 To Street Address and City (Country) ot School Sae ZP Code Name of Person Who Knew You Street Address Apt.. City (counlry) State ZP Code lelepnone Number ( ) Montntvear MonthlYear Code Name of School Degree/Diplomal Other MonthMlar Awarded #3 To street Address and City (<;ountry) 01 5':11001 State ZP Code. Name OT "'erson Who Mew You ~tteet Address Apt.# City (Country) State ZP Co< e Telepnone NumDe' ( ) Enter your Social Security Number before going to the next page... Page

131 _MPlll1aN4mAtES..... List your employment activities, beginning with the present (#1) and working ~ack 7 years, You ~hould list all full-time work, par~-lma work, military service, temporary military duty locations over 90 days, se1f-employment. other pad work, and all penods of unemployment. The entire 7-year period must be accounted for without breaks, but you need not litot employments before your 16th birthday. excepton; Show all Federal civilian ser'vlce. whether it occurred within the last 7 years or nat. Code. Use one of the codes listed below to identify the type of employment: 1 Active military duty stations 5 ~ State Government (Non-Federal employ- 7 - Unemployment (include name 9 Other 2 - National Guard/Reserve ment) of p&rson who can verify) 3. U,S.P.H.S. Commissioned Corps 6 SeJ'-empk)yment (include business name 8 ~ Federal Contractor (list COn~ 4 ~ Other Federal employment and/or name of person who can verify) tractor, not Federal agency) EmployerNerlfler Name. List the business name of your employer Or the name of the person who can verify your sell employment or unemployment in this block. f military service is being listed, include your duty location or home port here as well as your branch of service, You should provide separate listings to reflect changes in your military duty locations or home ports. Previous Period, of ActiVity. Complete these Jines if you worked for an employsr on more than one occasion at the same location. After entering the most recent period of employment in the initial numbered block, provide previous periods of employment at tho same location on the additional lines provided. For oxample, if you worked at XV Plumbing in Denver, CO. during 3 separate periods of timo, you would enter dates and information concerning the most recont period of employment first, and provide dates, position titles, and supervisors for the two previous periods of employment on the lines below that information MonthYear MonthYe.r Code EmployerNeri ier Name/Military Duty Location Your Position T1UoMilitary Rank #1 To Present Employer'slVerifier'sStreefAd ress City (Country) State ZiP Cod<! elepnone Number ( ) Street Address of Job Location (if different than Employer's Address) City (Country) State ZP Code Telephone Number ( ) Supervisors Nama & Street Address (if diffiirenfiliaiijob Location) City (Country) State ZP GOde l..epnone Number ( ) MonthYear Monttl/Year Position Title Supervisor To., Month/Year MonthNear Positioniitle Supervisor To MonthYe.r Mon-lilYElar Pos~ionTitle Supervisor To MonthNear Month!Yoar Code EmployerNerifler NamelMilitary Duty Location Your Position TitlelMilitary Rank #2 To "~t:-mpjoyer;sfilarmer's Street Address City (Country) State ZP Code Telephone Number ( ) Street Address 01 Job Location (f dinerent than Employer's Address) City (Country) State ZP Coda Telephone Number ( ) SuperviSOr'S Name & Street Address (it different than Job Location) City (Country) State ZP Code Telephone Number ( ) MonthlYear MonthYear Position Title. To MonthNear MonthlYear PoSRlon Title SuperVisor Supervisor To MonthlYear MonthlYear Position Title Supervisor : To MonthNear MonthYaar Code EmployerNeritier Name/Military Duty Location Your Position Title/Military Rank #3 To EmployersNerlfie,'s Street Addmss City (Country) State ZPCOde pelepn""e Number ( ) Street Address of Job Location (if different than Employer's Address) City (Country) State ZP Code Telephone Number ( ) SupervisorSName & Straet Address (if different than Job Location) rcltytcountry) State ZP COde Telephone Number ( ) MonthYear MonthNear Position Title Supervisor. To Month/Year MonlhlYear Position Title Supervisor To Mllf11hlYear MonthYear Position Title Supervisor To Enter your Social Security Number before going to the next page Page 3

132 ~Y"!J'3!~1(T f(ljrl (CONTNUED) Montrvve.r Momrvvear,",ooe "mployerlverller NamelMilltary DUty Location your ",.,ton,.e/m itary liank ~4 To Employe"Slve""er. street Address ""ty j",ountry) State ZtPCOde TelephOne Number ( ) Street Address of Job Location (f different than Employer's Address) City (Country) State ZP Code Telephone Number ( ) Superv,sors Name & Street Address (if different than Job Location) city (country) State ZP Cod. Telophon. Numb.r ( ) MonttVYear MonthfYear Position TiUo Supervisor To.. Month/Year MonthlYear Position Title Supervisor To MonlhYear MonthNear Position ilia Supervisor To Momrvvoar Monmrvear ",Od. cmployerne"fior NamOlMlllary uuty Location Your Pos~on litle/military RanK ~5 To ~mployer'sverlfier's Slr.ol Address City (Country) State ZP Cod. Telephone Number ( ) $Ueet Address of.job Location (if different than Employer's Address),;ty (Country) State ZP Cod. Telephone Number ( ) Supervisor's Name & Street Address (if different than Job Location) City (Counlry) State ZP COde Telephone Number ( ). MonthlY98r MontlvYear Position Tille To MonthlYesr MonthJYesr Position itle Supervisor SuparvJsor To MonthlYear MonthNaar Position Till. Supervsor. To Month/Yesr M011lrvVear '"" e ',11lpJOye"verifler NamOlMU",ry uuty LocatOn YOUr 'OSmon "ie/mil'tary liank #6 To ~mpoy."slv.rifie,'s ~treel Address City (country) state ZP Code Jillepnono Number ( ) Street Address of Job Location (it difterent than Employer's Address) City (Country) litote ZP Cod. Telephone Number ( ) Supervisor's Name & Street Address (f different llan Job Location) ""ty (,;ountryj l;tate ",~,;ode lelephone Number ( ) MonthNear MonthlYesr Position itje Supervisor To MonthlYear ManMaar Position Title Supervisor. To. MonlntYear Monll1lYear Position Title Supervisor To PEOPLE WHO KNOW you WELL. Ust three people who know you well and live in the United States. They should be good friends, Pfiler$, colleagues, college roommates, etc., whose combined association with you covers as well as possible the last 7 years. Do not list your spouse, formar spouses, or other relatives, and try nol to list anyone who is listed elsewhere on this form. Name #1 Home or Work Address ZP COde Name ~2 Home or work Address City (Country) litate ZP Code Name #3 Home or Work Address City (,;ountry) "tata ZP c;ooe Enter YOUr ::iocial Security Number belore ooina to the next oaae Page

133 o nl martal stalus and provide in1ormation about your spouse(s) in items ft, and/or b. 1 - Never married 3 ~ Separated. 5 - Divorced 2 - Married 4 - Legally Separated 6 Widowed B Current Spouse Complete' the following about your currenl SPOUN only. Full Name Da.te of Brth Place of Birth (nclude country ifoutside the U.S.) SOcial Security Number Other Names Used (SpfJCify maid/fm name, namf1s by other marriages, etc., and show dates,jsed ler each fla.me) Country(i8s) of Citizenship Date Married Place Married (1llclUdB country ifoutside the US.) State f Separated. Date of Separallon f legally Separated, Where is the Record Located? City (Country) State Address of Cunent Spouse. if different than your current address (Street. city. and countiy if outside th9 U.S,) ZP Code (!) Former Spouse(s) Complete the following about your former spouse(s) use blank sheets f needed ~Ull Name Date of Birth Place of Birth (nclude COUrltr'y if outside the U.S.) State Country(ies) of Citizenship Dale Married Placo Married (nclude country ifoutside the U. S.) Stale rlck One, Then GnDate Month/DaylYear f Divorced, Where is the Record Located? City (Country) State Divorced Widowed Address of Former Spouse (Street, city, andcountry foutside the U. $) Sla" ZP Code TtePhonelNumber YOUR RELATVES AND ASSOCATES Give the full name. correct code, and other reques'ed information to, each of your relatives and associates, living or dead. specified below. 1 Mother (first) 5 - Foster parent 9 Sister 13 Hall-sister 17 - Other Relative 2 ~ Father (second) 6 - Child (adoptfxi also) 10 - Stepbrother 14 Father-in-law 18 Associate 3 ~ Stepmother 7 - Stepchild 11 ~ Stepsister 15 ~ Mother-in-law 4 Stepfather 8 - Brother 12 - Hal' brother 16 Guardian 19 - Adult Currently Living With You Code 1,7 (Other RelativeHnclude only foreign national relatives not listed in 1-16 with whom you or your spouse are bound by affection, obligalion, or close and continuing contact. Code 18 (AsSOCiates) ~ nclude only roreign national associates with whom you or your spouse are bound by affecton. obligation, or close and continuing con1act. Full Name (f decea&ed, check box on the Cod of 81r1h Country of 81r1h Country( ) of Cumont Street Add,... end Cny State left before entering name) MonthlDaylY.ar Cnlzen.hip (country) 01 Living Ro.tlve. U 1 U 2 [J [J U U U U U 0 U 0 Enter your Social Security Number before going to the next page Pa9e5

134 ...~D""Nl3(l~1Ol.ELATVESAND ASSOCATES ~r mother, lather. :&i5t9r, brother, child. or C\lmmt spouse or person with whom you have a sj)ouse-like relationship is a U.S. Citizen by otlier than birth, or an alien residing in the U.S.. provide the nature of the individual's ralationship to you (Spouse, Spouse-like, Mother, etc.), and the individual's nemf;! and di;lte of birth on the first line (this information i$ needed to pair it accurately with information in items 13 and 14). On the second line, provide the individual's naturalization certificate or alien registration number and use one of the document codes below to identify proot of citizenshp status, Provide additional information on that line as requested. 1. Naturalization Certificate: Provide he date issued and the location where the person was naturalized (Court. City and State). 2. Citizenship Certificate: Provide the date and location issued (City and State) 3. Allen Registration: Provide the date and place where the person entered tile u.s. (City and State). 4. Other: Provide an explanation in the "Additional nformation" block Association Name Date of Birth (Monttl/OaylYear) Nl Certificate/Registration 1# Document CodeAdditional nformation Association Name Oal. Of ~"111 (MontrllUayNear) N2 Certificate/Registration it YOUR MLTARY HSTORY Document Code Addlliona! nformation 6) Have you served in the United States military? G) Have you served in the United States Merchant Marine? Ust all of your mlitary service below, ncluding service in Reserve, National Guard, and U.S. Merchant Maline. Start with the most recent period 01 service (1# 1) and work backward. f you had a break in service. each separate period should be listed. Code. Use one ot 1he codes listed below to identify your branch of service: 1 ~ Air Force 2 Army 3 ~ Navy 4 Marine Corps 5 Coalt Guarcl 6.. Merchant Marine 7 ~ Nalton,l Guard.. OJE. Ma.rk "O~ block for Officer Or "E~ block for Enlisted... Stlltus, "X~ the appropriate block for the status of your $8rvice during the time that you s~rved, f your service was in the National Guard. do no use an "X"; use the two-letter code for the state tq mark the block. Country. 11 your servic9 was with other than the U S Armed Forces identify the country for which you served MonthfYear MonthYear Code Service/Certificate,. 0 E Status COuntry Active t,ctive \:actlve Natlo~al Guard eserve 8serve ( ta'e) To To YOUR FOREGN ACTVTES fd Do you have any foreign property, business connections, or financial interests? Q) Are you now or have you ever been employed by or acted as a consultant for a foreign government. firm. or agency? G Have you ever had any contact with a foreign government, its establishments (embassies or consulates), or its representatives, whether inside or oulside the U.S., other than on official U,S. Government business? (Does not include routine visa applications and border crossing contacts,) mn the last 7 years, have you had an active passport that was issued by a foregn government? f you answered "Yes n to a. b, c, or d above. explain in the space below: provide inclusive dates, names 01 firms and/or governments lnvol~d. and an explanation of your involvement. Ves No v No MonthlYear MonthJYear Firm andlor Government To Explanation To FOREGN COUNTRES YOU HAVE VSTED Lislloreign countries you have visited, except on travel under official Government orders, beginning with the most current (#1) and working back 7 years. (Travel as a dependent or contractor must be lisled.) Use one of these codes to indicale the purpose of yourvisit 1 Business 2 Pleasure 3 - Education 4 ~ Other nclude short trips to Canada or Mexico, f you have lived near a border and have made short (one day or less) trips to the neighboring country, you do not need to USt each trip. nslead, provide the time period, the code, the country, and a note rmeny Short Trips") not repeat travel covered '10 items 9, 10, or t1. MonthlYear MonthlYear Code Counlry MonthlYear MonthlYear Code Country '1 To.3 To #2 To.4 To This concludes Part 1of this torm, t you have used Page 9, continuation alleels, or blank; sheets to complete any 01 the questions in Part 1. give lhe number for those questions in the space to the right t:nter YOUr ::;oclal Security Number before aolno to the next oaoe -..1 'i'i'j-'j'j-'j'j'j'j Page 6

135 DQQaldQ,." Revised september 1995 U.S. Office of Personnel Management 5 CFR Parts and 736 Part 2 YOUR MLTARY RECORD QUESTONNARE FOR NATONAL SECURTY POSTONS Have you ever received other than an honorable discharge from the military? f "Yes,~ provide the date of discharge and type of discharge below. Type 01 Discharge MonthYear YOUR Form apprqy90: OMB. No. 3ZQS-0007 NSN 754Q.OO ~O~FF~C!!!A~L USE ONLY SELECTVE SERVCE RECORD Ves No Q Are you a male born ahar December 31, f "No," go to 21. f ''Y... to go b. l:) Have you registered with the Selective Service System? (1 "Yes,~ provide your registration number. f "No," show the reason for your legal exemption below. Regstration Number Legal Exemption Explanation 6» YOUR MEDCAL RECORD Ves No n the last 7 years, have you consulted with a mental health professional (psychiatrist, psychologist, counselor, etc.) or have you consulted wth another health care provider about a mental health related condition? f you answered "Yes". provide the dates of treatment and the name and address of the therapist or doctor below, unless the consultation(s) involved only marital, family, or grief counseling, not related to violence by you. Ves No MonlhYear MonthNear Name/Address of Therapist Or Doctor Stato ZP Code To To fa YOUR EMPLOYMENT RECORD Has any of the following happened 10 you n the last 7 yelns? f "Yes," begin with the most recent occurrence and go backward, providing date fired, quit, or left, and other information requested, Ve. No Use the following codes and explain the reason your empjoyment was ended:, - Fired from a job 3 - left a job by mulual agreement following allegations of misconduct 2 Quil a job atter being told 4 - Left a job by mutual agreement following allegations of you'd be fired unsatisfactory performance 5 ~ Left a job for other reasons under unfavorable circumstances Monttv'Yea Code Specify Reason Employer's Name and Address (nclude city/c<>untty ifoutside U.S.) State ZP Coda YOUR POLCE RECORD Vea No For this item. report,"formation regardless of whether the record in your case has been ~sealed" or otherwise s1ricken from the court record. The single exception to this requirement is for certain convictions under the Federal Controlled Substances Act for which the court issued an expungement order under the authority of 21 U,S,C. 644 or 16 U.S,C Q Have you ever been charged with or convicted of any felony offense? (nclude those under Uniform Code of Military Justice) Have you ever been charged with Or convicted of a firearms or explosives offense? l:) G Are there currently any charges pending against you for any criminal offense? (!) Ha...e you ever been charged with or convicted of any Offense(s) related to alcohol or drugs? (\) 0 n the last 7 years, have you been subject to court martial or other disciplinary proceedings under the Uniform Code of Military Justice? (nclude non-judicial, Captain's mast, etc.) n the last 7 years, have you been arrested tor, charged with, or convicted of any offense(s) not listed in response to a, b, c, d, or e above? (Leave out traffic fines of less than 5150 unless the violation was alcohol or drug related.) f you answered "Yes~ to a. b. c, d, e, or f above, explain below. Under ~Offense." do not lis1 Specific penalty codes, list the aelued offense or volation (for example. arson, theft, etc.). MonthNear Offense Action Taken Law Enforcement Authority/Court (nclude City and county/country if outside u.s.) State ZP Code Enter your Social Security Number before going to the next page Page 7

136 . DOClD' YOUR USE OF LLEGAL DRUGS AND DRUG ACTVTY The following questions pertain to the mega' use of drugs or drug activity. You are required to answer the questions fully and truthfully, and your failure to do so could be grounds for an adverse employment decision Or action against you, but neither your truthful responses nor information derived from your responses will be used as evidence against you in any subsequent criminal proceeding. 0 e G Since the age of 16 or in the last 1 yeats,...hiche\ler is shorter, have you~ used any controlled substance, for example, marijuana, cocame, crack cocaine, hashish, narcotics (opium. morphine, codeine, heroin, etc,), amphetamines. depressants (barbiturates, methaqualone. 1ranquillzet5, etc.), hallucinogentcs (LSD. PCP, etc.), or prescription drugs? Have you.w!ll! illegally used a controlled substance while employed as a law enforcement officer, prosecutor, or courtroom official; while possessing a security clearance; or while in a position directly and immediately affecting the public safety? n the la.st 7 years, have you been involved in the illegal purchase, manufaoture, tmfficking, produodon, transfer, shipping. receiving, or sale of any narcotic. depressant. stimulant, hallucinogen. Of cannabis for your own intended profit or that of another'? Ve. No Uyou answered ~Yes" 10 a or b above. provide the date(s), identify the controlled substance(s) and/or prescription drugs used, Bnd the number of limes each was used. MonthJYear MonthlYear Controlled Substance/Prescription Drug Used Number of nmes Used To -- To YOUR USE OF ALCOHOL Ve. No n the lasl 7 years, has yo!)r use of alcoholic beverages (such as liquor. beer. wine) resulted in any alcohohelated treatment or counseling (Such as for alcohol abuse or alcoholism)? f you answered "Yes". provide the dales of treatment and the name and address of the counselor or doctor below. 00 not repeat information reported in response to tem 21 above. MonthNear MonlhlYear Name/Address of Counselor or Doctor SBtB ZP Code To To YOUR NVESTGATONS RECORD Ve. No E) Has the United States Government ever investigated your background andlor granled you a security clearance? f "Yea". use the codes that follow to provide the requested information below. f "Ves; but you can't recall the nvestgating agency andfor the security clearance (eceived, enter "Other" agency code or clea(ance code. as appropriate, and "OOn't know" or "Don't recall~ under the ~Other Agency" heading below. 11 your response is "No,~ or you don't know or can'l recall if you were investigated and cleared. check the "No~ box. Codes for nvestigating Agency Codes for security Clearance Received 1 Defense Department 4 - FB o Not Required 3 ~ Top Secret 6-L 2 State Department 5 Treasury Departmenl 1 Confidential 4 ~ Sensitive Compartmented n'formation 7 ~ Ott1er 3 < Office of Personnel Management 6. Other (Specify) 2 - Secret 5-0 MonthlYesr Agency Other Agency Clearance MonthlYear eney Other Agency Clearance ode Code "Bode Code e To your knowledge. have you ever had a clearance or access authorization denied, suspended, or revoked. or have you ever been debarred from government employment? f ~Ves," give date of action and agency. Note: An administrative downgf"8de Or Yo. No termination of a security clearance is not a revocation. MonthYear Department or Agency Taking Action MonlhfYear Department or Agency Taking Action YOUR FNANCAL RECORD Ve. No Q n the last 7 years, have you fled a petition under any Chapter of the bankruplcy code (to include Chapter 13)1 e n the last 7 years, have you had your wages garni$hed or had any property repossessed for any reason? n the last 7 years. have you had a lien placed a.gainst your property for falling to pay taxes or olher debts? G CD... n the lasl 7 years, have you had any judgments against you that halle not been paid? f you answered ~Ves" to abc or d provide the information requested below' MonthlYear Type of Action Amount Name Action OCcurred Under Name/Address of Court or Agency Handling Case St.;tte ZP Code Enter your Social Security Number before going to the next page J-1J9W PageS

137 ..'...m 1=N..1,,1., J" "*'~ \l,r.,ences v No (i) n the last 7 years, have you been over 160 days de~nquent on any debl(s)'? G) Are you currently over 90 days delinquent on any debt(s)? f you answered ~Ves" to a or b, provide the information requested below' ncurred satisfied Amount Type of Loan or Obligation Name/Address of Creditor of Obligee State ZP Cod. MonthNear MonthlYear and Acoounl Number 6) PUBLC RECORD CVL COURT ACTONS v No n the last 7 years, have you been a party to any publtc record civil court actions nollisted elsewhere on this form? t you answered ~Yes." provide the information about the public record civil court action requested below. MonthNear Nature of Action Result of Action Name 01 Parties nvolved.;ourt (lncluae (;ity ana county/country it outs/de u.s.) sta, ZP Code YOUR ASSOCATON RECORD Ve. No o Have you ever been an officer or a member or made a contribution to an organization dedicated to the violent overthrow of the Unit&d States Govemment and which engages in illegal activities to that end, knowing that the organization engages in such activities with the specific intent to further such activities? CD Have you ever knowingly engaged in any acts or activities designed to overthrow the United States Govemment by force? f you answered ~Yes" to a or b, explain in the space below. Continuation Space Use the continuation sheet(s) (SF S6A) for additlonal answers to tems 9, 10, and 11. Use the space below to continue answers to all other items and any information you would like to add, f more space is needed than is provided below, use a blank sheet(s) of paper. Start each sheet with )'Our name and Social Security Number, Before each answer. identify the number 01 the item, After completing Parts 1 and 2 of this form and any attachments. you should review your answers to all questions to make sure the form is complete and accurate. and then sign and date the following certiflcalion and sign and date the release on page 10. Certification That My Answers Are True My statements on this form, and any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are made in good faith. understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both. (See section 1001 of title 18, United States Code). Signature (Sign in ink) at. Enter your Social Security Number before going to the next page Page 9

138 DOCD: Standard Form 86 Revised September 1995 U.S. Office of Personnel Management 5 CFR Parts , and 736 UNTED STATES OF AMERCA AUTHORZATON FOR RELEASE OF NFORMATON Carefully read this authorization 10 release information about you, hen sign and date it in ink. Form approved: O.M.B. No NSN Q fH11 Authorize any investigator, special agent, or other duly accredited representative of the authorized Federal agency conducting my background investigation, to obtain any information relating to my activities from individuals, schools, residential management agents, employers, criminal justice agencies, credit bureaus, consumer reporting agencies, collection agencies, retail business establishments, or other sources of information. This information may include, but is not limited to, my academic, residential, achievement, performance, attendance, disciplinary, employment history, criminal history record information, and financial and credit information. authorize the Federal agency conducting my investigation to disclose the record of my background investigation to the requesting agency for the purpose of making a determination of suitability or eligibility for a security clearance. Understand that, for financial or lending institutions, medical institutions, hospitals, health care professionals, and other sources of information, a separate specific release will be needed, and may be contacted for such a release at a later date. Where a separate release is requested for information relating to mental health treatment or counseling, the release will contain a list of the specific questions, relevant to the job description, which the doctor or therapist will be asked. Further Authorize any investigator, special agent, or other duly accredited representative of the U.S. Office of Personnel Management, the Federal Bureau of nvestigation, the Department of Defense, the Defense nvestigative Service, and any other authorized Federal agency, to request criminal record information about me from criminal justice agencies for the purpose of determining my eligibility for access to classified information and/or for assignment to, or retention in, a sensitive National Security position, in accordance with 5 U.S.C understand that may request a copy of such records as may be available to me under the law. Authorize custodians of records and other sources of information pertaining to me to release such information upon request of the investigator, special agent, or other duly accredited representative of any Federal agency authorized above regardless of any previous agreement to the contrary. Understand that the information released by records custodians and sources of information is for official use by the Federal Government only for the purposes provided in this Standard Form 86, and that it may be redisclosed by the government only as authorized by law. Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for five (5) years from the date signed or upon the termination of my affiliation with the Federal Government, whichever is sooner. Read, sign and date the release on the next page if you answered "Yes" to question 21. Signature (Sign in ink) Full Name (Type or Print Legibly) Date Signed Other Names Used Social Security Number Current Address (Street. City) Stale ZP Code Home Telephone Number (nclude Area Code) ( ) Page 10

139 DOCD: d ~, Sfan ard"'fo'rm as Revised September 1995 U.S. Office of Personnal Management 5 CFR Parts , and 738 UNTED STATES OF AMERCA Form approved: O.M.B No NSN 1S40~ AUTHORZATON FOR RELEASE OF MEDCAL NFORMATON Carefully read this authorization 10 release nformation about you. then sign and date it in ink. nstructions for Completing this Release This is a release for the investigator to ask your health practitioner(s) the three questions below concerning your mental health consultations. Your signature will allow the practitioner(s) to answer only these questions. am seeking assignment to or retention in a position with the Federal government which requires access to classified national security information or special nuclear information or material. As part of the clearance process, hereby authorize the investigator, special agent, or other duly accredited representative of the authorized Federal agency conducting my background investigation, to obtain the following information relating to my mental health consultations: Does the person under investigation have a condition or treatment that could impair his/her judgement or reliability, particularly in the context of safeguarding classified national security information or special nuclear information or material? f so, please describe the nature of the condition and the extent and duration of the impairment or treatment. What is the prognosis? understand the information released pursuant to this release is for use by the Federal Government only for purposes provided in the Standard Form 86 and that it may be redisclosed by the Government only as authorized by law. Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for 1 year from the date signed or upon termination of my affiliation with the Federal Government, whichever is sooner. Signature (Sign in ink) Full Name (Type or Print Legibly) Oete Signed Other Names Used Social Security Number Current Address (St",.t, City) Stale ZP Code Home Telephone Number (nclud. Ar"" Code) ( )

140 DOCD: RANDOM VEHCLE CHECK RECORD VEHCLE AFFLATE OFFCER DATE (YYYYMMDO/ LOCATON 1---., TAG NUMlER ~~ S._~_ '.~_ TME (HHMM) COMMENTS (This section for noles about person~ demeanor, MAKE MOOEL-, K~9 called, etc, t /s f:/.q for race or gender statistics.) T--T----t----~ f"~>=t : : '-r t lapproved for Release by NSA o~ u FOA Case #4287~ FORM G2272 MAY 2002

141 DOClD: REAPPONTMENT REQUEST FOR PRVLEGES PRVACY ACT STATEMENT: Authority for collecting information requested on this form is contained in 50 US.C, 402 ill2.t-and 50 U,S,c , NSA's Blanket Routine Uses found at 58 Fed, Reg' 0,531 (1993) and the specilic uses found in QNSA 02 and 9 apply to this information. The requested information will be used by the Agency to update credentials. jor medical privilege", Failure to furnish any of the requested inlormation may delay processing or prevent assignment or grant credentials and/or me'clieal pnvlleges PEROD COVERED: FROM 1 CHECK THE APPROPRATE CATEGORY (Attach cutrertt requested DelinJated PrivilegeS) 0 Oa General Medical OfficE:!( 0 b. Aviation Medicine 0 0 c. Clinical Psychologist 0 0 d. Radiologist 0 h. e. Physician'S Ae.sistant f. Clinioal Social Worker g. Adult Nurse Practitioner 0 1 _ 01- _ Ok _ o 2 PRACTTONER'S EDUCATtONrrRANNG UPDATE a. Board Eligible (From Dare) b. Board El(amination Taken (Date) C. Board Certified DTotal o Partial DNO D Yes (Give Board Name) d. Recertnioation (Board and Da'e) e. Utilized in Primary Specialty. Years and Dates 01 Speciality Training (Specify only training since nitial app~tlon) g. Total Hours of Continuing Education h. To"!l Hours of Sub-Specialty BOard this i. Membership in Specialty Soclety(les) this period penod (Specify) j. Name of Practitioner k. Signature. Date 3, REMARKS (DOCument other education trammg update mformaflo/'l nor listed above. Document ProfeSSonal awards N3CSfved since last appomtmtmt.) 4 RECOMMENDATONS a. Medical Treatment Facility: National Security Agency Office of Occupational Health. Environmental am 5atety ServiCes (OHESS) Suite 6404 Fort George G, Meade, MD b. Status D Temporary D 2 Confidential o 3. Contractor D 4 Consulting D 5. Full (Af)tJOintment Status) c. Clinical Privileges o 1. Granted a$ requested D 2. Modified as recommended 3, Other (St9l Remarks) d. Division vhiel e. Signature f. Date g. Sr. MedicallPsychological Advisor h. Signalure i. Date 5. APPRCJV!'L a. Chief OHESS b. Signature c. Dale FORM P6763A REV SEP 2001 (Supersedes P6763A R V SEP 2000 which JS obsolere) pproved for Release by NSA FOA Case#4287

142 ~M3l!fJ~rtf DETERMNATON (Simplified Acquisitions and Commercial tems) CONTRACT/ORDER NUMBER WHEN TO USE THS FORM: For purchase of supplies and services for contract actions not exceeding the simplified acquisition threshold. For the acquisition of commercial items with a purchase value of <$5,000,000. HOW TO USE THS FORM: A commercial item is any item (supplies orservices) that is of a type J;l!.llomarlly used for nongovernmental purposes that has been sold. leased. or licensed or ofltred lor sale. lease. or license to the general publlj;. Neither FASA nor FARA defined "nongovernmental purpose" but it is reasonable to assume the term excludes all governmental purposes. There are still some references to "sold in substantial quantjties" especially in relation 10 procuring services or using catalog prices to determine price reasonableness. Substantial quantities mean "more than nominal" quantities considering the size of the market and the length of time the offered item has been available. Commercial items include modified commercial items if the modifications are customarily avallable n the commercial marketplace or are minor (does not alter the lunction, physical characteristics. or change the purpose) llll anciffery supply support services such as installation, maintenance. repair, training, etc., if offered to the general public and the Government contemporaneously. Aller an item has been classified as commercial, the price of that "commercial item" must still be determined to be lair and reasonable using price analysis (if possible). Price analysis nvolves making a comparison to the same or similar tems whose price has already been determined reasonable. 1a. A,wplJlD abstract Shall accompany he J26258 form il price reasonabieness is predicated on competition. 1b. Adequate price competition may also exist even if only one responsive offer was received provided it was submitted with the expectation of competition or the offered price of the commercial item is "based on" a recent price competition conducted for the same/ Similar items for comparable quantities and under comparable terms and conditions. 2c MaXimum Order Limitations (MOL) is the quantity beyond which the GSA pricing no longer applies. f the quantity to be procured exceeds the MOL a unit price less than that shown on the GSA schedule may/may not be appropriate; further investigation is necessary. 4. Media may take forms ranging rom published catalogs to interactive computer systems and telecommunication networks. Attach a copy of the catalog/price list, copy of lhe computer generated pricing (signed and dated), or a letter stating that the price is representative of a commerciai catalog or price Jist. KEY: s there an established price (andlor established discount price/policy) and s it generally lollowed? 5. A market price is one that has been established in the ordinary course of business between buyers and sellers ree to bargain. A market price is influenced by the torces of supply end demand; i.e., raw materiais/commodities. An offeror rnust demonstrate that an established market price exisls via submission of advertisements, trade publications, market surveys, or sales orders and contracts (if such orders and contracts are capable at independent verification). 6. Recent purchase/contract history is considered to be 12 months or less. Differences n quantities that do not result in different unit prices should be addressed. To be truly representative, the history should be for comparable quantities under comparable terms and conditions. BASS FOR DETERMNNG THE PROR PRCE WAS REASONABLe S MANDATORY. 7. The FAR recognizes an additional base for price analysis - "Comparison of proposed prices With prices for the same or similar items obtained through market research."' Example: Capability and pricing information obtained from contractor expositions. review of catafogs, product literature. or technical, business or trade publications, or consulting Government data bases. 8. 'Other" may be used for comparisons to (a) rough "yardsticks" Which reflect customary commercial practices, such as dollars per pound/cubic foot or (b) ndependent Government Cost Estimates provided the GCEs are based on realistic engineering analysis/estimates of what an ilem should cost and detailed rationale is attached. BASED ON (Check appropriate block(s) and anaoh expjanatoly addendum(s)) FAR a, NO, OF OFFERORS (Attac;f! Abstract) 0, "ONE BO OR "BASED ON" RULE APPLY?' 1. ADEQUATE PRCE COMPETTON DYES (AUaoh explaniltion) 0 NO 2. GSA PRCE COMPETTON 3. LAW OR REGULATON GSA CONTRACT NUMBER b, CONTRACT EXPRES c, MOL a TARFF NUMBER b. DATE a DENTFCATON NUMBER b DATE c. PAGE 4. ESTABLSHED CATALOG r-- PUBLSHED PRCE LST d. ESTAallSHED DSCOUNT PRCE' )B. "BASED ON" RULE APPLES? 5. ESTABLSHED MARKET PRCE DYES (Aniloh explanation addendum) o NO 0 YES (Anach explanation) ONO a SOURCE OF MARKET QUOTATON PROVDED BY OFFERORb MEANS OF VERFYNG ABOVE (AUaclimenr require<fl 6. COMPARSON OF CURRENT OFFER WTH THE SAME OR SMLAR TEM(S) (List inloffnarion as follows:) TEM NUM8~R UNT PRCE QUANTty CONTRACT ORDER NO AWARD DATE f-- 7. COMPARSON TO MARKET RESEARCH NFORMATON (At/ached delails). 8. OTHER (Derail8d JrltormlJfil)fl fequired; AoOTONAL NfORMATON Based on the above and all documents referenced and attached herein, / delermine tha the poce offered for this acquisition is!alt and reasonabte. CONTRACTNG OFFCER SGNATURE DATE FORM J2625B REV APR 2000 (Supersede, J26258 REV APR 97 which" ob,olele) NSN 7$40-FM'OD pproved for Release by NSA FOli\ Case #4287

143 OOClO: RECOMMENDATON FOR ACCEPTANCE OR REJECTON OF MPR DATE SUSPENSE MPA NUMBER CASE NUMBER TO REPLY TO DF The services/commodities cited on the attached Military nterdepartmental Purchase Request (MPR) appear to be within the purview of your office as the responsible agent for preparation or purchase actions. Accordingly, request you indicate below whether the MPR should be accepted or rejected based upon information provided to you in paragraph 2. f you recommend acceptance, your office is required to see that the procurement action is initiated. 2. Agency procedures and the Resources Management Manual (RMM), Part V, Chapter 10, Paragraph require that the decision to accept/reject a MPR be substantiated by your adherence to the following requirements: requester). a. The requested items must serve a proper N5A established requirements (vice a convenience to the b. The requested item(s) or task(s) must be clearly defined. c. There must be adequate time for the Contracting Office (DF11) to award the contract before the expiration 01 the funds cited on the MPR. Funds on this MPR expire on: d. Funding must be adequate to meet the customer's requirement. 3. Piease provide the following information for MPR acceptance: a. Reason the requested item(s) or task(s) should be procured by the NSNCSS: b. Estimated Purchase Request (PR) submission date: _ c. Estimated date of obligation: d. D An "X" in this box by DF2242 indicates the incoming MPR does not contain sufficient itemized detail of What is being procured under this MPR for DF22 to accept and process. The MPR will be rejected unless your office, as the acquisition agent, can determine the specific tasks or items required to adequately describe on the MPR acceptance. Please provide DF224 a breakdown of the items. e. Program Manager's name, organization, and phone number if different from the Acquisition Agent. NAME (Last) (First) (M) ORG SECURE PHONE PROJ EcT NAME TASK NUMBER f. Types of acceptance and how to determine which type of acceptance to check below: 1. Direct Citation procurement cites the customer's funds directly on the NSA contract/order including contractor's travel. This method is used for most DoD orders, except for those orders that are filled from the Agency Stock Fund and inventories. 2. Reimbursable Citation is used when the order will be financed by Agency Reimbursable Authority to fund orders received from Federal Civil Agencies or when the order will be filled from Agency resources (eg. Stock Fund or NSA Employee's TOY). FORM J7152 REV NOV 2000 (Supersedes J7152 REV AUG 2000 which s ob/ojete),1 pproved for Release by NSA a FOA Case #4287

144 DOClD: Follow-on Purchase Requests which include requirements from external customers must include: a, Address of the external customer to ensure correct distribution of the contract documents. b. MPR Number and the N Case Number assigned (shown on front of this form) must be included with the accounting classification n Block #19 of the Purchase Request. c. The following statement. which must be verified by you in the covering memorandum of all procurement packages which contain external requirements (acquisitions not otherwise requiring a covering memorandum shah include the statement on the purchase request): "This acquisition ncludes tems fl:r others external to NSA. The ncoming order has been reviewed by the _-,-_ organlntlon, and a determination made that the tems ordered together with funding clled hereon are consistent with and adequate to support the customer's order." This verification simply states that the items, quantities, and funding identified on the Purchase Request in support of external requirements are consistent with that of the itemized customer order acceptance and, thereby, ensures Agency acqu'lsition manager compliance with 000 and NSA procurement policies. MPR. 5, Based on the above considerations, please indicate recommendation of the acceptance or rejection of the o ACCEPT MPR DRECT CTATON REASON o REJECT MPR ADDTONAL FUNDS NEEDED? AMOUNT REASON FOR AODTONAL FUNDNG o NO DYES REMBURSABLE CTATON 6, Responsible AcqUisition Agent: PRNTED NAME SGNATURE ORGANZATON SECURE PHONE NON SECURE PHONE BULDNG ROOM NUMBER SUTE OF2242, Funds Administration Control Branch Secure Phone: Non-Secure Phone: (410) FAX: (410) Location: AXX4B32 FORM J7152 REV NOV 2000 Page 2-2-

145 n""tn. -:t11aoae:: RECOMMENDATON FOR AWARD For use of this form, see AR ; the proponent agency is ODCSPER For valoriheroisrn/wartirne and all awards higher than MSM, refer to special instructions in Chapter 3, AR , TO 2 FROM 3 DATE PART 1- SOLDER DATA 4. NAME 5, RANK 6 SSN 7 ORGANZAliON 6 PREVOUS AWARDS 9 BRANCH OF SERVCE 10 RECOMMENDED AWARD 11. PEROD OF AWARD a. FROM b TO 12 REASON FOR AWARD 13 POSTHUMOUS 12a. lndcate ACH, SVC, pes, ETS OR RET 12b, NTERM AWARD '"S NO F YES, STATE AWARD GVEN YES D NO D PART RECOMMENDER DATA 14 NAME 15. ADDRESS 16. TTLE/POSTON 1'7. RANK '8, RELATONSHP TO AWAROEE 19. SGNATURE 20 ACHEVEMENTS ACHEVEMENT 111 PART - JUSTFCATON AND CTATON DATA (Use specific bullet e.ampjos ofmeritorious ads orsonice) ACHEVEMENT N2 ACHEVEMENT #3 ACHEVEMENT #4 21 PROPO$f!O CTATON. DA FORM 638, NOV94 REPCACES DA FORM 638,. PREVOUS EDTONS OF DA FORM 636 ARE OBSOLETE

146 nofltn. NAME ':t114q4~ SSN PART V RECOMMENDATONSAPPROVAl,DlSAPPROVAL 22. certify 'hat this individual is eligible for an award in accordance with 22a, SGNATURE 22b DATE AR 600~8~22; and that rhe information contained in Part is correct. 23. NTERMEDATE a. TO b. FROM c, DATE AUTHORTY d. RECOMMEND, n APPROVAL n DSAPPROVAL UPGRADE TO, DOWNGRADE TO' e. NAME f. RANK g, TTLE/POSTON h, SGNATURE i. COMMENTS 24. NTERMEDATE AUTHORTY " TO b. FROM c. DATE d RECOMMEND n APPROVAL n DSAPPROVAL UPGRADE TO: DOWNGRADE TO: e NAME. RANK 9 TTLE/POSTON h, SGNATURE i.comments 25. NTERMEDATE AUTHORTY " TO b. FROM c, DATE d, RECOMMEND: n APPROVAL n DSAPPROVAL UPGRADE TO' DOWNGRADE TO e NAME f. RANK g, TTLE/POSTON h SGNATURE COMMENTS 26. APPROVAL a TO AUTHORTY b FROM c, DATE o. n APPROVED n DSAPPROVED RECOMMEND UPGRA.DE TO: DOWNGRADE TO: e NAME t. RANK 0- TTLE/POSTON h, SGNATURE COMMENTS PART V ORDERS DATA 27a OADERS SSUNG HQ 27b. PERMANENT ORDER NO 31. DSTRBUTON 28a. NAME OFOROEAS APPROVAL AUTHORTY 2Bb, RANK 28c, TTLEJPOStTlON 29 APPROVED AWARD 28d SGNATURE 30. DATE REVERSE, DA FORM 638, NOV 94

147 DOClD: SECURTY CLASSFCATON RECOMMENDATON FOR JONT SERVCE ACHEVEMENT MEDAL (Reference: NSAlCSS PMM 3!J..2, Chapter 230, Military Decorations and Awards) DATE ACTON NTATED (yyyy.mm DD) NAME (Last) (First) (M) RANK GRADE SERViCE SSN KEY COMPONENT OFFCE DUTY TTLE AFSC MOS NEG USSD 4000 REASON FOR AWARO o Outstanding Achievement 0 Meritorious service DYES ONO (On. $PlCfc actlprogram) (Enl/r. Tour) FORWARDNG ADDRESS / GANNG UNT OCCASON FOR AWARD OPCA Opes o SEPARATON o RETREMENT 0 POSTHUMOUS START (YYYY.MM DD) END (yyyy.mm DD! DESAED PRESENTATON DATE ryyyy.mm DD LST ALL DECORATONS AWARDED DURNG THS TOUR (nclusive dates: YrYY MM) LST Al.L PREVOUS JONT/DEFENSE DECORATONS (ncjubilfe dates; YYYY-MM) UNCLASSFED CTATON lnqabbbeylatons 08 ACRONYMS) MUSTSETyPfDN 12 PTCH" THRU /NTiALS DATE (yyyy.mm OO) CONCURRENCE BY COMMANDER MUrARY SUPPORT E:LEMENT SEA DYES DNO THRU NTALS DATE (YYYY-MM-DD) ALPHA +2 COORDiNATED WTH MUST BE SGNED BY JSAM APPROVAL AUTHORTY CLASSFCATON ADVSORY OFFiCER REVEW D APPROVE o DSAPPROVE TYPED NAME SGNATURE ORG DATE FORM P6564G REv DEC 2000 (Supe",edes P6564B REV NOV 97 which is obsolele) Page 1 SECURTY CLASSFCATON ll,pproved fo' Release by NSA o~ FOA Case # 4287

148 DocrD: SECURTY CLASSFCATON NAME (Last) (First) (M) SSN JUSTFCATON: rbullttt statements, Stress accomplis;unel1l, imp;tcl, and end result. LMT ONE PAGE ~ NO r;ontinll.tiqns PfW1ftfd MUST" tvthtd n 12 DilChD DRAFTER (Signature) CONCUR (Signature) (Typed Namo) (Typed Name) (Org,) (Org ) (Secure Phone) (Secure Phcne) (Dale) (Dale) FORM P6564C REV DEC 2000 Page 2 SECURTY CLASSFCATON

149 D \f"t1'\ -:a11aqaq REPORT CONTROL RECORD OF FREEDOM OF NFORMATON (FO) PROCESSNG COST SYMBOL Please read nstructions on back before completing form. 1. REQUEST NUMBER 2. REQUEST NUMBER (X one) 3, DATE COMPLETED (YYYYMMDD) a.ntal b. APPEAL TOTAL HOURS HOURLY RATE OOST 4. CLERCAL HOURS (E 9/GS S and below) (1) (2) (3) e. SEARCH b. REVEW EXCSNG.. X $12,00 c. CORRESPONDENCE AND FORMS PREPARATON d. OTHER ACTVTY TOTAL HOURS HOURLY RATE COST 5. PROFESSONAL HOURS ( /GS-9- GS-15) (1) (2) (3) 8. SEARCH b. REVEW EXCSNG.. X $25.00 c. COORDNATON APPROVAL DENAL d. OTHER ACTVTY TOTAL HOURS HOURLY RATE 6, COST EXeCUTVE HOURS (0-7 - GS-16 / ES 1 and above) (1) (2) (3) a. SEARCH b. REVEW EXCSNG.. X $45.00 o. COORDNATON APPROVAL DENAL 7, COMPUTER SEARCH TOTAL HOURS HOURLV RATE OOST (1) (2) (3) a. MACHNE HOURS b PROGRAMMER OPERATOR TME X (1}Clerical $12,00 (2) Professional $25.00 NUMBER RATE COST (1) (2) (3) 8. OFFCE COPY REPRODUCTON a. PAGES REPRODUCED X.15 a. MCROFCHE REPRODUCED X.25 = 9, MCROFCHE REPRODUCTON NUMBER RATE COST (1) (2) (3) 10. PRNTED RECORDS TOTAL PAGES RATE COST () (2) (3) a. FORMS b. PUBLCATONS X,02 c REPORTS NUMBER ACTUAL COST COST 11. COMPUTER COpy 11) (2) (3) a. TAPE X b. PRNTOUT NUMBER 12. AUDOVSUAL MATERALS ACTUAL COST COST (1) (2) (3) a. MATERALS REPRODUCED X 13. FOR FO OFFCE USi ONLY a. SEARCH FEES PAD f. TOTAL COLLECTABLE COSTS b. REVEW FEES PAD g. TOTAL PROCESSNG COSTS c COPY FEES PAD h. TOTAL CHARGED d. TOTAL PAD i. FEES WAVED REDUCED (X one) Yes No e. DATE PAD (YYYYMMDD) DO FORM 2086, JUL 1997 Chorgtlabkl to 011,..qu"f" afffl' applicalion ofall wq..., criteria. Chargeabl. only to commercial requ ten. PREVOUS EDTON MAY BE U5ED UNTL SUPPLY S EXHAUSTED

150 D NSTRUCTONS FOR COMPLETNG 00 FORM 2086 This form is used to record costs associated with the processing of a Freedom of nformation request. 1. REQUEST NUMBER First two digts will express Calendar Year followed by dash (.) and Component's request number, i.e TYPE OF REQUEST Mark the appropriate block to inetlcate initiol request or appeal of a denial. 3. DATE COMPLETED Enter yeor. month onet doy, Le" CLERCAL HOURS for eoch applicoble activity cotegory, enter time expended to the nearest 15 minutes in the total hours column The activity categories are' SearCh Time spent in locating from the files the requested nformaton, Review Excising Time spent n reviewing the document content anet determining f the entire document must retain its classification or segments coulet be excised thereby permitting the remainder of the document to be declassified. n reviews for other than classification. fo exemptions 2 through 9 should be considered. Correspondence and Forms Preparation - Time spent in preporing the necessary correspondence and forms to answer the reauest, Other Activity + Time spent in activity other than above. such as duplicating documents, hand carrying documents to other locations. restoting files, etc. Multiply the time n the total hours column of each category by the hourly rate and enter the cost figures for each category. 5. PROFESSONAL HOURS For each applicable activity category, enter time expended to the nearest 15 minutes in the total hours column. The activity categories are' Search Review Excising. and Other Acflvlty. See explanation above Coordination Approval! Denial - Time spent coordinating the stoff action with interested offices or agencies and obtaining the approval for the release or denial of the requested nformation.. Multiply the time in the toto hours column of each category by the hourly rate and enter the cost figures for each category, 6. EXECUTVE HOURS - for each applicable acflvity category. enter the time expended to the nearest 15 minutes n the total hours column, The activity categories are: Search Review Exci$ing. See explanation above. Coordl"atlon Approvol/ DanlCi - see explanation above. - Multiply the time in the total hours column of each category by the hourly rate and enter the cost fgures for each category. 7. COMPUlER SEARCH When the amount of government owned (not leased) computer processing machine time required to complete a search is known, and accurate cost information for operaton on on hourly basis is available, enter the time used and the hourly rate. Then, CalCulate the total cost WhiCh is fully chargeable to the requesler.. Programmer and operator costs are calculated using the,ome method as in tems 4 anet 5 ThS cost is aiso fully chargeable to requesters as computer search time, DO FORM 2086 (BACK), JUL OFFCE COPY REPRODUCTON Enter the number of pages reproduced, Multiply by the rate per copy anet enter cost figures. 9. MCROFCHE REPRODUCTON Enter the number of microfiche copies reproduced, Multiply by the rate per copy and enter cost figures. TO. PRNTED RECORDS - Enter the total pages in eoch category. The categories are: Forms (nclude any type at printed forms) Publications (nclude any ype of bound document, such as directives. regulations. studies. etc) Reparts (nclude any type of memorandum. staff action poper. etc.) Multiply the total number Of pages n each category by the rate per poge and enter cost figu,es 11. COMPUTER COPY Enter the total number of tapes and/or printouts. Multiply by the actual cost per tape or printout and enter cost figures. 12. AUDOVSUAL MAERALS - DuplicatiOn cost s the actual cost of reproducing the material. ncluding the wages of the person doing the work, 13. FOR FO OFFCE USE ONLY - Search Fees Pold Enter total search fees paid by the requester Review Fees Paid Enter total review fees paid by the requester. Copy Fees Paid Enter the total of copy fees paid by the requester. lotal Paid - Add search fees paid and copy fees paid. Enter total n the total paid block. Date Paid Enter year. month. and day. Le , the fee payment was received, Total Callectable Costs Add the blocks in the cost column marked with an asterisk and enter total in the total collectable cost block. Apply the appropriate waiver for the category of requester prior to inserting the final figure. Further discussion of chargeable fees is contained in Chapter V of DoD Regulotion R. Tatol ProceSSing Cosfs - Aetet all blocks n fhe cost column and enter total in the toto processing cost block, The total processing cost in most cases will exceed the total collectable cost, Tatal Charged - Enter the total amount that the requester was charged. taking into account the fee waiver threshold and fee woiver policy, Fees Woived Reduced ndicate if the cost of processing the request was waived or reduced by piaclng an "X in the "Yes' block or the "No' block

151 DOClD: SECURTY CLASSFCATON (if any} RECORDS CENTER WTHDRAWAL REQUEST NAME BULDNG SUTE ORGANZATON PHONE ROOM o DATE (YYYYMMDD) RESEARCH CUSTOMER PCKUP, APPROXMATE TME BOX NUMBER FLE DOCUMENT LOCATON DATE RECEVED TME NTALS DATE COMPLETED TME NTALS!=ORM REV JAN 2002 (Supersedes 03748B REV OCT 2000 which is ObSolete) SECURTY CLASSFCATON ii any).~ pproved for Release by N~A FOA Case# '

152 ' ' m DOCD: CiVi:;';s~~~~;;'6und RECREATON FACLTY RESERVATON 0 SOFTBALL FELD 0 PCNC 1. understand that the area which am reserving will be later used by other personnel. 1am to clean the area, place trash and olher debris n he lurnlshed conlainers, and report all damages 10 CWF pnor to 0900 hours Metal or paper containers may only be used at the facility NO GLASS BOTTLES ALLOWEP ON RECREATON AREAS, 2. Maintenance buildings and machinery located on the recreation site are OFF LMTS, t is my responsibility to prohibit my par1y from general abuse of NSACWFC property and grounds 3. SOFTBALL FELDS ONLY; ConcesSionaires, vendors, use of gnlls, pels o~ leash and alcoholic beverages are prohibited at all ballfrelds. (Patu.ent Research Refuge Property) RESERVED :Acea: (Ome) NO OF PEOPLE PRNTED ORG NON,SECURE PHONE NAME SGNATURE DATE THE ABOVE NAMED NDVDUAL HAS PERMSSON OF THE CWFC TO USE ABOVE MARKED RECREATON FACLTY. APPROVED BY DATE FOAM P4346A REV MAFl 2000 NSN' 754Q,rM 001 Q/64 THS FORM MUST ACCOMPANY ABOVE NAMED PERSON,pproved for Release by NSA a FOA Case #4287

153 DOClD: SECURJY CLASSFCATON (if arty) RED BADGE SPONSORSHP FORM COMPANY NAME PRVACY ACT STATEMENT' Auth for collecting info requesled on this form is contained in 50. US,C. Sec. 402 note; 50 U.S.C Se<:: ; and E,Q , and 1296B NSA's Blanket RouUne Uses found at sa Fed, R~ (1993) as well as the specific uses enumerated nfo you pro\'lde in GNSA10 will be used applyto10assist this;r'~ fo'i~ A~l.tihl!Otr~f: O. Red9397. Corridor RaqvE!sted Badge Request Your disci of requg6ted info, is voluntary, However, failure to furnish requesled into, Ofher than SSN. may delay pr of your Red Badge request. DATE (YYYYMMDD) COMPANY ADDRESS CONTRACT NUMBER ROJECTTlTLE NSA PONT OF CONTACT (Name) /La;;t) (First) (M) SSN NON SECURE PHONE (nclude Area Code) AUTHORZED SGNATURE (BranCh Ctuef or above) LOCATON OF WORK TO BE PERFORMED GATEHQUSE MOST FREQUENTLY VSTED expraton DATE (Up 10 yr.) (YYYYMMDD) WLL THS CONTRACT NVOLVE MANTENANCE OF AUTOMATED NFORMATON SYSTEMS (AS) EQUPMENT WHCH PROCESS, STORE DR REPRODUCE PLANTEXT CLASSFED NFORMATON? JUSTFCATON D YES TYPE BADGE REQUESTED NAME (Last, Fjr.t, M) SOCAL SECURTY NUMBER (Check Applicable Block(.)) RED l'tllli BADGE REO CORBDDBACCESS SPONSOR NOTE: AFTER CONDUCT OF NECESSARY CHECKS BY THE OFFCE OFSECURTY, TS POSSBLE THE REO PCTURE BADGE MAY BE WTHDRAWN FOR SECURTY REASONS, FORM G1619A REV MAR 2002 (Su!i<'rsodes G1819A REiVAUG 92 which is obsolete) SECURTY CLASSFCATON (if any) -PP:o -v-e~d ~fo-r~r-e'-le~a~se--cbc-y~n-;;s'c"a;;---oo FOACase#4287

154 DOClD: SECURTY CLASSFCATON (if any) DATE (YYYYMMOO) RED PCTURE BADGE APPLCATON TYPE OR PRNT (USE BLACK NK Q1JJ.r) PRVACY ACT STATEMENT: Auth tor collecting into requested on this form is contained in 50 U.S.C, Section 402 JOB NUMBER note; 50 USC Sections ; and EO 10450, '2333, 12958, and 12968, N$A's Blanket Rovtine Uses lol,md w,.f 58 Fed, Reg, H,),S31 (1993) as well as the specilic uses enl,lmeraled in GNSA10 apply to this info, Auth lor,,,===== requesting vow SSN S EO The requested info you provide will be used 10 assist in processing your RM icompanv NAME Picture Badge, request You disclosure oj requested,nto. ncluding S8N, is voluntary However, falure to furnish the requ(l$lecl other than $SN, may delay or preyenl processing of your request. 1a. NAME (Last) (First) (Middle) b, MADEN NAME (t anjl) _ 3. PHYSCAL CHARACTERSTCS (Complete AJJ. ~tocks! a SEX brace OM OF c HEGHT d. WEGHT e. HAR COLOR. EVE COLOR 4. DATE OF BRTH (YYYYMMOD) 5 PLACE OF BRTH a, CTY b, COUNTY estate d. COUNTRY 63 US CTZEN? b NATiVE? c, F NATURALZED. CERTFCArE NO(s) d F OERVED, PARENT') CETFCATE NO.1') DYES 0 NO DYES 0 NO 3 RELATONSHP AND NAME b, DATE OF BRTH (Lasl, First. M) (YYYYMMODj FATHER 7 FAMLY c PLACe OF BRTH d ADDRESS MOTHER (nclude Maiden Name) SPOUSE (,nclude Maiden Name. if applicable) CHLDREN e, ARE ALL MEMBERS OF YOUR MMEDATE FAMLY AND ALL PERSONS LVNG N YOUR HOUSEHOLD UNTED STATES CTZENS? (/1 you answ8r NO". sl/hetrfull name. relationship to you, and their citizenship in Sectl0fllfj2, "REMARKS".) DYES B, RESDENCES (Begin with CJJBf!El{[address and h.n /1st prioraddress).. a. DATES (YYYYMM) FROM TO b, NUMBER AND STREET ccty d. STATE e. ZP Code PRESENT - 9. EM /s ) PLOYMENT (L' CURRENT '00) a, DATES (YYYYMM) FROM TO b, NAME OF EMPLOYER c,address d. ZP Code e. SUPERVSOR PRESENT (yes) (no).. " 10 DRUG NVOLVEMENT AND MENTAL HEALTH ( YES answers MUS be explamed msecl/on #12 "REMARKS! a. Have you ever been involved in the illegal manufacture, produc1ion, trafficking, or sale of any naroouc or drug? b Have you ever been treated for a mental, emotional, psychological, or personality disorder/condition/problem? FORM G1819 REV MAR 2002 (Supersedes REV DEC 92 Which is obsolete) Page 1 SECURTY CLASSFCATON (if any) :i\; pproved for Release by NSA FOA Case #4287

155 DOCD: SECURTY CLASSFCATON (i' any) RED PCTURE BADGE APPLCATON (Continued) (yos) (no) 11 ARRESiS ("YeS" answers.mj.lube explain6d bf}low and/or in Section 1112, '"REMARKS'7 a. HavEil you ever' been arrested, charged, cited, convicted, or held by Federal, Stata, or other a.w enforcement or juvenile authorities regardless of whether the citation was dropped or dismissed or you were found not guilty? nclude all Courts-Martial or Non..Judicial punishment while in military service. (YOll may exclude minor traffic violations for which B fine Of forteituf9 or $100 or less was imposed.) b. Have you ever been detained, held in, or served time in, any jailor prison, or rek:>rm Of industrial school, or any juvenile facility or insti1ution unljer the jurisdiction of any City, County, State, Federal, Or Foreign Country? c. Have you evaf been, or are you now, under suspended sentence, parole, or probation or awaiting any action on charges against you? (f "YES", please complete nformation below) (1) DATE (2) NATURE OF OFFENSE (3) NAME AND LOCATON (4) NAME ANO LOCATON (YYYYMMDO) OR VOLATON OF POLCE AGENCY OF COURT (5) PENALTY MPOSED OR OTHER DSPOSriON N EACH CASE 12 REMARKS (f additional space /5 required, use a separare sheet of paper) SGNATURE SOCAL SECURTY NUMBER DATE (YYYYMMDD) FORM GB'9 REV MAR 2002 Page 2 SECURTY CLASSFCATON (if any)

156 DOCD: FERS Register Of Separations and Transfers Federal Employees Retirement System 1. Agency 2. Telephone Number 3. Date 4. Page No. ---_ Bureeu or Reporting Unit 6. Location 7. Payroll Office No. 8. Name, Date of Birth and Social Security No. 9. Current Year Retirement Deductions (for agency use only) 10. Total Retirement 11. Date of Separation Deductio ns to Credit and Remarks, of Employees if any $ $ Page Totals Totals Brought Forward from Page Accumulated Tolals to Date NSTRUCTONS: One Copy of this register MUST accompany FERS Retirement Records, SF 3100's, transmitted to the Office of Personnel Management at FERS, P.O. Box 200, Boyers, PA DO NOT USE this form to cover CSRS SF 2806's; nstead use form SF Use the payroll office number of SUBMTNG office. Offce 01 Personnel Managemenl 5 C!=R 841 NSN NSA - FrameMaker Standard Form 3103, January 1967

157 DOCD: REGSTERED MAL LOG REGSTEAEO NUMBER OR1GNATORJRECEVED FROM ADDRESSED TO MAL SECTON SiD SGNATURE ! J l FORM A4S REV MAY 2000 (Supsl'1:JHtes A45 REV JAN 79 which ijl ~ttf) N$N; 7540-FM-G01.(1019 V.pproved for Release by NSA o~ n FOA Case #428771

158 DOCD: REMBURSABLE PSYCHOLOGCAL EVALUATONS RECORD PSyCHOLOGST OATE CONTRACT NO PER CASE RATE NAME SSN EVALUATJON TYPE TME N jtmeout NAME SSN EVALUATON TYPE TME N [TME OUT NAME SSN EVALUATON TYPE TME N TME OUT NAME SSN EVALUATON TYPE TME N [TME OUT NAME SSN EVALUATON TYPE TME N,TMEOUT NAME SSN EVALUA.TON TYPE TME N TME OUT NAME SSN EVALUATON TYPE TME N ["M.OUT NAME SSN EVALUATON TYPE TME N ('MEOUT NAME SSN EVALUATON TYPE TME N [ TMEOUT NAME SSN EVAlUATON TYPE TME N,TME OUT NAME SSN EVALUATON TYPE TME N TMEOUT NAME SSN EVALUATON TYPE TME N,TMEOUT FORM P61B2 REV JUN 2000 (Supersedes P6182 SEP 91 which can be used unlll depleted) ppmved for Release by NSA FOA Case #4287

159 DOCD: REMBURSABLE PSYCHOLOGCAL EVALUATONS RECORD PSYCHOLOGST DATE CONtRACT NO PER CASE RATE FORM P6,a2 REV JUN 2000 (Supersedes P6182 SEP 91 which can be used until depleted)

160 DOCD: SECURTY CLASSFCATiON (ifany) RELEASE OF LABLTY OF THE UNTED STATES GOVERNMENT, TS AGENCES AND EMPLOYEES Authority for collecting information in 40 u,s,c, Sec, 318 and 50 Routine uses found at 58 Fed specific uses enumerated in The requ&sled information you provide will be used to identify the individual before an.,. emergency assistance S prq'jided, Failure to furnish the requested ntormation may delay or prevent emergency assistance, TME DATE ASSSTANCE PROVDED (YYYYMMOO) The National Security Agency Police will provide assistance to stranded motorists althe National Security Agency facilities for safety and security reasons. n consideration of their providing service(s)j the individual receiving the assistance, his/her heirs, assigns and personal representative, forever waives, reieases and discharges the officer, in both their individual and official capacities, heir agency(ies) and he United States from any and all personal injury or property damage, whettier direct or consequential. which may arise out of their acts in providing the assislance. f the individual receiving he assistance is not the sole owner of the property. the undersigned agrees to hold harmless and defend, the officer(s). their supervisors, agencies and the United States against any and all claims brought against them by the true owner(s). PERSON RECEVNG ASSSTANCE (Last First, M) erlf:m1. VEHCLE (Make) (Model) (Signafum) (Tag Numb6r) (Sral6) LOCATON OF VEHCL.E o UNLOCK DOOR o JUMP START TYPE OF ASSSTANCE PROVDED o OTHER (Describe) N PROVDNG THE ASSSTANCE, WAS ANY NCDENTAL DAMAGE DONE TO THE VEHCLE? o YES (f so, dosc"be?) 0 NO DD YOU VERFY OWNERSHP OF VEHCLE? DYES (/1 so. how?) DNa APPROXMATELY HOW LONG WERE YOU NVOLVED N PROVDNG ASSSTANCE? OFFCER(s) PROVDNG ASSSTANCE (last, First, Mil SGNATURE OF ASSSTNG OFFCER APPROVAL BY NSA POLCE SUPERVSOR FORM G3969 REV MAY 2002 ($upefs«1es (;3969 DEC 81 which is obsolefo) SECURTY CLASSFCATON (ff any) pproved for Release by NSA FOA Case # 4287

161 DOCD: r '1 RELEASER'S CHECKLST REPORT CONTENT -- REPORT CONTENT (Continued) FOREGN NTELLGENCE SECURTY CONTROL MARKNGS REPORTABLE --- EXPANDED ANSWERS A REQUREMENT FORMAT REQUREMENTS, MBB CODES SANTZATON FORMAT CORRECT NEWSWORTHY USSO 18 MNMZATON PRORTY COORDNATON REOURED SAN1TZABLE/WTA GRAMMAR SPELLNG PUNCTUATON WoRD USAGE FACTS SUPPORT CONCLUSON REPORT DSTRBUTON 5W. PROPER REPORT VEHCLE 5C. STANDARD DSTRBUTON ORGANZATONAL STRATEGES NON-STANDARD DSTRBUTON NVERTED PYRAMD LESS, WRTE-NS, ZENS LEAD PLUS EQUAL FACTS SPECAL OSTRJElUTON REQURED CHRONOLOGY DSTRBUTON SPELLED CORRECTLY STRONG LEAD ADDRESSEE GROUPNGS STRONG TTLE DDls AND TAa. HEADLNE STYLE SENS-CHECK REOURED VERB TENSE CUSTOMZED VEHCLE BODY, LEAD, TlTU: rer..l SAME STORY E-, '-, S-SERES STYLE AND USAGE ST(NDARDS CORRECTONiREADDRESSAL CAPTALZATON DATES AND TMES ABBREVATONS NUMBERS MEASUREMENTS, MONEY HEADNGS AND SUBHEADNGS COMMENTS USSO 1810ENTrTY FEl.DS CONTENT SOURCE CLASSFCATON CORRECT FORMAT COLLECTOR FELD COMPLETE COLLATERAL COLLECTOR FELD CORRECT CONTENT SEPARATE RECORD PER SOURCE FoAMAT SEPARATE PROALE PER MESSAaE FOOTNOTES SOURCE RECORD FOR COLLATERAL CONTENT ALL SECTONS VALDATED FORMAT ALL REQURED FELDS COMPLETE CLASSFCATON OVERALL FOR REPORT EACH PORTON NDVDUALLY SERAL SEAlES MATCHES FOAM M7216 REV JUN 2000:...,~!t"t'l'!'!'l'::t1l1""1'~""t'!'l'l"T_ "OF! OFFClllL tlm! OK i L... REPORT/SOURCE NFORMATON...1 pproved for Release by NSA FOA Case #4287

162 DOCD: SECURTY CLASSFCATON (ijj any) TRANSACTON NUMBER REPAR REQUEST DATE MAL.!NG ADDRESS PREPARE TWO COPES PRORTY CODE 0 02 EMERGENCY 0 12 DEADLNE 05 0 ROUTNE ORGANZATON END TEM EQUPMENT NOMENCLATURE (e fj., A/ViURf 65(Vj, Hoo8ylllt/lOON6, 'tt.11 NUMBER (model) (somal) (10) ORGNAL EQUPMENT MANUFACTURER AND CAGE CODE OF MAt-lUfACTUREAS EQUPMENT TYPE (e.g., Receiver, Computer, Recordsr, etc.) PART BENG RETURNED (e,g. f)""e<ld.tcbru. /llotor. ere,) PART OR MODEL NUMBER j SERAL NUMBER 8AR CODE NUMBER DOCUMENTATON SUBMTTEDWJTH TEM rnatonal STOCK NUMBER DYES DNO ESTMATED PRCE OF TEM PROJECT NAME/NOMENCLATURE TEM S FROM DE FCENCES OR SYMPTOMs/REMARKS (Give a thorough analyss of failure; also lndlcate any rematks pertinent fo the tem retumed) pproved for Release by NSA FOA Case # 4287 o AR PARCEL POST o REGSTERED MAL 0 Des o FREGHT O OTHER (Specify) CONTROL NUMBERS ASSGNED FOR SHPMENT BY REGSTERED MAL OR DCS FREGHT SHPMENTS (inc1icate traffic control number) FORM H6533 REV OCT 96 (Supersedes H6533 ReV MAR 89 which is obsolete) SECURTY CLASSFCATON litany)

163 DOCD: S~Cl"l~TYCLAS$FCATON (il any) REPORT OF ABSENCE NATONAL SECURTY AGENCY POLCE THE BElOW NAMED EMPLOYEE WAS UNABLE TO REPORT TO DUTY ON OATE SPECFED ABSENT EMPLOYEE pas1ton (Lasl) (F'f$.! 10 Nl"MBEA REASON REPORT OF ABSENCE ABSf;NT EMPLOYEE (Last) DNUM6ER REASON (First) (il,allyl NATONAL SECURTY AGENCY POLCE EMPLOYEE TO RETUf:1N TO DUTY (rime) (Dale> YWYMMDO) EMPLOVEE TO AETVRN TO Dlffi' (T~! (Dats YYYYMMOOJ REPOATNG person SGNATURE REPORTNG PERSON SGNATURE EMPLOYee's Nonce. OF NTENT AND ACTUAL RETURN TO Dl1TY EMPLOYEE'S NOTlCEOF NTENT AND ACTUAL RETURN TO DUTY NOTCE RECEVED (Time) (oale- yyvymm)d) NOTCE RECEVED /T17l8} (Dalll Y'YYYMMDD) EMPLOYEE RETURNED TO Dlfl"'V (17rn!) (Datil YY'r'YMMODj EMPLOYEE RETURNED TO DUTY (Tme) (Da~ YVYYMMDDJ Annual Lnvo CHARGE Slek Leave SUPERVSOR SGNATURE Annual wve CHARGE lek Leave SUPERVSOR SGNATURE hrn. hrs. hrs, FORM F'3767 REV FEB 200~ $ECURfTV CLASSFCATON (if.lilly) FORM P3767 REV FEB 2002 SECURTY ClASSFiCA'rON (if "oyj pproved for R.lease by NSA 0 2~ FOi" Case # 4287

164 DOCD: REPORT OF MSHAP TO: KEY COMPONENT SAFETY AND HEALTH OFFCER FROM ORGANZATON (Alpha. 4) PRVACY ACT STATEMENT AuttlOrity for collecting intorrnation reqljested on this form is contained in 5 U.S.C, 7901; 10 U.SC ; 29 CFA 668; 50 U.S.C 402 ~~ and E , Blanket Routine Uses found a158 Fed. Reg (1993) and the specific uses found in GN$A06 apply to tllis nformation. Authority lor requesting your Social Security Number is Execl,ltive Order 9397, The lrilotmation you provide witl be used (primarily) 10 track occupatonal ncidents, process accident and compensation claims and correct hal~r'dcus conditions Your disclosure 01 requested nl()(mation, including your SSN, S \/Olul'lary. However, failure to furnish any Ol the requested mformation may delay or prevent NSA from mainlaining proper records on occupational mishaps and potentially hinder the processing 01 your c1alm(s) DATE OF ACCDENr (YYYY MM DD) NAME (Please Print) (Last) (First) (M/) PhONE NUMBER (Where employee can be r9i3ched for clarification) (Secure) (Non-Secure) JOe TTLE SSN ACCOENT location (Building/Area: e.g. OPS 2r1(i fjodr h~lway) MOTOR VEHCLE ACCDENT' o ves (AttaCh copy 01 accidf)r1t repoft) ONO NARRATVE DESCRPTON OF MSHAP (E~p)a,n n derail tfje mishap event and nclude nf/jry(fes) and orllness, part of body rn/url6d, trl6chcallreatment (f any), and properly damage (if any). Use additional page 11 necessary) CORRECTVE ACTONS (Explain in detail any methods orsteps taken to prevent the mishap from reoccurring, Useaddifionalpage ifnacessary.) SEVERTY OF NJURY LLNESS (Check appropriate blocks)!approved for Release by NSA or b FOA Case # FMALlTY' ) DATE OF DEATH (YYYYMMDD) LOSS OF CONSCOUSNESS RESULTNG MEDCAL TREATMENT (Non-minor injun'es tl1af AfJ.lS b6 FROM AN NJURY'? treattk J2N...'f by a physician or licensed ~ personnel) DYES ONO DYES ONO DYES ONO WORK DAYS LOST (Not ncluding dily Of injury? RESTRCTED WORK DAYS LOST (Nor inclvding day ofinjuryp FRST AD (One time treatment tor minor iniury) (Number of (j;1ys) (Days unable 10 perlorm all of nclrmal duties) 1 (Number of days) DYES D NO EMPLOYEE (Signatvre) DYES 0 NO DYES ONO DATE OSHRep (Printed Nf.me) SGNATURE DATE SUPERVSOR (Pn'nfed Name) TTLE SGNATURE DATE KEY COMPONENT SAFETY AND HEALTH OFFCER (Slgnafure) (Please use addftronal page fcomments are n8cossary) FORM P7125 REV OCT 2000 (Supersedes P7125 REV AUG 95 wl"ch is obso'e'e) THE ELECTRONC VERSON CONTANS AN ADDTONAL BLANK PAGE F REQURED

165 DOCD: REPORT OF OTHER TRANSACTONS FOR PROTOTYPE PROJECTS REPORT CONTFlOL SYMBOL DD A&TAR) TYPE OF REPORT 2 ~EPORT NlJM8E~ 3 CONTRACTNG 4. NAME OF' CONTFlACTNG OFFCE OFFCE CODE no Original 1 Cancelling 2 Correctina 5 AGREEMENTS OFFCER b, TELEPHONE 6. PN 7. MODFCATON (ncl. Area C()(Je) NUMBER a, NAME (Last. Firs/. Middle nitial) 8, ACTON DATE 9 COMPLETON 10, DUNS NUMBER 11 CAGE 12, CONTRACTOR NAME AND DVSON NAME (YYYYMMDD) DATE (YYYYMMOD) CODE 13 CONTRACTOR ADDRESS (Stree', Suite Number. City, Slate and ZP Code) 14 CONSORTUM,S FRST TME ODD AGREEMENT CONTRACTOR YYe. nyyes N No N No 16 TYPE OF BUSNESS r-:-.:-:- A Small Disadvantaged Business Pertorming in U.S. M Domestic Firm Pertormlng Oulside U.S. B Giller Small Busmess perfonning in U.S U Historically Black Collages and Universities or Minority nstructions C Large Business Perlorming in U,S. V Other Educational L Foreign Concern/Entity Z Other Nonproftt 17 TN 18 PARENT TN 19 PARENT NAME 20. PRNCPAL PLACE OF PERFORMANCE a CTy OR PLACE CODE b, STATE OR COUNTRY CODE c CTY OR PLACE AND STATE OR COUNTRY NAME 21. PLACE; OF MANUFACTURE 22. COUNTRY OF ORO N 23. TECHNOLOGY AREAS OF RESEARCH CODE ~ A u.s B Foreipn 24 PRNCPAL PRODUCT OR SERVCE a FSC O~ b. DOD CLAMANT c. PROGRAM, SYSTEM d SC CODE e, NAME/DESCRPTON SVCCOOE PROGRAM CODE OR EOU PMENT CODE 2S TYPE OF 26 TOTAL DOLLARS 27. TYPE OF ACTON D Within Scope Change 28. CREDTED PAYMENTS OBLGATON A nitial Award F Termination 1 Obligation BOut 01 Scope Change G Cancellation Y l\!s 2 DeobJigatloll C rumina Action H Exercise 01 an Option N NO 29. TYPE OF NSTRUMENT 30. FNANCNG - A Filled-Price AedelerminatiQn R Cost-Plus-Award U Cost-Plus-fixed fee - A Progress Payments E Commercial Financing J Firm-Fixed Price Fee V Cosl Plus-lncenti\l$- D Unusual Progress F Payable Milestones K Fixed-Price Economic Price AdjlJstment S Cost-No Fee Fee Payments or Z Nol Applicable L FiXed-Price ncentive T Cost-Sharing W Other Ad",ance Payments 31. CONTAACTOR COST SHARE 32 TOTAL AMOUNT 33 EXTENT COMPETED 34. NUMBER OF OFFEFlORS 3S NUM8EROF OF AGREEMENT A Competed ACllon a AMOUNT b PERCENT SOLCTED OFFERS RECEVED C Follow-on 10 Competed Action 1 Ona o Not Competed 2 More than One 36 REASONS FOR USNG AN 845 OT AND EXPECTED 6ENEFrTS (Continue on a separato pags ifnecessary) 37 TECHNOLOGY AND NDUSTRAL BASE MPLCATONS (Continue on a separate page if necessary) DO FORM 2759TEST, OCT 1997 NSA FRAMEMAKER '2197

166 O('\('TO ':l.114qq4 REQUEST, AUTHORZATON, AGREEMENT, CERTFCATON OF TRANNG AND REMBURSEMENT A. Agency code and subtllejtont, and submitting B. Standard document number C Request Status or Process Code: (X one) o Amendment No.. office nljmber (X)l,-l(x XXlex) (Org ic1entifier / N, Doc. type code / Serial number) (1) nitial.. (2) Aesubmission 1(3) cot'rectionl (4) cancellation S..,tlon A" TRANEE APPLCANT NFORMATON 1. Name (Last, First, Middle nitial) 2. 1st 51.tler. of last n.me 13. Soelal Security Number., Ed.level a. 5. Year. Conlinuoul Federal... MOl'll'$ 6, Home Address (Slre~/, City, Siale ftnd ZP Code)(optional) 7. Phone Numbers (nclude area code) 8. PosltlQli Title a Home b. Office 9. POlitlon Level (X 01'18) 10. Pay Pion 5er;e' Grede' Step (RAn/( /MOS AFSC O{ Navy Dnign.llor) 11. Organlotation Name (1j Commercial a. Executive (2) AlJtovon b Manager 12. Organization Mailing Address (nclude ZP) 13, Organization UC c. Supervisory l'!:~pe o. '" no. g{~'" non-go..m-.. Ap ntment me t training <tays 16, Are you handicapped YeS d Non-Supervisory or disabled? (X one) No e, Other (Specify) Section B - TRANNG COURSE OATA ""ll 17, Course Tille 18. Tre.ining Objective$ (Benefits to be denved by the Government) 19. Recommended Training Source. SChool or Facility a Name b, Mailing address (nclude ZP) 20 COLlt'Se COdes o. Location of training site (f other rhan 100) a Purpose f Security Clearance k. Training Program b. Type g AllocatiOn Status L Reason for Selection 21. Cours. hou... (4 digits) 22. Cou... ldentiflert c Source h Priority 23. Trllllnlng Period (YYMMDD) a. Duty a SAD d $peciallnterest i Training Level a. Start b Non-duty b. Catalog/Cowrse No e Trallling Vendor Melhod 01 Training b, Complete c TOiAL c. Ofter\ngTLN... Section C " COST NFORMATON (Costs incurred and billed are not to exce9d amount in item 30) lr.ining do nollnvc/jve Cllpendltur. of lund. other nan N.!y. pay or compeon"um. ~p he remelrn2er or quesllon. n section C.nd Xhi. box Direcl Cosls 26. ndirect Cost. (Forinfonnation only) 27. Accounting Claui1icatlon a. Tuition cosl ij, Travel cost b, Books, material, other costs b. Per diem/other cosls c lotal <;flreet CO$$ C. Total indirect casts d. Funding source 28. Labor Co$ts 29. Signature 01 Fiteal Officer (Follow local procedure) "0. n':!tr~: ~= 31" Job Order No S..,tlon D" APPROVAL CONCURRENCE CERTFCATON 32. Supervisor: certify training is job relateo and nominee meels prerequisites 33. Training Officer; certify thl$training meets regulatory requiremen15, -tit nor, artach walverj a, Typed Name (l.ast. First. Middle nitia.l) u Phone f"llmbe( (nclude area code) a Typed Name (Last. Firs!, Middle nitial) b Pnone number (nclud(f ar86 codlfj) c, ;:)lgnalure 0< tle d Date c. Signature & Title d_ Date 34, Authorizing Official 35. Cow,.." Accept.noe (To be completed oy scho(}l offldal) a. Action (X one)... (1) Approved (2) Disapproved a A,cepted c. School Official Signature d. Date b Typed Name (Last. First, Middle nitial) C Phone number (nc ude area CDde) b NO Accepted 36. CourH Completion (TQ be completed by school offlcjal) d Signature & Title e, Dala a, n coome was not completed, Xthis box, lb. Actua!J'J':/llletron (: Gr~ckt 37. Billing in$truotioml (dentify discount tl;lrms % Clays.) Furnish original invoice and 3 copies 10 leave this SE!Cb~~lank.llnd return~ fl)/m Wllh an ex anelioo memo d Signature & Tille 38, c.rtifying Govemm.nt Offlcl.1 a cerlily thallhis account S correct and proper for payment n the amount of: $ Date (YYM DO) b, Signature 1;:. Date Signed e. Date d DSSN Number e Che<:k Number f. Voucher Number TRANNG FACLTY: nvoice should be sent to office indicated in item 37 Please refer to standard document number given in item 8 at lop of page to assure pro~t payment Framl;!Maker 4.0 DOD exce lion to Sf' FORM 1556, MAR 87 Previous edition may be ljsed until e)(hausted, approved gy GSA AMS 11-86

167 AUTHoRrry PURPOSE AND USE; DSCLOSURE....L... "z ;;> ';7"Z PRVACY ACTSTATEMENT The Government Employees Training Act of 1958 (USC, Title 5, 4101 to 4118), EO 9397, November 1943 (SSN). The information on this form is usad in tha administration of the Fadaral Training Program. Tha purposa of this form is to. document the nomination of trainaas and completion of training; it also sarvas as the principal repository of personal, fiscal and administrative information about trainees and the programs in which thed' participate. The form becomes a88rt of the permanent amployment record of participants in training programs an S included in tha Government's entral Personnel Data File. Personal information provided on this form is given on a voluntary basis. Failure to provide this information. however, may result in ineligibility for participation in training programs. 38. AGREEMENT TO CONTNUe N SERVCE SECTON E - TRANEE AGREEMENT CERTfiCATON This agreement applies to all non-government training that exceeds 80 hours (or such other designated period, 80 hours or less, as prescribed by the agency) and for which the Government approves payment of training costs prior to the commencement of such training. Nothing contained in this section shall be construed as limiting the authority ofan agency to waive, in Whole or in part, an obligation ofan employee to pay expenses incurred by the Government in connection with the training. a. AGREE that upon completion of the Government sponsored training described in this request, will serve in the' Department of Defense (000) three times the length of the training period; except that if receive no 8alary for the time spent in training the period of obligated service will be either one month or a period equal to the amount of time spent in training, whichever is greater. (The length ofpart-time training is the number of hours spent in class or with the instructor. The length of full-time training is eight hours for each day of training, up to a maximum of 40 hours a week.) b. f voluntarily leave the 000 and the Federal service before completing the period of service agreed to in item a above, AGREE to reimburse the 000 for the tuition and related fees, travel, and other special expenses (EXCLUDNG SALARY) paid in connection with my training. However, the amount of reimbursement will be reduced on a pro rata basis for the percentage of completion of the obligated service. (For example, if the cost of training is $900 and complete two thirds of the obligated service, will reimburse the 000 $300 instead of the original $900.) c. f voluntarily leave the 000 to enter the service of another Federal agency or other organization in any branch of the Government before completing the period of service agreed to in item a above, will give my servicing Civilian Personnel Office or Training Office advance notice during which time, in accordance with Federal regulations, a determination concerning reimbursement or transfer of the remaining service obligation to the gaining agency will be made. d. understand that any amounts which may be due the employing agency as a result of any failure on my part to meet the terms of this agreement may be withheld from any monies owed me by the Government, or may be recovered by such other methods as are approved by law. e. acknowledge that this agreement does not in any way commit the Government to continue my employment. f. Period of obligated service: (1) From (Elller rial' (YYMMOVJ/ (1) To (ef/l9tdlau1(yymmdd») 39. am not receiving any contributions, awards, or payments in connection with this training, from any other government agency or non government organization and shall not accept such without first obtaining approval from the authorizing training official. agree that should fail to complete the requested training successfully, due to circumstances Within my control, will reimburse the agency for all training costs (excluding salary) associated with my attendance., TRANEE SGNATURE b. DATE SGNED DD Form 1556 Copy 1 Reverse MAR 87

168 DOClD: HELP DOCUMENT FORM DA 31 REQUEST AND AUTHORTY FOR LEAVE t [Om1S being completed in soft copy, it is important to follow same directions as if completing in hard copy. Four copies of the form must be forwarded. Copy designation is as follows: Copy 1 =ORGiNAL 1 Copy 2 = NDVDUAL 2 Copy 3 ::: SUSPENSE 3 Copy 4 ::: ORGANZATON 4 Template already appears with appropriate Copy 1 designation. t is the users responsibility to ensure additional 3 copies are changed to appropriate copy designation before printing and forwarding. When priming form. it is not necessary to print this Help Document.

169 DOCD: REQUEST AND AUTHORTY FOR LEAVE This form is subject to the Privacy Act of For use of this form, see AR The proponent agency is ODCSPEA. (See instructions on reverse.) 2 NAME (Last. First, MiOd~ nitial) PART 1 'CONTROL NUMBER /3 SSN /4, RANK 15, DATE 6. LEAVE ADDReSS (StrB91, City. State. ZP Code and Phone NO.) 7, TYPE OF LEAVE e. ORGN. STATON, AND PHONE NO. ORDNARY o EMERGENCY o PERMSSVE TOY o orher 9 NUMBER DAYS LEAVE 10 DATES a, ACCRUED b REQUESTED o ADVANCED d EXCESS a. FROM b. TO 11 SGNATURE OF REQUESTOR 12, SUPERVSOR RECOMMENDATON! SGNATURE 13. SGNATURE AND TTLE OF o APPROVAL 0 DSAPPROVAL APPROVNG AUTHORTY,. DEPARTURE a DATF. C, TME c NAME TTLE SGNATURE OF OEPARTURE AUTHORY 15 EXTENSON a NUMBER DAYS b DATE APPRuVED c NAME TTLE SGNATURE OF APPROVAL AUTHUHTY 16 RETURN 8. DATE b. TME c, NAME' TTLE SGNATURE OF RETURN AUTHORTY 17. REMARKS Chargeable leave is from PART - - EMERGENCY LEAVE TRANSPORTATON AND TRAVEL 18. You are authorized to proceed on official trallel in connection with emergency leave and upon completion of your leave and travel will teturn 10 home station (or location) designated by military orders, You are directed to report to the Aerial Port of Embarkation (APOE) for onward movement to the authorized international airport desgnated in your travel documents. All additional travel is chargeable to leave. 00 not depart the installation without resarllations or tickets for authorized space required transportation. File a no-pay travel voucher with a copy 01 your travel documents or boarding pass within 5 working days atter your return. Submit (equest for leave extension to your commander. The American Red Cross can assist you in notifying your commander of your request for extension of leave. 19. NSTRUCTONS FOA SCHEDULNG RETURN TRANSPORTATON: to For return military travel reservations n CONUS call the MAC Passenger Reservation Center (PRC): Should you require other assistance call PAP' 20, DEPARTED UNT 121' ARRVED APOD 122 ARAVE:O APOD (return only) 123, ARRVED HOME UNT 24 PART DEPENDENT TRAVEL AUTHORZATON 25 0 o (Space requited) TRANSPORTATON AUTHORZED FOR DEPENDENTS LSTED N BLOCK NO. 25 (Space available or required cash reimbursabje) o ONE WAY o ROUNDTRP U:~1:1 a DEPENDENTS (LasT name, First. M) b RELATONSHP c, DATES OF BRTH (Children) d, PASSPORT NUMBER " PART V AUTHENTCATON FOR TRAVEL AUTHORZATON 26 DESGNATON AND LOCATON OF HEADQUARTERS 127, ACCOUNTNG CTATON 28. DATE SSUED 129 TRAVEL ORDER NUMBER 130 ORDER AUTHORZNG OFFCAL (Title and Slgnalure) OR AUTHENTCATON DA FORM 31. SEP 93 EDTON OF 1 AUG 7515 OBSOLETE ORGNAL 1

170 DOCD: AUTHORTY: PFUNCPAL PURPOSE(S): ROUTNE USES: DSCLOSURE: Title 5, USC, Section 301, PRVACY ACT STATEMENT To 8ulhorize military leave document start and stop of such reave: record address and telephone number where a soldisr may be contacted n case of an emorgency during leave; and certify leave days chargeable to a soldier's leave account To update a soldier's military leave and pay records. nformation furnish9d may be disclosed to DOD officials or employees who need this information to perform their duties; to federal, state, and local law enforcement authonties in appropriate cases; the American Red Cross: and relatives. The social security number s used for positive identification. Voluntary. Disclosure of SSN is voluntary. However, this form will not be processed without a SOldier's SSN, since the Army identifies mambar$ by SSN for payor leave purposes. NSTRUCTONS TO NDVDUAL 1. AUTHORTY FOR LEAVE. A soldier on leave must carry this form while on leave. 2. CHANGES. commander. A soldier who desires changes in authorized leave or does not begin leave on schedule will notify 3. REPORTNG. A soldier will report to duty station not later than 2400 on the last day of leave (block lob) (even if pes orders contain a later reporting date). 4. DEPARTURE RETURN. A soldier will begin and end leave on post, at the duty location, or from the place he or she regularly commutes to work. 5. CHARGEABLE LEAVE. f a soldier works over one-half of the normally scheduled working hours on the day of his or her departure or return, that day is not a chargeable leave day, (Soldier's commander may authorize early departure or late arrival.) f he or she returns on a normally scheduled nonduty day, that day is not chargeable to leave. 6. TRAVEL EXPENSES. A soldier on leave pays for all his or her travel expenses, to include return to duty station. He or she must have sufficient funds to pay all expenses. A soldier without sufficient funds to return to duty station reports to the nearest military installation. 7. LEAVE extensons. A soldier must request leave extension prior to end of leave. a, f disapproved, 3 above applies. b. f approved, complete block 15a Attach written notification of extension when received. 8, LOST OR DESTROYED LEAVE FORM EN ROUTE PCS. Request a reconstructed form from the losing station. Continue with required travel and reporting dates. 9. CASUAL PAY. A soldier who needs a casual pay while on leave should contact the servicing FAO for information and assistance. 10. MEDCAL TREATMENT. a. A soldier Who requires medical treatment while on leave, report to the nearest military medical facility. n the absence of such a facility. report to a uniformed services treatment facility or Veteran's Administration facility, if possible. b. Medical treatment at Government expense at other than federal facilities is authorized only for emergencies When treatment cannot be obtained from Government facilities or when prior approval is obtained. c. f a soldier becomes hospitalized by a civilian physician, the soldier or someone acting for him or her must contact the Patient Administration Office of the nearest military medical facility as soon as possible, A soldier may Seek assistance from the nearest U.S. Army recruiting station or local chapter of the American Red Cross. nformation provided must include nature of illness or injury, date and place of hospitalization, and name and telephone number of attending physician. d. f a soidier is placed sick-in-quarters by a civilian physician he or she will _. (1) Contact the Patient Administration Office of the nearest military medical facility. (2) Obtain written statement trom attending physician (military or civilian) verifying condition and including dates of treatment. Provide statement to leave approving authority upon return to duty. REVERSE, DA FORM 31, SEP 93

171 DOCD: REQUEST AND AUTHORZATON FOR TOY TRAVEL OF DOD PERSONNEL (Reference: Joint Travel Regulations) Travel Authorized as ndicated in lems 2 through 21. REQUEST FOR OFFCA~ TRAVEL 2 NAME (Last, First, MiddlQ nitial, AND SSAN 3. POSTON TTLE AND GRADE OR RATNG 1 DATE OF REQUEST 4, OFfCAL STATON 5. OAG\NlZATONAL ELEMENT 6. PHONE NO 7 TyPE OF ORDERS a. SECURTy CLEARANCE 9, PURPOSE OF TOY loa. APPROX. NO. OF DAYS OF TDY (including travel time) b PROCEED 0 A (DaM) 11 TNERARY o VARATON AUTHORZED 12. MODE OF TRANSPORTATON COMMERCAL GOVERNMENT PRVATELY OWNED CONVEYANCE (Ch9Ck one) RAL AR 1 BUS lshp AR VEHCLE SHP RATE per MLE: [J AS DETERMNED BY APPROPRATE TRANSPORTATON OFFCER 0 (Overseas Travel Otlly) 0 MORE ADVANTAGEOUS TO GOVERNMENT MLEAGE REMBURSEMENT AND PER DEM LMTED TO CONSTRUCTVE COST OF COMON CARRER TRANSPORTATON AND RELATED PER DEM AS DETERMNED N JTR. TRAVEL TME LMTED AS NDCATED N JTR 13. C PEA DEM AUTHORZED N ACCORDANCe: WTH JTR, o OTHEH RATE OF PER DEM (Specify) 14. ESTMATED COST 15. ADVANCE PER DEM T;AVEL TOTAL AUTHORZED ~THEA $ $ $ 16 ReMARKS (Uss this space for special requirements, tjave, supenor or 'sl-class accomodariol1s, excess baggage, registration fthjs, etc,) (Prior to trall8loverse.as comply wifh the Foreign Clearance Guide for passport, immunizaflon, and clearance requirements, Artach receipts showing cast of sf{ lodgings used during the period ofthis clslm, Sutxml TraVl!l Voucher Within 5 workdays altercompleton ot travel.) 17 REQUESTNG OFFCAL (Titl~ and signature) 18, APPROVNG OFFCAL. (TitiB and signature)! 19. ACCOUNTNG CTATON AUTHORZATON 20. ORDER AUTHORZNG OFFCAL (Title and signature) OR AUTHENTCATON 21. DATE SSUED 22 TRAVEL ORDER NUMBER DO FORM 1610, JUN 67

172 DOCD: REQUEST AND RECEPT OF COMSEC ACCOUNT FORMS (P,ea!le Read nstructions CSlrefllJl/\,m NSTRUCTONS Form M.UJll be completed in triplicate. Forward!w.Q copias, 10 address shown below, along with!w.q typed. self addressed, self-stick. address labels. lit is MANDATORY to include your mailing labels to receive your order!!) Keep one copy of this form for your records. The order will be processed and forwarded along with one copy of this form. Upon receipt of your order, please complete and relurn 'ReceiPt' portion, Piease allow 4-6 weeks for delivery. Any questions concerning your request may be directed to the nventory Manager of forms on (301) DATE OF REQUEST DATE DESRED COMSEe ACCOUNT NUMBER SPONSORNG ORGANZATON Y131 REQUESTER'S NAME PHONE NUMBER (nclude area code and, if applicable. extension) PLEASE COMPLETE AND FORWARD THS REQUEST FOR COMSEC ACCOUNT FORMS 10: ADDRESS WHERE ORDER TO 8E SHPPED MANDATOBY!( NATONAL SECURTY AGENCY AnN: 8711 (Gl01) 8AB # FORT GEORGE G. MEADE. MD L6061 COMSEC Material Record N2942B Signature Card FORM NUMBER AND TTLE STOCK NUMBER QUANTTY UNT OF SSUE 754O-FM 00H FM J O FM OO Each Request and Receipt of COMSEC Account Forms SF 153 (5 part Cartxmize<l) Sat COMSEC Material Report (Min;mum order is 100 Sets) SF 700 Security Container nformation COMMENTS Each Each Each DATE RECEVED PROCESSED BY FOR NSA USE ONLY CONTAOLNUMBER COMMENTS SGNATuRE,pproved for Release by NSA FOA Case # 4287 PHONE NUMBER FORM J2804 REV JUl2000 (Supersedes J2804 REV JUN 98 which is obsolete) N$N: 754Q.FM-Q ~-~ RECEPT (To be completed and returned to NSA after order received) RETURN TO NATONAL SECURTY AGENCY ATTN: S711 (Gl01) SAB"4 S4140 FORT GEORGE G. MEADE, MD RECEVED BY (Please print) FROM SGNATURE Raceipt is haraby acknowle<lgad for /tie fonns ordered under this control number: CONTROL NUMBER DATE RECEVED FORM J2804 REV JUL 2000 NSN 7540 FM Q

173 TRAVEL USE ONLY SEE NSTRUCTONS ON PAGE 2 PROR TO COMPLETON OF FORM ncompltttg forms will cause,. delay n processing. TON REQUEST AND TRAVEL AUTHORZATONlEXPENSE REPORT THS SECTON MUST BE COMPLETED (Mandatory) NAMe! (La~t) (First) W) SSN lorg SUTE NO HOME ADDRESS EllllAlW. DLOCA.L OrDV CVLAN GRADE OR MLTAAi GRADE/SERVCE PHONE rsectlre) (Non-se-cur8) TQTAL DAYS TlJ'V o S\JPPLEMENTA- DOCD: SEC~'~T~O 151 FUND CrrE $ 2nd FUND CTE $ DATES TOY LOCATON V$tTNC ACTUAL OATES ACTUAL TDY LOCATONS 11~~R~? FROM TO errv StA.'EOR COUNTRY AlO" TO en STATE OR COUNTFlV TES [)eopllttfmm' TRAVEl-PURPOSE o HOURS (p/(n/dfj llclj81 times) r MSSON PURPOSE, PROJECT. CONFERENCE OR COURSE NAME ACTUAL REMBURSABLE EXPENSES (You must c14lfm the t~m to {lei ntlmbutmd} CONFERENCE DATE NATURE OF EXPENSES AMOUNT TRANNG TAANSPOATAT(lN $ ES"Mr.TED REMBURSABLE EXPENSES (form/s) TRANSACTON FEE $ TRANSPORTATON CHARGE RANSACT()N FEE l~ntal.capl E"FlOEM $ $ $ $ LODGNG COST; $ CONFERENCE FEF. ~~g,e.:&ytla'/"r(lf GAS PARKNG LODQNG TAX (if~/it!. ~ ifll>!~~! $ $ $ $ S RENTAL CAR $ TAX POV MLEAGE OTHER--(~-E;'plajn) ATM FEE S $ MLES )(365_ $ $ EXPLAN 'OTHER' TOTAL $ $ - $ $ REMARKS (lnclljde JllSlifil:.atiM) $ oactual Expense Allowance 0 FQrelgn Flag o Collrier obl.sine$l> ClaSs REMAR<S (lndudfl JustifCation) D Safe A.rrival Phono Call o Rental Car h!;'~',uv~u for RiiTiiase by NSA 0 De-'l\a',.,. Olne,/JusljhclitiOf FOA Case #4287 r;nter OATES OF ANY LEAVE TAKEN DURNG mv~ /am.w'''tu,." EXfHfflH RfHH'tJfUS bt ffh Within 5 dlyl ofcomptfllm 01 TOY THS SECTON MUST BE COMPLETeD (Mand"tory) rrave;lef SGNATURE DATE TRAVELER SGNATURe: om THS SeCTON MUST BE COMPLETED (Mandatory) --._..._- APPROVNG OFFCAL PRNTetfNAME PATE ~ APPAO~"G Of'~AC "'NT,O""', OAT' t """""''', APPROVNG OFFCAL SGNATURE APPROVNG OFFlCli\L SGNATURE:: FORM K6934 RE"V JAN 2002 (PrJJVkJus e-:litiolls Of)l;otate) - Page , 1SECURTY Cl,.ASSFlCATON

174 NSTRUCTONS Contact Commercial Travel Office PROR to completing RTA, except for travel ofa sensitive nature. o o r-l r-l "'l.. AH o o Q REQUEST AND TRAVEL AUTHORZATON (RTAl TRAVELERS MUST USE CONTRACTED COMMERCAL TRAVEL OFFCE (CTO), except for travel of a sensitive nature. TON: Travel Order Number must be completed by Travel. Oates: Date of departure to date of return. Site Visiting & City, Coun~ry: Name of site, military installation, contractor, etc., to include Cty, county (ifknown). state and country. Travel Category: Course name. Exem~tion from use of Government Charge Card - Sensitive travel only, equires security approval FORM K$934 REV JAN 2002 Pt!ge 2 ndicate, as appropriate, Purpose, Project, Conference or Estimated Reimbursable Expenses: Enter all anticipated costs, or enter N1A for any item not applicable. Obtain Air/RaillRental Car and Transportation Fee costs from CTO. (Otherl: i.e. tous, excess baggage, currency exchange, phone calls, airport taxes, shu tie service, hotel tax. Remarks: Enter all requests for special authorizations and exceptions to policy. All exceptions to policy!!lyi! include a justification. Foreign Flag ~ eta must document necessity on itinerary invoice. ~ Employee must contacl SSO for briefing and signature on RTA. letter from Travel Office to avoid x-ray is required. Business Class eto must document authorization on ltinerary invoice. Excess Baggage State number of pieces/number of pounds. Actual Ex"""se Allowance (AEA Stale days and location where AEA is requested. Show AEA Amount. Government Equipment - Requires approval from the Approving Official, and a lefter from the Travel Office to avoid x-ray. mprestfunds Employee must contact Disbursing Office. Exemfttion from Contracted CTO Usage - Reier to Division Manager's Guide on ravel Page. Phone Calls - Stale that call was tor official purposes or Sale Arrival Call. Refer to Phone Policy on Travel Page..L..u.Ye. ~ Provide dates 01 any leave to be taken in conjunction with TOY. Rental car Approvaf tor any size larger than a compact must be documented on he RTA. Traveler, A~provlng Official Printed Name, Signature and Date: Approving Official signature Mandatory. EXPENSE REPORT (ERl Expense Report is required to be filed within 5 days AFTERcompletion of TOY, in accordance with federal travel regulation. TRANSPORTATON RECEPT MUST BE SUBMTTED WTH ER. Acceptable receipts are eta invoice, ticket receipt or copy 01 charge card bill. Actual Dates: Enter actual TOY dates. For travel between 12 and 24 hours, enter times of departure and return. Actual TOY Location: Enter actual TOY location(s). f local, enter location (ex: Crystal City) and 'Local Travel'. Parking Fees: f claiming Parking Fees, traveler~include on RTA total miles driven. Local Travel: When travelers claim 'Local Travel: they must deduct home to work mileage, and include the following statement in Remarks: 'Home to Work Mileage Has Been Deducted.' (See Corporafe Travel Gram ). Lodging Cost ncurred: The actual lodging cost(s) must be entered, and the lodging receipt(s) must be attached. (Lodging taxes within CONUS, AK, H, and U.S. possessions or territories musl be claimed as a separate expense but are reimburseable.) Actual Reimbursable Expenses: list.ll!.! expenses incurred. Receipts required for any single travel expense of $75.00 or more. Remarks: Enter any special authorization not previously approved; provide dates of any leave laken; indicate number and type (breakfast, lunch, dinner) of meals provided and dates. Phone calls must be itemized with dates and amount. Traveler's Certification and Oate: Your signature indicates that you have traveled as authorized, all claimed expenses are true and accurate, and payment! credit for claimed expenses has not been received. t also indicates that you have read and understand the Privacy Act Statement provided below. Falsification will cause forfeiture of this claim and may result in disciplinary action, fine, jail, andlor terminalion. f signing for another individual, you must have a valid Power of Attorney and it MWn. be included when filing the Expense Report. Approving Official Printed Name, Signature and Date: Required prior to submission for reimbursement. Reimbursement will not be made without this signature. PRVACY ACT STATEMENT AuthOrity: GNSA08.. GNSA09; 5 usc. 31 USC , and EO Princlpat Purpose(s): To substantiate authorization _and daims fof reimbursemem for official travel. Used for reviewing, approving, accourrting and disbursing for ot1lciallravel SSN is used to maintain a numerical identification system tor individual daims. RouUne U6e(&.); See GNSAOB and GNSA09; See also Blanket Routine Uses. Dlsclosure: Voluntary; however, failure to furnish inlofmation requeisted may deiay/cancel proposed TOY. andlor result in lotal or partial denial of amount daimed

175 "'~~ &(;1 S1!!JettEflT~f~(lecling nla requested OrllhiS form is conl.;jined in 50 U.S.C. 402 rulli; 10 U.S.C ilr'ld E,O NSA'e; B1ani4&1 ROOMS Uses round 8t 56 Fed. DO \R... Ni;i (1994l_...eU~...lol.ond n GN$A08 apply C~ this onlqrma.tion. /l.ijlhot,ty lor r&qul*\ting \,Cllr SSN is E.O nlo you pro~ide will be used (pnrnari\y) to determll'\e j1 the relocation 01 the emp1oyee's placo 01 resdence is primafily incldlln\ to e. Ch8.l"lge 01 SlfiliOl' arld wmther M'lP10)'eE! is eligible lor reimbul'$eltent at aulhorized mqyiflg t'llptl"ses $) relat$d, OjscO$J~ or fgq.ll'sled into, incluoioll YQur SSN, is voluntary However, 'a'lure 10 furnish requested n/o, other than your SSN, t'\'lay affel,:t the Aglilncy's ability to determine your eligibility lor and procass r6"t-ol.j'$qmef11 01 autharizea moiling epenscs,nt;:',d(ilnt to a ~na"oe of ~talior'1, REQUEST FOR APPROVAL OF LOCAL AREA RESDENCE CHANGE CHANGE OF STATON (from) TO NAME (Last) (First) (M), DSTANCE BETWEEN STATONS ::!E MD2 ft SSN PHONE ORGANZATON u. - '- LU Present t- '-'1Jl (old) Ow z'" o:it LULU Wo: ~8 00: "'t- ~~ wu -e> "'e> Proposed "'"!;:o- :::>" 58 :l'< (new) Zz!i)N '" RESDENCE ONE WAY MLEAGE COMMUTNG TME A. A PRESENT A TO YOUR NEw DUTY STATON RESDENCE (Old) B 6 8 TO YOuR PRESENT DUTY STATON DFFERENCE (A minus B) PROPOSED C C. RESDENCE C TO YOUR NEW DUTY STATON (new) DFFERENCE (A minus C) D, OTHER FACTORS JUSTFYNG PROPOSED RELOCATON OF RESDENCE ' ' (to) E. NAMES OF DEPENDENTS (10 include spouse) RELATONSHP DOB OF CHLDREN F DATE TRANSPOATATON AGREEMENT EXECUTED EMPLOYEE SGNATURE MD2 DETERMNATON RELOCATON OF RESDENCE S DETERMNED TO BE PRMARilY NCDENT TO CHANGE OF STATON. PAYMENT OF ANY ALLOWANCES 1$ CONTNGENT UPON THE RECEPT OF APPROPRATE pes ORDERS AND YOuR REPORTNG FOA DUTY AT THE NEW DUTY STATON RELOCAllON OF RESDENCE S DETERMNED NOT TO BE PAMARll..Y NCDENT TO CHANGE OF STATON RECOMMENDNG OFr:CAL (MD2) MD2) DATE APPROVNG OFFCA, (Chi.l, MD2) DATE T SHOULD BE NOTED THAT CLAMS FOR PAYMENT OF ANY ALLOWANCES OR REMBURSEMENTS SUBMTTeo PURSUANT TO THS DETERMNATON MUST BE OTHERWSE PAYABLE, THS DETERMNATON NOT WTHSTANDNG. FOAM K8749 AEV DEC 2000 (SuperSedes K8749 REV OCT 2000 which is obsolete) pproved for Release by NSA 0 2~ FOACase#4287

176 DOCD: REQUEST FOR DEVATONWAVER (RFD/RFW), DAr. (rryymmuu) Form Approved OMB No The public reportmg b...rdilfj lor this coliectiol'l of lllormaliql'l '$ $slimated 10 a~.rage 2 hol,lrs per '$$ponsll:, includirog the lime lor reviewing insln..ctions, 2, PROCURNG ACTVTY searchlf'lq existing dala sources, gathering...1;1 maintaining the data needed, am comp1eling the,olecl'on Of.nlonnation. 6et1u ~omm&l'\ts r$qardll'lq this NUMBER purden ast''l'li19 or afly Oh8' aspect olin,s COll1!C1jM o,l"ltormation. irclu(\ing!>uggest":'ns for rt!j(!!jdng 11'11$ bll'den, to Department 01 Delenso, Washinglcn HeadQua"ers SeNCe, O,rectorate ior nformation Opera~O/'s and AepOlts ( ), 1215Jotersoo Davis Highwa~, Suitu 1204, A1lnQlOrl, VA Respondents sl10uld De aware 'nat nolwthstandlng any other prov'son of law, '10 P&500 snail bll subjocf to any penally lor lia/iog tq CO'l'l()lV wilh a COllection o1,nlormatioo ~ doe$ flo' Ol$f:llil'\y :'l'.urljo,l'\\ly 'Jall" 1MB tonllo\ l1umbe, PLEASE DO NOT RETURN YOUR COMPLETED FORM TO E.THER OF THESE ADDRESSES. RETURN COMPLETED FOAM TO THE GOVERNMENT 300DMC SSUNG CONTRACTNG OFFCER FOR THE CONTRACT PROCURNG ACTVTY NUMBER USTeO N TEM :2 OF THS FORM. 40RGNATOR b, ADDRESS (Street, City, Slate. Zip Code) 5. (X ana) a TYPED NAME (First Middle nilial, LaSt) h DEVlATlON- waver 6 X ""e) h MAJOR '-- MNOA CRTCAL 7 DESGNATON FOR OEVATON WAVER a. BASELNE AFFECTED 9. OTHER SYSTEM/CONFGU. RATON TEMS AFFECTED a MODEUTYPE b CAGE CODE c SYS DESiO d. OEV/WAJVER NO, H FlJNC - 10 TTLE OF DEVATONWAVEA o AlCO l10nal CATED PRODUCT res nno 11. CONTRACT NO AND LNE TEM 12 PROCURNG CONTRACTNG OFFCER 2. NAME (First, Middle nitial, Last) b. CODE c. TELEPHONE NO. 13 CONFGuRATON TEM NOMENCLATURE 14. CLASSFCATON OF DEFECT CUNU u.uoroul NU. n- MNOf\ " 15 NAME OF LOWEST PART/ASSEMBLY AFFECTED 16. PART NO. OR TYPE DESGNATON rru" 1 MAJOR ncrftlcal 17 EFFECTVTY h RECURRNG DEVATONWAVER 19 EFFECT ON COST/PRCE FO EFFECT U" U."V<MY Yes rt NO 21 EFFECT ON NTEGRATEO LOGSTCS SUPPORT, NTERFACE OR SOFTWAR~ 22 DESCRPTON OF OEVATON'NAVEA 23. NEED FOR DEVATON/WAVER 24, CORRECTVE ACTON TAKEN 25, SUBMTNG ACTVTY a. TYPED NAME (First. Middle nitial, Last) b TTLE c. SGNATURE 26. APPROVAUDSAPPAOVAL a. RECOMMEND APPROVAl DSAPPROVAL b APPROVAL c,goveanment ACTVTY h APPROVED n DSAPPROVED d TYPED NAME (First, Middle nitial, Last) e SGNATURE f DATE SGNED (YYYYMMOD) fl'proval h. GOVERNMENT ACTVTY APPROVED n DSAPPROVED i TYPED NAME (First. Middl8lnirial, Last) j SGNATURE k, DATE SGNED (YYYYMMDD) DO FORM 1694, AUG 96 PREVOUS EDTON MAY BE USED

177 DOCD: REQUEST FOR FELD ASSGNMENT OR EXTENSON OF PRESENT TOUR (Contractor) PRVACY ACT STATEMENT: Aulh: P.L , E.O.s 9397, 1QB65, 12333, & 12958: System of Records: GN$AtO, info will be used for iovestigative and eval purposes to consider suitability tor Permanent Change of StatiOn assignment n support ol an NSA contract. Routine Uses: May be disseminated to government agencies and pril8." contractors as required lor clearance and national seculty r'1vestigalions and delermmations, and relaled litigation. Dsci of info aod SSN: Volunlary, Failure to provide info may result n inability 01 N5A. to make determination of eliqibility lor pes assignment Your Sianature below' indicates you have read and understand the above. FROM SGNATURE NAME SSN NSA: 1 PLEASE NTATE SECURTY PROCESSNG FOR THE ABOVE NAMED NDVDUAL FOR THE ACTON CHECKED BELOW pes OVERSEAS ASSGNMENT ON OR ABOUT (Date) LOCATON DATE EXTENSON OF PRESENT TOUR NDViDUAL ARRVED PRESENT TOUR ENDS 2 YOUR COMMENTS ARE REQUESTED NLT 3, PRESENT ADDRESS 4. AVALABLTY FOR PROCESSNG 5 LAST SSB DATE F OVER YEARS OLD, DATE RENVESTGATON NTATED 6 REMARKS COMMENT NO.2 FOR P4660A REN NOV 98 NSN 7540 FM Q SECURTY CLASSFCATON e<;: COR pproved for Release by NSA FO.A, Case # 4287

178 - DOClD REQUEST FOR RECORDS DSPOSTON AUTHORTY (See nstructions on reverse) LEAVE BLANK (NARA use only) JOB NUMBER TO NATONAL ARCHVES and RECORDS ADMNSTRATON (NR) DATE RECEVED WASHNGTON, DC FROM (Agency or establishment) NOTFCATON TO AGENCY 2. MAJOR SUBDVSON n accordance with the provisions of 44 U.S.C. 3. MNOR SUBDVSON 3303a the disposition request, including amendments, is 8p'proved except for items that may be marked disposition not approved" or ''withdrawn M in column NAME OF PERSON WTH WHOM TO CONFER 5. TELEPHONE DATE ARCHVST OF THE UNTED STATES 6. AGENCY CERTFCATON hereby certify that am authorized to act tor this agency in matters pertaining to the disposition of its records and that the records proposed for disposal on the attached.18ge(s) are not now needed for the business of this agency or will nol be needed after the retention periods specified; and that written concurrence from the General Accounting Office, under the provisions of Title 8 of the GAO Manual for Guidance of Federal Agencies. 0 is not required; 0 is attached; or 0 DATE SGNATURE OF AGENCY REPRESENTATVE TTLE has been requested GRSOR 10. ACTON TEM 8. DESCRPTON OF TEM AND PROPOSED DSPOSTON SUPERSEDED TAKEN (NAAA NO JOB CTATON USE ONLY) NSN PREVOUS EDTON NOT USABLE STANDARD FORM 115 (REV ) Prescribed by NARA 36 CFR 1228

179 DOCD: NSTRUCTONS GENERAL Use Standard Form 115 to obtain authority for the disposition of records. Submit two signed caples to the National Archives and Records Administration (NR), WaShington, DC 20408, and retain one copy as your suspense copy. NARA Will later return one copy as notification of tho items approved for disposal or archival (permanent) retention. This copy will also indicate any items withdrawn or disapproved. GAO's written approval must either accompany each SF 115 requiring Comptroller General concurrence or be requested prior to the submission of the SF 115 to NARA. The SF 115 may be accompanied by Standard Form 115A, Continuation Sheet, by schedule items entered on blank stationery formatted similar 10 the SF lsa, or by pages formatted to conform to the agency's published records disposition schedule. SPECFC Entry 1 should show the name of the Executive Branch department or independent agency, Legislative Branch agency, or the Adminsltrative Office of the U.S. Courts for the Judicial Branch that is submitting the request. Entries 2 and 3 should show the major and minor organizational subdivisions that creale or mainlain the records described on the form. f more than one subdivision maintains records described in the submission, the various office names should be specified in entry 8 Entnes 4 and 5 should provide the name and telephone number of he pelllon to be contacted for information. Entry 6 must be signed and daled by the agency official authorized to certify that the retention periods for records proposed for disposal are adequate to maet lhe agency's needs, and that GAO requirements have been met (check appropriate box). Unsigned SFs 115 will ba returned to the agency. Entry 7 should contain the item numbers of the records identified on the form tn sequence, beginning with "1". Lower case letters and numbers may be used to designate subdivisions of an item (la, b, 1b(1), lb(2), etc.). Agency file numbers should not be entered in this column, but may be ncluded in entry 8. Entry 8 should describe the records to be scheduled. Follow these steps in describing the records: (a) nclude centered headings for groups 01 items to indicate the office of origin if all records described on the form are not those of the same office, or if they are records crealed by enother office Or agency such as, for example, records inherited trorn a defunct agency. (b) dentify separate collections of nontextual records, such as photographs, sound records, maps architectural drawings, or magnetic tapes or disks, as separale and dislinct items, it such records are inlerspersed with textual records, as n case files, their presence should be noted in the description of he textual file. (c) Describe completely and accurately each series of records proposed for disposal or transfer 10 the National Archives, See 36 CFA 1228 for more detailed requirements. Failure 10 comply with lhe provisions of hat regulalion will resuft in the return of the SF 115 for corrective action, (d) Provide clear disposition instructions for each item and subitem. These instructions should include file breaks: the time after which records will be retired to Federal records centers, if applicable; for temporary records, the time after which they may be destroyed; and for archival (permanent) records, the time after which they will be transferred 10 the legar custody of fte National Archives. (e) t immediate disposal or transfer to the National Archives is proposed for non-recurring records, ndicate the volume and inclusive dates of the records and the Federal records center accession and box numbers, if applicable. (f) f future or continuing disposition authority is requested, state the retention period in terms of years, monlhs, elc. or n terms of future actions or events, Ensure that any future action or event that must precede final disposition is objective and definite. (g) f records are converted to electronic form, schedule both the original records and the electronic media, unless covered by the General Records Schedules. (h) f permanent or unscheduled records are converted to microform, the disposition for both the original and microform copies must be approved on an SF 115. The SF 115 covering the microform must contain lhe certifications required by 36 CFR 1230, Approval is not required lor the disposition of microform copies of records authorized for disposal, es specified in the regulation cited above, Entry 9 must nclude the previous NAAA disposition job and item numbers; General Records Schedule and item numbelll, if applicable; and agency directive or manuat and item numbers, t applicable, as required by 36 CFR f such information is missing from column 9, the SF 115 will be returned wilhoul action, Leave column 9 blank only if the records are being SCheduled tor the first time. Entry 10 is lor NARA use only and should be left btank. STANDARD FORM 115 BACK frev

180 DOCD: REQUEST FOR RECORDS DSPOSTON AUTHORTY - CONTNUATON J06NUM6ER GRSOR 10. ACTON TEM 8. DESCRPTON OF TEM AND PROPOSED DSPOSTON SUPERSEOED TAKEN (NARA NO. JOB CTATON USE ONLY) PAGE OF Two copies, including original, to be submitted to the National Archives and Records Administration. STANDARD FORM 115-A (REV. 3-91) Prescribed by NARA 36 CFR 126

181 DOCD: REQUEST o FOR: FOR E22 USE ONLY PROGRAM DATE PROGRAM TME ATVC ASSGNED Videotaping Support o Broadcast Support VDEO DRECTORNSUALSUPPORT RUNNNG TME Suomit 6 copies of completed form (due 10 deys prior to Program Date) to: E22 CUSTOMER RECEVED SENT TO MTC VHS SVHS BETA VHS SVHS BETA Central Conference Complex PRESENTATON OATA TTLE (QD..N.Q provide a classified title) DATE OF PROGRAM PONT OF CONTACT OVERALL CLASSFCATON LEvE:L o UNCL 0 SECRET o CONF 0 TOP SECRET ORG o COOEWORO 0 FOUO o COMPARTMENTED PHONE BROADCAST AUDO-VSUAL SUPPORT REQUREMENTs REMOTE CHECK APPLCABLE BLOCK(s) 0 FANX BROADCASTNG [] NEWSMAGAZNE 0 ROUTER CONNECTVTY o GGSTERiSDLN TO: 0 FELD STE(S) 350'111 SLDES (Sing'S Projoction ONLY!) "CONSUMeR SELF-SUPPORTEO VUGRAPHS CONSUMER SELF-SUPPORTED" VDEOSHOW 180 CHECK APPLCABLE BLOCK o FROM PROJECTON BOOTH o FROM FRONT FLOOR LEVEL VDEO TAPE SHOWN FROM PROJECTON BOOTH o VHS (112") o UMATC (314") CHE~K APPLCABLE ~LOCK PANEL DSCUSSON (A maximum of six (6) seated participants may r NUMBER OF SEATED PARTCPANTS appear on stage. Provide EXACT names ofall participants) TO APPEAR ON STAGE... PARTCPANTS OTHER (Be sr;h1clflc) DRECTORATE SENiOR LEADERSHP TEAM PARTCPATON (Specify) NO REOUREMENTS READ AND NTAL THE BELOW STATEllENTS NTALS 1. acknowledge receipt of Form P7321. "PUBLCATON VDEO CONSENT RECORD", accompanying this form. 2 understand it is my responsibility to self support my own visuals (35mm slir;je and vugraphs only). 3. unuerstand it is my responsibil~ to precede all briefs being video taped n Friedman Auditorium with an announcement to tho audionce, 'THS PROGRAM S BENG VDEO TAPED" 4. understand the E2 Multimedia services organization may use the master videotape to rebroadcast this program at a later date to Agency employees.... und.,.'and shall receve tho anginal recording of the completed documentat,on Video tape. As the requester, t s my responsbility ro obtam authorization/approval from the participants tor video taping and to coordinate any t;ldwl'lg, duplicatiotl, fj;rther modification, or placement of this video lape info the NCS Vdeo iibrary system with he Netional Cryptologic School Telavision Center. E22, FANX, Room A2A035, sJ (410) PRNTED NAME SGNATURE PHONE TODAY'S DATE ACCEPTANCE The recording of this documentation video tape has been completed and accepted. understand that release of this video tape, external to NSA, requires prior approval of N513, Aoom , s1(301) 688"6527b. PRNTED NAME SGNATURE ORG PHONE DATE RECEVED FORM REV OCT 95 (Supe"edils REV SEP 92 wnlch is obsolete) NSN: 7540~FM OO pproved for Release by NSA FOA Case #4287

182 DOClD: SECURTY CLASSFCA.TON (if any) REQUEST TO HOLD A PRVATE ORGANZATON SPECAL ACTVTY OR FUND-RASNG ACTVTY ON AGENCY PROPERTY NSTRUCTONS Complete top part of this form. Be sure to request approval of your event.ll.1.l.r.u1 two weeks prior to the date of the event to allow for coordination of approval, Submit form ele<:tronically to 'service@nsa' or in hard copy to L03, OPS1, 1W070. Suite 6445, /(301) 68e~7371b,.E2B.M..M.YST BE POSTED AT THE FUND-RASNG ACTVTY.!:LQ.l.:E.;.lf your organization is selling food products, you ~ adhere to the proper food handling instructions found in the Fund Raiser Guidelines. NAME: OF PRVATE ORGANZATON PROJECTED DATE(.) OF ACTVTY PROJECTED "MEl') OF ACTVTY NATURe OF ACTVTY (rf sale, what Will be SOld) PURPOSE OF AC11VTY (if sale, what will be done with proceeds) PONT OF CONTACT (Last) (First) (1.11) SD PHONE NO. (SeCtJll) (Non S8cure - Jnc/lJde Area Code) "X" PROJECTED ~OCATON BU~DNG MANAGEMENT'S "X" PROJECTED ~OCATON BU~DNG MANAGEMENT'S OF ACTVTY APPROVALDATE OF ACTVTY APPROVALJDATE Has (Loony ~ Confirm) OPS 1 GH 1#2 (LObby.rJllc.Confirm) OPS 1 GH #4 (Near TFCU) QPS 1 North Cafeteria Party Rooms OPS 1 CWF Space (LObby.QMlildfJ cafeleria) QPS 2A CWF Space (VCClSlairwell) OPS 3 (Front LObby) NBF' (Lobby mtl4it. cafetena) FANX 1 (LotWy 1l1JJ2JJt. Confirm) FANX 2 (Lobby na.t 10 Confirm) FANX 3 ONF Spa", (LoOby~ Conflm>) SAB4l.Qbby R&E (20' 1!H Confirm) R&E CWF Spa,. (Lobby~ cafeteria) Friedman Auditorium (Avetions D1lL.'tJ Colony 617 Areas (Auctions 2lJ') PRVATE ORGANZATON LASON OFFCER DATE ME3, ENVRONMENTAL COMPLANCE DATE SECURTY ME2, OCCUPATONAL RSK MANAGEMENT COMMENTS DATE RECEVED SCHEDULED ON CALENDAR? DYES 0 NO FORM P6744 REV APR 2002 (Supersedes P6744 RE:V DE:C 2000 whic!l i. obsolele) LASON OFFCER USE ONLY AUTHORZEO P.O,? DYES ONO SECURTY CLASSFCATON (if any) ORGNAL RETURNED TO POC1 DYES 0 NO pproved for Release by NSA FOA Case # 4287

183 D TANERtUf 1; \ REQUSTON AND NVOCESHPPNG DOCUMENT ~"::;~-()2 &, 'xptf(l$dec13.1 :~::~:~~~~:il~:t:,,~~:n~~$~:~~~h~~";"'~:ti~~':~~~'=:;'jl:::~~:~:~~~~~'l~~=s7~~~:~j:~$ ~:::1,'=~:~~~~~=~:'D=~:r''d flrorfr\'l,ll(l1l ~""'OM lfld Re~. 1~15 Jd...$0!'1 O<:!yis H~. SU~& 12M, MinglOl1, VA :>220;/'4302, and U the 0/ce()! l.aa~'nd Budg., ~r RlJduetll)M Pmjed (07G4-Q:>461, W&$h1nol()fl, OC PLEASE DO NOT RETURN YOUR COMPLETED FORM TO ETHER OFTHESE ADDRESSES. RETURN COMPL.ETED FORM TO THE ADDRESS N TEM RUM' (lflclvoo ZP Code) SHEET NO, ~~E~S 15, ~~STON fj REOUSTON NUM6ER 7 DATE MATERAl. REOUREO (YYMMOD) 8 PRORTY 2 TO. (ncludf/lz1pcode) 9. AUTHORTY OR PURPOSE MMM ~_ 10 SGNATURE '1 a VOUCHER NO, & OATE/YYMMODJ 3 SHP TO, MARK FOR 12 DATE SHPPEO (YYMMDD) b 13. MODE OF SHPMENT 14 BLL Of LADNG NUMBER -- ls AR MOVEMENT DESGNATOR OR POnT REfERENCE NO 4 APPROPRATONS SYMBOL AND $USHEAD OBJECT EXPENDTURE ACCOUNT CHARGEAe~l; BUREAU CONTROL BUREAU AMOUNT CLASS ACnVTY ACTVTY NO CQNTROLNO (/''romj To) n,~t. l)ntof QUm!l1Y federal STOCK NUM8ER. DESCRPTON, AND COONG Of MATEREL ANO/OR SERVCES SUPPLY 'lyp' CON NO SSUE REOUESTEO CO' TAlNEA UNT PRCE TOTAl COST " b ",, AC,:?N lalf:.er ~ 'h', 16. TAANSf'ORTATON VA M,,TS OR MST6 CHARGEABL.E TO 11, SPECM.HANOUNG " SSUED 6Y Totlll T"" DESCRPTON CONTANERS OATErY'r'MMDD; SHEET TOTAl., COr'llaifltlrli Corilain$r ~~ ~9:~ 19. RECEiVED " '0 A EXCEPT AS C, NOTED 'S CHECKED BY ~ OUANTTES OATE:(yYMMOD) GRANt) TOTAL '", ", RECEVED T P 'M,, ~ E~~~AS.. P PACKED BY " POSTED DATE{YYMMDD) BY 20 lllecevea's T T T VOUCtiEA NO, 0 TOTAL N... DD OHM 1148, D:C S S GEl G en

184 : REQUSTON AND NVOCE SHPPNG DOCUMENT(Contlnuatlon Sheet) ~}tro~02'" ENpires o.c 13, 1996 Pltlli(; '\lvo'~ b...den llf lhlli «klo~ Q1,l\t(Jmali(j~"..l'mlltd 11)-. ~r p"r rellpo\'lm, ~ lht 111'TlfJ kif 1'lW~ insndom, _ttllng ""l~&r:lul(:ft, \lmlirlllll.l'ld maintain'r,g tllll_""""', Md ~.-rod j~~'\~&.~~a~=';i~s5~~~~=~~,~,:=~~vt'i22k~:r:ndlo~=r:~",=~~nr:,:,=,='~~~~ro~~kl~e~~~~=!6 SaNdi, Olractoolc. tor PLEASE DO NOT RETURN YOUR COMPLETED FORM TO ETHER OF THESE ADDRESSES. RETURN COMPLETED FORM TO THE ADDRESS N TEiY 2 OF DD FORM 1149 SHEET NO NO OF SHEETS 1 6 REQUSTON NUMBER 114 VOUCHER NUMBEFl AND DATE b. YOUCHER NUMBER ANO O,o.TE TEM U.., QUANTTY SUPPLY TY CON NO FEDERAL STOCK NUMBER, DESCRPTON, AND CODNG OF MATEREL AND/OR SERVCES 0' REOUemo ACTON CON- TANER UNT PRCE TOTAL east SSUE TANER NOS. ') '',.) (0) (d) ') '01 'h) lil 00 FORM 1149C DEC 93 SHEET TOTAL

185 SHPPNG CONTANER TALLY \ S REQUSTON AND NVOCE SHPPNG OOCUMENT(Continuation Sheet) FomJ~"'" OMB. 07D4-D246 E1ipifes Dec 13, 1996 Public reporting burden tor ths coffecuon of in1ofmatiofl is estimated 10 average- 1 hour pel" Te$p0nS6. including the time for reviewiryj inslructions. seafching existing data sources, gall\etrdg and maintaining the data needed. and complellng and raviewing the collection 01 information. Serd comments flj~arding this. burdef'!ll'$1imate ar ;my cth9r aspect of this cojecfion of information, induding suggestions 10r r-educing this blm:ien, to wastlinqlcn Headquarters Se:vices, Di«K:torate tor nfdrmahon Operations and Reports, 1215 Jefferson Davis igtway. SUite APigton, VA and to the Office of Management and BtJdgef,~ Aeductton PrOiect (Ol04-()246j. washington, DC PLEASE DO NOT RETURN YOUR COMPLETED FORM TO ETHER OF THESE ADDRESSES. RETURN COMPLETEO FORM TO THE ADDRESS N TEM 2 OF DO FORM 1149 St-iEETNO NO OF SHEETS 6_ REQU1SmON NUMBER, lao VOUCHER NUMBER AND DATE b VOUCHER NUMBER AND DATE TEM UNT QUANTTY SUPPLY TYPE CONfEDERAL STOCK NUMBER, DESCRPTON, AND CODNG OF MATER1EL ANOOR SERVCES OF NO. REOUESTED ACTON CON TAiNER UNT PRCE TOTAL COST SSUE TANER NOS. (bl lei (dl (el () (g} (h) (i) ('1... ọ M Q H tj o DO FORM 1149C DEC 93 Q SHEET TOTAL

186 DOCD: 311S~03 securty CLAFCATON (if any) RESPRATOR MEDCAL EVALUATON QUESTONNARE PLEASE PRNT!! (Reference: Appendix C to Sec : OSHA Respirator Medical Evaluation Questionnaire (Mandatory)) pri...acy Act Statement: Authority for collecting information requested an this form is contained in 50 U.S.C, Section 402 note and 5 U.S.C. Section NSA's Blanket Routine Uses found at 58 Fed. Reg. 10,531 (1993) as well as the specific uses found in GNSA06 apply to this information. The Agency is required to collect the requested information by the Occupational safety & Healilt Administration (OSHA) for any employ"" selected to use any type of respirator. Failure to furnish the requested information may preclude your participation in, Or may result in your removal from the Respirator Protection Program. To the Employer: Answers to questions in Section 1. and to question 9 in Section 2 of Part A, do H.Q require a medical examination. To the Employee: Your employer must allow you to answer this questionnaire during normal working hours, or at a lime Can you read? and place that is convenient to you. To maintain your confidentiality, your employer or supervisor YES D 0 NO must not look at or review your answers. and your employer must tell you how to deliver or send this questionnaire to the health care professional who will review it. SECTON 1 The following information MUST be provided by every employee who has been selected to use MlYtype of respirator. NAME (Last) (First) (M) DATE (yyyymmodj AGE (to nearest year) SEX HEGHT WEGHT JOB TTLE o MALE o FEMALE ft in PHONE NUMBER WHERE YOU CAN BE BEST TME TO BE REACHED HAS YOUR EMPLOYER TOLD YOU HOW TO CONTACT THE HEALTH CARE REACHED (include Area Code) PROFESSONAL WHO WLL REVEW THS QUESTONNAAE? DYES o NO CHECK ALL APPLCABLE RESPRATORS YOU W..L USE N, R. or P DSPOSABLE RESPRATOR (fifter-mask. non-cartridge type only) o OTHER TYPE (e.g,. half- or fulj.facepiece type, powered-air purifying. supplied-air, self-contained breathing appara/us) HAVE YOU WORN A RESPRATOR? o YE;S o NO (f "YES". what typo(s)) SECTON 2.. PART A (Mandatory) Questions 1-9.MWll be answered by every employee who has been selected to use MlYtype of respirator., '" YES NO ', ""1'" " ~!". :il~,';" '::, ':'1' ;~, L' :" YES NO 4, 1. Do you currently smoke tobacco, or have you smoked 00 you currenl/v have any ot thalollowing symptoms of pulmonary or lung Hlness? tobacco in the last month? a. Shortness of breath 2 Have you ~ any 01 the following conditions? b. Shortness of breath when walking fast on level ground a. SeJlurlils (fits) or walkng up a slight hill orincline b. Diabetes (sugar disease) c. Shortness of breath when walking with other people at an or'dil'lelty pace on level ground c. Allergic reactions that interfere with your breathing d. Claustrophobia (Olr ofclosed-;n places) d. Have to stop lor breath when walking at )'Our own pace on level ground e. Trouble smelling odors 3. Have you h any Ot tne lo11owlng pulmonary or e. Shortness of breallt when washing or dressing yourself lung problems? a. ASbestosis Shortness of breath thai interferes with your job b. Asthma g, Coughing that produces phlegm (thick sputum) c. Chronio bronchitis h. Coughing that wakes you early n the morning d. Emphysema i. Coughing that occurs mostly when you are lying dolnn o. Pneumonia j. Coughing up blood in the last month f T""o""'Mi. k. Wheezing g. Silicosis L Wheezing that interferes with your job h. Pneumothorax (coltapsedlung) m. Chest pain when )'Ou breathe deeply L Lung cancer j. Broken ribs n. Any other symptoms that you think may be related to lung problems k. Any chest injuries or surgeries. """..,.: 'ii,, ""'!': '.',.'.',:, ;,."':: ",:rid:"':"11 ~!C "'.,. Any other lung problem that you've been told about. '... >. '"",.,,! :',,:,:",.,', FORM P7174 AUG Pagel. SECURTY CLASSFCATON (f any) pproved for Release by NSA FO.A Case # 4287

187 .. DOCD: SECURTY CLASSFCATON (if any) ' SECTON 2 PART A (Continulld) Questions 1-9 M.llJT be answered by every employee who has been selected to use Atrltype of respirator. YES NO.. 5. Have you ft:(..hjj any of the following cardiovascular 7. Do you take meoication lor any 01 toe following or heart problems? problems,? a Heart attack a. Breathing or lung probl(:lm$ b, Stroke b, Heart trouble c. Angina. c. Blood pressure d. Heart failure d. Seizures (fits) 'c'... YES NO e Swelling in the legs or feet (not caused by wa.lking) 8. f you've used a respirator, have you~ any of the, " following problems? r Heart arrhythmia (heart bearing irregularly) o (Check ths box ifyou have never uhda g. High blood pressure respirator, then mmediately proceed 10 question 9),,', h. Any other heart problem that you've been lold about s, Eye irritation 6. Have you ~any of the following oardiovascular b. Skin allergies or rashes or heart symptoms? 8. Freauent Min or tightness n your ohest c. AnXiety b Pain or tightness in your chest during physica.l a.ctivity d. General weakness or fatigue c. Pain or tightness in your chest tha interferes with e. Any other problem that interferes with your your job use of a respirator d. n the past two years, have you noticed your heart 9. Would you like to talk \0 the health care professional who skipping or missing a beat will revle'n your answers to this questionnaire? e. Heartburn or indigestion that s not related to eating f. Any other symptoms that you think may be related.'.',.{. to heart or circulatlon problems,.1:. i'i.»i'.;.,,,','..'.....",i.!!.;., <.:,i/:j ',.,11: (.. Questions MU.S be answered by every employee who has been selected to use ETHER a ful-faceplece respirator or a self-contained breathing apparatus (SCBA). For employees who have been selected to use OTHER TYPES of resp'rators, answering these quesrons is volunary. YES NO '., " 10. Have you ~vi5ion in either ave (16mpOrarilyor 15,00 you cwamt1yhave an~ of the following permanently)? musculoskeletal problems, a. Weakness in any of your arms. hands, 199s, or feet 11. Do you cu«enfly have any of the following vision b. Back pain problems? a. Wear contacllenses c. Difficulty fully moving your arms and legs b. Wear glasses d. Pain or stiffness when you lean folward or backward c. Color blind at the waist d, Any other eye or Vision problem e. Difficulty fully moving your head up or down 12. Have you ~ an injury to your ears, including a f. Difficulty fully moving your head side to side broken ear drum? g. DiffiCUlty bending at your ~noo$ you cu«enrty have any of the following hearing problems? h. Difficulty squatting to me ground a, Difficulty hearing i. Climbing a flight of stairs or aladder carrying more b. Wear a than 251bs. hearing aid c. Any other hearing Ot ear problem j. Any other muscle or skeletal problem that 14 Have you HBl1W1 a back injury? interferes with using a respirator.., SECTON 2 - PART B (Voluntary) At the discretion of the health care professional r8\llewrng the questionnaire, t MAY. be requested the following questions be answered., YES NO..' " 1 n your present job, are you working at high altitudes 2. At work or at home, have you ever been exposed to hazardous solvents, hazardous airborne chemicals lover 5,000 feef) or in a place that has lower fhan normal amounts of oxygen? f "YES", do you have feelings ofdizziness, shortness ofbreath, pounding in your chest, or other symptoms When you're working under these conditions? (o.g,, gases, fumes, or dusl), or have you come nto skin contact with hazardous chemicals? ( "YES", ns"", the chljfflica/s. ifknown) YES, NO,.., YES NO FORM P7174 AUG Page 2 SECURTY CLASSFCATON (il any)

188 YES DOCD: SECURTY CLASSFCATON (if any) SECTON 2 PART B (Continued) A the discrelion of he health cara protassional reviawing tha quaslionnaira, t MAY ba raquastad tha following quastions ba answarad. YES NO a. J..Glf (less than 200 kcal per hour) (Examples of a light 3. Have yoll ever wqcmdwith any of the materials, or work effort are lit1tjs. whijtll writing, typina. biting, or \,lnder any of the conditions. listed below? perlormin/j light assembly work; orjtljjuj1g whi/8 a. Asbestos OfXK9ting 8 drill press (1w3/bs.) or controlling macrnnes.) b. f Silica (e.g., in sandbjasting) "VE$", how long does this DYES o NO Period last during the average C. Tungstenlco!balt (e,g., grinding or welding this material) h's, mins d. Beryllium b MODERATE (200 to 350 kcal fj"r 1"'"'1 (Examples 01 e. Aluminum 12. During tile modetate werle effott are.llt1jdjj. whiltt nailing or filing; RJ:fx.iJJg a truck Of bus i,., urban traffic; ~ while period you t. Coal (e.g.. mining) drilling, nailing, MrfOrming assemt1y work. ortransferring a are using the moderare load ( bs) at trunk Jevel; tijjfjtjg on a g. ron respirator(s), level surlace about 1 mph or down a 5-degrtte grade about 3 mph; orjljjj/lld.sz a Whf'6roarrow with a hcila\')lload (aoout h. Tin is your work 100 bs.) on a 18WJ surface.). Dusty environment effort: :' "YES", how long does 'hi. j Any other hazardous exposures (if "YES", describe) DYES D NO ptriod last during the average c..me.an (above 35D kcalper hour) (EJtampiH of heavy work are JJt1JDJl a heavy load (about 50 bs.) from lha floor to your waist or shou/{jfk; working on a loading dock;,hqwinq; 1tJJ:Ji:lg while brk;klaying orchipping 4. List any second jobs or side businesses you currently have: castings; JH&lai up an 8-desJrH gtadt1 about 2 mph; climbing srai($ with 8. hsavy l08d (about 50 bs.) "YES'~ how O~oes this period last during average DYES DNO mins. hnll 5. List previous occupations: ',"i,',.; hi.l.,, >;:"",'. :.'.. ;Ji!1': YES NO 13. wm you be wearing pro'ective clothing and/or equipmant (athof than the rf!1spirtjtor) when using your respirator'? 6. List current and previous hobbies: hrs.1 f "YES", describe this protective clothing and/or equipmenl mu'\&, 7. Have you been in the military services? f "YES", were you exposed to biological or chemical agents (either in training or combat) '? '" '.,".., " 14. Will you be working under hot conditions (temperature """""ding T1 deg. F)? YES NO 15. Will you ba working under humid condnions? 16. Describe the work you will be doing while using respirator(s) NO 6. Have you ever worked on a HAZMAT toam? 9. Other than medications for breathing and lung 1r. uescnoe any special or nazaroous cartqllons you mlgm encounter wnen probrems, heart trouble, blood prsssure, and seizures using respirator(s} (e.g., canfinbd spaces, lifthhrtultening gash) mentioned earlier in this queslionnaire, are Y'9u taking any other medications for a~ reason incluaing over the-counter medication )7 f "YES", name the medications if known 18. Provide information (ii known) for aach toxic substanca you will be exposed to when using respirator: EXPOSURE PER SHFT TOXC SUBSTANCE NAME YES NO est MAX, LEVEL OURATON 10. " you oe using any OT na,ollowlng ams wttn your,. resplrator(s)? a. HEPA liitels 2 1 b. Canisters (e,g" gas masks) 3. c. Cartridges 11. How often are you expected to use the fospirator(sj? Other TOKic Substances (Provide name only) a. Escape only (no rescue) b Efmergency rescue only c. Less 1tlan 5 hours per WHk 19, OElscribe ant special responsibilities you will have while using respitalor(s) thai d. Lass tlan 2 heus -.sliy. O. 2 to 4 hours l'jujjy. f. Over 4 hours~ may affect t'le safety and well-being of others (e.o" rescue, Secuflly): FORM P7174 AUG Page 3 SECURTY ClASSFCATON (if any)

189 DOCD: RESTORATON OF FORFETED ANNUAL LEAVE REQUEST (Ref: PMM Chapter , "Leave") PRVACY ACT STATEMENT: Auth for collecting info requested on this form is contained in 60 U.S.C. 402llil1ll; 5 U.S.C. 6304; and EO NSA's Blanket Routine Uses found at 66 Fed. Reg. 10,531 (1993) and the specifio uses found in GNSAOa, GNSA09 and GNSA 11 apply to this info, Auth for requesting your SSN is EO nfo you provide will be used to verify hours of leave and C100ument reason for forfeited leave. "Dsci of requested info, including your SSN, is voluntary. However, failure to furnish requested info, other than your SSN, may prevent Age:ncy from processing your request for restoration of annual leave. f you decllne 10 provide your SSN, there may be a delay in processjng your request lor restoration of snnuallaave. TO THAU: MDllPA employ ::E: NAME (Last) (First) M) SSN ORG EMPLOYEE STATEMENT NUMBER OF HOURS FORFETED REASONS LEAVE WAS DENED CANCELLED NUMBER OF HOURS OF SCHEDULED ANNUAL LEAVE THAT WAS OENED EMPLOYEE. SGNATURE DATE SUPERVSORY STATEMENT AEASON(S) LEAVE WAS OENED CANCELLED RECOMMEND o Approval 0 Disapproval SUPERVSOR'S SGNATURE QROUP CHEF STATEMENT DATE DOCUMENT NATURE OF EXGENCY (verity that the exjgency was of such magnilude that employees could not be excused from duty) RECOMMEND o Approval 0 Disapproval GROUP CHEF SGNATURE DATE MOl PA REVEW FORFETEO HOURS ve;r~ed SGNATURE DATE M01 PA DECSON o Approval CHEF. MOl PA SGNATURE o Disapproval NUMBER OF HOURS APPROVED FOR RESTORATON DATE FORM P6322 REV JAN 2001 (Supersedes P6322 REV MAY 2000 which is 00$0/.,0) SECURTY CLASSFCATON lapproved for Release by NSA orl foa Case#4287

190 DOCD: SECURTY CLASSFCATON (if any) RETRED RECORDS DENTFCATON (bl (3)-P.L GENERAL NFORMATON 1. For assislarjc8 rootag'the NSAGSS ReCOrds Genter 'NCRf L- _.. Jon 972M 2295s or (301) 688M 5295b or visit OUf Website at 2. For Shipment andbox numbers contact the NCRC PROR TO MALNG boxes. 3. Records Disposition Schedule Number (RDS) llh1 appear on form. For assistance, see Website at hllp:urn. 4. Legal ownership andaccess ofrecords is controlled by the OP (Office ofprimary nterest) while maintained in the NCRC, SHPMENT NUMBER (Obtain from HeRe) BOX NUMSeR(S) (Obl'l" from NCRC) TOTAL NO. OF BOXES DATE RECEVED (NeRe USE ONLY) ORGANZATON HGHEST CLASSlFCAT10N OF RECORDS DATE OF MATERAL (DD MMM YYYY) (From) RDS NO. CHECK ONE ONLY AND PROVDE OATE MATE~AL TO BE REVEWED DESTROyED AS N ACCOROANCE WTH THE RDS pes RDs NO. opes odestroy ON: RETURN orevew ON: 0 PERMANENT RETENTON {Rfl'~w for T'nmr"" to NSAlCSS Archive' on:) (DD.MMM YYYY), (DD MMM YYYY) (To) (DO MMM YYYY) DATE (D().MMM. YYYY) ALTERNATE POC SECURE PHONE 33D-13A (Review n 5 years) CONTENTS (Describe the material, listing title, description, and any other information which will identify these records) certify that these records are l>elng senlln accordance with fhe.pproprlaterecords Disposition SChedule. underst.nd /lis my responsibility fo notify the NeRe ol.ny changes required 10 POC, Org., Phone, elc. TYPED OR PRNTED NAME SGNATURE DATE (DD MMM YYYY PHONE SUTE NUMBER FORM REV OCT 2001 (Supersedes REV JUL 2001 Which is obsolete) SECURTY ClASSFCATON (if any) pproved for Release by NSA 0'" FOA Case # 4287

191 DOCD: SERAL: 1 THS RESPONDS TO YOUR M~MOAANOUM(S DATED CONCERNNG A REQUEST FROM 2 YOUR MEMORANDUM(S) FORWARDED FOR REVEW' f--,-- DOCUMENTS) ORGNATED BY NSA/CSS DOCUMENTS) NOT ORGNATED BY NSA/CSS BUT CONTANNG NSAlCSS NFORMATON 3. APPROPRATE DELETONS ARE NDCATED PURSUANT TO THE EXEMPTONS CHECKED BELOW. THE REMANNG NSA/CSS NFORMATON MAY BE RELEASED TO THE REOUESTER 4 THE NFORMATON S PROTECTED FROM DSCLOSURE PURSUANT TO THE EXEMPTONS CHECKED BELOW, 5 5 U S.C 552 (b) (1) - THE NFORMATON S PROPERLY CLASSFED N ACCORDANCE WTH THE CRTERA FOR CLASSFCATON N SECTON'S OF EXECuTVE ORDER 12958, 6 5 U.S.C 552 b) (3) - THE SPECFC STATUTES) S/ARE LSTED BELOW 50 U_Sc. 402 NOTE (PUbliC Law 86 36, Section 6) 50 USC (e1151 '8USC U.S.C 552 (b) (5) 15USC552b)(6) 8 5 US C 552 (bl (7),C 5 U.S.C. 552 b)(7)(d) - 9 THE DSCLOSURE THAT THE NFORMATON CONTANED N YOUR RECORDSS THE RESULT OF SENSTVE COMPARTMENTED NFORMATON REQURES ADDTONAL SPECAL PROTECTON AND HANDLNG PROCEDURES. PLEASE ENSURE THAT, N ALL NSTANCES WHERE THE NFORMATON N YOUR RECORD(S) S ASSOCATED WTH, THS AGENCY AS THE ORGNATOR, OR N ANY OTHER WAY REVEALS SENSTVE COMPARTMENTED NFORMA- TON AS THE SOURCE, THE RECORDS) ANO ALL OTHER SUCH NDCATVE RECORDS S/ARE AFFORDED THE APPROPRATE PROTECTON, 10 WE 00 NOT WSH TO BE PUBLCLY REVEALED AS THF ORGNATOR OF THE NFORMATON CONTANED N THE RECORDS) AS THS DENTFCATON N - TSELF MAY BE A DSCLOSURE OF CLASSFED NFORMATON f THE CLASSFCATON OF CERTAN NFORMATON N THE ENCLOSED AECOAOjS) HAS BEEN CHANGED, PLEASE MARK ALL COPES ACCORDNGLY, f---,-- 12 Tl'1E NTAL DENAL AUTHORTY FOR NSA Nf=ORMATON S THE DE;:PUTY ORE:.CTQA OF POLCY. THE REQUESTER MAV APPEAL THE DELETONS WTHN 60 DAYS AFTER NOTFCATON OF THE DENAL BY WRTNG TO THE NSAlCSS APPEAL AUTHORTY, NATONAL SECURTY AGENCY, FT, GEORGE G. MEADE, MD , THE APPEAL SHALL REFERENCE THE JNJTAL DENAL OF ACCESS AND SHALL CONTAN N SUFFCENT DETAL ANO PARTCULARiTY, THE GROUNDS UPON WHCH THE REQUESTER BEUEVES RELEASE OF THE NFORMATON S REQURED THE NS..vcSS APpeAl.. AUTHORTY SHALL RESPOND TO THE APPEAL WTHN WORKNG DAYS AFTER RECEPT 13. SEe ATTACHED FOR ADDTONAL COMMENTS 14, F YOU HAVE ANY QUESTONS OR COMMENTS PLEASE CALL: PHONE (301) Sincerely, A7933A. 10,96 NSN: 7540-FM-OOH 554 pproved for Release byl\jsa FOA Case # 4287

192 DOCD: r PA.S. Autl1: PL 86 36; 41 CFR ,104: GSNA 01..A,lth ~ SSN: C.O nle.-ill Ot l,l$1k (prin) lq as$$l el1/. RDE MATCH APPLCATON emllloyess, mil J)OtS. and contraclor emplo,.. in ridesharing through «f l.nd vanl)ools. (t'o.tlnely) lnro may be dluetl'llnaled 10 \Xmmerclal or private 11U1'&PQrtll'llon entlues when indiv hn lodle.leo a d&sil1l to use Of join lftatipkhl... tratlsportllkj't nfo ma.y also be providelo 10 conlractor ernplov"s n accordance with purpose stl\led ~e Disci of info and SSN: Vol. lfocl on Return cof11>leted form to: indiv if il'llo not provided: May not 00 i~ to il.i$lst indiv eflllcliwly in ridllllshal'lng. Not proyid!nq S$N m~ delll,! applicalioo 5731, Commuter and Motor Fleet Services ptoce5slnq, VO\l signatl!(e OOlo\'<' inqlealoo. you 1'1"". read and undcll'slan<:lm above. ops 2A, VCC-101 (Ft. Meade) ALL nformation Mln Be Provided For Application To Be Processed Social SeCl,l(ity Number -. Name (Last, First) Street Address City Slate Zip Code ntersection nearesl your \'1ome Home Phone (nclude Aroa Code). Work location (PkWy etr, FGGM, FANX, etc.) Gat&l8uilding Work Phone Nan-Secure - Secufe. Organization Building Room No, Regular DUly Hours (i.e" ) - Flexible? (YN) Jt YES, by!low many minutes? Vanpooling as a driver coordinator vanpooling as a passenger Carpooling - win share the driving am interested in: Carpooling - will ddve only Carpooling. rider only n Carpool. Winl addl'l members (Please check all applicable blocks) am not interested in ridesharing at th'~ time. However, would be willing to provide an emergencyllemporary ric:le to another employee. 'SGNATURE DATE, L FORM P52,218!=lEV SEP 96 (Supersedes PS2218 REV AUG 92 which 1$ (1lJsok1te) NSN: 7540 FM-OOl ~-~ Actual size offonn '" 8" x 4", Please cut to appropriate size before submitting to 5731, Commuter and Motor Fleet Services, pproved for Release by NSA FOA Case #4287,

193 DOCD: ROUTNG AND TRANSMTTAL SLP Data TO: (Name, office symbof, room number, bwlding. AgencylPO$l) nitials Date 5. Action Approval As Requested Circulate Comment Coordination REMARKS File For Clearance For Correction For Your nformation nvestigate Justify Note nd Retum Per CClnversatlon Prepare Reply SaeMe Signature 00 NOT use this form as a RECORD of approvals, concurrences, disposals, cle.rances, and similar actlons FROM: (Name, org. symbol. AgencylPO$t) Room No. Bldg. Phone No. OPTONAL FORM 41 (Rev. 7.76) Prescribed by GSA FPMR (41 CFR) :!06

194 DOCD: ROUTNG AND TRANSMTTAL SLP DATE TME SCHEDULER EMPLOYEE'S PHONE NUMBER TYPE PHYSCAL pes LOCATON DESK OFFCER EMP.ORG BULDNG o HANDS ON o NO HANDS ON NAME SSN DOB PSYCH VR OS 06 DATE COMMENTS FORM P4706 REV SEP 97 (Supe',edes P4706 REV APR 97 wh,ch" obsol.'e) NSN: 7540 FM OO1 32BS pproved for Release by NSA FOACase#4287

195 DOCD: SECURTY CLASSFCATON (jf any) RUBBER STAMP REQUEST REQUeSTED COMPLETON DArE REQUESTER ORG OAT~ BULDNG ROOM AND SUTE NUMBER SD PHONE (St1curelNon Secure) GENERAL NFORMATON Read ALL instructions carefully!! 1~ To order rubber stamps which are cover teem sensuive and classified and are not kept in the Agency stock system, till in the information below for EACH different stamp requested. (A~ferer1ce.. NSAlCSS Regulab'on No ) 2. Rubber stamps listed in the Annex C of NSAlCSS RegUlation on cannot be provided by Y193. These stamps must be obtained tit ordering through the Agency stock system on Form J3353, Supply/Furniture Order Request Psr NSAlCSS Regulat10n No forward this form through your element Classification Advisory Officer for validation of stamp classification. 4, 'Red handles are tor classified stamps QN.Y TYPE STAMP TEXT aty CLASSFCATON SZE STYLE BLACK HANDLE...RED JUSTFCATON FOR USE BY ELEMENT CLASSFCATON ADVSORY OFFCER ONLY cerlify that the above rubber stamps are properly classified as defined by NSAlCSS RegUlation ND PRNTED NAME ORG SGNATURE DATE FORM J1310 REV MAY 2000 (Supersedes J1310 REV JAN 97 which,s obsolele) NSN: 7540 FM-oOl 5010 SECURTY CLASSFCATON (ifany) 'Approved for Release by NSA on FOA Case # 4287,

196 DODJOy Aliil:arlkJ.lSPECTlON RECORD *Must provide a corrective lc'ionlexplanauon n section G. OSH REP lorganzaton 16U'lO'NGJRCX>M 1F /OTR A, FlOORS, CELNGS. AND W1NDOY/$: 1, Are traffic areas, personal and common, clear? 2 Are floors ~O Of trip hazards and/of holes? 3. Are ccl1!ng tiles in plac$ al'ld f((lo from holes/cracks? 4. sma ceiling grid fre$ of sl$peoded hazards' 5. l; all glass froo 01 damage'! 6. s OV(lmead lighting in WQrking order? 7 1. Are cabinemloaded propel'ly (heavy 00 bottom. light on top)? 2. There should be nottling storoo beneath the raised lloor. S this true lor ttlls area? Ot$CREPANCVE)(PLANATONCOMMENTS (Continue on Bst P8(Jtt. ifnecessary) 4, s me plane t'1al hes 18" below sprinkler hoods olear? 5. Are combustible mattlrial$ $oted more than 6' away!rum heat sources? 6. Are chemicals, cleaning fluids, correcting llulds, and/or glue properly lablil/ed 11M stor"" securely? 7. An; 1/lCk;Jng bookcasos only two units high? Are threg Of four units again!lt a t1x&d wall? (No multiple units greater htw 4 a~ ljllqwed). 6, Are items safely stored n stlxage rad<. (i.e" hsight, weight. stability)? 9. 1;(' 1. Are desks free of clu«$1'? 2. 1$ fumiturelree of sharp edges, points, burnlii or splintefs? 3, Are chains, free olloo6e ~slers, ru"lqs. lega, or ohair oocq? 4. Are step stools free of folers or caslel'$ that lt!\ke lhem unsafe? 5, Are phone lineslelectrlc cords secured under desks or along baseboards? r'lpproved for Release by NSA o~ FOA Case# FOf'lM 04284A FEB 99 N$N 7S40-FM--Q ATEND OF EACH OUARTER, FORWARO COMPLETEO FORM ro OOSAFETY AND HEALTH OFRCER, POl4, Ops " S.lte 6424 Pa9810f3

197 Do ELECTRCAL: 1. s au electrical equipment in good working order? 2. s commercial off-the-shetf elecrical UL listed? YES 'NO NlA Must provide a corrective actionlexplanation in section G. DSCREPANCY EXPl..ANATONCOMMENTS (Continua on lastpage. inecessary).. 3. Are only UlL Listed, circuit breaker-protected. muiti-outlet strips in use? 4. s area free of "piggyback" power strips, loose ftoof outlets, uncovered receptade boxes. etc.? 5. Do appliances (8XdUding refrigerators) fest on a non-combustible surface? -5. s area free 01 unauthorized appliances (Note.- See Tech Guide #13 & 14) electrical panel boxes have 36" of dearance in front floor to ceiling? 8. Do electrical pane; boxes have 15~ of deafance 'rom each side? 9. E. FRE SAFETY PROCEDURES AND EQUPMENT: YES 'NO NlA DSCREPANCY EXPLANATONCOMMENTS (Coplinua on lastpage. if necessary) N r- r- 10 r- r- rt',. Are building lire instructions (Form 04194) posted at each ellit? 2.15 the CurrentOSHRep identified and posted on Form 04194? 3. s a -current evacuation map with muster JXJlnt posted at each ejeif? 4. Are Egress routes completely free of all obstructions? 5. s the Common Path 01 Travel less than too' walking distance to a halldoq(? 6. Are primary aisles at least 44" wide? 7_ Are secondary aisles at feast 36" wide? 8. Are etectricaf exit 51gnS and emergency lig.~_fulfyfunctioning?. (E Jiahts work when test button S vushed for 30 seconds.j 9. Are Fire Exlinquishers inspected monthly in accordance wit Tech Guide,1n 10. Are F,re ExttOQoishers properly hung and accesstbre in accordancewith Tech Guide #1n A H U o A ~~Mi=~~.:;:age 2 AT END OF EACH QUARTER, FORWARD COMPLETED FORM TO DOSAFETY AND HEALTH OFFCER, POf4, Ops " Suite 6424 Page2of3 NlA

198 G.<:oRRECTVE ACTONS TAKENlEXPLANATONS (Use addtjona pages"necessary) SECTON TEM CONOlTON NOTED DATE CORRECTED... N rtl Cl H t) o Cl OSHREP SUPERVSOR DATE DATE SGNATURE SiGNATURE FORM D4284' FEB 99 Page 3 AT END OF EACH QUARTER, FORWARD COMPLETED FORM TO DOSAFETYAND HEALTH OFFCER, POf4, Ops f, Suite 6424 NSN 7540-FM Page30f3

199 DOCD: SAFETY SHOE REQUEST ~EQUESTER'S NAME (Last) (First) (M) SD REMEDY NUMBER SHOE STYLE NUMBER SHOE SZElWDTH OR.GANlZATON BULDNG PHONE NUMBER SUPERVSOR'S SGNATURE DELVERy ORDER NUMBER DELVERY OADER DATE FORM J341 B REV MAR 2002 (SU/J8rsedes J3418 REV MAR 99 which is obsolete) Mall completed form to: SAFETY SHOES LL SAil 4 Suite 6632 Room pproved for Release by NSA FOA Case # 4287

200 ~OY!'il"'B1~ONS KEY ORDER REQUEST TO: nformation required to complete this order form can be found on the appropriate User Represenralive Registration notice which identifies the User Repr8S9ntatiV9's currsnt set ofprivheges. USER REPRESENTATVElE~MS 10 FOR CENTRAL FACLTY USE ONLY {AtphlJlNumeric} OROERO ENTER fils CoR FROM; ADDRESS DATE (YY, MM. 00) TRAN~CTONNUMBER '(~ MAl. XXXX//:,XXX s l.. n T'dt<i~,n"""'lh"..m, EKMS Central Facility P,O, Box 718 FN~SBURG, MO B PARTTON TYPE (Must nh..,.. ONE ONLY. f "CLOSED",.ntor ron-dlglloodo) D OPEN D CLOSEO EOUPMENT TYPE KEY TYPE (Choose ONE) Choose ONE) KEY APPLCATON (Chao..0tf) o SEED 0 o OPERATONAL TYPE 1 o TYPE2 o TEST 0 OPERAnONAL TEM NO. OTY (Two-digit CLJ.SSlFlCATON oevlce CAPABLTES ACCeSS (Slartwilh numen'c (Check atleastone OPT. (ChoOse max. of three, CONTROL (fflpresenting no. of box or any 2 /etfer codes.) OPT. 01 and keys to b8 ordered. combination of AV Auxiliary Vector (f speoial REMARKS OPT.Provids mcrsasb Max. of99keys can class. listed. CA Central Reod, accqss USER ACCOUNT by one for NOTE: EaCh additfonal info t/'lat may aid the be ordered per line CC COMSEC Custodian C:lp.8.biJ1ies. choice is discrers; (LMD's EKMS 10 QcPOifS) each Central Facility in processing item, & max of 400 lower Class. levels LO. Local Domain Aulh. "X' in column $ub$e~ keys maybe are not incjvsivo LM LMOKey Processor and complete orr:hjr. This space may.also be quent ordered under (i.e" 10 receive RA Rekey Agent Form L6644, used to note info!of local use.) item) same trans. no.) levels of Con!. Sec, SM System Mgr, Access & TSec, all 3 boxes TO Tier 1 Control must be checked)) UA User Rep Scheduie,) U C S TS U c S TS u c S T5 S TS u c S TS U U C C S TS u c S TS U S COM$EC ACCOUNT NUMBER (1=or all physical key orders, indicate account no and BssociatfNJ address that keying material is to be shipped) c TS BENGN FLL? COMseC ACCOUNT ADORESS 0 Ves 0 No b FOA Case # 4287 USER REPRESENTATVE OR ALTERNATE'S TYPED OR STAMPED NAME SGNATURE PHONE NUMBER (Commml.tl Of DSH)!Approved for Release by' N~~ FORM L6648 REV DEC 96 (Supersedes L6648 REV SEP 94 whch S obsolete) NSN: 7540 FM PAGE OF

201 ~yo~~~tons KEY ORDER REOOeST NES TO: FROM: USER REPRESENTATVElEKMS 10 (Num.rlc) nformation required to complete this order form can be found on the appropriate User Representative Registration noticff which identifies the User Representative's current set of privileges, FOR CENTRAL FACLTY USE ONLY ORDERJO ENTER ElS C-R ~ OATE (YY, MM, 00) TRANSAC'T10N NUM,8E 'M)'Y. MM, XXM/,gffX ill EKMS Central Facility P.O, Box 718 FNKSBURG. MD ll718 Mq"i"~ O!~ i~ r ~ t' PARTTON TYPE (Must choose ONE ONLY. t "CLOSEO", Mt., tjln.<f1/glt code) o OPEN 0 C"OSEO EQUPMENT TYPE KEY TYPE (ChOt>SS ONtE) NOTE: f2 EKRs.re being requested ror 1 key, Z farm,.f'$,.qulredand em,. ()( EKR MUS! bf compler.d. KEY APPUCATlON (CnDON...' D SEED DTE9T DEKR OAT~ OFr{y~ MM'r l 0 OPERATONAL ooperatlona" TEM NO. OTY(R't$uired if Non-EK ) (Twodigit numeric (Start with Oland KEY REGSTRATON NUMBER representing no. 01 increase CLASSFCATON keys to be ordered. (( ordering lin EKR only, enter the TO-digit by one for Max. of99keys can registmtion number (Key Material/D) of the (Check on. box each be ordered per /ina k.y to be replaced) ONLY} subse- ifem, & max Qf400 Quant k~smbyb6 item) or vred under same trans. no.) FREE FORMD S TS " S TS u c S TS /1111/1 8 TS u c S TS 8 T8 S TS COMSEC ACCOUNT NUMBER (For all physical key orders indicato account no. and associated address that keying material is to be shipped. For EKRs, list the account responsible for ensuring EKR s picked up.) r r U U U U U C c c c c COMSEC ACCOUNT ADDRESS ~?proved for Release by NSA ~~ FOA Case # 4287 USER REPRESENTATVE TYPED OR STAMPED NAME SGNATURE PHONE NUMBER (COrrtmorcilll or DSN) FORM L6648A REV DEC 96 (Sup.lS.d.s L6648A REV SEP 94 whch,s obsot.te) NSN: 7540 FM-OOl-5431 PAGE OF

202 E P"" Slat""""" A"," '.' "qu.'".. U.S.C. 40, OS'o; SO V S.C " U,S,C. 198; am 1: and "'%~... Auth SSN is ~!S$ F (199:3) 10 '-,.._ 1.J dooul'tletll \1<:11)/' access \0 Pro\ecled nformatlm ano ytu conlllluing obitgallql'l n~~ \-. 10 Oi$d()$A Protected rnfofmalion without aulhorilalion. Your d!s(;oslire of inlql'ft\l,lion le(lul!!sted by this 10'll'l ($ \olunt~ bul,etus,al e provide nformation, otl'ler than 'j(ur SSN. may jmyenl yqu from ob18lnltlg atcfts to ProltC!;Kl lnformalicn.refu5allo provide your SSN may delay you tr'om ablalning acc.ess 10 Protected nformation DOCD: AMP..r NATONAL SECURTY AGENCY Fort George G. Meade, MD SECURTY AGREEMENT ntending to be legally bound. in consideration of being assigned or detailed to, or employed in, or having access to Protected nformation at the National Security AgenCy (NSA), and recognizing that this assignment. detail, employment access involves a position of special trust and confidence regarding the national security. hereby accept the obligations:set forth n this Agreement 1. have been advised that Protected nformation is infonnatron obtaineo as a result ofmy rejationst1lp with NSA which is classified or in the process of a classification determination pursuant to the standards of Executive Order or any successor order, and implementing regulatjons. t includes but is not limited to intelligence and inteuigenee-.related information, senstive compartmented nformation (information concerning or derived from intelligence sources and methods), and cryptologic information (information concerning communications security and signals ntertlgence. ncluding nformation which is also sensitive compartmented nformation) protected by Section 798 of Title 18, United States Code. 2, understand that the burden is upon me to determine whether nformation or materials within my control are considered by the NSA to be Protected nformation, and whether the person{s) to whom disclosure is to be made is/are authorized to receive it 3, understand that all Protected nformation to which may obtain access during the course of my employment or other service with NSA, is and will remain the property of the United States Govemment unless and until otherwise determined by an appropriate official or final ruling of a court of law, SUbject to such determination, do not now nor will ever, possess any right, interest. tide or claim whatsoever to such information. agree that upon demand by an authorized representative of the NSA or upon the conclusion of my employment or other relationship with the NSA. shall return all material containing such Protected nformation in my possession, or for which am responsible because of such access. understand that failure to return such materials may be a violatjon of Section 793 of TiUe 18, United States Code, and may constitute a crime for which may be prosecuted, 4. understand that the unauthorized disclosure of Protected nformation may invoke the criminal sanctions prescribed by one or more of the fohowing slalules Seclions 793, 794, 79B and 1924 of nue lb, United States Code, and Sections 4211hrough 426 and 7B3{b) of Title 50, Uniled States Code. 5. understand that any breach of this Agreement by me may result in termination by the NSA of my employment in, or my assignmentor detail to, NSA and/or my access to Protected nformation. The NSA may, n accordance with applicable law terminate my employment in, or my assgoment Of detail to, the NSA or may withdraw my access to any or all protected nformation at any time it determines such action to be in the intetest of national security. 6. 1agree not to djscuss matters pertaining to Protected nformation except when necessary for the proper performance of my duuesand only with persons who are currently authorized to receive such information and have a need to know. 7. agree that will report, without delay, to a NSA security representative the details and drcumstances of any possible unauthorized disclosure of Protected nformation or of any unaulhorized person obtaining or attempting to obtain Protected nformation. 8. understand that the United States Govemment may seek any remedy available to it to enforce this Agreement induding, but not limited to, application for a court order prohibiting disclosure of information in breach of this Agreement. have been advised lhat the action may be brought against me in any of the several appropriate United Stales District Courts where the United Slales Government may elect to file the action. Court costs and reasonable attorneys fee incurred by the United States Government may be assessed against me if tlase such action. 9. agree that will submit for security review. in accordance with NSAiCSS Regulation 10~63, "NSAlCSS Prepublication Review Procedure,n au informauon or materials, including works of fiction, that have prepared for public disclosure which contain Of purport to cortain, refer to, or are based upon Protected nformation, as defined in paragraph 1of this Agreement. understand that the term "public disclosure" includes any disclosure ofprotected nformation to one or more: persons not authorized to have access to it. n addition, agree: hereafter; (til) to submit such information and materials for prepublication review during the course of my employment or other service with the NSA and (b) access to them: to make any required submissions prior to discussing he information or materials with, or Showing them to anyone who is not auhorized to have (c) not to disclose such information or materials 10 any person who is not authorized to have access to them until 1 have received written authorization frem the NSA that such disclosure is permitted; and, (d) to assign to l1e United Slates government all rights. tltle, and interest and all royalties, remuneration, or emoluments of whatever form thai have resulted, Will result. or may result from any disclosure, publcation. or revelation of Protected nformaton not consstent with the terms of this Agreement undel'stand that the purpose of the prepublicauon review pro<:edure is to determine whether material contemplated for public disclosure contains Protected nformation and, jf $0, to give the NSA an opportunity to prevent the public disclosure of such information. understand that the NSA is Obligated pursuant to this agreement and in accordance with the terms of NSAlCSS Regulation ( to conduct the prepublication reviewln a reasonable time, to consult as necessary with me through the review process, and to provide an opportunity for me to appeal initial review delerminalions. also understand that, as is necessary to conduct my personal affairs. [ may reveal unclassified information as to where am employed, assigned or detailed, the generic nature of my employmenf, assignment or detail in accordance wilh the descriptions provided for in Annex B to NSAlCSS Regulation Release of Unclassified NSAlCSS nformation," and the amount of salary receive in connection therewith. understand tha should exercise discretion and care in revealing such information and l1al by releasing such information. have not violated this Agreement FORM G170 REV APR 2001 (Supersedes G170 REV JAN 2001 which is obsolete) page 1 NSN. 7540"FM-001-Q068 pproved for Release by NSA FOA Case # 4287 PAGE 1

203 DOCD: n addition to other conditions imposed on me as e result af my employment or other service with NSA, agree to: (a) Notify the Office of Security, NSA, of any unofficial foreign travel by me during the period of my employment. assignment or delailto the NSA; (b) Accept such restrictions on unofficial foreign travel during the period of my employment, assignment or detail to the NSA, as may be deemed necessary, to prevent unacceptable risk to the na~onal security. to the NSA. to personnel associated with the NSA or to Prole~d nformation. (c) Report foreign national associations that arb close and continuing. Close and continuing associations are characterized by tiesof affection, kinship, obligation or capacity to influence. (d) Report, in advance, all visits to foreign embassies, 11. understand that each of the provsions in the Agreement is severable, i.e" all other provisions of this Agreement will remain in full force should it be determined that any provision of this Agreement does not apply to me or is unenforceable. also understand that if am a member of a military service, assume by this agreement only the Obligations not mposed by a similar government non..<flsclosure agreement which may have signed as required by my military department. 12, This Agreement Shalt be interpreted under and in conformance with the law or the United States, 13, have read this Agreement and my questions, if any, have been answered, acknowledge that the briefing officer has made available Sections 793,794, 798, and 952 of Tille 18, United Stales Code: Sections 421 through 426 and 783(b) of Tille 50, United Slates Code: PUbliC Law ; pertinent sections of Executive Order or any successor order; and NSAlCSS Regulation 1Q..63. ~NSNCSS Prepublication Review Procedures,~ so that may read them at this time, if so choose, understand and ~ccept that unless am released in writing by an authorized representaive of the NSA. this Agreement applies during the time am granted access to Protected nformation and at all times thereafter, and applies to all Protected hformatlon to which may be granted access. 14. make this Agreement without any mental reservation or purpose of evasion. 15. These restrictlons are consistent with and do not supersede, conflict with orolherwise alter the employee obligations, right& or liabilities created by Executive Order 12958: Section 7211 of Title 5, United States Code (governing disclosure to COflgress by members of the miliflfy); Section 1034 of TiUe 10, United States Code. as amended by the Military Whistleblower Protection Act (governing disclosure to Congress by members of the military); Section 2302(b)(8) of Title 5, United States Code, as amended by (he WhistJeblower Protection Act (governing disclosures of illegality. waste, fraud, abuse or public health or safety threats); the intelligence dentities Protection Act of 19S2 (50 USC 421 et seq.) (governing disclosures that could expose confidentlai Government agents), and the statutes which protect against disclosures that may compromise the national security, including Sections 641, 793, , and 952 of Title 18, United States COde, and Section 4(b) of the Subversive AcUvitles Act of 1950 (50 USC Section 783(bl). The definitions, requirements, obligations, rights, sanctions and liabililies created by said Executive Order and list statutes are incorporated into this Agreement and are controlling, SGNATURE MLTARY SERVCE RANK CVLAN GRACE ORG 1YPED OR PRiNTED NAME SOCAL SECUR1Y NUMBER CATE SGNATURE The execution of this Agreement was witnessed by the undersigned who accepled t on behalf of the National Security Agency as a prior condition of access to Protected nformation. PRNTED NAME DATE FORM <;170 REV APR 2001 Page.2 NSN; 7540 FM..Q01..()068 PAGE 2

204 '~MELlJ (NSA/CSS Military Assignees) 1. PERSONAL NFORMATON NAME (/.Ut (Fint) (_ (Mlden) DATE AND PlACE OF BRTH SERVCE RATE 011 RANK 2. LST MEMBERS OF YOUR FAMLY AND PERSONS N YOUR HOUSEHOLD WHO ARE NQ.U.S. CTZENS NAME AND RELATONSHP DATE AND PLACE OF BRTH CTZENSHP 3. WST MEMBERS OF YOUR FAMLY AND PERSONS N YOUR HOUSEHOLD WHO ARE NATURALZED u.s. ClnzENS NAME AND RELATONSHP DATE AND PLACE OF BRTH FORMER crnzenshp 4. LST LAST THREE (3) ASSGNMENTS TO NCLUDE BASC TRANNG (00 Not nclude CUlTent assignment) LOCATON (list most _ HS khfjlng inforrnljlion uncssslfitkj) OATES EXAMPLE: Osan AB, 303D S, Korea Sept 1999 May HAVE YOU EVER MANTANED A CLOse OR CDNTlNUNG ASSOCATON WTH ANYONE WHO S JA u.s. CTZEN? (TOs of...hlp ".../Dn or obl/ptldn) o NO 0 YES (f y<l$, give n.fu!, _hlp,ld n.ru",of'$socl.llon) 6. ohave YOU EVER BEEN APPROACHED BY AN UNAlfltORZED PERSON TO DVULGE CLASSFED PROTECTED NFORMATON? NO 0 YES (f yes, J..circumstan_ Jld... the briefer) o? HAVE YOU EVER BEEN OR ARE YOU CURRENTLY THE SUBJECT 01' ANY DSCPLNARY ACTONS? NO 0 YES (fyes, K/efly give circum."""'..) pproved for Release by NSA FOA Case #4287 FORM G511 REV JULY 2003 (Su,.,- <;511 REV FEB 9! "",'e /$"'lol''''1

205 DOClD: SECURTY CHECK LST SECURTY CHECKERS () ORGANZATON ROOM NO(S) DATE (from) (2) CHECK TEMS NDCATED BELOW, AS APPLCABLE 5 M T W T F 5 5 M T W T F 5 CLASSFED MATERAL SECURED (Check fops 01 all surfaces) BURN BAGS STORED DESKS LOCKED SAFES/CABNETS LOCKED KEYS PROPERLY SECUREO DOORS LOCKED PERSONNEL REMANNG OVERTME (Lis! ill remarks) TME REMARKS - (3) (to) NOTE: This form will be turned over to the Security Coordinator at end of 2~we9k perk:ld FORM REV JUN 78 (Superse<tes REV JUL 54 which fs obso/efe) NSN: 7540 FM SECURTY CHECK LST SECURTY CHECKERS (1) ORGANZATON ROOM NO,(s; DATE (from) (2) CHECK TEMS NDCATED BELOW, AS APPLCABLE s M T W T F S 5 M T W T F s CLASSFED MATERAL SECURED (Check lops 01 all surfaces) BURN BAGS STOREO DESKS LOCKED SAFES(CABNETS LOCKED KEYS PROPERLY SECURED DOORS LOCKED PERSONNEL REMANNG OVERTME (Lis! n remerks) (3) (to) TME REMARKS NOTE: This form will be turned over to the Security COOrdinator at end of 2~we&k pertod FORM REV JUN 78 (Supersedes G7038 REV JUL 64 which is obsolete) NSN: 7540 FM pproved for Release by NSA FOA Case # 4287

206 DOClD: SECURTY CLASSFCATON (if any) SECURTY CHECKLST FOR NEWLY ASSGNED PERSONNEL NSTRUCTONS The employee and the employee's supervisor will review this checklist together and will discuss each item as it applies to the organization concerned. When the supervisor and employee are satisfied thai the security instruction is complete, they should sign the form. Forward completed form to Key Component Staff Security Officer. NAME (Please Print) (Last) (First) (M) SSN GRADE/RANK ORGANZATON DATE ASSGNED (YYVYMMDD) SUPERVSOR'S BREFNG FOR NEW EMPLOYEE ASSGNEE A. AREA CONTROL FOR AUTHORZED ACCESS - 8. USE OF TELEPHONE 1. OFFCE PHYSCAL C KEY CONTROLS SECURTY D. LOCK-CHECKER SYSTEM PROCEDURES REVEW E. SECURTY NSPECTONS VOLATONS NTALS SUpy EMPL F EMERGENCY EVACUATON SAFETY PROCEDURES G. PROHBTED TEMS A. NEED To-KNOW STORAGE SYSTEM CLASSFED C. AUTOMATED NFORMATON SYSTEMS (AS NFORMATON PROTECTON D CLASSFED WASTE E. PACKAGNG AND WRAPPNG RESPONSBLTES F. LOCAL CLASSFCATON OFFCER A. FOREGN TRAVEL 3. NDVDUAL RESPONSBLTES 8 ASSOCATON WTH FOREGN NATONALS C FORGOTTEN BADGES D. REPORTNG SECURTY PR08LEMS E. AWOL F. WHERE TO TURN FOR HELP, NFORMATON OR ADVCE 4. OENTFCATON OF ELEMENT ANO STAFF SECURTY OFFCERS ANO ORGANZATON COMPUTER SECURTY MANAGER DSCUSSON ACKNOWLEDGEMENT acknowledge that have been informed 01 the procedures andpractices of the Agency Security Program and how the program is implemented in my element as outlined above. EMPLOYEE ASSGNEE SGNATURE REMARKS ORG DATE (YYYYMMDD) SUPERVSOR SGNATURE TTLE DATE (VVYYMMDD) FORM G1927 REV OCT 2001 (Supersedo, G1927 REV SEP 2000 which is obsolete) SECURTY CLASSFCATON (ilany) ~fproyed for Release by NSA 9~ FOA Case # 4287

207 DOCD: SAMPLE Pf:ttVACY ACT STATEMENT: Auth for Collecting inlo requested on this form is contained in 50 U,S,C., Section 402 'Ole; 50 U.S.C.; Sections 831, 835: Executive Orders , 12958, and 12968: 8n<:l DC Diret:tlllEl No. 6/4. NSA's Blankel Routine Uses lound at 58 Fed, Reg (1993} as well as the specific uses found in GNSAOl and GNSA10 apply 10 t"l$ info. AUlh lor requesting SSN is E,O The fe<luested info will be Jsed to document your access to protected nfo aim Vour Obligation no to disclose Portecled nlormation without aulhoritalion. Your disci 01 requested info. including SSN, is VOluntary. However, failure 10 lurnisn the requested into, other than SSN, may result in a delay aulhorixing your access to sensitive inio 01 the NSA SECURTY DECLARATON Upon entering on duty at the National Security Agency,, have been made aware of my responsibility to protect the Agency. fully understand that the security of the information and the activities of the Agency is of vital importance to the welfare and defense of the United States. realize that am not to discuss the Agency or personal information about employees of the Agency with any unauthorized person. J will report without delay to a representative of the Office of Security any incident whereby an unauthorized person obtains, or attempts to obtain information concerning the classified operations of the National Security Agency. affirm that am familiar with the provisions of Sections 793, 794, and 798,ntle 18, U.S. Code (Su()ersedes pproved for Release by NSA FOA Case # 4287

208 LE ~~if~1t\l"-'xt NTERVEW PRVACY ACT STATEMENT AUlh for roqu,s"n9 SSN eo 9~97 Pnnc:p:l1 purpose far whle~,nfo will be used: To identify ndividual and ntervew int1lvlc1ual. NZ""S Blanket Routine Uaes faund at sa FJd. Reg (199J) apply to this inform8110n, Oisclosure of SSN; '1oluntJr/. Erred on indvidual if info not provided: Will delay agency processing. All. PERSONS 8ENG DE8REFED ARE REQUESTED TO COMP.ETE THS FORM o would like a confidential exit interview with a Security Officer. wish to discuss: o Unusual inlerest in NSAlCSS personnel and activities. o The o The unauthorized disdosure of c~assified information by an NS~jCSS,employee or assignee, behavior. ac:ivities or altituc'e of ao NSAJCSS employee or assigne2' which mav be 0; sec:.;rit'l concem.,- Rec:mme!icar;cns 'NhiC~ ll:elieve may irr.,orove the secojrity ~osture of NS,.\...CSS. - Ctr:er: do nal desire a persan~1 exit interview, SGNATURE SOCAL SECURTY NUMBER FOAM 0o,11:: REN Fe!))O NSN i'solo F'M,130'.lS0B pproved for Release by NSA FOA Case #4287

209 DOC D: s lcqrty CLASSFCATON Security nformation Report (See NOTCE on Reverse Side) TYPE OF NCDENT CODE DATEfTME. vf OCCURENCe TEM SERAL NUMBER REPORTNO OFFCER 10 LOCAlluN UF NCiDENT uhgan""ton PERSON,S) NVOlVEO V Victim G Visrt", W Wrtness E EmpoyJ. e-con1ractor A Reporting Person CODe f OR<lAOORESS CTY STTE ZP TELEPHONE NUMBER l.(3m 4-Bu CODE 2-Yel 5-Red 3-elk BADGE 10 Escorl 13 r.mp 12-1lppl 14-PV SECURTY NSPECTON OSCREPANCES CODE 2O'lo$l CODE t1-exp il2-0em THE FOlLOWNO WERE FOUNO UNSECURED MATE~A.L Pt.ACEO N lo-clllss. mal. l5-lynbag 63-Loot 51-cless. sta~ il6-type ribbon COCE 64-Exp COOE 52-carbon paper (usod) til''.rq. modia 6-SS0 53-k.y 1l8-do<lrlroom llli-wfin M-saftl1contr. 1/1._...a (decall1;er#) NOT RETURNED CODE UNAllTHORZED POSSESSON COOE A Key -Badge G C... H-Cla... Mat. Maletial Prohtlit.d AS DETALS certify lall have receved lire abo1l8 listed lrem: SONATURE DATE FORM0_ REV DEC 9. SECURTY CLASSFCATON NSN, 154o-FM-oOl-0651 QQFXOJl!Bll!!lT1Qlt Copy 1 WhltOj He""",""e.. S42 Copy 2 (Yellow, Olfender (Only d as SD n 0_ "not, '" Z""" f/f) Copy 3 [Pn<) S"",nly Cpo_no Center pproved for Release by NSA FOA Case#4287

210 D~TT'"~"T"ln::-r"'2rn------'" NOTCE NOTCE NOTCE Privacy Act Stlltoment: Auth: GNSA08 and 50 U.S.C. section 831, EO section 1.12(b) (10); NSA's Blanket Routine Uses ound e/ 58 Fed. Reg. 10,531 (1993) apply to this information. Auth fa reques1ing SSN: EO nto wid be used to protect NSA property, installe/ions, ectiv~ies and informlltion. SSN used 10 verily ident~y. Disclosure of the intamation, including SSN, is volunlory. Fai",e to f...ish any 01 the requested information may delay or prevent: the relum of confiscated property or ingress and egress info Agency controlled areas. THE PURPOSE OF THS REPORT S TO ADVSE THAT THE SECURTY DSCREPANCES LSTED ON THE FRONT OF THS FORM, WERE DSCOVERED BY OFFCERS OF THE SECURTY PROTECTVE FORCE. T S SUGGESTED THAT THE STAFF SECURTY OFFCER RESPONSBLE FOR YOUR GROUP/SECTON BE CONTACTED REGARDNG THS MAnER. FORM G3344 REV DEC 98 NSN: 75olO-FM-4lO1 0657

211 DOCD: SECURTY NTERVEW CONSENT PANTED NAME consent to an interview by a representative of NSNCSS Security Services. 1. have been informed that: NATONAL SECURTY AGENCYCENTRAL SECURTY SERVCE (NSAeSS) STATUS EMPLOVEE CANDDATE FDA ACCESS TO NSAlCSS NFORMATON o ASSGNED OR DETALED a. The interview is being conducted for security purposes. My participation is voluntary, and can terminate fhe nterview at any time, interview. b. The interview room may confain viewing and recording devices which may be used to observe, record, or listen to the c. n accordance with the Fifth Amendment to the U.S. Constitution (or Article 31 of the Uniform Code of Military Justice, f applicable), may refrain from saying anything that may implicate me in a criminal offense. d. Refusal to cooperate on grounds other than my right not to incriminate myself could be the basis lor denial, revocation or suspension of my access to NSNCSS classified material or facilities and, if am a civilian NSNCSS employee, may result in disciplinary action under the NSNCSS Personnel Management Manual. 2. With regard to the Privacy Act of understand that: a. The principal purpose for which the information provide in this interview will be used is to ensure compliance with statutory and regulatory requirements for employment or assignment involving access to sensitive cryptologic information. These requirements are imposed by Public Laws and 86 36, Executive Orders and 12333, and 12968, DCD 1/14, and DoD Directive , or their successors. b. My disclosure of information is voluntary. Except for the uses described in this form, the information will be considered confidential and protected as provided in the Privacy Act of The information is to be used in employment, clearance and aacess determinations, in investigations and in assignment, reassignment or other personnel aclions where security considerations are part of the determination. Such uses may entail furnishing the nformation to appropriate Agency officers and employees in the performance of their duties or responsibilities Additionally, the information may be furnished to properly authorized investigators, evaluators and adjudicators for the conduct of security determination or to individuals with responsibililies for inspections or litigation, The information provided during this nterview may be furnished to law enforcement authorities if the information relates to possible or actual violations of criminal law, c, f do not provide the requested information, the result may be processing delays or the nability of the Agency to reach a final determination with respect to employment, clearance, continued assignment, access and other related actions. d, The authority for the collection of intormation during this interview is ReCOrd System GNSA10, PL and PL N WTNESS THEREOF, PLACE MY SGNATURE BELOW SGNATURE WTNESS THE ABOVE WAS READ AND SGNED N MY PRESENCE DAre (Day, Month, Yttafj DATE (Dery, Month, Year) FORM G950A REV MAY 97 (Supersedes G950A REV OCT 90 which is ooso/efo) NSN 7540 FM,OOl.(J158 1"01'1 O""CAL tis! O~L' pproved for Release by NSA FO.A. Case #4287

212 DOClD: \JrOY'{T'":1 SAJ.v~...a..J1!J PRVACY ACT STATEMeNT. Aulh far coliectll"ltjj nto requested an lhill ro,m ill COnt.1lned n 50 u.s,c. Scan <CO2 nate: 50 U.S.C.. Secdans 8:n. B:l5.!<lCUlMt 0","" 10450, lz333. Zl5B l1l 12!1e8; l1l DC OlnJCtiVe No: 8/4, r4.a,', Bt;tnflet Aoutine Use. DUtld at!58 Fed. RctQ. 10,5:11 gga) as _.1'"OP-... ",., n GNSAO i1cl Gl'SAl0 illly lo "'" inf. ~"'" for roquo$llng SSN is EO. t:l97. Th.roqu_1nfo Wll b. uled lo -''''''''1 y<jt... lo protec:ed nfo /ld your obllg:ujon 1101 to dlsdosl Potteded nformation withoul Lt1Crizatian. '"1btr disc a' _!led in1o, including SSN. YOUntoy. How..., laure lo lumish ll. raqu 1lld nfo. om., llan S!N, may rtllut n dalay U1l11izing your acc:ns to sllrlilive il'a Of the NSA. SECURTY OATH Upon being cleared to protect the sensitive information of the National Security Agency, subscribe to this oath freely. without mental reservation. and with the full intent to exercise meticulous care in abiding by its ~ems, solemnly swear that will not reveal to any person any information pertaining to the classified activities of the National Security Agency, except as necessary toward the proper performance of my duties or as specifically authorized by a duly responsible superior known to me to be authorized to receive this information. further solemnly swear that will report without delay to my security representative the details and circumstances of any case which comes within my knowledge of an unauthorized person obtaining or attempting to obtain information concerning the classified operations of the National Security Agency. fully appreciate and understand that the securi~1 of the information and activities of te National Security Agencf is of vital importance to the welfare ar:d defense of the United States. affirm that am familiar wilh the provisicns of S"C:ions and 798. 'Title 18, United Slates Code. do hereby affirm any uncerslancing that the obligations of this oath will continlie even atler severance of my connec:ions with the National Security Aljenci' anc hat they remain fully binding on me curing peacetime as well as dumng wariime. GAACE. RANK er CRGANlZATCN $CC:AL. se':urty NWMEiR WTNESS CAlC FCAM GT10F REV JUL 2C!01 (SlJfJers«tt:$ GlroF MEV JAN 9" Wf1C."t U OO$$/d) pproved for Release by NSA FOA Case # 4287

213 DocrD: SECURTY CLASSFCATON SECURTY REVEW CHECKLST DATE (YYYYMMDD) Office Security Coordinalors or Advisors (SC/SA's) will determine which area should logically constitute a unit for review purposes, Surveys will be conducted by the SC or SA'S or an alternate approved by the Key Component Staff Security Officer (SSO). Upon cornplelion of each survey, the Branch Chief Or Team Leader will indicate that he/she has been briefed on the results of the security review by signing the report. Where a question is checked "NO, an explanation or corrective action to be taken will be entered in the "REMARKS" section or on a separate sheet, and the checklist should be classified CONFDENTAL. When submitting completed security review reports to the SSO, the SC/SA will attach a cover memorandum containing comments on the overall state 01 physical security within the office. Problem areas uncovered hat do not lend themselves to immediate or simple remedies should be brought to the attention of the SSO and S41 immediately. S41 Facilities Security Officers are located in Room 3W156 in Operations Building 1 and can be reached at s or b. Completed Security Review Checklists should be forwarded to the SSO no later than 15 May of each year. PART - PHYSCAL SECURTY.... '.' 1. s the Key Access List current? (Re, Office of Security Services Policy ssuance , Annex K) 2:- Have procedures been established for safeguarding keys drawn trom the Key Desk or the Automated Key Ac:cess~Machine (AKAM) while in the custody of the organization? (Rei Office of Secur;ly services Policy ssuance , Annex K) 3. Are 24 hour retention keys cited weekly by filling out a new key card or returning to the AKAM? (Ref. Office ofsecurity Services Policy ssuance Annex K) 4. Are a\1 convenience knob lock keys (CKLs) for main door or interior offfces accounted for and safeguarded? 5. Except when actually in use are corridor doors kept closed at au times? (Ref. Ottics of SBCurity $srvicqs Policy ssuance 121~'8, Annex F) 6. Are duplicate desk and container keys stored in a locked container when the Bres is secured? (Ref. Office of Security Services Policy ssuance , Annex K.) all safes in the area carry a unique identification number? 8. Are combination padlocks properly safeguarded when not in use? (Ref. PMM ) 9 Are combinations a. When combination lock is first placed in operation? being changed: (Rsi. Office 01 b. When the combination S or may have been compromised? Security Policy ssuance, Annex C.) c. At least once every two years? 10. s the Support Services Operation Center (SSOC) properly notified via Form SF 7QQ of au combination changes (container and padlock)? (Rei Office 01 Sscurily SeN/cas Policy ssuance , Annex C.) 11. s all locking hardware operating properly? f not, contact $4123 Protective Security Technologies for repairs. They can be reached via at LOCKHELP@ nsa or at s the Alarm Activation/Deactivation list current? 13. Have 24 hour unmanned computer operalions been approved by your element SSO and properly labeled to preclude shut off? f not, contact your SSO for guidance. 14. s classified information or material being stored or protected by the most secure method possible, consistent with its sensitivity? (Ref. PMM 803.3'1 through 3 4). 15. Have all Open Storage requirements been reviewed and approved by S41? (Ref. Office ofsecurity Services Policy ssuance 121~18, Annex H.) 16. n areas with Open Storage approval, has an attempt been made to obtain sufficient lockable containers to store all classified material? not, has an attempt been made to archl~/destroy outdated or unciassified material? (Re Office 01 Security Services Policy ssuance 121 t8, Annex H.) 17. Are newly assigned personnel apprised of their security responsibilities by their supervisors using Form 01927, Security Checklist for Newly Assigned Personnel? (Ref. NSA Reg c.) 18. s Form G1927 for new arrivals being forwarded to the appropriate SSO? '9 f there afe Limited nl$rim Clea.rance (Lie) Of Red-Badged personnel assigned to the area, has the area been surveyed and approved by your element ssa or 841? (Ref. Office of Security Services Potiey ssuance , Annex E.) 20. Are appropriate security measures in place to safeguard classified information from disclosure to lie or uncleared personnel worlo;ing in area? (Ref Office 01 Security Services Policy ssuance 121~18, Annex E.) 21, Are assigned a. NEWSMAGAZNE personnel familiar with and adhere to b. Non-secure facsimile devices security procedures c. Non-secure modems associated with the use 01: d. Secure facsimile devices YES NO NJA 22. Are telecommunicalions equipment. to include STU-lls, used in accordance with anonymity/opsec considerations? (Re. NSA Rso ) FORM G8512 REV NOV 20<10 Page 1 SECURTY CLASSFCATON PAGE 1 (Supersedes G8512 REV SEP 2000 which S obsolete) ~fpro\led for Release by ~jsa FOA Case # 4287

214 DOCD: SECURTY CLASSFCATON (continued) PART 1- PHYSCAL SECURTY (continued) 23. Are all Crypto-gnition Keys (elks) for STU llls secured when not in use and at the end of the day? (Re, NSA Reg ). '.. ::"'t', ',"" YES NO NA 24. Does Reproduction equipment have a Printing Control Number (pen)? Contac1 Y19/PCO for more nformation (Ref. NSA Reg ) 25, Has a Reproduction Operation SOP been established? f not. contact Y19/PCO for guidance, (Ref. NSA Reg AnnexK.) 26. Are all partially filled burn bags safeguarded in the manner prescribea TOr me highest level of classified waste contained thoroin? (Ref. PMM803,5 lc.) 27, When classified material is being handcarried. has the malerial been properly Jnventoried and wrapped? (Ref. NSA Reg ) 28. Have all couriers been properly briefed by 5443 to handcarry classified materials outside NSA Headquarters Facilities? (Re. NSA Reg, 123-2) 29. Are all other handcarrying procedures being observed? (Ref. NSA Reg ) 30. Has a locker/checker procedure been astablished for securing the area at close of business? (Ref. Office of Security Services Policy ssuance , Annex J.) 31, Are all personnel thoroughly familiar witl110cker/checker procedures? 32. Are checks made to ensure that [ocker/checker procedures are followed? PART - ACCESS CONTROL. '...,':. ".,"':',,: ;"".,, ' YES NO NJA 33, Are assigned personnel located 50 that access to the area can be visually monitored at all times? (Ref. OffCe of Security Services Palicy ssuance , Annex F.) 34, Are visitor registers being properly completed when r&quired? (Ref. Office ofsecurity Services Policy ssuancs , AppendX 2 to Annex F.) 35, Are assigned personnel alert to their responsibility to challenge visitors in the work area? 36, Are assigned personnel adequately alerted to the presence of uncleared visitors in the work area? 37, Are Visitor Requests being approved at the Branch Chief Or Team Leader level or higher? 38. Are classifjed Visitor Requests submitted in a timely manner to permit appropriate processing? PART -NTERNAL HANDLNG OF CLASSFED MATERAL 39 Are mail distribution receptacles under continuous surveillance by area personnel? 40. Do office personnel ensure that others do not "browse n through mall destined for elements other than their own? 41 Are mail distribution receptacles located away from personnellraflic passageways? (f not, consideration should be given to altering the arrangement.) 42 Do mail handlers (including secretaries) strictly observe caveats "to be opened only by", ~eyes only", or ~exclusjvety for"? 43. s there a real need to know for all classified publications received by the element? (f not. action should be initiated to discontinue receipt.) 44 Do personnal who open sealed envelopes containing compartmented material possess the necessary c!earl:inces? 45, s all compartmented material which is dispatched or received in the element wrapped in a sealed opaque envelope bea.ring the caveat "to be opened only by", "eyes only', or "exclusively for"? 46 Are holders of combinations to safes containing compartmented material limited to those cleared for access to the material? 47. s need-to-know JUDCOUSLY considered by personnel who determine distribution of classified material generated by the element? REMARKS YES NO NA SGNATURE OF COORDNATOR/ADVSOR SGNATURE OF CHEF FOA A.REA REVEWED FORM G6512 REV NOV Page 2 SECURTY CLASSFCATON 2

215 DOCD: SAMPLE PRVACY ACT STATEMENT: Autn lor COktCting inrc requested on tin Orm i. con1red n 50 US.C., Section <lo2 nole; 50 US.C.; Soctiool ; E_U1lva Ord , 12333, 12958, and 12968: and OC DirectMt No. 6(4 NSA's B'-nket Routine Lei Ql.lno at sa Fed. Reg. 10,531 (1993) as well as the $pcilic uses found in GNSA01 and GNSA10 'Ply thi. info. Auth lor raquastinj SSN ~ ao T1o requnted into will be UHd to docul\"c!n your accet kj PfO*:ted into and your obligation not ro cscfou Protected nformation without authorization Your dlsdos... of requnted nformation, nduding SSN, vol,lntary. Mow~, fai/ul'tt to furnish the requtlled il"lfo. other than SSN. may Mutt in a delay authoriting your acl;8s to sensitive info of the NSA. SECURTY TERMNATON STATEMENT fully appreciate and understand that the preservation ofthe security ofall sensitive and/or classified defense information is ofvital importance to the welfare and defense ofthe United States. acknowledge that termination of an appointment, detail, assignment, or association with the National Security Agency/Central Security Service under which was eligible for access to sensitive and/or classified defense information terminates my right to have access to all information. do hereby swear or affirm that upon termination ofmy appointment, detail, assignment, or association with the National Security Agency/Central Security Service, will not thereafter reveal my knowledge of sensitive and/or classified defense information orally or in writing to any unauthorized persons or agency, except as may be required by my reassignment or future employment with a United States government agency or component which has a specifically defined responsibility and a need-to-know such information, or except as may otherwise be required by law. further swear or affirm that do not have in my possession or control any material containing such information. further swear or affirm that will report without delay to the National Security Agency/Central Security Service or the Federal Bureau of nvestigation any incident wherein an attempt is made by an unauthorized person to solicit sensitive and/or classified defense information. f am in an overseas area, will immediately report the facts to the nearest National Security Agency/Central Security Service Headquarters, to the Commander ofthe U.S. military installation, or to a Security Officer ofthe Department ofstate. understand the provisions of Sections 793, 794, and 798, Title 18 United States Code. and reaffirm the continuing security obligation that readily accepted at the time of my appointment, detail. assignment or association with the National Security A.gency/Central Security Service. ORCl"Jo/ZATfON. SERVce OR COMPANY AFFLATON PRNlllO N.\rdE scx:al SECURTV NUMbl:.R PeRSON ADMNS'mRtNG OAnt OA'" FORM G170D NOV 03 pproved for Release t1'y NSA FOA Case # 4287

216 DOCD: Occupational Safety and Health Program SELF-NSPECTON GUDE 1. EMPLOYER POSTNG 2. RECORD- KEEPNG - a. s the required 000 Safety and Occupational Health Protection Program workplace poster (DO Form 2272) displayed in a prominent location where all employees are likely to see it? b. s the NSA 911 Emergency poster (Form 04194) displayed in a prominent location where all employees are likely to see it? c. Where employees may be exposed 10 toxic substances or harmful physical agenls, has appropriate information concerning employee access to medical and exposure records, and "Material Safety Data Sheets", etc., been posted or otherwise made readily available 10 aftected employees? d. Are signs concerning exiling from buildings, room capacities, floor loading, exposures to x-ray. microwave, or other harmful radiation or substances posted where appropriate? e. s the end of year (FY) Summary of Recordable Occupational llnesses and njuries posted in the month of November for 30 days? a. Are all recordable occupational injuries or illnesses reported to OHESS? YES NO NlA 3. a Do you have a safety and health program in operation? SAFETY b, Do you have a working procedure for handling employee complaints regarding safety AND HEALTH and health? PROGRAM c. Are you keeping your employees advised of the successful effort and accomplishments in assuring they will have a workplace that is safe and healthful? 4, a, Do employees know the location of NSA's medical center? MEDCAL b. Are emergency phone numbers posted (911 and SSOC)? SERVCES AND c. Are first aid kits easily accessible to each work area, wilh necessary supplies available, periodically inspected and replenished as needed? FRST AD d. Are means provided for quick drenching or flushing of the eyes and body in areas where corrosive liquid on materials are handled? 5, FRE PROTECTON PREVENTON a. Do fire doors operate freely and are they in good working order and mainlained in the closed position? b. Are fire doors and shutters unobstructed and protected against obstructions, including their counterweight? c. Are sprinkler heads protected by metal guards, when exposed to physical damage? d. Are materials and obstructions 18 inches below the sprinkler deflector level? e. Are employees periodically instructed in the use of extinguishers and fire protection procedures? f. f a local smoke detection system is provided, is it operational? (s the green power light on?) g. Are the proper type of fire extinguishers available? (Class.~" water andiorcarbon Dioxide) h, Have all extinguishers been inspected within the past lwelve months? i. Are extinguishers mounled, accessible and type identified? j, Are portable fire extinguishers located within 75 feet? k. s trash anevor oily waste malerial removed on a dally basis?. Are waste receptables containin~ flammable/combustible waste constructed of metal and provided with a self closing lid? :ORM D6936A REV AUG 2001 (Supers8cfe~ 06936A SEP 95 wnich is OOsOiete)., - ~fproved for Release by NSA ~~ FOA Case #4287

217 DOClD: FRE PROTECTON- m. Are flammable liquids stored in metal containers or approved safety cans? n. Are flammable liquids andlor oily waste materials atored in approved cabinets or containers? o. s the area beneath raised flooring free of storage? p. Are electrical circuit breaker panels, disconnect switches, power distribution units, air handling units and smoke detection system panels clear from obstructions including combustibles? (thrae (filet mmimum) q. S the area free of unauthorized healin~ appliances? (exposed filament hot plates, portable heaters, popcorn popper, etc.? r. Are microwave ovens, refrigerators and other major applicances plugged directly into a single wall oullet? s. Does each coffee pot rest on a non-combustible surface? PREVENTON t. Are coffee pots plugged direclly into an outlet or single fused multi-outlet power strip? (continued) u. Are coffee pols powered 011 when unattended? YES NO N/A 6. PERSONAL v. s the area free of non-fused extension cords, loose floor outlets, multiple outlet plugs etc.? w. Does this area have electrical equipment operating while the room is unattended? x. Are all wall penetrations properly sealed? y. Are ceiling tiles in place? z. Are occupants aware of how to report a fire? aa. s the area free of any fire hazard? a. Are protective goggles or face shields provided and worn where there is any danger of flying particles or corrosive materials? b. Are approved safety glasses required to be worn at all times in areas where there is a risk of eye injuries such as punctures, abrasions, contusions or burns? c. Are adequate work procedures, protective clothing and equipment provided and used when cleaning up spilled toxic or otherwise hazardous materials or liquids? d. Are protective gloves, aprons, shields, or other means provided against cuts, corrosive liquids and chemicals? e. Are hard hats provided and worn where danger of falling objects exists? PROTECTVE 1. Are hard hals inspected periodically for damage fa the shell and suspension system? EQUPMENT AND CLOTHNG g. s appropriate foot protection required where there is the risk of foot injuries from hoi, corrosive, poisonous subslances, falling objects, crushing or penetrating actions? h. Are approved re.pirators provided for regular or emergency use where needed? i- s all protective equipment maintained in a sanilary condition and ready for use? j. Are eye wash facilities and a safety shower Within the work area where employees are exposed to corrosive materials? k. Where special equipment is needed for electrical worksrs j is it available?. Where lunches are eaten on the premises, are they eaten in areas where there is no exposure to to,ic materials or other heallh hazards? m. s hearing protection (i.e.. P".J/ and muffs) provided and required to be worn when the sound ievels exceed 85 d A?. FOAM D6936A REV AUG 2001 Pa.ge 2-2 -

218 DOClD: a. Are work areas clean, safe and orderly? b. Are work surfaces kept dry or appropriate means taken to assure the surlaces are slip-resistant? c. Are all spilled materials or liquids cleaned up immediately? d. s combustible scrap, debris and waste stored safely and removed from the worksite promptly? e. Are accumulations of combustible dust (aluminum, carbon, wood, plastic) routinely removed from elevated horizontal surtaces including the overhead structure of buildings, etc? GENERAL WORK f. s combustible dustcleaned up with an approved explosion proof vacuum system to ENVRONMENT prevent the dust going nto suspension? HOUSEKEEPNG g. s metallic or conductive dust prevented from entering or accumulating on or around electrical enclosure of equipment? h. s trash removed from work areas dally? i. Are areas beneath raised floors free of storage? YES NO N/A j. Are adequate toilels, handwashlng and shower facilities provided? k. Are office vending, cotfee mess and microwaves clean and sanitary?. Are all toilets and washing facilities clean and sanitary? m. Are all work areas adequately illuminated? a. Are aisles and passageways permanently marked and kept clear? b. Are aisles and walkways marked as appropriate? c. Are wet or potentially moisture laden surtaces covered with non-slip materials? d. Are holes in the floor, sidewalk or other walking surface repaired properly, covered or otherwise made safe? e. s there safe clearance for walking in aisles where motorized or mechanical handling 8. equipment is operating? WALKWAYS f. Are material or equipment stored in such a way that sharp projectiles will not interfere wifh walkways? g. Are changes of direction or elevations readily identifiable? h. Are aisles or walkways that pass near moving or operating machinery, welding operations or similar operations arranged so employees will not be subjected to potential hazards?."... ~... j, s adequate headroom provided for the entire length of any aisle or walkway? j. Are standard guardrails provided wherever aisle or walkway surfaces are elevated more than 30 nches above any adjacent tloor of the ground? k. Are bridges provided over conveyors and Similar hazards? 9. FLOOR AND WALL OPENNGS a. Are floor openings guarded by a cover, guardrail, or equivalent on all sides (except at enlrance to stairways or fadders)? b. Are loeboards installed around the edges of permanent floor opening (where persons may pass below fhe opening)? c. Are skylight openings and holes guarded by screens and railings? d. s the glass n the windows, doo,s, glass walls, etc.. which are subject to human mpact, of sufficient thickness and type for the condition of use? e. Are ~rates or similar type cover floor openings such as floor drains, of su.ch design that oot trahic or rolling equipment will not be ahected by the grate spacing? FORM D8936A REV AUG 2001 ' Page 3

219 DOCD: f. Are unused portions of service pits and pits not actually in use either covered or 9. protected by guardrails or equivalent? FLOOR AND WALL OPENNGS (continued) g. Are manhoie covers, trench covers and similar covers, plus their supports designed to carry a ruck real axle load of at least 20,000 pounds when located in roadways and subject to vehicle traffic? h. Are floor or wall openings in tire resistive construction provided with doors or covers compatible with the fire rating 01 the structure and provided with self closing feature when appropriate? YES NO N/A a. Are standard stair rails or handrails on all stairways having four or more risers? b. Are all stairways at least 22 inches wide? c. Do stairs have at least a 6'6" overhead clearance? d. Do stairs angle no more than 50 and no less than 30 degrees? e. Are stairs of hollow-pan type treads and landings filled to nosing level with solid material? f. Are step risers on stairs uniform from top to bottom, with no riser spacing grealer than 7.5 inches or less than 6.5 inches? 10. g. Are steps on stairs and stairways designed or provided With a surface that renders them slip resistant? STARS AND h. Are stairway handrails locatad between 30 and 34 inches above the leading edge 01 stair treads? STARWAYS i. Do stairway handrails have at least 1.5 inches of clearance between the handrails and the wall or surface they are mounted on? j. Are stairways <44" wide both Sides enclosed, one handrail descending? k. Are stairways <44" wide one side open, one stair railing on each side?. Are stairways <44" wide both sides open, one stair railing on each side? m. Are stairways >44" but 88" wide, one handrail on each enclosed side, and one stair railing on each open side' n. Are stairways >88" wide, one handrail on each enclosed side, one stair railing on each open side, and One middle stair railing'? o. Where stairs or stairways exit directly into ar:r area where vehicles may be operaled, are adequate barriers and warnings provide to prevent employees slepping into the path of traffic? p. Do stairway landings have a dimension measured in the direction of travel, at least equal to the width of the slairway? q. s the vertical distance between stairway landings limited to 121eet or les.? a. Are signs posted, when appropriate, showing the elevated surface load capacity? b. Are surfaces elevated more than 30 nchas above the floor or ground provided with standard guardrails? c. Are all elevated surfaces (beneath which people or machinery could be exposed to 11. falling objeots) provided with standard 4-inch toeboards? ELEVATED ct, s a permanent means of access and egress provided to elevated storage and work surfaces? SURFACES e. s a minimum of 6 feet 8 inches headroom provided to elevated storage and work surfaces? f. s malerial on elevated surfaces piled, Slacked or racked in a manner to prevent it from tipping, falling, collapsing, rolling or spreading? g. Are dock boards or bridge plates used when transferring materials between docks an trucks or rail cars? FORM 06936A REV AUG page 4 4-

220 DOCD: a. FOR NON SPRNKLERED BULDNGS: f your araa has only one exit access, s the walking distance to the corridor door 75' or less? b. FOR SPRNKLERED BULDNGS: f your area has only one exit access, is the walking distance to the corridor door 100' or less? (75' n leased spaces)? c. f area is occupied by 50 or more people are there at least two separate means of egress available at all times? d. Are all occupants familiar with the evacuation procedures for their workspace and building? e. Are main aisles at least 44 inchas wide? YES NO N/A f. Are cross aisles at least 36 inches wide? g. Are all 8xislS. aisles or Corridors kepi open and free of obstructions? 12. h. Are exit pathways clearly labelad wilh directional exil signs where exll acces is not EXTNG readily apparenl? OR i. s each exit clearly marked? EGRESS J. Are exit si~ns provided with the word "EXT' in lettering alleasl5 inches high and the slroke all e lettering at least.5 lnch wide? k. Are all exit pathways lluminated during normal operations?. Are all exil pathways illuminated with emergenoy lighting? f no battery powered emergency lights are Visible, contacl the building manager for guidance. m. Are all doors in he means of egress operable from the occupied side without he use of keys or olher devices? n. Are exit doors side hinged? o. Are alleast two means of egress provided from elevated plalrorms, pils or rooms where the absence of a second exil would increase the risk of injury from hot, poisonous, corrosiva, suffocating, flammable, or explosive substances? p. Are NSA 91 1 posters displayed n each work area? q. s an NSA emergency evacuation plan pasted in each work area? s. Are evacuation roule maps posled, clearly showing routes of travel and designated assembly areas? 13. EXT DOORS a. Are doors which are required to serve as exits designed and constructed so that the way of exit travel is obvious and direct? b Are windows which could be mlslaken for exil doors, made inaccessible by maans of barriers or railings? c. Can exit doors open from the direction of exit travel Without the USe of a key Or any special knowledga or effort when the building is occupied? d. s a revolving, sliding or overhead door prohibited from serving as a required exit door? e. Whera panic hardwara is installed on a required exit door, will it allow the door to open by applying force of 15 pounds or less in tha direction of the exit traffic? FORM D6936A REV AUG Page 5 f. Are doors on cold storage rooms provided with an inside release mechanism which will release the latch and opon the door even jf it's padlocked or otherwise locked on he oulside? g. Where exil doors open directly onto any street, alley or other area where vehicles may be operaled, are adequate barriers and warnings provided to prevent employees stepping into the path of raffic? h. Are doors thai swing in bolh directions and are located between rooms where there is frequent traffic; provided with viewing panels in each door?

221 DOCD: a. Are all ladders maintained in good condition, joints between steps andside rails tight, all hardware and fitli1.s securely alfached and moveable parts operating freely without binding or un ue play? YES NO NlA b. Are non-slip salety feet provided on each ladder? c. Are non-slip safety leel provided on each metal or rung ladder? d. Are ladder rungs and steps free of grease and oil? e. s it prohibited to place a ladder in front Of doors opening toward the ladder except when the door is blocked open, locked or guarded? t. s it prohibited to place ladders on boxes, barrels, or other unstable bases to obtain additional height? g. Are employees instructed to face the ladder when ascending or descending? 14. h. Are em~loyees prohibited from usin~ ladders that are broken, missing steps, rungs, or PORTABLE cleats, roken side rails or other fau ty equipment? LADDERS i. Are employees nstructed not to use the top step of ordinary stepladders as a slep? j. When portable rung ladders are used to gain access to elevated plalforms, roofs, etc., does the ladder always extend at least 3 feet above the elevated surface? k. s it required that when portable rung cleallype ladders are used, the base is so placed that slipping will not occur, or it is lashed or otherwise held n place?. Are portable metal ladders legibly marked with signs reading "CAUTON - Do Not Use Around Electrical Equipment" or equivalent wording? m. Are employees prohibited from using ladders as guys, braces, skids, gin poies, or for olher than their intended purposes? n. Are employees nstructed to only adjust extension ladders while standing at a base (not while standing on ladder ortram a position above the ladder)? o. Are metal ladders inspected for damage? p. Are the rungs of ladders uniformly spaced at 12 inches, center to center? a. Are all tools and equipment (both government and employee-owned) used by employees at their workplace? b. Are hand tools such as chisels, punches, etc., which develop mushroomed heeds during use, reconditioned or replaced as necessary? c. Are broken or fractured handles on hammers, axes and similar equipment replaced promptly? 15. HAND TOOLS AND EQUPMENT d. Are worn or bent wrenches replaced regularly? e. Are appropriate handles used on files and similar tools? f. Are employees made aware of the hazards caused by faulty or improperly used hand tools? g. Are appropriate safety glasses, face shields, etc., used while using hand lools or equipment which might produce flying material or be subject to breakage? h. Are jacks checked periodically to assure they are in good operating condition? i. Are tool handles wedged tightly in the head of alilools? j. Are tool CUlling edges kept sharp so the tool will move smoothly without binding or skipping? k. Are tools stored in dry, secure location where they won't be tampered with?. s eye and face protection used when driving hardened or tempered spuds or nails? FORM D6936A REV AUG 2001 Page 6 6

222 DOCD: a. Are grinders, saws and similar equipment provided with appropriate machine guards? YES NO NfA b. Are power tools used with the correct shield, guard. or auachment, recommended by the manufacturer? c. Are portable circular saws equipped with guards above and beiow the base shoe? 16. d. Are circular saw guards checked to assure they are not wedged up, thus leaving the lower portion of the blade unguarded? PORTABLE (Power e. Are rotating or moving parts of equipment guarded to prevent physical contact? Operated) TOOLS AND EQUPMENT 17. ABRASVE WHEEL f. Are all cord-connected, eiectrically-operated tools and equipment effectively grounded or of the approved double insulated type? g. Are effective guards in piace over belts, pulleys, chains, and sprockets, on equipment? h. Are portable fans provided with full guards or screens having openings one-hall (112") inch or less? i. Are ground-fault circuit interrupters provided on all temporary electrical 15 and 20 ampere circuits, used during periods of construction? j. Are pneumatic and hydraulic hoses on power-operated tools checked regularly for deterioration or damage? a. s the work rest used and kept adjusted to within one-eighth inch (1/8") of the wheel? b. s the adjustable tongue on the top side of the grinder used and kept adjusted to within on-forth inch (1/4") of the wheel? c. Do side ~uards cover the spindle, nut, and flange and 75 percent of the wheel diameter. d. Are bench and pedestal grinders permanently mounted? e. s primary eye protection (i.e.. safety glasses. goggfes) alwa s worn when grinding? s secondary protection (faceshlelds) worn when necessary EQUPMENT \. s the maximum RPM rating of each abrasive wheel compatible with the RPM rating of the grinder motor? GRNDERS g. Are fixed or permanently mounted grinders connected to their electrical supply system with metallic conduit or other permanent wiring method? h. Does each grinder have an individual on and off control switch? i. s each electrically operated grinder effectively grounded? j. Before new abrasive wheels are mounted, are they visually inspected and ring tested? k. Are dust coliectors and powered exhausts provided on grinders used in operafions that produce large amounts of dust?. Are splash guards mounted on grinders that use coolant to prevent the coolant reaching employees? a. Are employees who operate powder-actuated tools trained in their use and carry a valid operator's card? 18. b. s each powder-actuated tool stored in its own locked container when not being used? POWDER ACTUATED TOOLS c. s a sirn at least 7 inches by 10 inches with bold lace type reading "POWDER- ACTU JED TOOL N USE" conspicuously posted when the tool is being used? d. Are powder-actuated tools left unioaded until they are actually ready to be used? e. Are powder-actuated tools inspected for obstructions or defects each day before use? f. Do powder-actuated tool operators have and use appropriafe personal protective equipment such as hard hats, safety goggles, safety shoas and ear protectors? FOAM D6936A REV AUG 2001 Page 7

223 DOCD: YES NO N/A a, s there a written training program to instruct employees on safe methods of machine operations? b, s there adequate supervision to ensure that employees are following safe machine operating procedures? c. s there regular program of safety inspection of machinery and equipment? d, s all machinery and equipment kept clean and properly maintained? e, s sufficient clearance provided around and between machines to allow for safe operations, set up and servicing, material handling and waste removal? f. s equipment and machinery anchored when necessary to prevent tipping or other movement that could resull in injury? g, s there a power shut-off switch within reach of the operator's position at each machine? h, Can electric power 10 each machine be locked out for maintenance, repair, or security? i. Are foot-operated-switches guarded or arranged to prevent accidental aotuation by personnel or falling objects? j, Are manually operated valves and switches controlling the operation of equipment and machines clearly dentified and readily accessible? 19. MACHNE GUARDNG k, Are all emergenoy stop buttons colored red?. Are all pulleys and belts that are within 7 feet of the floor or working level properly guarded? m, Are all moving ohains and gears properly guarded? n, Are splash guards mounted on machines that use coolant to prevent the coolant from reaohing employees? 0, Are methods provided to protect the operator and other employees in the maohlne area from hazards created at the poinl of operation, ongoing nip points, rotating perts, flying ohips, and sparks? p. Are machinery guards secure and so arra.nged that they do not ofter a hazard in their use? q, f special hand tools are used for piaoing and removing material, do they protect the operetor's hands? r. Are revolving drums, barrels, and containers required to be guarded by an enclosure that is interlocked with the drive mechanism, so that revolution cannot occur unless the guard enclosure is in piace? s. Do arbors and mandrels heve firm and secure bearings end are they play free? t. Are provisions made to prevent machines from automatically starting when power is restored after a power failure or shutdown? u. Are machines conslructed so as to be free from excess vlbralion when the largest size tools is mounted and run at full speed? v. f machinery is cieaned with c0"'feressed air, is air pressure controlled end personal protective equipment or other sa eguards utilized to protect operators and other workers from eye and body injury? w. Are fan blades protected with a guard having openings no larger than.5 nch, when operating within 7 feet of the floor? x. Are saws used for ripping, equipped with anti-kick back devices and spreaders? y. Are radial arm saws so arranged that the cutting head will gently return to the back of the table when reieased? FORM D6936A REV AUG page 8 8

224 DOCD: a. s all machinery or equipmenl capable of movament, required to ba de-enargizad or disengaged and blocked or 10cked-ouVtagged-out during cleaning, servicing, adjusting or setting up operations, whenever required? b. Where the power disconnecting means for equipment does not also disconnect the electrical control circuit: (1) Are the electrical enclosures identified? YES NO NA (2) s means provided 10 assure the control circuit can also be disconnected and locked-out? c. s the locking-out control in lieu of locking-out main power disconnects prohibited? d. Are all equipment conlrol valve handles provided with a means for locking-out? a. Doas ha lock-out procadure raquira storad enargy (mechanical, hydraulic, air. ate.)? 20. LOCK.QUT TAG-OUT PROCEDURES f. Are appropriate employees provided with individually keyad personal safety locks? g. Are employees required to keep personal control of their key(s) while they have safety locks in use? h. s it required that only tha employee exposed to tha hazard, place or remove the safety lock? i. s it required that employees check the safety of he lock-out by attempting a slart up after making sure no one s exposed? j. Are employees instructed 10 always.:flush the control circuit stop button prior 10 reenergizing the main power switch. k. s there a means provided to idenlify any or all employees who are working on lockoul equipment by their locks or accompanying lags?. Are a sufficient number of accident preventive signs or tags and safety padlocks provided for any reasonably foreseeeble repair emergency? m. When machine operations, configuration or size requires the operator to leave his or her control station to install tools or pertorm other operations, and that part of the machine could move if accidently activaled, is such element required to be separately locked or biocked out? n. n the event that equipment or lines cannot be shut down, locked-out and tagged, is a safe job procedure established and rigidly followed? a. Are oniy authorized and trained personnel permitted to use welding, cutting or brazing equipment? b. Does each operator have a copy of the appropriate operating instructions and are hey directed to follow them? c. Are compressed gas cylinders reguiarly examined for obvious signs of defects, deep rusting. or leakage? 21. d s care used in handling and storage of cylinders, safety valves, relief valves, etc. to prevent damage? WELDNG, CUTTNG AND e. Are precautions taken to prevent the mixture of air or oxygen with flammable gasses, except at a burner or in a standard torch? BRAZNG f. Are only approved apparatus (forches, regulars, pressure-reducing valves, acetylene generators, manifolds) used? g, Are cylinders Kept away from sources of heat? h. Are the cylinders kept away from elevators, stairs, or gangways? i. s it prohibited to use cylinders as rollers or supports? j. Are empty cylinders appropriately marked and lheir valves closed? k. Are signs reading: DANGER-NO SMOKNG. MATCHES, OR OPEN lights, or the equivalent, posted? FORM 00936A REV AUG P,go 9 9-

225 DOCD: Are cylinders, cylinder valves, couplings, regulators, hoses. and apparatus kept free of oily or greasy substances? m, s care taken not 10 drop or strike cylinders? YES NO NJA n. Unless secured on special trucks, are regulators removed and valve-protection caps put in place before moving cylinders? 0_ Do cylinders without fixed hand wheels have keys. handles, or non-adjustable wrenches on stem valves when in service? p- Are liquefied gases stored and shipped valve-end up with valve covers in place? q, Are provisions made to never crack a fuel~gas cylinder valve near sources of ignition? r. Before a regulator is removed. is the valve closed and gas released from the regulator? s, s red used to identify the acetylene (and olher fuel-gas) hose. green for oxygen hose, and black for nert gas and air hose? l. Are pressure-reducing regulators used only for the gas and pressures for which they are ntended? u, s open circuit (h'o load) voltage or arc welding and'cutting machines as lowas possible and not in excess of the recommended limits? 21. v, Under wet conditions, are aulomatic controls for reducing no load voltage used? WELDNG, - CUTTNG AND w, s grounding of the machine frame and safely ground connections of portable machines checked periodically? BRAZNG x_ (continued) Are eleclrodes removed from the holders when nol in use? y s it required tha electric power 10 the welder be shut off when no one is in attendance? z, s suilable fire extinguishing equipment available for immediate use? aa, s the welder forbidden 10 coil or loop welding electrode cable around his body? bb, Are wet machines thoroughly dried and tested before being used? cc. Are work and electrode lead cables frequently inspected for wear and damage. and replaced when needed? dd. Do means for connecting cable lengths have adequate,"sulation? ee. When the object to be welded cannot be moved and fire hazards cennot be removed, are shields used to confine heat, sparks, and slag? f, Are fire watchers assigned when welding or cutting is performed in locations where a serious fire might develop? gg. Are combustible floors kept wet. covered by damp sand. or protected by fire-resistant shields? hh. When floors are wet down, are personnel protected from possible electrical shock? ii. jj, kk_. When welding is done on metal walls. are precautions taken 10 protect combustibles on rhe other side? 8efore hot work s begun, are used drums. carrels, tanks. and other containers so thoroughly cleaned that no substances remain that could explode. ignite. or produce toxic vapors? s it required that eye protection helmets, hand shields and goggles meet appropriate standards? Are employees exposed to the hazards created by welding. cultinq, or brazing operations prolected with personal protective equipment and clothing? mm. s a check made for adequate ventilation in and where welding or cutting is performed? nn, When working in confined places. are environmental monitoring lests taken and means provided for quick removal of weiders in case of an emergency? FORM D6936A REV AUG 2001 Page 10

226 DOCD a. Are compressors equipped with pressure relief valves, and pressure gauges? YES NO N/A b. Are compressor air ntakes installed and equipped so as to ensure that only clean uncontaminated air enters the compressor? c. Are air filters installed on the compressor intake? f-. d. Are compressors operated and lubricated in accordance with he manufacturer's recommendations? e. Are safety devices on compressed air systems checked frequently? 1. Before any repair work is done on the pressure system of a compressor, is the pressure bled off and the system locked-out? g. Are signs posted to warn of the automatic starting feature of the compressor? 22. h. s the bell drive system totally.nclosed to provide protection for the front, back, top, COMPRESSORS and sides? AND i. s it strictly prohibited to direct compressed air towards a person? COMPRESSED AR j. Are employees prohibited from using highly compressed air for cleaning purposes? 23. COMPRESSED k. f compressed air is used for cleaning off clothing, is the pr.ssure reduced to less than 10 psi?. When using compressed air for cleaning, do employees wear protective chip guarding and personal protective equipment? m. Are safety chains or other suitable locking devices used at couplings of high pressure hose lines where a connection failure would create a hazard? n. Before compressed air is used 10 emply containers of liquid, s he safe working pressure of the container checked? o. When compressed air is used with abrasive blast cleaning equipment, is the operating valve a type that must be held open manually? p. When compressed air is used to inflate auto lires, is a clip-on chuck and an in-line regulator preset to 40 psi required? q. s it prohibited to use compressed air to clean up or move combustible dust if such action could cause the dust to be suspended in the air and cause a fire or explosion hazard? a. Are compressed gas cylinders individually secured to a rigid, permanent ffxture in an upright pos~ion? b. Are valve covers in place for full and empty cylinders? c. Are status tags (FULL, N USE, EMPTY) attached to the valves and fully visible? d. s each cylinder stamped with a hydrostatic test date within the past 5 years? e. Are the contents clearly identified wilh stencils or iabels? GAS f Are MSDSs readily available? CYLNDERS g. Are the valves and gauges in good condition? h. Are cylinder hand carts available for moving the cylinders? L Are empty cylinders stored separately from those that are full? j. Are oxidizers, flammables, and toxics segregated from one another? k, Are any emply cylinders reading less than 25 pslg?. Are cylinders stored in a cool, dry place away from heat, open flames, and sparks? FOAM D6936A REV AUG Page 11 11

227 DOCD: m, Are cylinders located or stored areas where they will not be damaged by passing or falling objects or subjects to tampering by unauthorized persons? COMPRESSED GAS n. Are cylinders stored or transported n a manner to prevent them oreating a hazard by tipping. falling or rolling? CYLNDERS 0, Are all valves closed off before a cylinder is moved, when the cylinder is empty. and at (continued) the completion of each job? YES NO NJA a. s each overhead electric hoist e~ulpped with a limit device to stop the hook travel at its highest and lowest point of sa e travel? b. Will each hoist automatically stop and hold any load up to 125 percent of its rated load, if its actuating force is removed? c, s the rated load of each hoist legibly marked and visible to the operator? d. Are stops provided at the safe limits of travel for trolley hoist? 24. e. Are the controls of hoist plainly marked to indicate the direction of travel or motion? HOST AND f. s each cage controlled hoist plainly marked to indlcale the direction of travel or AUXLARY motion? EQUPMENT g. Are close fitting guards or other suitable devices installed on hoist to assure hoist ropes will be maintained in the sheave groves? h. Are all hoist chains or ropes of sufficient length to handle the full range of movement of the application while still maintaining two full wraps on the drum at all times? i. Are nip poinls or contact points batween hoist ropes and sheaves which are permanently located within seven leet of the floor, ground or working platlorm. guarded? j. s it prohibited to use chains or rope slings that are kinked or twisted? k. s it prohibited to use chains or rope or chain wrapped around the load as a SUbstitute. for a sling?. s the operator nstructed to avoid carrying loads over people? a, Are only employees who have been trained in the proper use of hoists allowed to operate them? b. Are only trained personnel allowed to operate industrial trucks? c. s substantial overhead protective equipment provided on height lift rider equipment? d, Are the required lift truck operating rules posted and enforced? e, s directional lighting provided on each industrial truck that operates in an area with 25. less then 2 foot candles per square foot of general lighting? NDUSTRAL f, Does each industrial truck have a warning horn, whistle. gong, or other device which Can be clearly heard above the normal noise in the areas where operated? TRUCKS FORKLFTS g. Are the breaks on each industrial truck capable of bringing the vehicle to a complete and safe stop when fully loaded? h, Will the industrial trucks' parking brake effectively prevent the vehicle from moving whi e unattended? i. Are jndustrial trucks operati"1 in areas Where flammable gases or vapors, or combustible dust or ignitable ibers may ba present in the atmosphere. approvad for such locations? i Are motorized hand and hand/rider trucks so designed that the brakes are applied. and power to the drive motor shuts off when the operator releases his or har grip on the device that controls the travel? k. Are ndustrial trucks with inlernal combustion en~ine. operated in buildings or enclosed areas, carefully checked to ensure sue operations do not cause harmful concentration of dangerous gases or lumes? FORM D6936A REV AUG 2001 Page 12 12

228 DOCD: YES NO N/A 8. s adequate ventilation assured before spray operations are started? b. s mechanical venlllation provided when spraying operations are done in enclosed areas? c. When mechanical ventilation is provided during spraying operations. is it so arranged that it will not circulate the contaminated air? d. s the spray area free of hot surfaces? e. s the spray area at least 20 feet from flames, sparks, operating electrical motors and other igniton sources? f. Are portable lamps use to illuminate spray areas suitable for use in a hazardous location? g. s approved respiratory equipment provided and used when appropriate during spraying operations? h Do solvents used for cleaning have a flash point to 100 degrees F or more? 26. SPRAYNG OPERATONS i. Are fire control spllnkler heads kept clean? j. Are "NO SMOKNG" signs posted in spray areas, paint room. paint booths. and paint storage areas? k. s the spray area kept clean of combustible residue?. Are spray booths constructed of metal, masonry. or other substantial noncombustible material? m. Are spray booth floors and walls noncombustible and easily cleaned? n. s infrared drying apparatus kept out of the spray area during spraying operations? o. s the spray booth completely ventilated before using the drying apparatus? p. s the electric drying apparatus properly grounded? q. Are lighting fixtures for spray booths located outside of the booth and the interior lighting through sealed clear panels? r. Are the electric motors for exhaust fans placed outside booths or ducts? s. Are bells and pulleys inside the booth fully enclosed? t. Do ducts have access doors to allow cleaning? u. Do all drying spaces have adequate ventilation? a. Are confined spaces thoroughly emptied of any corrosive or hazardous substances. such as acids or caustics, before entry? b. Are all lines to a confined space, containing inert, toxic. flammable, or corrosive materials valved off and blanked or disconnected and separately before entry? 27. CONFNED SPACES c. s it required that all impellers, agitators, or other moving equipment nside confined spaced to be locked-out if they present a hazard? d. s either natural or mechanical ventilation provided prior to confined space entry? e. Are appropriate atmosphere lests performed to check for Oxygen deficiency, toxic subslances and explosive concentrations in the confined space before entry? f. S adequate illuminalion provided for the work to be performed n the confined space? g. /s the atmosphere inside the confined space frequently lesled or continuously monitored during conduct 01 work? FORM D6936A REV AUG Page 13 13

229 DOCD: h. 1$ there an assigned safety standby employee outside of the confined space, when required, whose sole responsibility is to watch the work in progress, sound an alarm if necessary, and render assistance? i. s the standby employee appropriately trained and equipped to handle an emergency? j s the standby employee or other employees prohilfited from enterinll.the conllnen space wilhout lifelines and respiralory equipment if there is any question as to the cause of an emergency? k. s approved respiratory equipmenl required if the atmosphere inside the confined space cannot be made acceptable? YES NO N1A e 27. i. is all portable electrical equipment used inside confined spaced eilher grounded and CONFNED insulated, or equipped with ground fault protection? SPACES m. Before gas welding or burning is started in a confined space, are hoses checked for leaks, compressed gasbotties forbidden insid~ of the confined space. torches light (continued) only outside of the confined area and the confrned area tested for an explosive almosphere each time belore a ghled lorch is to be taken into the confined space? n. f employees will be using oxygen.consuming equipment such as salamanders. torches, furnaces, etc., in a confined space, S sufficient air provided to assure combustion with reducing the oxygen concentration of the atmosphere below 19.5 percent voiume? o. Whenever combustion-type equipment S used in confined space, are provisions made to ensure the exhaust gases are vented outside of he enclosure? p. s each confined space checked for decaying vegetation or animal matter Which may produce methane? q. s the confined space checked for possible industrial waste which could contain toxio properties? r. the confined space is beiow the ground and near areas where motor vehicles will be operating, is it possible for vehicles exhaust or carbon monoxide to enter he space? a. Are all work areas properly illuminated? b. Are employees instructed in proper first aid and other emergency procedures? c. Are hazardous SUbstances identified which may cause harm by inhalalion, ingestion, skin absorption or contact? d. Are empioyees aware of the hazards involved with the various chemicals they may be exposed to in their work environment, such as ammonia, chlorine, epoxies, caustics, elc? e. is employee exposure to chemicals in the workplace kept within acceptable levels? f. Can a less harmful method or product be used? 28. g. s the work area's ventilation system appropriate for the work being performed? NVRONMENTAL CONTROL.S h. Are spray painting operations done in spray rooms or booths equipped with an appropriate exhaust system? i. s employee exposure to air contaminants controlled by ventilation or other means? J f forklifts and olher vehicles are used in buildings or other enclosed areas. are the carbon monoxide levels kept below maximum acceptable concentration? k. Has there been a determination that noise levels in the facilities are within acceptable levels?. Are steps being taken to use engineering conlrois to reduce excessive noise levels? m. s asbestos and other fibrous materials only identified, sampled, and removed by competent Agency personnel or a licensed contraclor? n. Are wet methods used, when practicable, to prevent the emission of airborne fibers, silica dust and similar hazardous materials? FOAM 06936A REv AUG Page 14 14

230 DOCD: o. s vacuuming with appropriate equipment used whenever possible rather than blowing or sweeping dust? YES NO N/A 28. ENVRONMENTAL p. Are grinders. saws. and other machines that produce respirable dusts vented to an industrial collector or central exhaust system? q. Are all local exhaust ventilation systems designed and operatingj'0perly such as air flow and volume necessary lor the application, ducts not plugge or belts slipping? r. s personal protective equipment provided, used and maintained wherever required? s. Are there written standard operating procedures for the selection and use of respirators where needed? 1. Are restrooms and washrooms kept clean and sanitary? u. s all water provided for drinking. washing. and cooking potable? CONTROLS v. Are all outlets lor water not suitable for drinking clearly identified? w. Are employee's physical capabilities assessed before being assigned to jobs requiring heavy work? x. Are employees nstructed n the proper manner of lifting? y. Where heat is a problem. have all fixed work areas been provided with spot cooling or air conditioning? z. Are employees screened belore assignment 10 areas of high heat to determine f their health condition mighl make them more susceptible to having an adverse reaction? aa. bb. Are employees working on slreets and roadways where they are exposed 10 he hazards of raffic, required to wear brighl colored (tranic orange) warning vests? Are exhaust stacks and air intakes so located that contaminated air will not be recircuiated within a building or other enclosed area? cc. s equipment producing ultra violet radiation properly shielded? a. Are combustible scrap, debris and waste materials (oily rags, etc.) stored in covered metal receptables and removed rom the worksite promptly? b. Are proper storage practices used to minimize the risk of fire including spontaneous combustion? c Are approved containers and tanks used for the storage and handling of flammable and combustible liquids? d. Are all connections on drums and combustible liquid piping. vapor and liquid tight? e. Are all flammable liquids kept in closed containers when not in use (e.g., parts. cleaning tanks. cans. etc.)? 29. FLAMMABlE AND COMBUSTBlE MATERALS 1. Are bulk drums of flammable iiquids grounded and bonded to containers during dispensing? g. Do storage rooms for nammable and combustible liquids have expiosion-proof lights? h. Do storage rooms for.nammable and combustible liquids have mechanical or gravity ventilation? i. s iquetied petroleum ges stored, handled, and used according to safe practices and standards? j. Are "No Smoking Signs" posted on liquefied petroteum gas tanks? k. Are liq uelled petroleum storage tanks guarded to prevent damage from vehicles?. Are all solvent wasles, and flammable liquids kept in fire resislant, covered containers until they are removed from the worksite? m. s vacuuming used whenever possible rather than blowing or sweeping combustible dust? FORM D693SA REV AUG 2001 Page 15 15

231 DOCD: n. Are firm separators placed between containers of combustibles or flammable, when stocked on upon another, to assure their support and stability? YES NO NlA o. Are luel gas cylinders and ox~gen cylinders separated by distance, fire resistance barriers, etc. while in storage. p. Are lire extinguishers selected and provided for the types of materials in areas where they are to be used? (1 )Class A - Ordinary combustibte material fires. (2) Class B - Flammable liquid. gas or grease fires. 29_ FLAMMABLE AND COMBUSTBLE MATERALS (continued) (3) Class C - Energized-electrical equipment fires. q. Are appropriate fire extinguishers mounted within 75 feet of outside areas containing flammable liquids, and within 10 feet of any inside storage area for such materials? r. Are extinguishers free from obstructions or blockage' s. Are extinguishers serviced. maintained and tagged at intervals not to exceed one year? t. Are all extinguishers fully charged and in their designated places? u. Where sprinkler systems are permanently installed. are the nozzle heads so directed or arranged that water will not be sprayed into operating electrical switch boards and equipment? v. Are "NO SMOKNG" signs posted where appropriate in areas where flammable or combustible materials are used or stored? w. Are safety cans used for dispensing flammable or combustible liquids at a point of use? x. Are all spills of flammable or combustible liquids cleaned up promptly? y. Are storage tanks adequately vented to prevent the development of excessive vacuum or pressure as a result of filling. emptying, or atmosphere lemperature changes? z. Are storage tanks equipped with emergency venting that will relieve excessive internal pressure caused by tire exposure? ea. Are "NO SMOKNG" rules enforced in area involving storage and use of hazardous materials? a. Are employees trained n the safe handling practices of hazardous chemicals such as acids, bases. caustics, etc.? b. Are employees aware of the potential hazards involving various chemicals stored or used in the workplace such as acids. bases, caustics. epoxies, phenols, etc.? 30. c. s employee exposure to chemicals kept within acceptable levels? HAZARDOUS CHEMCAL EXPOSURE d. Are eye wash fountains and safety showers provided in areas where corrosive chemicals are handled? e. Are all containers, such as vats. storage tanks. etc. labeled as to their contents. e.g.. "CAUSTCS"? f. Are all employees required to use personal protective clothing and equipment when handling chemicals (gloves, eye protective, respirators, etc.)? g. Are llammable or toxic chemicals kept in closed containers when not in use? h. Are chemical piping systems clearly marked as to their content? L Where corrosive liquids are frequently handled in open containers or drawn from storage vessels or pipe lines. are adequate means readily evallable for neutralizing or disposing of spills or overflows properly and safely? f:orm D693ElA REV AUG 2001 Page 16 16

232 DOCD: J. Have wri«en standard operating procedures been established and posted? Are they being followed when cleaning up ohemical spills? YES NO N/A k. Are employees prohibited from eating in areas where hazardous chemicals are present?. ts personal prote-ctive equipment provided, used and maintained whenever necessary? m. Are there written standard operaling procedures for the selection and use of respirators where needed? n. Have control procedures been instituted for hazardous materials, where appropriate, such as respirators, ventilation systems, handling practices, etc,? o. Whenever possible are hazardous substances handled in properly designed and 30, exhausted booths or similar locations? HAZARDOUS CHEMCAL EXPOSURE (continued) p. Do you use general dilution or local exhaust ventilation systems to control dusts, vapors, gases, fumes, smoke, solvents or mists which may be generated in your workplace? q. s ventilation equipment provided for removal of contaminants from such operations as: Production grinding, buffing, spray painting, andlor vapor degreasing, and is t operating properly? r. Do employees complain about dizziness, headaches, nausea, irritation, or other factors of discomfort when they use solvents or other chemicals? s. s there a dermatitis problem? Do employees complain about dryness, irritation, or sensitization of the skin? t. Have you considered the use of an industrial hygienist. safety engineer or medicel personnel 10 evaluate your operation? u. f internal combustion engines are used, is carbon monoxide kept within acceptable levels? v. s vacuuming used, rather than blowing or sweeping dusts whenever possible for clean-up? w. Are matenals which give off toxic asphyxiant, suffocating or anesthetic fumes, stored in remote or isolated locations when not in u~e? a. s there an inventory of hazardous substances used in your workplace? b. s there a written hazard communication program dealing with Material Safety Data Sheets (MSDS), labeling. and employee training? c. Does the plan cover the following topics: (1)Compliance with NSA Technical Guide 20? 31, HAZARD COMMUNCATON (2) Labeling and warning plans? (3) Method for obtaining Material Safety Data Sheets (MSDS's)? (4) Method for providing MSDS's to employees? (5) Method for providing training and information? (6)A list of toxic chemicals, cross-referenced to the MSDS's? (7) Communication of hazards from unlabeled pipes? (8) Method of informing contractors of hazards? d. Do supervisors understand the plan, all aspects covered in training, and their responsibilities? e. s each container for a hazardous subslance (i.e. vats, bottles, stora~e tanks, etc.) labeled with product identity and a hazard warning (communication 0 the specific heanh hazards and physical hazards)? FORM 06936A REV AUG 2001 Pa!jfl

233 DOCD: f. s there a Material Safety Data Sheet, cross referenced to the hazardous substance inventory readily available for each hazardous substance used? YES NO NJA g. s there an employee training program for hazaldous substances? h. Does this program include: (1) An explanation of what an MSDS is and how to use and obtain one? (2) MSDS contents for each hazardous substance or class of substance? (3) Explanalion of "Right to Know?" (4) dentification of where an employee Can See the employers wrinen hazard communication program and where hazardous substances are present in their work areas? (5) The physical and health hazards of substances in the work areas, and specific 31, proteclive measures 10 be used? HAZARD (6) Details ot the hazard communication program, including how to use the labeling COMMUNCATON system and MSDS's? (continued) (7) Methods of detecling the presence of chemical hazards? (8) Exposure symptoms and treatment? i. Are training records maintained in a central location? j. Has management pertormed operational reviews to determine hazards, and evaluated and documented the findings? k. Do labels and placards exist, and correspond to MSOS's?. Are waste receptables and containers labeled properly? m. Are their appropriate PPE provided, easily available, and used? n. Are all materials and chemicals stored in a safe manner? o. Are observable workplace operations appropriate? p. Do workers know: (1) The location of the HAZCOM plan? (2) Hazard exposure symptoms? (3) Preliminary treatment for exposure to the chemicals in the workplace? a. Do employees review the manufacturers manuals or guides before electrical equipment is used? b. Are all employees required to report as soon as practicable any obvious hazard to life or properly observed in connection with electrical equipment? c. Are employees inslrucled to make preliminary inspections andlor appropriate tesls 10 determine what conditions exist before starting work on electrical equipment or lines? d. When eleclrical equipment or lines are to be serviced, maintained or adjusted, are 32, necessary switches opened, locked out and tagged whenever possible? ELECTRCAL e. Are portable electrical tools and equipment grounded or of the doubie insulated type? FORM D6936A REV AUG 200' Page 1B t. Are electrical applicances such as vacuum cleaners, polishers, vending machines, etc., grounded? g. Do extension cords being used have a grounding conductor? - h. Are multiple plug adapters prohibited? i. Are found-faull circuit interrupters nstalled on each temporary 15 or 20 ampere. 120 volt C circuit at locations where construction, demolition, modifications, alternations or excavations are being pertormed?

234 DOCD: j. Are all temporary circuits protected by suitable disconnecting switches or plug connectors at the junction with permanent wiring? YES NO N/A k. 00 you have electrical installations in hazardous dust or vapor areas? 11 so, do they meet the National Electrical Code (NEC) for hazardous locations?. s exposed wiring and cords with frayed or deteriorated insulation repaired or replaced promplly? m. Are flexible cords and cables free of splices or taps? n. Are clamps or other securing means provided on flexible cords or cables at plugs, receptacles, tools. equipment, etc., and is the cord jacket securely held in place? o. Are all cord, cable and raceway connections intact and secure? p. n wet or damp locations, are electrical tools and equipment appropriate for the use or location or otherwise protected? 32. ELECTRCAL (continued) q. s the location of electrical ~ower lines and cabies (overhead, underground, underfloor, other side of wa s, elc.) determined before digging, drilling, or similar work S begun? r. Are metal measuring tapes, ropes, handlines or similar devices with metallic thread woven inlo the fabric prohibited where they could come in contact with energized parts of equipment or circuit conductors? s. s the use of metal ladders prohibiled in ereas where the ladder or the person usinq the ladder could come in contact with energized part of equipment, fixtures or circuit conductors?. Are all disconnecting SWitches and circuit breakers labels to indicate their use or equipment served'? u. Are disconnecting means always opened before fuses are replaced? v. Do all interior wiring systems include provisions for grounding metat parts of electrical raceways, equipment and enclosures? w. Are all electrical raceways and enclosures securely fastened in place? x. Are all energized parts of electrical circuits and equipment guarded against accidental contact by approved cabinets or enclosures? y. s sufficient access and working space provided and maintained about all electrical equipment to permit ready and safe operations and maintenance? z. Are unused openings (including conduit knockouts) in electrical enclosures and fittings closed with tight-fitting covers or plates? aa. Are electrical enctosures such as switches, receptacles, junction boxes, etc., provided with tight-fitting covers or plates? bb. Are disconnecting switches for electrical motors in excess of two horsepower, capable of opening the circuit when the motore is in a stalled condition, w~hout exploding? (Swirc es must be horsepower rated equal to or in excess 01 the motor hp rating.) cc. s low voltage protection provided in the control device of motors driving machines or equipment which could cause probable injury from inadvertent starting? dd. s each motor disconnecting switch or circuit breaker located within sighl of the motor control device? ee. s each motor located within sight of its controller of the controller disconnectin~ means capable of bein9 locked in the open poshton or is a separate disconnecting means installed inteh errcuil wtihin sight of the motor? ft. s the controller for each motor in excess of two horsepower. raled in horsepower equal to or in excess of the rating of the motor it serves? gg. Are employees who regularly work on or around energized electrical equipment or lines instructed in the cardia-pulmonary resusc~ation (CPR) methods? hh. Are employees prohibited from working alone on energized line or equipment over 600 volts? FORM D6936A REV AUG Page 19 19

235 DOCD: YES NO N/A ii. Has the equipment been approved by a nationally recognized testing laboratory? jj.. the equipment being u.ed for it. intended u.e? kk. Are emergency.hut off methods available? 32. ELECTRCAL (continued). Are contingencies in effect for action once an electric shock or electrocution has occurred? mm. s there a possibility of damage from vehicles or personnel operating around the equipment? nn.. a clear three foot work area around or in front of the equipment? 00. Could accumulations of surface water. rainfall,.now or ice adversely effect the safety of the persons using electrical equipment? pp. Are the live parts of electrical equipment, 8 feet or less above the Noor level guarded by approved cabinets or other forms of approved enclosures? qq. n location where electrical equipment would be exposed to physical damage. are enclosures or guards arranged and of such strength a. to prevent any damage? rr. ss. Are entrances to rooms and other guarded locations containing exposed live parts conspicuously marked with standard warning signs forbidding unauthorized persons to enter? Are the overcurrent devices readily accessible to each employee or authorized building management personnel? U. Do all circuit breakers clearly indicate whether they are in the open (OFF) or closed (ON) position? uu. Are the circuits for each circuit breaker identified? w. Are all grounding conductors clearly identified and maintained? ww. Do all exposed non-current carrying metal parts of equipment have a grounding conductor? xx. Are all Class liquids dispensed into containers electrically interconnected with a bonding wire? yy. Have all electrically operated e~ipment been reviewed for methods to control the electrical current by means of p ysically locking the supply circuits in open position and draining off any stored energy? zz. Are energy control locking devices available for use? 1- Have all persons affected by electrical equipment energy control program been trained? a. Does the user have a copy of the Agency's written program, Technical Guide 15? b. Has the Agency RPO performed a survey of the operation during the past year? c, Are survey reports, special evaluations, and inspection records on file? d. Are there any outstanding abatement requirements from the most recent survey? 33. e. Do you maintain an up-to-date inventory of ionizing radiation-producing devices? RADATON f. Have dosimeters stored in a location approved by the NSA Radiation Protection SAFETY Officer with a "control badge"? g. Do you provide dosimeters for each authorized user? h. Are dosimeters stored in a localion approved by the NSA Radiation Protection Officer with a "control badge"? i. Do you forward a copy of your dosimetry records to the Agency RPO? j. Has every authorized user and persons who frequent areas where sources are used attended CD-E42 through the NCS during the past 12 months? k. Has every authorized radiation source user received device-specific user training?. Are radiation protecfion SOPs published and enforced? FOAM D6936A REV AUG Page

236 D ':l 1 1 :: 1 :: ':l m, Have all female users been provided a copy of NRC Guide 8,13, nstructions 33. Concerning Prenatal Radiation Exposure? RADATON n. Are all radioactive materials and devices labeled in accordance with the Technical SAFETY Guide 15? (conllnufk) o. Are all radiation sources secured to prevent unauthorized use? a, Are there areas in the workplace where continuous noise levels exceed 85dBA? b, s there an ongoing preventative health program to educate employees in: safe levels of noise. exposures; effects of noise on their health; and the use of personal protection? c, Have work areas where noise levels make voice communication between employees difficult been identified and posted? d, Are noise levels being measured using a sound level meter or an octave band 34. analyzer and records being kept? NOSE e, Have engineering controls been used to reduce excessive noise levels? Where engineenng controls are determined to not be feasible, are administrative controls (i,e" worker rotation) being used to minimize individual employee exposute to noise? f, s approved hearing protective equipment (noise a"enuating devices) availeble to every employee working in noisy areas? g, Have you tried isolating noisy machinery from the rest of your operation? YES NO NJA h, f you use ear protectors, are employees properly fitted and instructed in their use? 35. FUELNG i, Are employees in high noise areas given periodic audiometric lesting to ensure that you have an effective hearing protection system? a, s it prohibiled to fuel an internal combustion engine with a flammable liquid while the engine S running? b, Are fueling operalions done in such a manner that likelihood of spillage will be minimal? c, When spillage occurs during fueling operations, is the spilled fuel washed away completely, evaporated, or other measures taken to control vapors before restarting the engine? d, Are fuel tank caps replaced and secured before starting the engine? e, n fueling operations, is there always metal contact between the container and the fuel tank?, Are fueling hoses of a type designed to handle the specific type of fuel? 36. DENTFCATON OF PPNG SYSTEMS FORM 06936A REV AUG Page 21 g, s it prohibited to handle or transfer gasoline in open containers? h, Are open lights, open flames, or sparking, or arcing equipment prohibited near fueling or transfer of fuei operations? a, When nonpotable water is piped through a facility, are outlets or tags posted to alert employees that it is unsafe and not to be used for drinking. washing or other personal use? b, When hazardous substances are transported through above ground piping, is each pipeline identified at points where oonfusion could introduce hazards to employees? c. When pipelines are identified by color painting, are visible parts of the line so identified? d, When pipelines are identified by color painted bands or tapes, are the bands or tapes located at reasonable intervals and at each outlet. valve or connection? e, When pipelines are identified by color. is the color code,fasted at all locations where confusion could introduce hazards 10 employees, f. When the contents of pipelines are identified by name or name abbrevialion, is the information readily visible on the pipe near each valve or outlet? g, When pipelines carrying hazardous substances are identified by lags. are the tags constructed of durable malerials, the message carried clearlr and permanently distinguishable and are tags installed at each vaive or outlet h, When pipelines are heated by electricity, steam or other external source, are suitable warning signs or lags placed at unions, valves, or other serviceable par of the system? 21

237 DOClD: s there safe clearance for equipment through aisles and doorways? b. Are aisleways designated, permanently marked, and kept clear 10 allow unhindered passage? c. Are motorized vehicles and mechanized equipment inspected daily or prior to use? d. Are vehicles shut off and brakes set prior 10 loading or unloading? e. Are containers of combustibles or flammables, when stacked while being moved, always separated by dunnage sufficient 10 provide stability? f. When loading or unloading operations are taking place between vehicles and docks, are dock boards (bridge plates) used? g. Are trucks and trailers secured from movement during loading and unloading operations? 37. h. Are dock plates and loading ramps constructed and maintained with sufficient MATERAL strength to support imposed loading? HANDLNG i. Are hand trucks maintained in safe operating condition? j Are chules equipped with sideboards of sufficient height to prevent the materials being handled from falling off? k. Are chules and gravity roller sections firmly placed or secured to prevent displacemenl?. A the delivery end of the rollers or chutes, are provisions made to brake the movement of the handled materials? m. Are pallets usually inspected before being loaded or moved? YES NO NlA n. Are hooks with safety latches or other arrangements used when hoislin~ materials so that slings or load attachments won't accidently slip off he hoist hooks. 0 Are securing chains, ropes, chokers or slings adequate for the job to be perlormed? p. When hoisling material or equipment, are provisions made to assure no one will be passing under the suspended loads? q. Are malerial safety data sheets available to employees handling hazardous substances? a. Do employees who operale vehicles on public thoroughfares have valid operator's licenses? b. When seven or more employees are regularly transported in a van, bus Or truck, is he operalor's license appropriale for the class of vehicle driven? c. s each van, bus or truck used regularly to transport employees, equipped with an adequate number of seats? 38. d. When employees are transported by truck, are provisions provided to prevent their falling from the vehicle? TRANSPORTNG e. Are vehicles used to lransport employees e~uipped with lamps, brakes, horns, EMPLOYEES mirrors. windshields and turn signals in goo repair? AND MATERALS f. Are transport vehicles provided with handrails, steps, stirrups or simlar devices, so placed and arranged that employees can safely mount or dismount? g. Are employees transport vehicles equipped at all times with at least two reflective type flares? h. s a full charged lire extinguisher, in good condition, with at least 4 B:C rating maintained in each employee transport vehicle? i. When cutting lools or lools with sharp edges are carried in passenger compartments of employee transport vehicles, are they placed in closed boxes or containers which are secured in place? j, Are employees prohibited from riding on top of any load which can shift, topple, or otherwise become unstable? 39. a. Where lires are mounted andlor inltated on drop center wheels, is a safe practice procedure posted and enforced? TRE NFLATON b. Where tires ate mounted andlor inltated on wheels with split rims and/or retainer rings, is a safe practice procedure posted and enforced? FORM D6936A REV AUG Page 22 22

238 DOCD a. Ate the monitor/documents positioned too high O( too low? YES NO N/A b. Are the monitor/documents positioned too far away (14"-22")? c. Are the monitor/documents height adjuslable? d. Are the monitor/documenls difficult to see/read? e. s the ambient light too brighl or too dim? f. f task lighling is needed, is il available? g. s glare visible on the monilor? h. Does the operator face an uncovered window or uncovered lightsource? i. s the work surface too crowded or too small? 40. j. s the keyboard or work suriace too high or 100 low? VOT/ k. Does the work suriace and keyboard angle or orientation cause non-neutral wrist WORKSTATON posillons? ERGONOMCS. Does the hand and wrist rest on hard or sharp edges? m. Does he hand and wrisl resl on a palm rest While keying? n. Does the work area restrict body movement? o. Does the work area cause the employee 10 reach, wist, bend or awkward posrtions? p. Are anti-fatigue mats, 'ootrails or footresls provided when needed? q. Does the chair/seating have a backresl separate from he seal pan? r. Does the chair/seating have adjustable lumbar support? s. Does the chair/sealing have adjustable seal height?. Does the chair/seating have adjuslable armresl if required? u. s the room temperalure too hal or too cold? v. Do the walls or dividers minimize noise? w. s the workstation located in a crowded area? x. s the workstation separaled from aisles and walkways? FORM D6936A REV AUG 2001 ' Page 23

239 mmm... D09otllf9Qtio \ Sl~tvlnQ Health Program SEtFNSP't:cnoN"'FT:CORD BULDNG ROOM NO.-.. ORGA"'ZATQN SUl"cAVSQ' ( tst) ("'jfll) em'! PHONE (Stc1Jtw) 'NOMiflCWiJ" OSH REPRESENTATVE (Last) ( rst) (Ml PHONE (Secul'lf) (Notr~) SECTON TEM AlG< ASSESSMENT UNSAFE CONDllQN REQURED CORRECTVE ACTON CODE DATE CO1RECTED _m no... SGNATURE DATE FOAM D6936 REV FEB 2002 ($UpefSK!fJs AUG 2{lQ( Whic/l ill ODs0let81 ~~proved for Release bv NSA ~~ FOA Case #4287/

240 DOCD: SECURTY CLASSFCATON SENOR TECHNCAL DEVELOPMENT PROGRAM (STDP) APPLCATON HEpROGBAM PRVACY ACT STATEMENT: Autl1 tor collecting inlo requested on this lotm is contained in 50 U.S,C, Sec. 402 note. NSA's Blanket Routine Uses found at sa Fed, Reg, (1993) as well as lhe specific uses found in GNSA09 and GNSA12 apply '0 this info Aulh lor reqljesling your SSN is E.O. 9397, The requested nfo will be uaed to a$&iist in determining individljal qualilicatlons for participation in the Senior Technical Development Program (STOP), Your disci of requested info, including SSN, is vounlary. However, failure to furnish the requested info. other than SSN. may prevent a complete assessment of your abilities and may delay processing of your application. GENERAL NFORMATON (Ref: NSAlCSS Reg, NP , dated 12 July 1993) The goal of NSA's Senior Technical Oevelopment Program (STOP) is to increase skills of NSA's leaders in the technical dlsclpllnes.o their expertise can be brought to bear with increased etiecfiveness on NSA's major problems, Additionally, the program is also open to leaders in other selected professional disciplines, To this end, he program provides for each participant a tailored progrem to intensify and accelerate the development of technical or professional and leadership skills and to broaden exposure to major organizational challenges. Each participant works with two advisors who will be from the senior technical and senior executive ranks to design a development plan (based on a program proposed n the participant's application). The program s individually designed to meet he goals of the participant and to meet needs of NSA in the participant's field of expert.e, The target length for the program is three years; participants will spend at least 50% of their time, overall, n STOP activities. PartiCipants remain assigned to their parent organizations while in the program. Participant. will be expected to develop technical leadership skills as part of their program, in support 01 Agency is.ues/goals, ELGBLTY All OSLs, all GG-15" and only those GG-13114's who are titled Master in the Technical Track. are eligible to apply. Additionally, Directorale or Field Chiefs may submit high-potential GG-14's for the STOP. APPLCATON PROCESS Complete the Applicant nformation and Section of the application. The purpose of the application form s to allow the Senior Technical Review Panel (STRP) to form an opinion as to the applicant's qualifications and ability to actually carry out a program leading to the announced goal. Applicants will not necessarily be held to the specifics of their program as described, so you do not have 10 spell it out in great detail. However, please give the STRP enough information about your proposed program to help them make selections. You may want fa consub with seniors in your career field or your organization n developing your proposed program. All applicants should have a member 01 the senior technical ranks (a DSLJDSES) complele Section (someone who consulted with you in the development ofyour proposed program would be a good choice), Then have your immediate supervisor complete Section and forward the completed application through the organizational chain, The Directorate/Field Chief will prepare the last endorsement and forward the application to the STRp, which will evaluale it and notify you of its action. f you need additional information during this process, calilhe STOP Program Manager in DE, s/(30t) b. APPLCANT NFORMATON PRNTED NAME (L8S) ( irst) ) SSN ORGANZATON GRADE PHONE (S8Cure) (Non $ecvf9 fo include Area Code) PRMARY F1ElO(S) OF EXPERTSe -'A~C:-:A"'OE'"M"'C"'"'AC'"C"'O:-:M"'P"'L1"'SH=ME"'N"'T"'S7.N:::a-::m-:'a7.ol-:-sc "'h-:'ool"',7fiel-,d"ro""":':stu-.d7y).ldoa"'g-:',.."""aa:-:m:-:.-=d,-"yea=rj OTHER NTERNAL AND EXTERNAL TRANNG (Past three years) TECHNCAL TRACK STATUS (La"") SGNATURE DATE (VYYYMMDD) FORM 1'6723 REV NOV 2001 Page 1 (SUPSrsOrJ8S P6723 REV MAY 2000 which is o/)soefej Approved for Release by NSA or h FOA Case #4287

241 DOCD: SECTON TECHNCAL ACCOMPLSHMENTS AND PROPOSED STOP DEVELOPMENT (To be completed by applicant. Please use ltj..r the space provided.) DESCABE YOUR AREA OF TECHNCAL EXPERTSE, TECHNCAL ACCOMPLSHMENTS, AND HOW YOU KEEP UP WTH THE ONGONG CHANGES N YOUR FELD. DESCRBE ANY EXPERENCES YOU HAVE HAD TEACHNG OR DEVELOPNG COURSE MATERAL. PROVDE A LST OF YOUR PUBLCATONS; DESCRBE ANV EXTERNAL PRESENTATONS YOU HAVE MADE N THE LAST FVE YEARS FOR THE PURPOSE OF DSSEMNATNG TECHNCAL KNOWLEDGE. DESCRBE ANY ADDTONAL EXPERENCES THAT RELATE TO SHARNG KNOWLEDGE OR DEVELOPNG OTHERS, (lbu may attach lists of pvblications andlorpresentations.j FORM P6723 REV NOV page 2 SECURTY C-ASSFCATQN

242 DOCD: SECURTY CLASSFCATON SECTON CONTNUED (To be completed by applcant) PLEASE SPECFY THE AREA N WHCH YOU WSH TO BeCOME EXPERT (Parr of the STOP experience is a r::j(mp mmersion in your area Of expertise. e.g. an acad8mic program, research prowct, workng wiln an acknowledged expert, erc. Spec//)' the YPe Of mmersion you snvislon as pan of this program, ffs appro,1tlmale duralion, and the benefit it will p'avjde) SECTON DSLJDSES ENDORSEMENT PLEASe: COMMENT ON APPLCANT'S SUBJECT MATTER EXPERTSE, PROFESSONAL STANDNG, PAST ACCOMPLSHMENTS, POTENTAL FOR FUTURE CONTRBUTONS AND THE VALUe PARTCPAtiON WilL PROViDE NOT ONL.Y TO THE NDVDUAL'S PERSONAL OeVELOPMENT, BUT TO THE AGENCY'S MSSON. N ADDTON, PLEASe: PAOVOE COMMENTS ON THE APPLCANT'S DRive AND MOTVATON AS WELL AS EXAMPLES OF TECHNCAL LEADERSHP. PANTED NAME (Last) (First) (M) SGNATURE PRNTEO TTLE OATE (YYYYMMDD) FORM P6723 REV NOV 2001 Page 3 SECURTY CLASSFCATON

243 DOClD: SECURTY CLASSFCATON SECTON SUPERVSOR ENDORSEMENT PLEASE COMMENT ON APPLCANT'S SUBJECT MATTER EXPERTSE, PROFESSONAL STANDNG, PAST ACCOMPLSHMENTS, POTENTAL FOR FUTURE CONTRBUTONS AND THE VALUE PARTCPATON WLL PROVDE NOT ONLY TO THE NDVDUAl:S PERSONAL DEVELOPMENT, BUT TO THE AGENCY'S MSSON, HOW WLL THE APPLCANT'S PARTCPATON N THE STOP HELP ATTAN THE GOALS OF THE ORGANZATON? PRNTED NAME (L,) ( rst) (M) AU PRNTED TTLE DATE (YYYYMMDD SECTON V DRECTORATE'lfELD CHEF EVALUATON PLEASE COMMENT ON APPLCANT'S SUBJECT MAnER EXPERTSE, PROFESSONAL STANDNG, PAST ACCOMPLSHMENTS, POTENTAL FOR FUTURE CONTRBUTONS AND THE VALUE partcpaton WLL PROVOE NOT ONLY TO THE NDVOUAl:S PERSONAL DEVELOPMENT, BUT TO THE AGENCY'S MSSON. HOW WLL THE APPLCANT WTH THl: ADDTONAL EXPERTSE GANED N THE STOP, FT N WTH THE DRECTORATE'S PLANS FOR THE FUTUAE? PANTED NAME (Last) (First) (M) SGNATURE PRNTED TTLE DATE (YYYYMMDD) FORM P6723 REV NOV 2001 Page 4 SECURTY CLASSFCATON

244 DOCD: SERVCEABLE AND UNSERVCEABLE TAG - FORM J , /' /' /' ( D Sl'':-:G DSrORAGE DrURN-N :@ L NUMBER! QUANTTY 'NO"'M =O~F _ -:::cc:_d_el /_:_FG _ GREEN-SERVCEABLE " " " " FORM J5284 REV MAY 86 NSN: 7540 FM OO l /' /' /' ( i@ " r ;:;L1;<;Ni7"U_MB_E_R _Q_UA_N_T_TY O~F _ NOM. D.,,:"':_DE_L SJ'PNG FORM J5264 REV OCT 86 NSN: 7540 FM DsrORAGE DrURN-iN...--,~=DF_G YELLOW UNSERVCEABLE.l pproved for Release by NSA FOA Case # 4287 BOTH FORMS MUST BE USED N HARD COPY AVALABLE THROUGH THE SUPPLY SYSTEM

245 _m... DOCD: S.H.A.P.E. FTNESS CENTER PROGRESS CHART CARD NO STARliNG DATE (YYYYMMOD) TARGET HEMT RANGE NAME (LlA!Jl'.. (F'$/J (M) WARM up COOL DOWN DATE, EXERCSE BP RESTNG BP/lm BODY WEGHT.~ AD -- LC -- M -_., TREApMlll Time RPM Workload Peak hr Time Speed --_...._. Elevation Peak HR.- R'H~ Time Level Peak HR - X_CO\!NTSY SK Titne Distance (km) Workload Peak HR BQl"llli{l Time Strokes ell -- l.!llj1 Seal -- H -- D PeaK HR Time RPM Workload Handle Peak HR AEROBCS CLASS TME PEAK HR... EOCATONS LlMTflTlONS COMMENTS FOAM P5523 REV DEC 2001 (Supersedes PS523 REN SEP 90 which may be used lintrl depleted) ~fproved for Release by NSA FOACase# NSN. 754Q FM OOH157. WHTE NSN 754Q FM OO YELLOW

246 ~~..H~E..... ~rr~ess~enter PROGRESS CHART (Reverse) OATE,-... # MACHNE SEAT 1 Leg Press / / / / / / / / / / / / / / / / / / / / 2. Leg Ext. a c- / 1/1/1/1/1/1/1/,// / / / / / /!/1/1// 3. Leg Curl / / / 1// / 1// / / / / / / / / / / / / 4 Chest Press / / 1/1/1// 1/1/'// / / / / / '/1// / / 5, Shoulder Pross / V / 1/1/1/1/;// / / / / / / / / / / / 6. Lateral PuUdown / C 1// / 1/1// / / / / 1/1// / / / '// / 7. Rowing S - / 1// / 1/ '/ 1// / / / / / / / / / / / / 8. Arm CUrl C S - / 1// / / / / / / 1/1/1/1/V / / / / / / 9, Tncep 8 Extensions S - 1/'/1// / / / / 1/1/1/1/V 1/V / / / 1/1/ 10. Abdominal t-- 1/1/1// / / / / / / / 1/1/V V / / / 1/V 11 Back 8 ExtenSion L 1// 1// / / / 1/1/1// / / / V 1/1/1/1/1/ 12. Abdominal Board f----v / 1/1// / 1/1/1/V 1// / 1/1/1/V V 1/V, 3. Pulley H c f----v / 1/1// 1/1/1/V 1// / / / 1/1/V 1/1// 14 V / 1/1/1/1/1/V / '// / '/'// / 1// / / 15. 1// / 1/1/1/V 1/1// / / / / / / V / / / 16 / / /,// 1/1/1// / / 1/V 1// / / / / / 17. 1/ 1// 1/V 1// / / / 1/V 1/1// / / / / / 18. / 1// / 1// '// / / V V 1/V / / / / / / 19. / / / / / / / / / / 1/1/1/V / / / / / / 20 / 1// / / '/1// / / 1/V V V / / / / V / 21 / 1// / / / / / V 1/V V V V V V / 1/1/V 22. V V V / / / / / / V 1/!/!/V 1/1/1/1/V 1/ 23. V 1/1// / / / / 1/1/1/1/i/1/1/1/V V 1/V 24. V / 1// / / / 1/V 1/:// / 1/i/1/V 1/V / RESSTANCE TRANNG COMMENTS GOALS FORM P5523 REV OEC R"erse

247 DOCD: SGNATURE CARD NAME (Type orprint. lam, fif$j, middle initial) PHONE NO- ~---., ORGANZATON AND ADDRESS TYPE AND DATE; OF CLEARANCE ACCOUNT NO. SGNATURE DATE SGNATURE CERTFCATON certily that the above signature and information are correct. NAME OF WTNESSNG OFFCER ] TTLE SGNATURE OF WTNESSNG OFFCER ' NSN: 7540 FM OOi 0547 L_~ Form Size 3" x 5" pproved for Release by NSA FOA Case # 4287,

248 DOCD: SOCAL HSTORY DATA RECORD Privacy Ad Stalen'ler'lt: Aulh for collecting the requested info \s contained in 5 U.$.C 7901: 10 U.S,C ; 50 U.S.C. 402.tlQ.ti and Execulive Order 12333, NSA's Blanket Routine Uses klund at Fed. Reg. 10,531 (1993) and the specific: uses found in GNSA06 apply to this information Authority lor requesting yol,lr Social Security Number is Executive Order The ntormalion you provide wul be used (primarily) to provide. J)lan and coordinate certain health care services. Disci 01 requested nto including your SSN is voluntary However, failure to furnish inlo, other than your SSN, may alfeet or delay,the Agency's effort to provide hearth care setllll:;es to YOll and/or your family. PERSONAL NAME (LastJ (First) (M) SSN DOB (YYYYMM-OO) ADDRESS AGE SEX HOME PHONE (nclude Area Coce) OM n F EDUCATON MARTAL STATUS Os OM OSepOO Ow NO, CHLDREN MLTARY SERVCE BRANCH o USAF 0 ARMY 0 NAVy o USMC OCV PHONE (Secure) (Non-Secure) ---:-::::::-:;:::c-::--~~~ JOB TTLE GRADE UNT DUTV ORGANZATON TME (n Service) CLEARANCES o SC o PRP (At Ft. Meade) o FLYNG STATUS HAVE YOU VSTED A MENTAL HEALTH CLNC BEFOAE' o YES REASON FOR COMNG TO CLNC TODAY MENTAL HEALTH HOW DO you FEEL WE CAN HELP YOU? WHERE ARE YOUR MEDCAL RECORDS KEPT? FORM P6821 REV DEC 2000 (Suparsaaes P6B21 JUN 94 which is obsolete) pproved for Release by NSA FOA Case # 4287

249 DOClD: SECUfUTY ClASSFCATON (' ~ny) SOFTWARE VRUS SCANNNG REQUEST NOTE: The nformation Systems Security program Managers (tsspm) Working Group recomm9rlds that users 01 Windows and Windows NT obtain virus scanning software on the user's individual workstation to perform continuous virus scanning. Software can be obtained on Niagara or contact your SSPM. THS DSK WLL BE ENTeRED NTO A SYSTEM CLASSFED AS; o NSA CLASSFED o SECRET o UNCLASSFED CUSTOMER NAME (LoS') (!=irs,) (1.4/) SD DATE ORGANZATON SECURE PHONE NONoSECURE PHONE DESTNATON OF DSKS (Buietin(J and Room_) NUMBER OF DSKS TYPE o TYPE OF WOAKSTAON/SYSTEM FLOPPY scan UN/X disks lor indicakjr& of computtlr ~i11jses. bur kadjd scan for actual UNX WuStlS) OCD Om o UNX (McArEE ViM scanning 5Olhvs1'8 Wi" o ZP (ScannHl/l ZP dlsks.flqfl scan scanltle ) thtj oll8m'8w of the disk. t00f NQT WHO AUTHOFtZED THE NTROOUCTON OF THS SOFTWARElFllE(S) NTO NSA SPACES? (Provldt!J contract name or number. fsso approtl8l metno1xhj1lmr. or SU(J(JMSOr'S nformation) certify that the softwarelfi/e(s) am introducing into NSA AS systems is approved for introduction under procedures listed in NSA Manual13D-, and that the soltwarelfile(s) is/are for official government use. understand that introducing this softwarelfile(s) into the NSAMMC classified virus-scanning computer will classify the softwarelfi/e(s) at the Ts/SC level. f scanned in the unclassified system, my fde(s) wv! remain unclassified until placed into a classitied, networked computer system. understand that, should a virus be found on this softwarelfile(s), the softwarelfile(s) wlll!:j2 be returned to me; it will be sent to the appropriate KC SSPM for revlew/aetion, as necessary. CUSTOMER SGNATUAE RESULTS OF SCAN o NEGATVE o VRUS FOUND (provido dolo"o) DATE VRUS WAS REPORTED TO SHO (f1pp/cm>/e) MMC USE ONLY MMC REPRESENTATVE NAME SGNATURE FOAM H7162 REV MAR 2002 (SupersBc1e8 H7162 REV AUG 2001 whch s Ob$o6fe) SECURTY CLASSFCATON (f ll1y) pproved for Release by NSA or FOA Case # 4287

250 Da~TAt::i~~T/ORDER'FOR COMMERCAL TEMS rjff, ETE BLOCKS 12,17,23,24, & 30 2 CONTRACT NO. 3.AWARO/EFFECTVE DATE 14 ORDER NUMBER 5. SOLCTATON NUMBER M!l'-",WON SSlJE 1, REQUSTON NUMBER PAGEl OF 7. FOR SOLCTATON a. NAME b. TELEPHONE NWeER (NO _ cals) ~EDATE NFORMATON CALL: lil' 9 SSUeOey CODE 10. THS ACOUSTON S 11. DELVERY FOR FOB DESTNATON UNWS 12. DSCOUNT TERMS BlOCK S MARKED o UNRESTRiCTED o SETASrOe: " FOR o SEE SCHEDULE D SMAlL eusness 013&. THiS CONTRACT S A RATEO ORDER UNDER DP\S (15 CFR 7001 D SMAlL DSADV. BUSNESS 13b RATNG DS(A SC: 14. METHOO OF S<J.ClTATON SZE STANDARD: D RFO 0 Fe 0 RFP '5 DELvER TO CODE 16. ADMNSTERED BY CODE 11a CONTRACTORJ CODE FACLTY,sa. PAYMENT WLL ee MADE BY CODE OFFEROR COOE TELEPHONE NO. o 17b CHECK F REMTTANCE 1$ DFFERENT ANO PUT SUCHAOORESS N OFFER 18b. SUBMT NVOCES TO ADDRESS SHOWN N BlOCK '110 UM.ESS BlOCK BELOW S CHECKED D SEE AODENDUM TEM NO. SCHEDULE OF SUPPLEs/SERVCES OUANTTY UNT UNT PRCE AMOUNT (Attach Addirional Sneets as Nf1CSssaty) 25 ACCOUNTNG AND APpROPRATON DATA 26. TOTAL AWARD AMOUNT (FN Go... Uss Only) H27. SOLCTATON NCORPORATES BY REFERENCE FAR 52.2'2 ' FAR 52.2'2-3 AND '" ARE ATTACHED ADDENDA,R7EDARE NOT ATTACHED. 27b CONTRACTPURCHASE ORDER NClCRPORATES BY REFERENCE FAA FAA 52.2'2'5 S ATTACHED. ADDENDA n ARE ARE NQT ATTACHED 28. CONTRACTOR S REOUREO TO SGN THS DOCUMENT AND RETURN ClCPES 29. AWARD OF CONTRACT: REFERENCE OFFER o TO SSUNG OFFCE. CONTRACTOR AGREES TO FURNSH AND OELVER ALL TEMS SET DATED. '«lur OmR ON SOUCTATON FORTH OR OTHERWSE DENTFED ABOVE AND ON ANY ADDTONAL SHEETS SUBJECT o (Block 5), NCLUDNG ANY AODTONS OR CHANGES WHCH ARE SET TO THE TERMS AND CONDTONS SPE;CFED HEREN. FORTH HEREN. S ACCEPTED AS TO TEMS: 30a SGNATURE OF OFFERoACONTRACTOR 31. UNTED STATES OF AMERCA (SGNATURE OF Ce»mlACTlNG OFFCEm) 30b. NAME AND TTLE OF SGNER (TYPE OR PRNT) :lk. DATE SGNED 31 b NAME OF ClCNTAACTNG OFFCER (TYPfi OR PRJNT) 31c. DATE SGNED 32/l, OUANTTY N COLUMN 2' HAS BEEN 33. SHP NUMBER 34 VOUCHER NUMBER 36. AMOUNT VERFlEO ClCRRECT FOR D ACCEPTED. ANO CONFORMS TO THE o RECEVeo o NSPECTED PAATA.L FNAL ClCNTRACT. EXCE;PT AS NOTED 36. PAYMENT 37. CHECK NUMBER 32b SGNATURE OF AUTHORZED GOVT REPRESENTATVE 32c. DATE o OCMPLETE o PARTAL o FNAL 38. SR ACClCUNT NUMBER 39. SR VOUCHER NUMBER 40. PAD ev 41. CERTFY THS ACOCUNT S CORRECT AND PROPER FOR PAYMENT 424. RECEVED BV (/'filt) 41b. SGNATURE AND TTLE OF CERTFYNG OFFiCER 410:. DATE 42b. RECEVED AT (l.ocalion) 42c. DATE REC'D (VYMMlDO) 42<1. TOTAL CONTANERS AUTHORZED FOR LOCAL REPRODUCTON STANDARD FORM 1449 (10-1/5) Prescribed by GSA FAR (46 CFR) 53212

251 D~~=~~!OROEFl F'OFl COMMEFlCAL TEMS 1, REQUSTON NUMBER PAGE t OF ETE BLOCKS 12, 17,23,24, & 3() 2 CONTRACT NO 3. AWARD/EFFECTive DATE 14 ORDER NUMBER 5, SOLCTATON NUMBER &.~T,l(fKlN SSUE 7, FOR SOLCTATON a. NAME b. TELEPHONE NUMBER (lvo coac:1 calli) e$~date NFORMATON CALL: DESTNATON UNLESS BLOCK S MARKED UNRESTRCTED MARYLAND PROCUREMENT OFFCE o SEE SCHEDULE ATTN: o SET ASDE: "FOR UNDER 0_1'5 CFR 100) FT MEADE. MD o SMALL DlSAOV. BUSNESS 13b. RATNG OS(A) DO: Jlg,SSUEOBY CODE H , THS ACOUSTON S ' 1. OEUVERV FOR FOB 12. DSCOUNT TERMS 9800 SAVAGE ROAD o SMALL eusness THS OONTRACT S A RATED ORDER SC: 14, METHOD OF SOLCTATON SZE STANDARD: ORFQ OFB ORFP 15. DEUVER TO CODE H ADMNSTERED BY CODE 17a CONTRACTOR! CODE FACLTY lsa. PAYMENT WLL BE MADE BY CODE H98230 OFFEROR CODE TEl EPHClNE NO, o 1'tb. CHECK F REMTTANCE 15 DFFERENT AND PUT SUCH ADDRESS N OFFER 1811 SUBMT NVOCES TO ADDRESS SHOWN N BLOCK 180 UNLESS BLOCK BELOW S CHECKED o SEE ADDENDUM , 24. TEM NO. SCHEDULE OF SUPPLEs/SERVCES QUANTllY UNT UNT PRCE AMOUNT (Attach Adaitional Sheets as Necessarv) 25, ACCOUNTNG AND APPROPRATON DATA 26 TOTAL AWARD AMOUNT (For Goo. /Js Only) B273 SOLCTATON NCORPORATES BY REFERENCE FAR , , FAR AND 52,212 5 ARE ATTACHEO ADDENDA EH;REUARE NOT ATTACHED. 27b. CONTRACT/PURCHASE ORDER NCORPORATES BY REFERENCE FAR 52, FAR ATTACHED. ADOENDA nare ARE NOT ATTACHED. 28. CONTRACTOR S REOURED TO SGN THS DOCUMENT AND RETURN COPES 28. AWARO OF CONTRACT: REFERENCE OFFER o TO SSUNG OFFCE CONTRACTOR AGREES TO FURNSH ANO DELVER ALL TEMS SET OATED. YOUR OFFER ON SOliCTATON FORTH OR OTHERWSE DENTFED ABOVE AND ON ANY AODTONAL SHEETS SUBJECT o (B- 5), NCLUONG ANY ADDTONS OR CHANGES WHCH ARE SET TO THE TEAMS AND CONDTONS SPECFED HEREN. FORm HEREN. S ACCEPTED AS TO TEMS: 30a. SGNATURE OF OFFEROR/CONTRACTOR 31. UNTED STATES OF AMERCA (SG1A7JRE OF CONTRACnNG OFFCER) 300 NAME AND TTLE OF SGNER (TYPE OR PRNT) :loc. DATE SGNED 31 b. NAME OF CONTRACTNG OFFCER (TYPE OR PRNT) 31c. DATE SGNED 323. QUANTTY N COLUMN 2' HAS BEEN 33. SHP NUMBER 34, VOUCHER NUMBER 36. AMQUNT VERFED CORRECT FOR o RECEVED o NSPECTED o ACCEPTED. AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED PARTAL FNAL 36 PAYMENT 37. CHECK NUMBER 32b SGNATURE OF AUTHORZED GOVT REPRESENTATVE 32c DATE o COMPLETE o PARTAL o FNAL 38. SR ACCOUNT NUMBER 39 SR VOUCHER NUMBER 40. PAD BY 418. CERTFV THS ACCOUNT 1$ CORRECT AND PROPER FOR PAYMENT 42. RECEVED BY (Print) t, SGNATURE AND TinE OF CERTFYNG offcer 41C. DATE 420. RECEVED AT (LOCtionJ 42c. OATE RECO (YY/MMl)Q) 4:ld. TCTAL CONTANERS AUTHORZED FOR LOCAL REPRODUCTON Overprint NSA FrameMal<er V8rsion March 1996 STANDARD FOAM 1449 (10-95) Pre""l>od bv GSA FAR (48 CFR)

252 '"'\"""'''''TT'''o. ~1"-"'''' SOLCTATON, OFFER AND AWARD 11. THS CONTRACT S A RATED ORDER OF...1RATNG PAGE UNDER DPAS (15 CFR 350) PAGES 2. CONTRACT NO, 3. SOLCTATON NO, 4 TYPE OF SOLH::tTATON 5. DATE ssued 6. REOUSTONPURCHASE NO o SEALED BD (FB) n NEGOTATED (RFP 7. SSUED BY code 8. ADDRESS OFFER TO ( oher llar> tem 7J NOTE: n sealltd bid SOlicitations "ofter' and 'oflaror" mean ~bit::l and ~bidder". SOUCTAOON 9 Sealed otters in Mginal and copies lor furnishing the supplies or S8Nlcea in the Schedule will be receiwtd.1lhe P"lce specified in tem 8. or t nandcamed, in the depository located in until local til'tw...,""'''''_ (Hour) (DiiM) CAuTON - LATE$ubmissions, MOdifications, and Withdrawals.: see Section L, Provision No or , All offers tt tubjerct to all term. aoo conditions contained in this solicitation 10. FOR NFORMATON... AREA CALL: A. NAME B. TELePHONE (NO COLLECT CAllS) C. E-MAL ADDRESS COOE NUMBER EXT 11 TABLE OF CONTENTS X) SEC DESCRPTON PAGElS) (X SEC. DESCRPTON PAGE(S PART J THE SCHEDULE A SOlCTATlONfCONTRACT FORM CONTRACT CLAUSES PART 11 CONTRACT CLAUSES B SUPPLES OR SERVCES AND PRCEs/COSTS PART - UST OF DOCUMENTS, EXHBTS AND OTHER ATTACH. C DESCRPTONtSPECS.JWORK STATEMENT J ",ST OF ATTACHMENTS 0 PACKAGNG AND MARKNG PART V REPRESeNWONS AND NSTRUCTONS E NSPECTON AND ACCEPTANCE REPRESENTATONS, CERTFlCATlONS AND K F OE;l,.V6:R1ES OR PERFORMANCE OTHER STATEMENTS OF OPFERORS G CONTRACT ADMNSTRATON DATA L NSTRS., CONDS., AND NOTCES TO OFFEFlORS H SPECAL CONTRACT REOUREMENTS M EVAlUATON FACTORS FOR AWARD OFFER (Must be 1uJ/y ccmpeledby oflsror) NOTE. lem 1:2 does no apply if the solicilaticn includes the provisions al ' 6. Minimum Bid Acceptance Period. 12. n compliance with tile above, the undersigned agrees" ilthis offer is accepted within cajendar daya (60 C1fH'dardlys unhjss' dffctrfj/t period S inserted by t!'tt!j o/efqr) from 'le date Jar receipt of ofll!rs specified abovtt. k:l furnish any or s:~ item. upon which prices 118 oftlmtd at r~ pticltsat ~tij" each ibrn, delrvered atlhe designated poinl(s), within the time specified in the schedule. 13. DSCOUNT FOR PROMPT 10 CAlENDAR DAYS 1%) 20 CALENDAR DAV (%)S 30 CALENDAR DAVs 1%1... CALENDAR DAYS 1%) PAYMENT 14. ACKNOWLEDGEMENT OF AMENO- AMENDMENT NO. DATE AMENDMENT NO. DATE MENTS (The ofsror acknowled8:js ~t 0/ amendments to tha SOLe/TArt lor 0 erors and related documents numbered and dated): '5A NAME AND ADORESS OF OFF EROR CODE FACLTY 16.!t,AME AN TTLE OF PERSON '11 SGN OFFER (lypo or phnt) 15B TELEPHONE NUMBER AREA CODi NUMBER EXT 0 15C. CHECK F REMlnANCE ADDRESS 17. SGNATlJRE lb. OFFER DATE S OFFERENT FRQM ABOVE ENTER SUCH ADDRESS N SCHEDULE. AWARD (To b8 completed bygo""",msn) 19. ACCEPTED AS TO TEMS NUMBERED 120 AMOUNT 21. ACCOUNTNG AND APPROPRATON 22 AUTHORTy FOR USNG OTHER THAN FULL AND OPEN COMPETTON: 23. SUBMT NVOCES TO ADDRESS TEM o 10USC.2304(cll 1 04, U.SC253c ) SHOWN N (4 caples"""'..o/horwlse spoc/fbd) ADMNSTERED BY (fother rhan tem 1) CODE 26, PAYMENT WLL BE MADE BY CODE 26 NAME OF CONTRACTNG OFFCER (Type or print) 21. UNTED STATES OF AMERCA 211. AWNlJ DATE (Signature 01 COO".cting 0icJr) MPORTANT Award Wll be made on this Form, or on Standard Form 26, or by other authorized offlqal wntten OOliCllt, AUTHORZED FOR LOCAL REPRODUCTON Previous editlon 15 Jnusable STANDARD FOR 33/REV P'oscrlbed by GSA - FA'l(48 CFR) (01

253 DOCD SOLCTATON, OFFER, AND AWARD (Cons/ruction, Anera/ion, or Repair) 1. SOLCTATON NO. 2. TYPE OF SOLCTATON 3 DATE SSUED PAGE OF PAGES SEALED BD (FB) o NEGOTATED RFP) MPORTANT The "ol'er section on the revser must be fully completed bv olfelqr. 4 CONTRACT NO. S REOUSTON/PURCHASE NO, 18, PROJECT NO, 7 SSUED BY CODE a ADDRESS OFFER TO 9. FOR NFORMATON A NAME B, TELEPHONE NO, ( COde) (NO COLlECTCALLS) CALL:.. SOLCTATON NOTE: n sealed bid soilchatlons "offe~' and "oflero~ maan "bid" end 'llidde~, 10 THE GOVERMENT REOURES PERFORMANCE OF THE WORK DESCRBED N THESE OOCUMENTS (T1t _lying no. aa,,): The Contractor shall begin periormance within calendar days and complete it within calendar days alter recemng o award, 0 notice to plqceed, Thia periormance period s 0 mandatory, 0 nagotlable. (SH.j 12A THE CONTRACTOR MUST FURNSH ANY REDURED PEROFRMANCE ANO PAYMENT BONOS? (f "YES", indicate within how fl1j!1f1y calendar days after (lward in tem 128.) DYES ONO 13. ADDTONAL SOLCTATON REOUREMENlS; 128, CALENDAR OAYS A. sealed offsrs in original and copies to perfotm the work required are due at the place specified in item 8 by (hour) localtima (dalej. f this is a sealed bid solicitation, Olfelll will be publicly opened at tha tima, sealed envelopes oontalning offers shall be marked to show the offe'or's name and address, the solicitation number, and the date and time Oflelll are due. B. An after guarantee 0 s, o is not required. C. All oflers are subject to the (1 work requirements, and (2) other provisions and c1ausas ina>rporaled in the so_tion in fum text or by ",ference, D, Offers providing less than _ will be rejected, NSN 75«)-Q calandar days lor Government acceptance aftar the date offers ara due wll not be consd_ and!ltandard FORM 1~ (REV ~5) Proacr_ b'/ GSA FAA 14B CFR\ 5." Hd\

254 130G13: 11151Ui OFFER (Must be fully completed by offeror) 14 NAME AND ADDRESS OF OFFEROR (lnc/uid. ZP code) 15. TELEPHONE NO. (1""_... COde) 15. REMTANCE ADDRESS (lm;lud<o 0fiY it d".,.", ttjan "em 14) CODE FACLlTV CODE 17. The offeror agrees to perform the work required at the prices specified below in strict acoordance with the terms af this solicitation, 11111s offer s accepted by the Government in writing within calendar days after the date offer. are due. (nsert any numbersque! 10 or groster lhen the minimum reo quirement stated in lem 13D. Failure to insert any number msans the otteror accept$ the minimum in rtem 130.) AMOUNTS The offeror agrees to furnish any required performance and payment bonds. AMENDMENT NO. 19. ACKNOWLEDGEMENT OF AMENDMENTS (The offeror acknowledge. receipt a/amendments to the sol/ciration gill8llu111b4h end date 01""chi DATE 20A NAME AND TTLE OF PERSON AUTHORZED TO SGN OFFER (TYPe or print) 2OB. SGNATURE 200. OFFER ME 21, TEMS ACCEPTED' AWARD (Tb b" completsd by Government) 22 AMOUNT 23 ACCOUNTNG AND APPROPRATON DATA 24. SUBMT NVOCES TO ADDRESS SHOWN N... TEM oher THAN FULL AND OPEN COMPETTON U UANT (4 copies unles. otherwise speciffed) '0 U.S.C. 2304«)( ) D 4t U,S,C.253«)( 26. ADMNSTERED BY CODE Z7. PAYMENT Will BE MADE BY CONTRACTNG OFFCER WLL COMPLETE TEM 28 OR 29 AS APPLCABLE o 28. NEGOTATED AGREEMENT (Contrector s (fqulred 10 sign this o 29. AWARD (Contractor is not (fqulffjd to sign this document.) 'lbor offer document and return copies to issuing office.) Contractor agfhs on this solicitation is he~ccopted as to tha tems listed. This awerd con to turnllih and deliver ali tems or perform all work requirements identified on summates the oontraet, wh conli, ta 01 tal the Gowlmman' sol_lion and this form and eny continuallon sheets for the the consideratiuon sfated n your offer, and (b) this contract award. No further oonllactual document s his contract The rights and obligalions of the parties 10 this contract shall necessary. be governecl by (a) this contract awald. (b) the solicitation. and (c) the clauses, representations. certifications, and specifications ncorporated by reference in or attached to thsi contract. 30A NAME AND TTLE OF CONTRACTOR OR PERSON AUTHORZED TO SGN 31 A. NAME OF COTNAACTNG OFCER ( (1yPe Or (Jnr'ltJ 30B SGNATURE 300. DATE 31 B UNTED STATES OF AMERCA 31C. AWARD DrrE BY STANDARD FORM 14421ACK (REV. 4-85)

255 " ~P. HEQl.~~o ~T1L1ZATON RECORD PROJECT NAME 01\ Tt 8ECEVEO {Y,('lYMMDDJ,'".. RFOUCSTED OY Liil$l} (Fiffil! (M) PHONL rsoc(ifej \ (N<i/<SeCJlJ DATE DESRED (Y'r'('MMDD) REOUESTED LOCATON \ self AREA? \FUNDNG SOURer PRORTY? S612 PONl OF CONTACT (L.lS) (Flrstl (M/) SGNA.TURE DYES DNa DHGH o AOUTNE sa. FT NUMBER Chie( Key Comporoent (KC\ O! Group; Crlioi. omac Conlwenct! Room 400 SPACE NEEDED DELTA SPACE MAXMUM SPACE: PERSONNEL CURRENT SPACE (A ~ ALLOWA8LE REQURNG SPACE B) (C Ol (A (81 (C) (01 le... mmmm..... '.'.._- DCH, KG: Chief 01 $t;'lu, KC: DCH, Group: Staff Chief, Group; Chief, Office 300 D Staft Chi"t, KG; Chief, KC 8eachtlead; Exocutive, KC; D Stall Chisf, (lrovp; E::xocw\iVOi Group; D Chief, Oflice; Chiel, DiviSiO~ ~ w t" STEslNol1 Supervisory SeEs; Staff Chief, Office 150 Z 0 Spr:eial A$sislanVTechnical Assistarlt, Grcup; E~ecuh\le, Otlice; SpecialfTechnir.a1 A."Sistan~~g.f,l!ce: DC, Division 100 '" a: w 0.. Supervisors. Branch 75 nformal Toaming Arsa (20+ Employees) 70 AllOlhers.. PERSONNE:L TOTALS <l 1 ili 2 a: ";! 3 " w 4, 0.. '.. '" SPECAL AREA TOTALS SUB-TOTAL (Pet$(:nnel + $pechll1 Area) _._m.'..._., MSSON STATEMENf TOTAL (SUb-Total x 1.5). ". : pproved tor Release by NSA FOA Case #4287, FQnM D2714 REV OCT 2000 (Supersedes D2714 REV AUG 2000 which s o/lwj@(@)

256 DOCD: SECURTY CLASSFCATON SPECAL FACTORS SOCAL SECURTY NUMBER Privacy Act Statement: Authority for collecting inl(') on this form is contained in 10 U.S.C and E.O and 12968', N$A blanket routine U$eS found at 56 Fed. Reg, 10,531 (1993) and the spficlfic uses found a1 GNSA 09 apply to his info. Aulh 10r COllecting SSN is EO, 9397, The requested inla will be used for promotion, training, assignment and other human resource purposes, Your dsci of SSN is vol, but failure 10 provide may delay inclusion Of the info into your personnel tiles tor consideration in human resource actions WORK ROLE GRADE/STEP FROM DATE NSTRUCTONS Special Faclors are responsibilities that apply 10 all employees. They support he EEODiversity policies of the NSA and the U.S. Government and protect classilied information, government resources, and employee and environmental health. The following regulatory guidance should be reviewed when developing Performance Plans and when conducting nterim Reviews and Final Evaluations. an employee has significanl responsib,lilies in any of these areas, separate objectives should be caplured in the Performance Plan and rated during the nterim Review and Final Evaluation. At any lime a rater notes a deficiency (i,e., Needs mprovsmentj in a SpeCial Factor, the rater ShOuld take appropriate action to assist the employee in resolving he deficiency. f an employee is rated as "Unacceptable" n any of these a,eas, the raler should contact the Employee Relations for assistance. ALL EMPLOYEES MUST BE EVALUATED ON THE NEEDS UN ACCEPTABLE FOLLOWNG MPROVEMENT ACCEPTABLE OCCUPATONAL SAFET.Y-AND HEALTH OSH) OlJECTlVES: Employee complied Wth applicable NSAlCSS ash program rules and regulations by following local ash procedures; properly using personal protective equipment and clothing: promptly reporting unsafe conditions, hazardous exposure, or occupational injury or llness to appropriate authority and attending safety and health training as necessary, Reference NSAlCSS Regulation 140-1, "Occupational Safety and Health (OSH) Program" for specific guidelines. EEO'-;;!VERSY OBJECTVES: The employee treats all co-workers with fairness and respect regardless of race, color, national origin, gender, religion, age, or disability. An acceptable rating in this factor indicates compliance with NSA/CSS RegUlation "Equal Employment Opportunity," NSNCSS PMM Chapter 365, "Equal Employmenl Opportunity;' and NSNCSS PMM 366, "Personal Conduct." SECURTY OlJECTfVES: The employee demonstrated sound security awareness and adhered 10 NSNCSS security practices and procedures for the protecton of classified information and activities. The employee has shown an understanding of the responsibility to report situations that affect security of the NSAlCSS including any issue which brings into question \(ustworlhiness, reliability, or vulnerability to exploitation on their part or the part of any other person with access to NSA spaces or material, See NSNCSS Regulations 120-4, "Security Supervision," and , "ndvidual Security Reporting ReqUirements," _.~-~._- MANAGEMENT CONTROl. 06JECTVES: The employee demonstrated responsibility for promoting effective and efficient use 01 Government resources and protecting those resources from fraud. waste, abuse, misuse, and mismanagement as outlined in the NSA Management Control (Me) Program. The employee demonstrated goed property accountability pracllces and can account tor all assigned Agency property. See NSAiCSS Regulation , "nternal Management Control" and NSA CSS RMM Part V, Chapter 14, "Properly Accounling." HAND.NG QLc.~.ASSEEP NEQRMATON: The employee demonstraled responsibility for proper tlandling 01 classified information, An employee who is authorized to create and/or handle classified information is responsible for the proper marking of that nformation which includes the overall classification, por1ion marking, and tho classiticationfdeciassilication information (known as the ''classilication blocki. See Executive Order "Classified National Security nformation." _..._... EMPLOYEE'S SGNATURE TTLE ORGANZATON DATE NAME TTLE ORGANZATON DATE SUPERVSOR SGNATURE ---_.- FORM P3C REV MAY 2001 DSTRBUTON. SECUR'TY CLASSFCATON (Sl,ipersedes p:;c REV Original. Employee JAN 98 wilich S Obsolete) C'll. Rater pproved for Release by NSA ~~ Cy 2 - nclusion ill Ofiiclal Personnel File FOA Case # 4287

257 DOClD: SPECAl. REQUEST J AUTHORZATON NAVF'Ef1$ 1336/3 (AllU. g.-15) SiN 0106 LP 06';' 6633 DEPARTMENT: DiVSON WARD DUTY SECTON QROUP r..atur OF REQUEST O LEAVE 0 REQU ST SPECAL NO DAYS REQJEST FROM (Dar8 afldlimfl) O SPECAL 0 COMMUTED 0 OTHER PAy RA'fON$ (BelOw) TO (DalQ and rime) ~STANCF. (Mil"$) MODE OF TRAVEL o AR D TRAN Deus DeAR 'iea\?: ADDRESS r5lrflflt, 00)( or rauh, no.. ell): Srtm~. Zip Cads) TELEPt-iONE NuMBER SONATUH~ or: APPLCANT AM EliGBLE AND OBLGATE MYSELF TO FlEAFORM All DUTES OF PERSON MA<NG APPLCATON- ""NAlVRE OF S'A'D" l.o.".'.y.s.'a.'.'o.' _ EARNED LEAVE CAYS AS OF RECOMMrNDLD APPROVAL o YFS PERSONNEL OFFCE leave THS FSCAL YEAR DATE LAST PAD $CNATl,JRf. AND RANK RATE TTLE DATE 0 NO ~ 'SGNATURE AND RANK RATE j TTLE DATE o y S DYES DYES o APPROED 0 DSAPPROVED REASON FOR DSAPPROVAL SGNATURE AND AA~K RATE TTlE DATE 10'...' A URr::AJ'JDHM'K."""" "'E.-l:fU"'e log OUT AND N WTH 000 (WMt1 r9quirod) HTCHHKNG 1$ PROHBTED

258 DOCD: SPECFCATON CHANGE NOTCE (SCN) 1. DATE (YYYYMMDD) Form Approved OMS No ~ t'e public reporting huf{le!1.or tnis colleclion or n ormal'o(l 1$ ($llmaled 10 averalll:l 4 ",ours per ft!5por'\$e. nc "u;lng the lime 01 reviewing rstruclu')(s, stlarcl'nng 2. PROCURNG exis:,l1q d(l.b sources, galmr"..g a'lo mainta,ning the data "'*deo, anti comple1lng and reviewing the collection of n1ormatll;m, $end comments fegardlt"lq this bun.!9n ACTVTY NO. e~'l1"ate or "l'1y OlhJi!f aspect 01 thm collection 01 ino(l1"ao'l, 11cluding suggestions lor reduclt'llllh,s t;\.jrden. 10 DGpartJTJllnl ot Defen$&. Washington Headquarters SCr\(<;es, Directorate lor nl0.mst'c>t'l OperQ1,0ns and Reports ( ), 1215 JeUer$or'l Davis Hll1lway, &111& 1204, ArllnglOn, VA , RQ&pondents Maula be aware lhat 110tw'll'lSMd,ng any othel provision 01 la"", no person s;halll'.le 6ubj6C1 to ll/'y penalty lor (ailirtg to compl)' with t cohectlofl 01 mlofl'l'll'ltiofl " '( does nol d;5p1~y a C~flftnllV vq'd OMS OOr11rol numoor 3. DODAAC PLEASE DO NOT RETURN VCllA COMPLETED FORM TO THS ADDRESS. RETURN COMPLETED FORM TO THE GOVERNMENT SSUNG CONTRACTNG OFFCER FOR THE CONTRACT f PROCURNG ACTVTV NUMBER LSTED N TEM 2: OF THS FORM. 4 ORGNATOR 5. SCN TVPE a TYPED NAME (First, Middle nitial, Last) PROPOSED APPROVED b, ADDRESS (Street, City, Sf le, Zip COd~.j - n 6. CA.GE CODE 7. SPEC NO. 8. CAGE COOE 9. SCN NO. 1O.-SYSTEM DESGNATON 11. RELATED ecp NO. 12. CONTRACT NO. 13. CONTRACTUAL AUTHORZATON H. CONFGURATON TEM NOMENCLATURE 15. EFFECTlVTV T11; notice 110rms recl,1j1ems ttldt t"~ sper;lfic,,!ton i<jlmtified by the number (and r(fvision lettef) shown in /lem 7 has been changed. Thtl pages cnanged by this SeN are those tumished herewith and carry the approvai dale of the relafea ECP listed in tem 11. The pages of the page numbers ana aates listed t(j tems '6 and 17, combined Wllh 11O:His/M pages of the origli18tlssue of the revsion shown in tom 7, constitule the curreot approlffld version of this sp8cification 16. PAGES AFFECTED BY THS SCN TYPE OF APPROVAL DATE PAGElS) CHANGE' (YYYYMMDD) a b. c. 17. SUMMARY OF PREVOUSLY CHANGED PAGES DATE SUBMTED TYPE OF APPROVAL DATE (YYYYMMDD) CHANGE" (Y'r'YYMMDD) a b c d f SeN NO RELATED ECP NO PAGES os' indicates supersedes earlier page. "A" indicates added page "0" indicates deletion 18.a GOVERNMENT ACTVTY c SGNATURE d. DATE SGNED (YYYYMMDD) b TYPED NAME (First, Middle nitial, Last) DD FORM 1696, AUG 96 PREVOUS EDTONMAY BE USED.

259 DATE FROM TO nitial Clearances Office of Security Services NSAlCSS COMPANY CAGE CODE THE FOLLOWNG PERSON WLL REQURE CLEARANCE ACTON NDCATED: CONTRACTOR EMPLOYEE JUSTFCATON r:or SC o CONTRACTOR CONSULTANT (Type A Consultant Agreemenl roquired) NOMNEE'S MALNG ADDRESS AND HOME PHONE NUMBER ;:>ROJECT NAME CONTRACT NFORMATON CONTRAcr # DATE NEEDED 6Y NSA COR (Name) COA ORG COR PHONE / ACCESS O ) AT NSA AssignmentiDelai1lPCS/Core Access (FJ, Scope Polygraph Requred) PREviOUS CLEARANCE (Cleared by) o Contractor Facility With NSA Networking Connectivity (Full-SCope Polygratlh Required) (Lf1Vf1! 01 clearanc6lacc8ss) TYPE OF CASE Contractor Facility Without D NSA Networking Connectivity (Counter-1nrelligcnce Pofypraph ReQuired) (Date Of clearance/access) 1B PROVDER 30 Day COR CONCURRENCE DATE FORMS SENT TO 61 PROVDER DUAL TRACK [60 Day SNGLE TRACK DATE OF 5GB SSBJ BY (SSB date is within 188( five yea.rs) RENSTATEMENT -- (Previously cleared by NSA) Must provide mailing address as requested above, Debriefed from NSA SC less than 6 DATE (Debriefed) (Hired) months (Sponsorship letter. Authorization to Obta" Consumer (Credit) Report, and Contractor Employee Advisory Handout required) Debriefed from NSA SC 6 24 months DATE (Debriefed) (Hir~) (Complete forms package required) CONDTONAL CERTFCATON of SC ACCESS FORM G6787 must be completed in it. entirety and attached. CHANGE N STATUS o Contra.ctor Employee to Contractor Consultant (Consultant Agreement required) D Contractor Consultant to Contractor Employee CHANGE N ACCESS (FUll-scope polygraph now required) ADDED Ar"FLATON (Concurrent access with multiple affiliates)......_... - PCS F YES, 10 NO o YES o CONUS OOCONUS (Form P4660A must be auacjod) REQUREMENT COMMENTS COMPANY NAME AND MALNG ADDRESS FOR ACCESS \OTFCATQN CSSO rprlllled Name) FORM G3542 REV FEB 2000 (SuperSedes G3542 REV NOV 98 which is Obsolete) NSN 7540 FM OO pprovm for Release by NSA FOA Case # 4287

260 DOCD: STATEMENT OF CONDTONS OF EMPLOYMENT This form must be signed, dated, and returned to the National Security Agency, along with the attached application for employment. The purpose of this statement is to inform applicants of the general criteria and procedures for employment with the National Security Agency. Employment with the National Security Agency is governed by the provisions of Public Law and Public Law 86 36, as amended, (/he National Security Agency Act of 1959). Public Law requires that initial and continued employment with the Agency, and access to its classified information, shall be clearly consistent with the national security. The law prescribes further that employment in the Agency shall be contingent upon favorable evaluation of a completed background investigation. To meet the statutory security standard, the National Security Agency maintains special employment criteria and prescribes certain conditions of employment which may exceed those of other Government organizations which do not have the highly sensitive responsibility borne by the Agency. The special criteria and conditions include, in addition to others prescribed by Executive Order, and Departmental regulations. the following: States. a The person shall be of stable, trustworthy, excellent character and discretion, and of unquestioned loyalty to the United b. With limited exceptions, both the person and the members of his or her immediate family shall be United States citizens, For these purposes "mmediate family" is defined as including the individual's spouse, parents, brothers, sisters and children. c. No member of the person's immediate family and no person to whom he or she may reasonably be expected to be bound by res of affection, kinship, or obligation should be of questionable loyalty to the United States. d. No member of the person's immediate family and no person to whom he or she may reasonably be expected to be bound by ties of affection, kinship or obligation should be a resident of a foreign country having basic or critical national interests opposed to those of the United States. e. The person shall be required to execute an NSA Security Agreement in which he or she agrees not to disclose certain information to unauthorized persons, agrees to Agency pre-publication review of certain material prior to disclosure during and after employment with NSA, and agrees to certain restrictions on foreign travel. f. Although individuals may be conditionally employed prior to the completion of a background investigation, continued employment with the Agency S contingent upon favorable outcome of this investigation. Further, all employees are subject to aperiodic reinvestigations and personal interviews with the aid or a polygraph instrument, and continued employment is contingent upon favorable outcomes of these aperiodic reinvestigations and interviews. g. Employees of NSA have a continuing responsibility to abide by all security regulations, policies, and other requirements, ncluding, but not limited to, cooperating in the above-mentioned reinvestigations and interviews and reporting promptly information that could affect their access to sensitive classified material. h. Employees of NSA who are hired after admitting prior unlawful use of controlled substances may be required to sign an agreement SUbjecting t~lem to random urinalysis for a petiod of up to five years following entrance~on~duty. The following is a typical sequence of steps and procedures which may lead to NSA Employment: a Aptitude and proficiency lests for certain occupations, and other psychological tests, are administered to help select and place applicants n NSA. b. The applicant parlicipates in a personal interview with an NSA recruiter from the Office of Human Resources Services to determine general acceplability and qualification for Agency employment. This interview will cover academic training and accomplishments, aptitudes and interests, employment history, inrormation about NSA and its jobs, within security limits, and a brief discussion by the recruiter of the major secunty requirements for employment with the Agency. c. A personal interview with the aid of a polygraph nstrument is conducted by a security specialist. The purpose of this interview S to provide data which may be used, together with dala collected from other source. in determining an applicant's eligibility for access to sensitive classified material. This determination, combined with information relating to other requirements, will be considered in appraising an applicant's suitability for employment. d. A medical examination which includes a physical examination and a psychological evaluation based on testing or a personal interview, or both, is normally required, ~ORM P2771 REV FEe 95 (Supersedes P277T MAR 88 which is obsolete) NSN FM-001-0S06 (over) pproved for Release by NSA FOA Case #4287

261 DOClD: (continued) e. A urine test for the unlawful use of controlled substances may be required. Positive test results or refusal to be tested will be considered in determining an applicant's eligibility for employment and may be the basis for denial of employment. 1. Other data are obtained through a National Agency Check and a complete background investigation. Favorable evaluation of the results of the above procedures is required before an offer of employment is made and completion of preemployment negotiations does not imply or guarantee an offer of employment. As a general policy, offers of appointment are made in writing to each person selected for employment. The offer will indicate the effective date of the appointment, as well as the kind of appointment and the conditions pertinent thereto. The Director, NSA. has the authority to impose limitations on unofficial foreign travel in or through areas which are determined to pose an unacceptable risk to employees of the National Security Agency. Close and continuing association with foreign nationals characterized by ties of affection, kinship or obligation are normally considered incompatible with NSA employment. Exceptions may be granted by the National Security Agency on a case by case basis Pursuant to Public Law 86-36, employees of the National Security Agency serve in positions which are excepted from civil service laws. and in accordance with PUblic Law , they serve at the discretion of the Director, NSA. Further, employees may be required to serve anywhere in the world to meet the needs of the Agency as determined by the Director. Employees of NSA are required to participate in the Direct OeposiVElectronic Funds Transfer (DO/EFT) system for distribution of their net salary, allowances, and allotments. This requirement is in accordance with DoD Regulation R which states that OO/EFT is mandatory for civilian employees and is a reasonable condition of employment. This document, when signed by the applicant. signifies that the applicant fully understands the criteria, conditions and procedures lor employment with NSA. and that this document should not be used for any other purpose. whether signed or not. SGNATURE DATE FORM P2771 REV FEB 95 NSN 7540 FM OO~ 0506 Reverse

262 _ ~ DOCD: STANDARD FORM 1149 Revised MarCh 1982 Oept 01 the TreaSlJfY TFRM NAME OF DSBURSNG OFFCER OR CASHER STATEMENT OF DESGNATED DEPOSTARY ACCOUNT NAME (Funds advanced by) STATON OR OFFCE NAME OF DEPOSTARY LOCATON OF DEPOSTARY ACCOUNTNG NUMBER (or o/her designation) as showll on depositaf'j statement (SEE REVERSE SDE FOR LNE NSTRUCTONS) 1. Check-book balance at close of prevous perlo~... _ 2. Deposits to official credit; Translers. _ Others -:-:-:-:-:---;- _ 3. Checks canceled this perict! Undeliverable checks credited his period... _. _. _ 5. Adjustments _ 6. Uncurren! checks. _.... _ _ 7. TOTAL TO BE ACCOUNTED FOR... _ 8. Total checks drawn this period... _ 9. Uncollectibie checks returned by depositary.. _ _ 10. Adjustments 11. TOTAL Check-book bala~~e~lo;._ofperiod. : : : :: :. :. -. : : : :. : : :: : :: : RECONCLATON 13. Balance per bank statement.... _.. _. _ 14. Add; DeposilS in transit... _.... _.. _ 15. TOTAL _ _. _ _. _. _ 16. Deduct Outstanding checks... _ _. 17. Deduct DepOSits not credited by _--;-;== ===== _ (Disbursing officer or cashier) 18, Balance per check boo~ ~ ~ ~ ~ _ ~.. _ ~ ~. ~ ~ M ~ ~~~~~~~~~~~ 19. U.S. dollar equivalent _ Rale of exchange per $1.00 BEGNNNG SERAL NUMBER CHECKS USED THS PEROD ENDNG SERAL NUMBER DATE certify hal the above slatements and supporting data are correct and in accordance with applicable regulations. SGNATURE OF DSBURSNG OFFCER OR A HER NSN PREVOUS EDTON USABLE

263 DOCD: STANDARD FORM 1149 (REV3 62)8ACK LNE NSTRUCTONS Report the balance in checking account carried forward from previous statement. 2, Enler the totals of all deposits, segregating transfers, made to the checking account during the month and submit a lis1 showing date and amount of each deposit. 3 Show the tolal of all checks canceled during the report period, to be supported by corresponding Schedules of Canceled Checks. Standard Form '098, and Unavailable Check Cancellation, Standard Form Show on this line the total of credits 10 the checking account for undelivera.b1e checks which tlave been credited to appropriation or fund accounts as supported by Standard Form 1185 schedules. 5. Report the lotal of a/l adjustments increasing the accountability during the report period. A detailed explanation should support each adjustment. 6, Add the total of all checks that became uncurrent at the close of the fiscal year, A complete detailed listing of each uncurrent check should support the entry on this line. 7 Show the total of lines 1 through 6. reflecting total accountability for the reporting period, 8, The grand lolal 01 all checks drawn for the period will be shown here, A complete detailed list or check carbon copies should be submitted. 9. The total of uncollectible checks returned by the depository during tlo report period will be shown here with supporting schedule showing the dale and amount of the original certificate 01 deposit or deposit slip, 10. Enter the total of all no-check adjustments processed during nc period which reduces the accountability, and submit a supportlngdetalled explanation of each adjustment. 11. Show the total 01 lines 8 through 10. This amount represents the total decrease in the checking account accountabilty for the report period, 12 The figure shown here will be the difference between the totals on lines 7 a.nd Show on this line the balance of funds in lhe checkmg account as shown on the bank statement Support with bank statement 14 Show the total of all deposits in transit to the checking account. the amounts of which have been included in line 2, A detailed list showing the amount and date of each deposit must support this line amount. i5 Show here a total 01 lines 13 and Report here the total of outstanding checks in the account. Support this figure wi1j1 a detailed listing of each check. 17. Report here the total of deposits credited by the bank but not credited in the checking account. A detailed list showing the amount and date 01 each deposit must support this line, 18, The amount on this line should be the same as the total shown on line 12, f not, explain in detail. 19 The amount shown on this line will be the U.S. dollar equivalent 01 the monetary units shown on line 12 and as reported on the Statement of Accountability, 20 Show here the rate of exchange used in the conversion shown on line 19.

264 DOCD: STATEMENT UNDER OATH DATE PLACE PRVACY ACT STATEMENT Authority 'Of colloctlng informalion reqoosted 01'1 this form $conlained in 50 US.c. 402 mllil:; 50 U.SC. 831 ttf seq.', ExecutlVo Orders 10450, and 129fJa, ~nd DC Oiractive No. 614, NSA's Blanket Routine Uses found at 58 Fed. R.eg 10,531 (199~) and the specific uses found in GNSA10 apply 10!\'iS information,,t\.l,1honty fot requestmg YOUt SOCal SeCl:Jf1ty Number S ExecutiVC Order nformaton you provide: will be used (~nmari'yllo determine eligibility \0 recqlve access 10 classfied information; lovestigale loss or GomprQfT\se,of classified information or violation of law affecting lho Agency; and/or determine Se<;t,Jrity eiigib1lity or general sullabihly tq~ Agency employmenl, assignment, reasslgnmenl official or unofficial foreign travel. or other personflel action Oisclor.ure of requ~sted inform81on, including yqljr SSN. is voh,mtary, However, failure. to futnlsh mqu8&ted information may delay or prevent NSA from providing access to classified inlorl'ylfj,tlon Of from approving Agency employl'l"lent. assignment. reassignment, or Other action, Your SSN will be used \0 distinguish )'OU from other individuals providing statements under oa.lh PRNTED NAME (Lasf) (First) (M) SPECAL AGENT (Last) (Fl'rst' (M, do hereby make the following voluntary statement to the above named, identified to me as Special Agent, Office of Security, National Security Agency/Central Security Service, U, S. Department of Defense. No threat, promise, coercion, or duress has been used to induce me to make this statement. COMMENTS (Use addwona/ sheet($) ifteqvired) pproved for Release by NSA , FOA Case # FORM G2300 R:V AUG 2000 (Sup.".a., G2390 REV NOV 90 ana G2390S REV NOV 90 which a.. ot>solele)

265 DOCD: STATEMENT UNDER OATH (Continued) COMMENTS (continued) solemnly swear (or affirm) that the foregoing statement has been read by me and it is true and correct to the best of my knowledge and belief STATEMENT DATED NO_ PAGES [~S':"GN~A~TU~R~E Subscribed and sworn to (or affirmed) before the below named, Special Agent ofthe National Security Agency/Central Security Service, under authority of 5 USC 303 (1976), at the location specified, TYPE/PRNTED NAME (ta.') (Firsl) (M) DATE SWORN SPECAL AGENT ~==:: _-= L NSA/CSS SGNATURE AT WTNESSED FORM G2390 REV AUG 2000 (Supersedes G2390 REV NOV90 and G2390B REV NOV90 which are Obsolete) Last Page

266 DOClD: UNTED STATES GOVERNMENT memorandum DATE, SC32/SAB 2/ REPLY TO ATTN or, 5C32, nformation Acquisitions SueJECT, Status of Enclosed Book/Periodical Request(s) (H2525(s)) - NFORMATON MEMORANDUM TO' Publication Procurement Coordinator for: ==::;- (organization) Publications requested on the attached H2525(s) are on order. Any future inquiries on these titles should cite both: (1) the Purchase Request (PR) nymber (at the top right) and; (2) the po nymber (at the bottom Jeft) of the Form H2525. NOTE; Domestic book vendors usuelly requite 6-8 weeks to fill orders. Foreign sources often require days, Subscription vendors/publishers require days to start SUbscriptions. Publications requested are stocked in SC32 and have been forwarded to the requester. Publications requested are stocked items NOTcurrentlv n stock. tems will be forwarded upon receipt in SC32. PPC will be nformed it items are not forwarded within 90 days. -- Publications requested on the attached H2525(s) are NOToblained/djstrlbuted bysc32. The request has been transferred to the appropriate organization as noted. Attached requests are cancelled; Publication NOlavailable (OP - Out ofprint, OS; Out ofstock ndefinitely) Per discussion with PPC Request duplicates a previous request OtHER (Specify) Please refer questions to: 1 18C32; SAB2, 972; (b) (3) P.L pproved for Release by NSA 0 2~ FOA Case # 4287 CHEF, SC32/ACQUSTONS ENCL: als EXCEPTON TO OPTONAL FORM NO. 10 APPROVED BV GSA/RMS 5/88 GSA FPMR (41CFR FORM H711d REV JUL 2000 (Supersedes H7114 REV MAR 98. which S obsolete)

267 DOClD: STOCK FUND SUPPORT REQUEST (Prepare in Triplicate) NATONAL STOCK NUMBER (f known) The torm J5737 requests the S Organization t(l stock., store. and issue consumable supplies for Agency organizations and helps ensure that material will be available when required. f there are any anticipated changes in established requirements. a new Form J5737 should be forwarded to the appropriate 571 item manager. For information regarding the submission or change 0' a Form J5731, contact S71.lnventory Management, on 977~1131s or E88 EE83b. UNT OF SSUE UNT COST MANUFACTURER MANUFACTURER'S PART NO. NOMENCLATURE ~ COMMENOEO SOURCES SHELF LFE MONTHS (No.) DATE REQURED (allow90 day6) REQUREMENT (cfhick OM) Will Reorder: Annu.lly -_... END TEM APPLCATON PROJECT OATES (From) (10) Monthly (qty) o n.l,ranee PONT OF CONTACT (1.0$1) (first) (M) PHONE (Stcure) (Non-Secure) ORGANZATONROOM NUMPER HAZARDOUS MATEREL DYES lt YES, Office of Environmental 0 APPROVED Satety, (0.E,8,), 521, Appro\l81 o NO Required --_..._-.. 0 DSAPPROVED MSSON JUSTFCATON $21 SAFETY REP SGNATURE DATE RECEVED 1 PHONE (secure) (Non.&u:ur.) MPORTANT NOTCE 1, Specific temlsole Source Justifications must be attached and updated annually. Sole Source documentation must comply with the provisions of NSAlCSS RegUlation All personnel should be aware that STOCKAGE OF SUPPLES NCURS COSTS N FUNDNG, MANPOWER AND WAREHOUSE SPACE. As such, each employee has an obllgatlonto ensure that supplies be used n the most effective manner and for offlclal purposes only. 3. f addition of a new item to the supply system will require a significant investment of stock funds. the originator may be required to provide certification from N445 that funding is available to support the request._., ;;',:'1,111",' CERTFCATON CERTFYNG AUTHORTV FOR REQUREMENT (A/pha +2eveJ) TTLE ORG DATE QSl j!l!ll!i'!!l NLY,'-'!i,;","H,W:yl: :';','-J ;"-".,',,', _,", ";,,,,,.,,,.,i'liiiy BUDGET CONTROL OFFCER (Alpha + 11.v.~ TTLE ORG DATE OATE COM~1.EfEll "," 1.".' ',", FORM J5737 REV OCT 2000 (Supersedes J5737 REV MAY 97 which is obsolete) bfproved for Release by NSA ~~. NSN: 7540 FM FOA Case # 42871

268 L STOCK NUMBl:.fl FROM LOCATON iolocaton QUANTTY COMMENTS..._----j j ~--- --_l_ , _ \ '"ORM J3a9~ R('.v JAN 2002 (SuP<JfSedeS J3893 AUG 87 "'hich is abila/ills) " hpproved for Release by NSA 0' FOA Case #4281~

269 ,,,-,,-,, -~._,,~~--,,-. -~ DOCD ~ "cj,~1,~",~~,y) STORAGE (Check appropnate block) 0 REQUEST 0 WTHDRAWAL S,QHAG': '1EQuEST NUM8H ~TR== U. 1 is responsible for onsuring materials and equipment aocepted for storage are properly stored and pro/ecled. f ilams baing pieced ill storage require special protection, packaging, orstorage environment, please document/hose requirements and attach to this form Please contact/he Dorsey Road Warehouse on for further ns/ructtons. 2 Only 1l!iC1.~$FEO material can be placed in slorage. 3. GrouP identical ifems together and anno/ate lolal quantity. TO (S/6'FiiijiilfrgJ 'QRG Rt.cRJtoS Nt;; :;i1(j".<:;;t:. ) Kl;Y CUM1"ONENT --PROJECT NAME (if applicabie) PATl -----_ _- PAGE ae pont OF GONTA,CT 1r H""", (;;;/x;urf) (/'on Secure) OR" HvOM Nl"MS"H OUllJJj.., ) ORGANZATON OF OWNERS,HlP (F OTHl'R THAN PR V10US) STORAGE: JU$Tl'CATON AND CE'1T'CATON 'TriAT ALL MANUALS ARE UNCLASSFED AND ALL :O.J"MENT HAS BFFN SANTZED STORAGE PEROO (up/a 1 year) ALPHA +2 (T\"Pe1'P,,"led NarllQ, rmll. Si911~lure & Date) ~ _JPROPERTY ADMNSTRATON OFFCEl (TYPi'dlPrlnl&d Name, Sif}1a1ure & Dare) MAttDAQBY - ---~--- ~- -~ ~-,- ", LNE TEM NO. NOUN NAME OR NOMENCLATURE MODEVPART NUMBER MANUFACTURER SERAL NUMBER D NUMBER/BAA CODE ' un CTY STORAGE LOCATON L-L1 USE ONLY LU APPROVAL (Signarure & Dlle} Ll1 WTHDRAWAL (SignatllTl1& Dale) RECEVED BY (Ty/lfldlPrf1'l11ld Name, Sign.tlUrtl & 08,.,)(1\;1 oe cornpll1f8dtly ctj$~r wtlel'll'6m(llli/u mad) FORM J949'7 REV AUG 2001 (Supersedes J9497 REVMAY 2001 wflid i$ o/)soletc) SECURTy CLASSFCATON (~any) ~fproved for Release by NSA ~~ FOA Case 4287

270 mm_..._._.... DOCD: Sl'cCUf'lTY CLASSnCAT10N (if ;;fly) STORAGE REQUEST WTHDRAWAL (Continuation) SWRAG' REOUEST NUMB'R T/'tis ContinuatioT'! Sheet, Form J9497c MJJH be used in cot'l)uncll'on with and attached to Form J9497, Storsge RoquesllWithdrawal, DATE PAGE prior 10 submission. fbasic Form J9497is not aundled, this continuation sheet wiff be roturned unprocass/jr!- or 'O'"T 0' CO,""T Pf1ONE'(S'OCUf8J ORO ROOM NUMBER. BULDNG...- LNG TEM NOUN NAME OR NOMENCLATURE MODEUPART NuMBER MANUFACTURER SERAL NUMBER 10 NUMBER/BAR CODE Uil OTY STORAGE LOCATON l.l1 USE ONLY NO..._ _._.-_. m n'_ LL1 APPROVAL (Si9"Mfll(/" Olle) LL1 WTHrn:1A.WAL (!$lfll/lpe & Dale) RECEVED BY (1}ipeQ/Print~ N/VTlfl, Signatww & Oa~)(Tl) be CCK7phffedbycuslomM wh6ll mmolliflg rrnlltlrial) FORM,Jllo497c REV AUG 2001 (SlJP6rnooe.s J9497c REV MAY 2001 Whidl is obsolete! SECUFlTY a..assfcaton (if any) Approved for Release by NS.A ~~ Q7 FOA Case # 4281

271 DOCD: STU- KEY ORDER REQUEST (NSTRUcnONS ON REVERSE) 1 FROM USER REPEKM$C 3 CURRENT DATE (yrlrnoldaj 4. U/R TRANSACTON NUMBER r;-to L 5. TYPE OF KEY 6 KMODC ORDER NUMBER Type 2 Type1 Seed Type 1 Operational 7 EKMS STU KEY ORDER 0 o NO EKMS (YES, /r STU-J will support LMO) YES Central Facility P.O. Box 718 Finksburg, MD ~ 8, SPECAL NSTRUCTONS 9 11 CLASS '2 1O. TEM TYPE' CLASS 13. DAO CODE 14. EKMS ADDTONAL DENTFCATON DATA 16. REMARKS OTY ONLY 6 NO. (Check below) CODE U C S TS u C S TS U c r r, S T$ u C 1 S TS u C S TS u C i S TS,, r r u e $ TS U e S TS r U C 1 S TS 1 U C r 1, r r r r S T5 u e TS U - e... -:: 'Ts 1 S u c T u C S TS u C T u C 1 S TS 1 18, SGNATURE OR USER REPRESENTATVE ~ $H?TO COMSEC ACCOUNT NO L 19 TYPED OR STAMPEO NAME pproved for Release by NSA ~~ FOA Case # PHONE NUMBER FORM L3769 REV DEC 96 (Supersedes L3769 REV SEP 94 which is obsolete) NSN: 7540 FM OO J 121. PAGE OF

272 DOCD: 3115~RUCTONSFOR THE STU- KEY ORDER FORM (More detailed procedures may be found in FSVS-120 Key Management Plan.) (For Clarity and Legibility ALL data should be entered in Blocks 9 15 with a typewriter 10 pitch font placing one character per indicated space using a character/space format) BLOCK 1... Enter the name, address and User Representative number of the User Representative submitting the key order. BLOCK 2 BLOCK 3 BLOCK 4 Address of the EKMS/Central Facility Enter the date the key order is submitted. Enter Transaction Number (8 digits) for this key order. Format of this number is YYMMXXXX where YY is the year, MM is the month, and XXXX is the sequence number of the transaction within the month. BLOCK 5... ndicate the type of key desired for this order by placing an "X" in the proper square. A separate key order form must be submitted for each type of key ordered. (Type, Type Seed, Type Operational). ONE KEY TYPE PER ORDER. BLOCK 6 BLOCK 7 Leave blank. (Number will be provided by EKMS CF). Check appropriate block. EKMS STU key is required when the STU 11 is used in conjunction with a Local Management Device (LMD). BLOCK 8... Enter any special instructions to the EKMS CF staff (e.g.. specific shipping requests Registered Mail - urgency, etc.) DCS. BLOCK 9... Enter order item number. BLOCK 10.. ndicate the number of keys required for this order item. A maximum of 400 keys may be requested on one order. BLOCK 11.. ndicate the classification of Type key by placing an "X" in the proper classification square. For Type key, leave square blank. BLOCK 12.. Enter appropriate two-digit Class 6 code for key, if desired. (The User Representative must have the key ordering privilege for the Class 6 code requested). BLOCK 13.. Enter appropriate DAO code for key. (NOTE: User Representative must have key ordering privilege for the DAD code identified). BLOCK 14.. f YES was checked in block 7, enter EKMS 10 number. BLOCK 15.. Enter any additional identification (10) information for key. This information will be displayed on the terminal display foilowing the DAO description. f the DAO description is one line, two iines of additional D data can be added; if the DAO description is two lines, only one iine of additional 10 data can be added. DO NOT REPEAT YOUR DAO DESCRPTON. The DAO description, additional 1.0. and class 6 code (which takes up 9 spaces) cannot exceed 51 characters. BLOCK 16.. NOT USED BT THE EKMS CF. For local use by the User Representative only. BLOCK 17 Enter the address and account number of the receiving COMSEC account. All key on a single order form must be sent to a single COMSEe account. The EKMS CF will send keys to registered COMBEC account address existing in the CF's database. BLOCK 18.. The User Representative must sign this block. BLOCK 19.. Type. print or stamp the User Representative's name. BLOCK 20.. Type or print User Representative'S phone number. BLOCK 21.. indicate page number of this page and total number of pages in key order. FORM L3769 REV DEC 96 Reverse NSN.7540 FM

273 DOCD: SUPERVSOR SECURTY EVALUATON PLEASE NOTE: The supervisor WLL NOT review the employee's security forms. NSTRUCTONS; Supervisors are required \0 complete a Supervisor Security Evaluation (SSE) of SUbordinates as part of their reinvestigation. The subordinate will seal hislher completed security forms in a small envelope and provide this, a larger pre-addressed envelope and the SSE to his/her supervisor. After the supervisor completes the SSE, he/she will place it and the small, sealed envelope in the larger envelope. The entire package will be forwarded to 0233, PERSONNEL SECURTY EVALUATON CRTERA a Conduct which suggests possible involvement in espionage, sabotage, or subversion; b. ndicalions of disloyally to the U,S. (this would mclude disloyally to the U.S, on the partof a close relative of the employee or on the ptlrt ofan assocate wilh whom the employee S bound by affection orobligation): c nvolvement in outside activities or employment which might create a potential conflict with the individual's responsibility to protect classified information from unaulhorized disclosure; d. ndications of poor judgement, indiscretion, unreliability, or untrustworthiness which suggests that the employee may be unsuitable for continued access to classified information or assignment to sensitive duties: e, Exploitable personal conduct /lifestyle which might subject the employee to undue influence, duress, or blackmail; f. Unreported Unofficial Foreign Travel; g. Unreported close and continuing association with a non-u.s. citizen; h. Excessive indebtedness, financial irresponsibility, or unexplained affluence (ev;dence of living beyond one's means):. Use involvement With controlled substances illegal drugs since entering on duty; J. Alcohol abuse; k EVidence of an emotional. menial, or nervous disorder (10 include consultation with a psychologist, psychiatrist. orcounselor for such a problem); nvolvement in criminal activity or a record of law violations; m. Deliberate violations of security regulations and policies; n. Negligence or carelessness in performance of individual security responsibilities. D o AM.1'Q AWARE OF NFORMATON PERTANNG TO THE ABOVE CRTERA OR ANY OTHER NFORMATON WHCH MGHT AFFECT THS EMPLOYEE'S ABLTY TO PROTECT CLASSFED MATERAL. AM AWARE OF NFORMATON PERTANNG TO THE ABOVE CRTERA OR ANY OTHER NFORMATON WHiCH MGHT AFFECT THS EMPLOYEE'S ABLTY TO PROTECT CLASSFED MATERAL, SUPERvSOR'S NAME (Print) TTLE SGNATURE DATE PHONE FORM G6920 REV APR 2002 (Supersedes G6920 REV NOV 96 which S obsolete) pproved for Release b'y NSA FOA Case #4287

274 NAM. (as/) (M) SOCiAL SECUR1Y NUMBER L.ALl1Y Eo: or'- COUNTRY ASSGNED NSTRUCTONS Each employee aulhorized a Living Quarters Allowance (LOA) S 10 submit An actual e~pense Submit reproduction of all bills Employee 1<'\ 10 hold origlflal All bills must be tor lctual paid SF 1190 with Supplement at the end 01 lease year. llqase is lor more tharl onc year, employee expenses and oonlliin the 'allowing irllormation; Dale of B~L Date oj Payment: bib is not in will submit lll;;tu<t1 expl;'nses ilnnl,1...lly on ii1nniver~ry ot lease. 11 no annual lease exists,. -. employoe will submrt actual expenses annually on annivarsaty of mclvlng nto permanent English, supply a translation of basic dala, Bill or translation mus identify willt bill is tof, period quarlers tor whioh an LOA. io;; payable Use separate line below, lor each bill Use additional sheets t necessary. For each entry write the Bill Number (len column) on lha bill 0. (YYYY'MM~DD) covered, aod amount: Exchange rale in clfec\ when payment was made: Any additlooal information thai will assist in computing four actuai expenses BillS N FOREGN CURRENCY z OATE BLL PAD f:xchange RATE --: ELECTRC O'C COST OTHER (SpeCify) RENT WATER ELECTRC (U.S. Doll!'lf$) ~ $U.S.-FGN. ClJA ~ 1 OTHER (Specily} _..,- B REMARKS _._ ~ _ _... " 17 1B " r.pproved for Release b'y NSA 0:,1.... _-... -_..._.~ FOA Case # FORM Kl 190 REV FEB 2001 ("tj:xl5l!de's Kl 190 REN DEC 97 whoch is obscwe;- Page 1

275 SUPPLEMENT TO SF 1190 (Continued) i BLLS N FOREGN CURRENCY o! NAME (Last) First) (Mi) lsoc1al SECURTY NUMBER lqcauty CODE OF COUNTRY ASSGNED z DATE Bill P.l\D EXCHANGE RATE ELECTRiC loll COST -' ';( OTHER (Specify) (YYYY-MM-DO) $U.$.-FGN. CUR RENT OTHER (Specify) (u.s Doia,s) --' w WATER ELECTRiC 10 :: REMARKS <" r- r- r- M Q H U o Q FOAM K119C REV FEB 200, Page 2,

276 WHERE YOU HAVE LVED: MonthYear MonlhNear! Street Address #1 To Name 01 Person Who Knew You MonthNear #2 To Montrvvear Streel Address Name of Person Who Knew You MonthlYear #3 To MonlhNear Street Address Name of Person Who Knew You Privacy Act Statement on SF 86 applies f you resided overseas, provide the name of one additional person (other than listed on the SF 86 #9) who currently resides in the United States and who can verily your residence and activities. Street Address Street Address Street Address Apt. # City (Country) slate \ ZP Code Ap. C~y (Country) State ZP Code Telephona Number ( ) Apt. # City (Country) State, ZP Coda Ap. City (Country) State ZP Code Telephone Number Apt. City (Country) State ZP Code Apt. City (Country) State ZP Code Telephone Number MonthlYear MonthlYearStreet Address #4 To Name 01 Person Who Knew You MonthNear MonthlYear Street Address #5 To Name of Person Who Knew You Street Addr.ss Streel Address Ap. City (Country) State ZP Code Apt. City (Country) Stale ZP Code Telephone Number Ap. City (Country) Slate ZP Code Apt. City (Country) State ZP Code Telephone Number FOREGN TRAVEL: you have no reportable foreign travel, enter NONE. COUNTRY/CTY DATES NAMES AND ADDRESSES OF NDVDUALS N THE U.S. WHO CAN VERFY TRAVEL FOREGN NATONAL ASSOCATONS: f you have no reportable foreign nafional associations, enter NONE. FULL NAME CTZENSHP DATE AND PLACE OF BRTH AGE ANQ SEX OCCUPATON NAME OF EMPLOYER AND ADDRESS DATE FRST MET DATE OF LAST CONTACT - FREQUENCY OF CONTACT NATURE OF RELATONSHP FOAM P86S NOV 98 (over) ~fproved for Release by 'JSA ~~. NSN ' S40 FM"OO1" FOA Case # 4287

277 DOCD: SUPPLEMENT TO FORM SF 86 (Continued) MMEDATE FAMLY: (ncludes mother, father, spouse, brothers, sisters. children, and any ather persan residing in your hausehold) S ANY MEMBER OF YOUR MMEOATE FAMLY EMPLOYED BY OR OHiERWtSE AFFLATED WTH A FOREGN BUSNESS OR FOREGN GOVERNMENT AGENCY? (Jf YES, explam, f NO, enter NONE.) ARE YOU OR ANY MEMBER OF YOUR MMEDATE FAMLY THE SUBJECT OF ANY LTGATON OR NVESTGATON, OR UNDER NDCTMENT BY ANY AGENCY OR DEPARTMENT Or THE UN1TF..D STATES, STATE. OR LOCAL GOVERNMENT? (f YES, explain f NO, enter NONE) ADDTONAL NFORMATON EMPLOYER OF FATHER EMPLOYER OF MOTHER EMPLOYER OF SPOUSE EMPLOYER'S AD:::JAES$ EMPLOYER'S ADDRESS EMPLOYER'S ADDRESS HAVE YOU EVER MADE OR 00 YOU PRESENTLY HAVE APPLCATON FOR ~MPLOVMENT PENDNG WTH ANY GOVERNMENT AGENCY? (f YES. grve agency, dats 0' appllca/io(j, and wherher accepted) have you EVER BEEN POLYGAAPHEO" (' Yes. list W!1en. where. by whom, and for wtlaf purpose.) NAME OF PERSON COMPLETNG FORM SOCAL SECUATY NUMBER SGNATURE DATE FORM pags NOV 98 - Reverse NSN 7540-FM

278 ...m_..._-.- ~--- DOCDitcuRla~1<~99:;;,':l1.-,- SUPPLY FURNTURE ORDER REQUEST ~L!~f.Ql3MATo.N, For PRCE, PART NUMBER, and F$N contact tho local Customer Service Center (esc) and/or call LL 11 on (301) 6e For ORDERNG, r.ubmrt completmj torm tor data entry to Organization on line poe, esc. or lorward to LL11, SAB 114. S4140. FAX (301) 68S For FURNTURE & FURNTlJRE RELATED TEMS ONLY, surxnillo LL11, SAB N1. SteEl' or call (301) or (H'na;1 n "FUANlr 4 For OE..tVSRY slati,ls, COntacllL 15, Deliveries, on (410) or (410) MUST be approved by your BUdi)el Control Officer NON-SECURE PHONE-- M (lncl~rjt Aida Code) DATE (Reqves1ed)YYY'MMDO) (A.,,,,,,,, ('YYYMMOO, 8EQUESTER'SNAME (L~fil) _... Federal Stock Number Oty Unit 01 Cost Per tem Name (FSN R., ssue Unit Total Cosl em! Cooler LL USEONLV Code! Budgel aly aly Fundoo Org DOCWTlell1 Number C"" RelellSe(l BacKordered (H;Od.1y5),..._.. REMARKS PRNTEO NAME ORO Budget Control Officer hs~o~n~<"'~ua~e~ 'm~'~e~~yyy=y~m~m~o~o)'------~ (Mandatory) ORAND TOTAL $ FORM J3353 REV OCT 2001 (SU~ J3353 REVMAN 2J01 which i$ OOio/eftJ) SECLJRTY CLASSFCATON (if ilfly) pproved for Release by NSA 0,".16,2007 FOA Case # 4287

279 D~6G SHOAl illll' EDTON RERUN MATERAL REG NUMBER RECAN$TERED MATERAL ,~+---,----_.::..:..-~=~- NlTlALS ~OlTON AfG NUMBER NTALS...- _- _ _ _ ~-+--~-~ ' _.._ _-. FORM HUn ~E N AlJG 9a NSN' 7$4 FM.{J(Jj 5149 fpproved for Release by ~JSA ~~ FOl6c:;ase # 4287

280 :DOC :J;:Dsicu"~~ai,~~R~lc-N- TASK ORDER PAGE NO. OF...,""'E"'o.,.""'E"'sT,..E_" _o_ff_c_e _P_H_O_NE _ REMARKS PACK/SHP TO; REFERENCE MSGNO. EFR NO. OPREO DATE PFlOFlTY CORE 1OEL BV DATE P OR T MATERAL (Admin Pouches ONLY) PROJECT TEM NO. OTV Ull CLASS TEM NAME DESCRPTON NDEX NUMBER SERAL N NSN DNUMBER mmm,_. ---!Approved for Release by NSA o~ FOA Case # m._. HEADOUARTERS USE ONLY M. PC. CU. RECEVED BY DATE..- TASK ORDER NUMSER DATE SHPPED POUCH NUMSER..._- FORM J3860 REV NOV 93 (Supersede' J3860 REV FE8 89 which" ob,o'.'ej NSN 7540-FM _- ~'TYCLASSFCAT'ON

281 ...h... DOClD: SECURTY CLASSFCATON TASK ORDER (Continuation) PAGE NO OF TEM QTY Uti CLASS TEM NAME DESCRPTON NDEX NUMBER SERAUNSN DNUMBER NO. - _.. _om...- -_._. ".h _.._~.. -- REGSTRY CONTROL NUMBER DATE SHPPED POUCH NUMBER FORM J3860A REV NOV 93 (Supersed J3860A REV FES 92 which" ob,oete) NSN 7540FMOO' 5356 '~pproved for Release by NSJ, ~~ FOA Case # 4287 CLASSifiCATON

282 mm" '" DOCD: SECURTY CLASSifiCATON PriVACY Act Statement: Al.lthorlty1or collecting tm requested nformation s con,alned n 50 U.S.C. 4021W1l. N5A's Blanket Routine use. found 1158 Fed. Reg. 10,531 (1993) and *petirlc use. foul'd in GNSA09 and GNSA12: agply 10 this ntermallon. Authority 'or requltllng your Social security Numb&r 18 Ex.ecutlv.t rdet The information you provide will be u,ed (primerily) to.ssist n the lelectlon and appl'oy8l procell for perticlpmlon n ttle Technical i'rat;:k Progntm. Failure to furnish r.que_ted nformallon, other then your SSN. may ""ault n the delay or deni.l of ttle appifclltlon Co me Technlc.lTrack Program. TECHNCAL TRACK PROGRAM REVEW DATE NAME (LAST) (tlrstj (M) SO SSN ORGANZATON O APPLCATON BULDNG D PERODC REVEW NON-SECURE PHONE CAREER FELD secure PHONE REFERENCE CRTERA FOR WHCH YOU ARE APPLYNG, LST CATEGORES, SU8CATEGORES, AND ASSOCATED ACTlYTES FROM THE CRTERA OFTHE CAREER FELD FOR WtllC1 YOU ARE APPLYNG. MAKE CROSS-REFERENCE TO ANY "nached DOCUMENTATON, E.G. NTERNAL STAFFNG RESJME. PERSONNEL SUMMARY, ETC. (Use addlrlonal sheet it nece$s8ry), the employee l certify the above "EMPLOYEE SGNATURE information ;$ true and accurate., the supervisor. certify the employee is SUPERVSOR SGNATURE w currently fictive in skill field., the career panel, verwed cerlifk:ation and aspirant CAREER PANEL SGNATURE status has been entered in M204. '_m _. TECHNCAL TRACK REVEW PANEL USE ONLY - ti: Q CAREER PANEL USE ONLY TTRP level ASSGNED M204 DATABASE LEVEL ENtEREO DATE PERODC REVEW DUE -nrp"charman SGNATURE COMMENTS COMMENTS THA9 APPROVAL (Master Only) OATE FORM P6770 REV MAR 2001 (Sypersecles P6770 OCT 93 which s obsolete) SECURTY CLASSFCATON!Approved for Release by NSA ~j FOA Case #4287

283 DOClD: r , TELEPHONE DALY LOG NOTCE AJ.J. calls M.llHbe recorded below. VEHCLE TAG PHONe NUM6EA PURPOSE OF CALL TME 0 z" '" ~ ~ ;;/ w DATE :> USER l: 0 0 " 1\ is >= (J ::> l: '" z " 0 STAAT ENO i!; a: ~ i!' ~ ~ " FORM K41 07 REV MAR 98 (Supersedes K4107 REV FEB 97 w'lich s obsoleto) NSN 7540-FM ~--~---~ ~------~ SZE; 5 112" X 8-112" pproved for Release by NSA FOA Ca5e#4287

284 DOCD: r----~ ~ , TELEPHONE DALY LOG NOTCE AlJ, calls MW be recorded below. VEHCLE rag DATE (:J z () " PURPOSE OF CALL TME (:J z 0 ;;!, w (5 USER ;;!, il: 0 z 8 START END it ~ '" 0 w "- :;; 0 :> 0 " i3 g >= ::J?; 0: W L FOAM K4107 REV MAR 98 Reverse NSN 7540 FM _ ~ SZE: 5 1/2" X 8 112"

285 DOCD: TEMPORARY QUARTERS SUBSSTENCE EXPENSE (TQSE) (Supplement to DD Form ) COMPLETE REVERSE SlOE ANO ATTACH RECEPTS PRVACY ACT STATEMENT: AUlllOrily tor collecting nformation requested on this torm s conta.ined in SO U.S,C. 402 QQ1e; 5 U.S.C, 5923: and Executive Order NSA's Sianket Routine uses found at 58 Fed.Reg (1993) and the specific uses found in GN$AOB and GN$AQ9 apply to this information. Authority tor requesting your Social Security Number is Executive Order 9397, nformation you provide will be used to verily your claim for reimbursement of expenses associated with temporary quarters lodging. DisclOSUre of requested information" including your SSN, S loluntary. However, falure to lurnish requested ulformation, other than your SSN, may prevent AQency from processing your request for reimbursement t you decline to provide YOLlr SSN, there may be a delay in processing your request tor reimbursement. NOTE: rose reimburses you for tne cosls actually incurred (up to a maximum amount) while your family occupies temporary quarters, because of a permanent change of station to a new station within the United States or i16 territories, f you are entering temporary quarters prior to departure from your old duty station you must vacate your permanent quarters prior to enle/ring temporary quarters, Further, there must be a compelling reason for leaving permanent quarters, i.e., YOllr household goods have been picked up. f you are in temporary quarters preparatory to entering your permanent quarters, you are expoc:ted to move into your permanent quartors, at the earliest practicable time. E:xpenses incident to rase which may be reimbursed include: a. Lodging (For you and your family. Receipts rsquired,) b. Laundry and Dry Cleaning (A/tactl recaipls and itemize coin operated (aundry expenses.) c. Groceries (Purchased to prepare meals n your temporary quarters.) Receipts required tor purchases exceeding $ d. Meals Eaten at Restaurants (Each meal must be itemized.) Receipts required for restaurant bills exce6ding $75,00. e. Non Commercial Quarters (Living quarters, usually owned by 8 relative or frfend. not normally rented. Expenses limited to costs actually incurred by the flost as a result ofyour stay. Attach Form F8550A) A routine function of voucher examination is the review of expenses for reasonableness. Each expense stands alone, i.e" a dinner. Even if tile total day's expenses are lower than the maximum daily allowance, an individual expense may be considered unreasonably high, and adjusted downward based on appropriate considerations, NAME (last) (FRST! (M) OLD STATON DATE VACATED (YYYY.MM OD) PERMANENT RESDeNCE 1-:-:---: (AddreSs) NEW STATON DATE OCCl,JPED (YYYY-MM DD) DATE (picked tlp 011 old residence) (YYYY MM DO) HOUSEHOLD GOODS (delivered to new residence) (YYYY-MM-DD) LST TEMPORARY OUARTERS OCCUPED (f employee and all dependants fisted on the trsvel order did not stay in the listed querters, please list the names of those hat stayed 131 each establishment. f a/1 family members stayed at the establishment, write "ALL")_ ESTABLSHMENT AND ADDRESS NAMES OF OCCUPANTS NCLUSVE OATES (YYYY-MM DD) FROM TO FORM REV MAR 2001 (Supersedes FB550St REVJUL 98 which is obsolete) NSN 754o-FM OO,.,748 (over) pproved for Release by NSA FOA Case#4287

286 (wt1iinued) DAY DATE ROOM (Receipts reqwred) GROCERES LAUNDRY AND MEALS (plus tips) (ReceipfS requiredfor OTHER (specify) CON LAUNDRY DRy CLEANNG (Receipts required for meals OVER $75.00) purctlases OYER $75(0) {Receipts required) BREAKFAST LUNCH DNNER DALY TOTAL , i 'Ot' 24 o ~ "30 ::: TOTALS UoRM F855OS1 REV MAR 2001 Reverse OsN: 7540-FM-Q Q

287 _hm..- DOCD: TESTNG SCHEDULE,,,, --..._...., mm.."'_' NAME ORO SSN ATTERY \ ROOM ldate rim!;. y CV/ TE$T! FORM SERAL LANGUAGE ML' RETEST USED NUMBEFt NAME OM! ----,,.-,, ~... " "..._---_.--. -_.. " - " " 15 " "._. " <J " " " pproved for Release by NSA o~. "...- " FORM E28itS REv DEC; 83 (Supersedes E2826 REV FEB 70 which S DbsQle'e) NSN: 7540-FM.( b FOA Case #4287~

288 mm..._. DOCD: THNGS TO DO TODAY OATE~m COMPL.fTED YES NO _~.."m_m~ FORM A5083 NOV 82 NSN: 7540 FM pproved for Release by 1\151<, FOA Case # 4287

289 OOClO: FORWARD COMPLETED FORM TO: DF22 (Payroll) TME AND ATTENDANCE AUTHORZATON FOR CERTFCATON OF SGNATURE (REFERENCE: PMM Chapter 360-2) Privacy Act Statemenl: Authority for collecting information requested on this form is contained in 50 U.S.C. 402 Wlll: 10 U.S.C ; and Executive Order NSA's Blanket Routine Uses found at 58 Fed. Reg. 10,531 (1993) and the specific uses found in GNSA08 apply to this information. Authority for requesting your Social Security Number is Executive Order nformation you provide will be used (primarily) to identify individuals authorized to certify Time and Attendance Cards. Disclosure of requested nformation, including your SSN, is voluntary. However, failure to furnish requested information, other than your SSN, may affect Agency's grant of authority to certify Time and Attendance Cards. 55N NAME (Last, Firsf, Middle) EFFECTVE DATE (Year. Month. Day; 'SGNATURE THE NDVDUAL WHOSE SGNATURE APPEARS HEREON S: S a supervisor and may carlily T/A cards for the assigned and any subordinate organizations. T authorized to certify selected T/A cards. Documentation has been submitted to Payroll. ASSGNEO ORG GRADE OF APPLlC'ANT OUTSDE PHONE NO. APPROVNG OFFCER'S NAME APPROVNG OFFCER'S TTLE APPROVNG OFFCER'S SGNATURE APPROVNG OFFCER'S ORGANZATON FORM P1434 Rev SEr 2000 (SlJPefsed9s P434 REV FEB 99 which is obsolete) pproved for Release by NSA FOA Case # 4287

290 ' DOCD: TMESHEET FORMAT 1 SSN NAME PLTROT PEROD SEQ # Bt'KioRP ACT UC OST (OrQ) SFT ROT ENDNG (Agency) STDJON HOURS OF WORK (From) A WS SUN MON TUE WED THU FA SAT SUN MON TUE WED THU FA SAT TOUR,,,, TYPE/SHFT GRADED,,,,, NTe DFF,,, WEEK DAY 'TYPE START HOUR HOURS JOB ORDER NUMBER n~"".w,~ 1~ ~11E FF TME,,,,, {ToJ NT ,,, ur u,,,,,, REol OT COMP CR:?:DT HOL SUN 12ND 3RD NO EiH LV NP!LV WEEK WEEK 2 'T!"H",;rc~ (AOOilio,...,1 ~&8 ate avlj~bl9in h$ N OUT N OUT N OUT N OUT lime eper manu ) AG.. Regular, GS SUN RF. Regular,, st Shift AS. Regular, 2nd Shift - AT.... Aegular, 3rd Shift MON, OS.... Overtime, SCheduled OU. Overtime, UnSCheduled rue LA. Annual LeaWl OC Overtime. Callback LH. Holiday Leave WED LS. Sick Leave CC. Comp Time Callback THU LN. Administrative Other LC., Court leave CE. CT.. Comp Time Earned comp Time Taken FR LM,, Military Leave CD,... Credit Hours Earned CN.., Credit Hours Taken SAT KA" Lealie WithOU1 Pay CERTFCATON' Attendances and absences certified correct Overtime REMARKS approved in accordance with existing laws and regulations For non-exempt FLSA, did no! suffer or permit any overtime work other than as reported lor this pay period AUTHORZED SGNATURE PHONE (Secure) (Non Securel FORM P3091A MAA 96 NSN 7540 FM Supersedes P3091A JAN 96 which is obsolete pproved for Release by NSA FOA Case #4287

291 DOCD: TMESHEET FORMAT 2 SSN NAME PLT ROT PEROD SEQ. BLK/GRP ACT UC 015T (Orgl SFrROr ENDNG (Agency) STD JON TOUR YPE:/SHFT "- HOUAS OF WOAK (From) A Ws SUN MON TUE WED THU FA SAT SUN MON TUE WED THU FR SAT,, (To),, GRADED NTE DFF,,,,,, :,, Joe ORDER NUMBER 'T~~f HO A WEEK SUN MON TUE WED THU FA SAT NT 1,,, 2,,,,, 1,,,,, 2,, 1,,,,, 2,,,,, 1,,,,,, 2,,,,., 1,,, 2,,, 1,,,,,, 2,,,,, AEG Ol COMP/ HOL SUN 12ND 3AD NO ElH LV NPlV CREDT N WEEK 1 WEEK 2 'TypeHoorC~ (AddlliOflS <':=$ Bra able n the OUT N OUT N OUT N OUT li!l"4l efl:p$ll'l'\llnwal) RG., Regutar, <as SUN AF, Regular, 1s1 Shift RS Regular, 2nd Shift AT. Regular, 3rd Shift MON OS Overtime, Scheduled OU OvertirM. UnsCheduled OC...,. Overtime, callback TUE LA,,. Annual Leave LH... HOlidaY Leave WED LS,. Sick Leave CC. Comp Tme Callback CE Comp Time Earned THU CT. Comp Time Taken LN Administrative Other LC. Court Leave FA LM. Military Leave CD.,,,Credit Hours Earned en Credit Hours lallen SAT KA. Leave Without Pay CERTFCATON Attendances and absences certified correct OverUme REMARKS approved in accordance with ell;sting laws and regulations For non-exempt FL$A, did flot suffer or perlt'll! any overtime work other than as reported for this pay penod. AUTHORZED SGNATURE PHONE (Securo) (Non Secu,.) FORM P309, B MAR 96 NSN, 7540 FM Si,JperSedes P3091 B JAN 96 wllich is obsolete pproved for Release by NSA FOA Case # 4287

292 'hmmm.._ DOClD: SECURTV CLASSFCATON TRANSFER OF ACCOUNTABLE EQUPMENT OOCUMENT FROM DOCUMENT TO Use this form whenever NSA D'ed equipment is transferred from one organization to another or when a reorganization has occurred. 1. Complete all blocks. 2. The preparer musl provide a copy of this form (to include the signature 01 both the preparer and receiver) to the appropriate PO. 3 The PO will make he necessary changes fa the Property Database unless the transfer is between UCs, then a copy must be provided to the PAO for changes to be made to the Properly Database. FROM: ORG ROOM SECURE PHONE PRNTED NAME SGNATURE DATE TO: ORe: ROOM SECURE PHONE PRNTED NAME SGNATURE DATE ACCEPTNG PROPERTY OFFCEA SGNATURE DATE _... NSAD# NOUN NAME MODEL NUMBER SERAL _m _.._. FORM J6576 REV OCT 2001 (Supersedes J6576 REV JUN 200' which is ObSOlete) SECURTY CLASSFCATlON COPY DESGNATON: ~fpw,ed for Release by' NSA 0 ORGNAL PO/PAO: COpy Customer FOA Case #4287

293 DOClD: SECURTY CLASSFCATON TRANSMTTAL OF MATERAL 2. Acknowledge receipt ofthis material by executing and returning the below receipt This transmittal may be downgraded to n This transmittal may be det:,:l5sified upon removal of the NSTRUCTONS ON REVERSE!! upon removal of the enclosure(s) 3, TO 4, FROM (Retum Address) 5, CONTROL NUMBER 6. PREPARATON DATE DeS ACCOUNT NUMBER OU 0 s Do DYES o NO ~ ~- 9, NUMBER OF PACKAGES 10. COMSEC 7. WRAPPED 8, FORM A1295A ENCLOSED REMARKS 0 YES o NO 11. TEM NO. COpy OR CLASS. OF TEM SERAL NO. UNCLASSFED TTLE! DESCRPTON OF TEM (.bo'ovi.loo) 12. JUSTFCATON (For Specal Hafldlltlg) 13 PREPARED BY (Typed Name) ($ignotv",) 1'4.0RG. 1'5. PHONE FORM A1295A REV MAY 2000 (Supersedo, A129M REV DEC 94 which wifl be used unui depleted) 1. SECURTY CLASSFCATON N$N; 7540 FM DO NOT STAMP RECEPT PORTON WTH CLASSFCATON RECEPT RETURN TO FROM (Please sign and return immediately. Avoid tracer action) Receipt is hereby acknowledged for the material or documents listed under this control number, CONTROL NUMBER DATE RECEVED NAME (Typed Of Ptirlted) SGNATURE 'ORM A1295A REV MAY 2000 (Supersedes A1295A REV DEC 94 which will be used unl# depleted) ~SN: 7540 FM pproved for Release by NSA FOA Case # 4287

294 DOCD: NSTRUCTONS UNWRAPPEP Material, Form A1295A, must be prepared in triplicate by the originator of any unwrapped classified correspondence. (one to be retained by the originator and two copies are to be forwarded with material.) PREWRAPPED Material, Form A1295A, must be prepared in triplicate by the originator of any prewrapped classified correspondence. (one to be retained by the originator, one to be included in the first wrap and one attached to the material.) 1. The classification will be stamped at the lim and Bottom of the transmittal portion of the form in the appropriate block. Codewords and Caveats wjl! never appear on the transmittal. When the material is SC, the transmittal must be stamped with "Appended Documents Contain Sensitive Compartmented nformation." 2. The transmittal downgradel declassify block must be marl<ed. 3. 'To" Block - Type complete address for Mailing Type complete nner and.q.u1iir address for Q.Q!2. 4. "From" - Type complete return address. 5. Add your office control number (all classified material MJ.lH have a control number.) 6. The date the form was prepared. 7. Wrapped: U - Unwrapped S - Single wrapped D - Double wrapped 8. A1295A enclosed: Y-for Yes; N-for No (all classified material MJ.lH have an 1295A enclosed.) 9. Number of packages being sent (not the number ofitems listed on A 1295A.) 10. Comsec: Y-for Yes; N-for No 11. Give an unclassified description of material to include a page count/number of copies. Abbreviate the classification in the Class. of tem column. 12. Need specific details for anything other then routine mailing, i.e., Such as date & reason required by recipient for delivery via Express Mail (all Express Mail must be wrapped by the originator). 13, Type name of individual preparing form and sign using a ballpoint pen. 14. & 15. Type in your organization and secure or non-secure phone number. 16. Receipt portion: Return to, From and Control number Ut be completed.

295 DOCD: SECURTY CLASSFCATON TRANSMTAL OF MATERAL F receipt of 1hiS material by executing and returning the below receipt. This transmittal may be downgraded 10 This lransminal may be declassified upon removal of the enclosure(s). upon removal 01 the enclo5ure(s). TO CONTROL NUMBER PREPARATON DATE WRAPPED FORM A1295B ENCLOSED Ou Os OD DYES o NO FAOM NUMBER OF PACKAGES COMSEC DCSACCOUNTNUM8EA n YES n NO TEM NO. COpy OR SERAL NO. UNCLASSFED TTLE DESCRPTON OF TEM CLASS. OF TEM (abbreviated) JUSTFCATiON (ForSpec8HandJmg) PREPARED BY (TYped Name) ORG. PHONE FORM A12958 MAY 97 ENGRAFT NSN: 7540 FM OOt 56D3 SECURTY CLASSFCATON DO NOT STAMP RECEPT PORTON WTH CLASSFCATON RECEPT RETURN ro (Please sign and return mmediately. Avoid trace,action) Receipt is hereby acknowledged for the material or doouments listed under this contrq number. SGNATURE NAME (Typed or Printed) --=::::-:-~~~~~~~~~~~~~~~~-l FROM DATE RECEVED CONTROL NUM8ER 'ORM Al295B MAY 97. ENGRAFT ~SN: 7540 FM pproved for Release by NSA FOA Case #4287

296 nnl"'ttl. ~""""7,. SECURTY CLASSFCATON 2. SHPMENT NO TRANSMTTAL RECORD For lise of ths form, see AA25 50; the proponent agency is ODSC4 3 lltl8fle DENTFCATON 4, AS OF DATE 5. SHPMENT DATE YEAR MONTH DAY YEAR MONTH DAY AUTHORTY FOR SHPMENT 7 NUMBER OF RECORDS TRANSMTTED 8 PERSON TO CONTACT (Name and telephone) 9. REQUREMENT CONTROl SYMBOL (AR ). 10. rype or Media Transmitted Hard Copy Punched Cards Cassetles Microfilm Ptlolo Fiche 11 NUMBER OF BOXES/PACKAGES 12 NUMBER OF TEMS 13. Method of Shipment Courier First Class Parcel Post Express Mail Registered f-_ SHPPED to 15 SHPPED FROM 0 Return Reeeipt Aequuted (When box is checked, sign below and rerum copy to sender) 14a TYPED NAME AND nru:; OF RECEiVER lsa. TYPED NAME AND TTLE OR SENDER 14b SGNATURE OF RECEVER AND DATE 15b. SGNATURE OF SENDER 16 SPECAL NSTRUCTONS -_.._-----_...,--_. 17 TYPE COMPONENT USED (for magnetically recorrjed datb) '8 REMARKS DA FORM 200, APR 83 EDTON OF FEB 78 WLL BE USED UNTL EXHAUSTED NSA Framemaker Y 1,00

297 DOCD: TRAVEL MEDCNE FLOW CHART MEDCNES Chloroquine / / / / / / / / / Diamox / / / / / /'/' / / Doxycycline /'/'/'/' / / / / / Floxin / / / / / / / / -;7 modlum 1/ / / / / / / / / Metloquine / / 1/ / / / / /' / / /' / / /' / 1//'7 / /' / / 1/ / / / /' Dengue Fever Diarrhea Embassy Check-n Exercises High Altitude NSTRUCTON Jet Lag JEV Malaria Rabie. STO/ADS Tick -- DECLNED Pregnancy REASONS Breast Feeding Time Constraint Other A.. LERGES pproved for Release by \lsa FOA Case # 4287 NAME FORM P6626 REV AUG 2000 (SUpersedBS P6626 OCT 92 wnich is obsolete)

298 DOCD: BUR.AU NUMBER D.o. VOUCHER NO. TRAVEL VOUCHER. PAYMENT FOR PAD BY 1. ADVANCE OF TRAVEL ALLOWANCES (TD'/TA.V) 6, fransport4ton OF OEPENDENTS 2. ADVANCE OF TRAVEL ALLOWANces (pes) 7. DSLOCATON ALLOWANCE 3. ACCURED PER DEM FOR TOVfTAO e. TRALER ALLOWANCE 4. SETLEMENT OF TOV/TAD TRAVEL 9, 5, SETLEMENT OF pes TFAVEL 10,. NDVDUAL PAYMENT 1. PAYEE (las Name, Firsl, Middle nlfild) 12. RANK OR GRADE 3. 'SERVCE NUMBER 4. ORGANZATON AND STAtiON 5. TRAVEL ORDER 6, ADVANCE OF TRAVEL ALLOWANCES ELECTED BY ABOVe NAMED MEMBER AS FOLLOWS: 7. CHECK NUMBER rcheck DATE 9, AMOUNT PAD 110. DATE PAD j 11. RECEVED N CASH (Signlllllrto/p«yt:r). PAYMENTS CONSOLDATED 1, PER SUBVQUCHER NO, THROUGH ATTACHED. 2. PEA TRAVEL ALLOWANCE PAYMENT LSTS ATTACHED. V. APPROVED FOR PAYMENT (U'h/! rnjuirtti by iruhl'idunl sl!rvir:e Tllgu/nfirNrs) 1, TYPED NAME AND TTLE 12. SGNATURE V. REMARKS V. ACCOUNTNG CLASSACATO(S) $ COMPUTED BY AUDTED BY POSTED TO TVL RECORD BY DATE ENTERED AMOUNT PAD FORM DO 1 JUL6S1351 FORM APPROVED BY COMPTROLLER GENERAL. U,S, 2 JUN. 1965

299 D. -:1111::')-:11 TRAVEL VOUCHER OR SUBVOUCHERAll8d P,;,,,y Ad Sral.m",r, p""nys"""",or, andln"rud.osonp'ck00"" """""'i1gtomt U8CypeWlitet,," ()( bajl pol/lf pelt PRESS HARD DO NOT use pencil. f mote $pce 1$ nettij4jd, COlllmie n Remar*6, 1, PA'{MENT REOURED ey (X orre-) 2. TYPE OF as apphcabl$) 3. FOR 0.0. USE ONLY TDYTAO PAYMn =l CASH CHECK H pes a. D.O. VOUCHER NUMBER Memberl ELECTRONC FUND TRANSFER OTHER EmnK)v-ee r10cpc11clel1t\s) DLA NArliH: (..as, rsl, Middle 'Mum nfl! or type) 15 GRADE 6. SSN b, SUBVQUGHER NUMBER 7 ADDAESS a. NUMBEA AND" "0"' lb. CTy c. STATE d, ZP CODE c, PADSY t TELEPHO~ENUMBER (fl1clvdb 9. TRAVEL ORDER NUMBER 10 PAEVOUS PAYMENTS ADVANCES Area Code) 11 ORGANZATON AND STATON 12 DEPENDENT(S) (X ;md complete as applicable) 13, DEPENDENT'S ADDRESS ON RECEPT OF ACCOMPANED UNACCOMPANED ORDERS (nclude Zip Code) a NAME (LdS, First, Middle nitial) b RELATONSHP c. 1lA'/j.ll\"Ff/i'Gl"._om. rxono) lye. NO (Explain in RemW) 15 TNERARY a DATE - b LOCAL c PLACE, NUMBER OF ~EALS TME (24 (Home, RE:SON 19 - Office, Base. Act,...ily, City and.rdr~f 9 hour) State; City and Country, CC.) FOR STOP (1) TAVEL 12) Gov't POC Oed DEP (ER-O) (a-l-ol MLES AA" DEP ARR ',,,,, OEP,."",,rj; ARR DEP.."" ARA DEP AAA DEP " d. COMPUTATONS ARR OEP ", " e SUMMARY OF PAYMENT ARR (1) Per Oiem DEP (2) Aclual EJ:pense A1owMCe ARR (3) Mileage 16 REMBURSABLE EXPENSES 17 LEAVE (4) Department Travel it DAn: b. NATuRE OF EXPENSE c AMOUNT d ALL.OWED a. DAYS b. HOURS (51 OLA c. AKEN "'"' '00" (7) Total \8. poe TRAVEL X Otle) OWN! OPERA.TE PASSENGER " 'A\ffii3~~~ToNiMtA\ 20, LONG DSTANCE TELEPHONE CALLS ARE CERTFED AS NECESSARY N THE NTEREST OF THE GOVERNMENT APPROVNG OFFCER (31 USC 1348(b») (6) ReimbUrsable &:ptl'5e8 (8) Less Advance d AND (9) Amount Owed 101 Amount Due A 10NAEQUEST (GTR MUTARY TR.NSPOOTATON a GlR! MTA NO, b. FAOM c. TO 21.a CLAMANT SGNATURE b DAT; APPROVNG OFFCER SGNATURE b. DATE 23 ACCUUNNG CLASSFCATQN 2' wllol"undata 2.5 COMPUTED BV 126. AUDTED BY r7. TRAVEL ORDER,28. RECEiVED (Payee Signature and Date or Check No.) 129. AMOUNT PAD POSTED By 00 Form , OCT 91 Replaces prev/ousedrtrdns of DO Form and 00 Fonn , whch maybe used. Exception to SF 1012 approved by GSAJ RMS

300 DO'~;J;)..;-.j..;':l',.'.-5-: c::'.,~'':l:i.j.- ' , PRVACY ACT STATEMENT AUTHORTY: 5 USC 5701,37 USC , and E , PRNCPAL PURPOSE(S): ROUTNE USE(S): DSCLOSURE: Used for reviewing. approving. accounting and disbursing for official travel. SSN is used to maintain a numerical identification system for individual olaims. To substantiate claims for reimbursement for official travel. Voluntary; however, failure to furnish information requested may result in total or panial denial of amount claimed. PENALTY STATEMENT There are severe criminal and civil penaltjes for knowingly submitting a false, fictitious or fraudulent claim (U.S, Code, Title 18. Sections 287 and 1001 and Title 31, Section 3729). NSTRUCTONS REOURED ATTACHMENTS " Original an(vor legible copies of all travel orders and amendments, as applicable, 2, Two copies of dependenllravel authorization if issued. 3. Copi~s of secretarial approval of trttvel jj claim concerns parents who either did not reside in your household before their lravel and/or will not reside in your household after travel, 4, Copy of GTR or ticket used. 5 Hotel/molel receipts and any item 01 e>:pense claimed in access 01 $ , Other attachments will be as directed. DEDUCTBLE MEALS Meals consumed by a member/employee when furnished with or without charge incident to an olficial assignment by sources other than a governmont mess (see JFTR, Vol. 1 App. A and JTR, Vol. 2 App. 0 lor definition of deductble meals), Meals furnished on commercial aircraft or by private individuals are no] considered dedl.jclible meals. TEM 15. TNfRARY SYMBOLS 15d. Means/Mode of travel (Use two letters) tse. GTRKT T AutolTlQbile A Government Transportation. G Motorcycle M COmmercial Transportation. C Bus B (Own expense) Plane P Privately Owned CQnveyance Rail R (POC! P vessel v Reason lor Stop Awaiting Transportabon Leave En Route Mission Complete Authorized Delay Temporary Duty 15t. Number of Meals AT LV MC AD TO Breaklast 8 Lunch L Dinner REMARKS DD Form , oct 91 (Back)

301 D. ':1,r:::.,':" TRAVEL VOUCHER OR SUBVOUCHER 4. NAME (Last. First, Middle nitial) (Print or type) (Continuation Sheet) PAGE OF PAGES 15. TNERARY 3. FOR D.O. USE ONLY a DATE 0_ LOCAL c PLACE d t NuMBER OF MEALS, lime 124 (Home. Olfioo, Base. Activity. Cily dlld ~~~~ REASON hp~'r) Sliml," Gill' am;! Coumry. Ellc.) FOR STOP (1) (2) POC. " --_._-... """', Dod MLE.$ DEP (E.\-L-O) (9,"-0) A"R DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR DEP ARR 16. REMBURSABLE EXPENSES.. _"m._.m a. DATE b. NATURE OF EXPENSE c. AMOUNT d ALLOWED 19. GOVERNMENT TRANSPORTATON REQUEST (GTR) MLTARY TRANSPORTATON AUTHORZATON (MTA) a. GTR MTA NO b. FROM c. TO 30, REMARKS 00 Form C, OCT 91 Exceplion to SF 1012A approved by GSNlRMS Previous edition may be used. NSA FRAMEMAKER1~7

302 DOClD: SECURTY CLASSFCATON TSEC NOMENCLATURE REQUEST TO Y13 THAU 1412,DDVCAO , Short Title: a. Descriptive Digraph or Trigraph b. tem Number c. Modei Designator if applicable (X. V, E, P, N) Long Title and Classificotion, Le., (TS), (5), (C), (U) Classification of item (TS, 5, C, U) Speciai Markings, e.g" ec 5. Accounting Legend: ALC l: Continuous Accountability by Serial Number within the CMCS ALC 2: Continuous Accountability by Quality within the CMCS ALC 4: nitial receipt required; May be controlled in accordonce with Service or Agency Directives., 1, SHORT TTLE A B C - 2. LONG TTLE 3, CLASSF 4. SPECAL 5, ACCTG CATON MARKNGS LEGEND SGNATURE DATE SGNATURE (1412) DATE REMARKS: Further information regarding this action may ba obtained from t is requested that 1412 and DD/CAO complete applicable portions of this form and forward it 10 Y13 for processing, _ REMARKS ( DDt/CAO) TO FROM' DATE SGNATuRE COPES FURNSHED NOMENCLATURE S ASSGNED AS REQUESTED ABOVE WTH THE FallOWNG EXCEPTONS: ~fproved for Release by NSA ~~ FOA Case # 4287 FOAM L3690 REV AUG 2000 (Supersedes LJ690 FEB 97 which is obsolete) (over) SECURTY CLASSFCATON

303 DOCD: (continuf/d) SUBJECT _... SHORT TTLE A B C 2. LONG TTLE 3. CLASSF- 4. SPECAL 5. ACCTCl. CATON MARKNGS LEGEND.._ FORM L3690 REV AUG 2000 Rev.,.. SECURTY CLASSFCATON

304 DOCD: TURN-N/EXCESS EQUPMENT REQUEST FOR EXCESS C'TER USE f:i.:j:f. DATE' AS$G'ECJ (YYYYMMDO) WAREHOUSE locat10n(s OSf>OSTON DOCUMENT NO ~..!NFQRMATON 1 For disposal 01 COMSEC equipm~nl, contact your COMBEe Cl..stod~n. :3 ALL. lorms must be submined through your PAO Of designee 2, Abb lieldsmy.s! be filled;"', Mark 'NA" j1 not applicable DATE OF REoueST (1"YYYMMDO) TRANSFER DOCUMENl NUMBER 4. 'Specillily designal&d or mo(jified hems that require oestruetior'l Mark.y. on all items that roquire delllructlocl Ul>6 comment section tor $peclll1 security requrements. F'ROPEi=lTY ADMNSTRATiON OFFiCER SGN"TUAE (PAO) FROM: NAME ORGANZATON ROOM NUMBER BULONG PHONt'. (Secure) (Non-Sec"$ wilf! Area Coda) COMMENTS --l L "- -- CONO COOE BREF DESCRPTON EXPANDED DEFlNmON A Serviceable Properly that is usable and will be advertised for reutililalion, F Unserviceable/Repairable Property lt1at is not usable without repairs and will no! be adlffirtised lor reutilizalion. HX Salvage (SC(li/P, unrepbimbie Property has some value in excess of its basic content bul rape'lf or rehab'ulalion to use for original ntended purpose is clearly impractical. Repair for _... equipment) any use would exceed % of the original acquisition cost. HS Scrap Material Malerial hss no value except for its basic material content (1.9., scrap mqtal, cables, etc.). PU NUMBER NOMENCLATURE (Des<:ription) NUMBER 'OESTR COND COST MANUFACTl,JF1l';R LNE BARCOOE ~~ CODE QTY 1--- v N TEM TAG STOCK NUMBER MODEL SERAL V N UN" TOTAL FORM J2151 REV MAV 2001,Page 1 (Supersf!(J(Js J2151 RFVAPR 98 anj21slc APR 08 which lrtl oojole/ej - Tt1fs form conlains 5 sheets, A t!lhlmjhd. of four (4) continualion Sheels may be used. ~?proved for Release by NSA ~~ FOl/lCasA # 4287 SUBTOTAL (Pogo GAANDTOT~L (A" P1geS).!~7C:

305 TURN-NlEXCESS EQUPMENT REQUEST (Continuation Sheet) FROM NAME ORG TRANSFER DOCUMENT NO p/u NUMBER NOMENCLATURE (Description) NUMBER "DESTR COOD COST MANUFACTURER AEOD OTY UNE BARCODE CODE Y N STOCK NUMBER MODEL SERAL TEM TAG Y N UNT TOTAL i, ~~ ~~ ;~ ~ ~OAM J2151 REV YAy Page 2 This form contains 5 sheets. A maximum of four (4) continuation sheets may be used. 0 SUBTOTAL (Page 2) ~?i'..

306 TURN-N/EXCESS EQUPMENT REQUEST (Continuation Sheet) FROM NAME QRG TRANSFER DOCUMENT NO PU NUMBER NOMENCLATURE (Description) NUMBER DESTA COND COST MANUFACTURER REOD QTY CODE v N line BARCODE STOCK NUMBER MODEL SERJAl y N UNT TOTAL TEM TAG :, ~ ~ ~ ~ QORM J2151 REV MAY 200t - Page 3 This fotm contains 5 sheets. A maximum ot fout (4) SUBTOTAL....~~... - (Page 3) continuation sheets may be used. - 0

307 TURN-NlEXCESS EQUPMENT REQUEST (Continuation Sheet) FRQM- NAME OPG TRANSFER DOCUMENT NO, P/U NUMBER NOMENCLATURE (Description) NUMBER OESTR CQND COST MANUFACTURER REQD OTY CODE v N LNE BARCODE STOCK NUMBER MODEL SERAL Y N UNT TOTAL TEM TAG ~ ~ ~.. b ~MJ21S1 REV MAY2Q01-Page-4 This form contains 5 sheets. A maximum of four (4) t) continuation sheets may be used. o ~ SUBTOTAL (Page4) /ci'~.

308 TURN-N/EXCESS EQUPMENT REQUEST (Continuation Sheet) FROM NAME GRG TRANSfER DOCUMENT NO. ~DESTR P/U NUMBER NOMENCLATURE (Description) NUMBER COND COST MANUFACTURER REOD QW CODE y N UNE BARCODE STOCK NUMBER MODEL SERAL y N UNT TOTAL TEM TAG, ~.. :~ l~ i: i;j0rm J2151 REV MAY Page 5 This form contains 5 sheets, A maximum of four (4) continuation sheets may be used. 0 SUBTOTAL (Page 5) c

309 DOCD: TYPE 2 PRODUCT SPONSORSHP/KEY SERVCES REQUEST (Please Type or Print) Mail completed form to the address below and one copy to customer identified in Block..C~, National Security Agency ATTN: Vll, Suite Savage Road Fl. George G, Meedo, MD FOR NSA USE ONLY A. FEDERAL SPONSOR NFORMATON NAME DEPT AGENCY ALTERNATE ADDRESS TELEPHONE CTV/STATE/ZP o NEW SPONSORSHP COMMENTS/AUTHORZED LMTATONS MODFY PREVOUS NFORMATON B. TRANSACTON TYPE O ADDTONAL KEY SERVCES AUTHORZATON O RESCND SPONSORSHP COMPANY NAME ADDRESS C. SPONSORED COMPANY OR ENTTY P'o,c, ALTERNATE TELEPHONE CTY/STATE/ZP KND QF EQUPMENT leg., STU. 0$ 3. etc.} ORDER AND RECEVE D. CUSTOMER KEY ORDER/RECEPT AUTHORZATON (Additional space on reverse side) RECEVE l:tl.y NAME ORG, NAME ORG ADDRESS AODRESS CTY/STATE!ZP CTYSTATE/ZP NAME ORG NAMe DRG ADDRESS ADDRESS CTY/STATE/ZP CTY/STATE2P E. By signing this form, the U.S. Government Representative certifies that the above 8pon8ore<i U.S. entity mayacquire SGNATUR' Type 2 products to protect unclassified U.S. nformation. n addition, this signature certffles the' a Type 2 EUC Control Agreement is currently n effect between the sponsor and the custom.,;.~;,;' _ DATE FORM L5886 REV FEB 2000 (Supersedes LSB86 JUN 91 which is obsolete) NSN 7540 FM (over) pproved for Release bv NSA FOA Case #4287

310 mm. mmm.' DOCD: (continued) D. CUSTOMER KEY OROERRECEPT AUTHORZATON (continued) ORDER AND RECEVE RECEVE Qtlll NAME -pm., NAME ORG f:;hone ORG PHONE ADDRESS ADDRESS CTY:$TATE:ZP C,TYSTATEZP NAME th~!'>!jm~ NAME ORG PHONE ORG PHONE ADDRESS ADDRESS CTy/STATE/ZP CTV1$TATElZP,... NAME N~',~l4\~~ NAME ORG j PHONE ORG J PHONE ADDRESS ADDRESS CiTY:STATEiZP C1TYfSTATE/ZP NAME 1:,!~,,~.li~U NAME ORG PHONE ' ORG. PHONE ~ ADDRESS ADDRESS CTY/STATEiZP CTY/STATElZP NAME '!1iM;J/J JJfm NAME ORG jphone ORG. lphone ~ ADDRESS ADDRESS CTYiSTATE/ZP CTV/STATE/ZP NAME ~~~~~ ORG. 'PHONE ORG PHONE NAME ~ ADDRESS ADDRESS CTY:STATE/ZP CTYSTATEZP FORM csass REV FEB 2000 >Page 2 NSN 754Q-FM

311 ..._... _.._- U~-P ARE~D A7;: HE,- COMFLA1NT(S) 11M AGe 1 o FEMALE o MAL: W~F CURRENT MEDCATONS.,.- - "1i.; _... A~~ERGES OROERS TME SiGNATURE -,, VTAL SGNS ME = ':LS:::... ~:,1;::. -.~S::: ox: j ~,ol,tie~jt D 0 0 C;V ML Fi~,"lK DSFOS:TON NAME,F.'...C) FHCNii rcnfiii~7 v." o NO E;i,;H'(SC:A~ FfiOvCE~ Si\j;N,J,7'JFi: ANO 10 S7'~MF ~::G.! =:-;:::: MAY ::00 :";.:::.;~"..;C '.. 5i::-a rrg _FcNe (Heme) - (We,",,) '\pproved for Release by NSA or h FOA. Case # 42ST

312 DOCD: GFO BUREAU OF GOVERNMENT f'lnanc~ OPERATONS Stundaf"J Form No, '84 (Ro:., 8,$.41 P.o..trc.ed trv O"pl ot t,,, T,...,""' 1 TFAl.r\ 4_7000 " ~ '''(US Ed,\i:;{lU"~&"~,, UNAVALABLE CHECK CANCELLATON NSN 7540 <XHj25<f09 CK SYM, CK. SERAL CK AMOUNT CK, DATE AGYJPAYEE 10 NO L.NE CODE STOP CD AGENCY CODE P,A,Vf;E NAME FOR D, 0, USE o R~lJest prr:j(;6ssed Payment return9d and o cancel/tid by DO on ADDRESS o No payment issued o ncorrect/incompl9t9 SF 1J84 D. O. Aetivny NAME OF DECEDENT (Signature) 0, OF DEATH AMT. TO BE RECLAME:D AGY LOC CODE AGENCY OUTPUT AGENCY REFERENCE FOR AGENCY USE Agency (Signature) NSA - FrameMaker 5,0 August 1998 FORMS12E: 5 1/2")(8 1/2" SPECAL NSTRUCTONS COPy OSTRBllTON: ORGNAL Administrative: Agency Will Forward To BGFO Through Disbursing Office DSBURSNG OFFCE COPY DO. Retain This Copy For nlernal Use AGENCY RECEPT COPY DO Send This COpy To AgMCy AOMNSfRATlVE AGENCY COPY Agency Retain This Copy For nte-mal Use

313 DOCD: UNCLASSFED FURNTURE NSPECTON CERTFCATE NOTE: Remove and destroy this form when the furniture is reislued or released outside the Agency. NSTRUCTONS FOR RELEASNG ELEMENTS,. READ THORQUGHLY the detailed instructions affixed to the top 4. Sign this form. remove backng sheet and affix to the inside of the of this form label. f you need assistance, contact your Security desk pedestal or face of all otl1er furniture. Dates and signatures must be Coordinator. vlsibilij. 2, Combjnation safes must be reset to the manufacturer's setting (L 50 R 25 L 50) and be locked. 3, Key lockable containers must be Jocked wilh the key{s) taped under or inside drawer/door handles. 5. Pickup of furniture must be requested from the OS organization. This may be accomplished by either a-mail (moved;st@nsa)or by calling lj1e DS esc on /(301) Ensure all doors/drawers are locked or taped shut. Do not abandon n the hallway and do not continue to use. certify that the above instructions have been complied with. acknowledge that may be held responsible for Agency materials subsequently discovered in the furniture identified above. PRNTED NAME (SuperVSOr, Releasing Element) SGNATURE NON-SECURE PHONE DATE NSTRUCTONS FOR SECURTY REPRESENTATVE 1. nspect furniture thoroughly to ensure it contains no classified, 2. Sign in space provided below. official or Agency-related material. 3. Affix to furniture that will be released to OS. have inspected the furniture and certify that it contains no classified. official or Agency-related material. PRNTED NAME (Security Representative) SGNATURE ORG DATE 2, f any classified, official or Agency-related material is located. secure the material and notify the QUice of Facilities Security, ATTN; 541 or. f aller duly hours, the SSOC, (301) NSTRUCTONS FOR OS REPRESENTATVE 1 nspect furniture thoroughly. Remove and check under each 3, Sign in the space provided below. drawer. leaf or part which might conceal material. 4, Ensure that this form remains affixed to the furniture whhe in storage. 5, Remove this form when the furniture is reissued or released outside the AgenCy. have nspected the furniture and certify that it contains no classified, official oragency-relateri material. PRNTED NAME (OS Representative) SGNATURE ORG DATE FORM G6210 REV APR 98 (Supersedes G6210 REV OCT 92 Which is oosolete) NSN 7540,FM 001 t \ ~-~ CUT HERE CUT HERE CUT HERE SZE: 8-1/2" X 7-1/2" pprol/ed for Release by NSA FOA Case # 4287

314 nq.hd..as$1f.l!d 6QRNTURE NSPECTON CERTFCATE NSTRUCTONS Read all instructions carefully. After form has been completed, remove this top instruction sheet, peel backing from reverse side of form label and affix to furniture as specified on actual form. f an electronic version of form is being used, form M.lSbe taped to the furniture. 1. Ensure Agency D number or full description of furniture is shown. 2. Supervisor, Releasing Element - A supervisor within the office releasing the furniture. (fndividual signing this form assumes responsibility for any Agency materials left in the furniture. ncidents involving classmed information/material found in the furniture released by Agency elements may result in msjor security violations being issued to those responsible.) 3. Security Representative - Staff Security Officer, Securily Coordinator or Security Advisor. PROCEDURES 1. Desks: Pull out pencil drawer, look underneath and feel between the drawer and the fop of the desk. Starting at the top, remove all pedestal drawers, use a flashlight to search inside the pedestal and drawer tracks. Fully extend pull-out slider leaf, look for matenal taped to he leaf. Slide a piece of cardboard between the lop of the leaf and the desk. Feel behind the leaf end underneath the top of the desk. 2. Key Lock File Cabinet: Without False Bottoms: Starting at the top, fully extend each drawer, use a ffashlight to search the back, sides and runners of the cabinet. nsure nothing is caught on the sides, back or underside of the drawers. Remove the bottom drawer completely and search the base of the cabinet. With False Boltoms: Remove each drawer above the false bottom and search as defailed above. 3. Safes: Starting al the top, (ully extend each drawer and use a flashlight to inspect each space including slides and runners. Feel behind the back ledge and below the bottom edge at each drawer. 4. Miscellaneous: Remave ribbons from typewriters and search cushions on sofas and chairs. Check lable drawelll end remove items taped to shelf unils. 9' NSN" rs4q FM 001 ' 136 obsolete) SZE: 8-/2" X 7-/2" F ELECTRONC VERSON OF FORM BENG USED, FORM MUSTBE CUT ON DOnED LNE AND TAPED TO FURNTURE. THS NSTRUCTON SHEET NEED NOT BE PRNTED.

315 DO omf~~buest ORDER NUMBER SAB1 NOTE: Forward entire 4 part set to: L3 UNFORM ROOM OATE (Received) NA.ME SOCAL SECURTY NUMBER'" ORG' POSTON " SHFT (Day) (Night) SZES (Bust) (Waist) (Hips) (Length) (Neck) SUPERVSOR/FACLTY MANAGER'S NAME SUPERVSOR (White/Navy/Gray) WORKER (Light Blue/Navy)..._.. FEMALE icheck appropriate blocks) MALEFEMALE (Check appropriate blocks) Long Sleeves 1. Oxford Shirt, White 1. ndustrial Shirt Short Sleeves Navy 2. Ellazer 2, Polo Cotton Shirt Gray Long Sleeves Short Sleeves Long Sleeves Short Sleeves 3. A-Line Twill Skirt 4. Executive Slacks 5. Bow Tie 6. Polo Cotton Shirt Navy Gray Navy Gray Navy Gray Navy Gray 3. Vlnex (Flame Retardant) Shirt Long Sleeves 4. ndura Cotton Shirt - Long Sleeves....o _m""m."" 5. ndura Actlonback Coverall 6. A Line Twill Skirt 7. Female Jumper 8, Cover Smock, 3/4 Length Sleeves 9. Side Elastic Pants 10. Preshrunk Colton Twill Pants MALE (Check appropriate blocks) 11. Vinex (Fire Rasistant) Pants Long Sleeves 1. Oxford Shirt, White Short Sleeves 12. ndustrial Work Pants Male Female 2. Polo Cotton Shirt Long Sleeves Short Sleeves 13. Painter's Pants, Off White f 4. Jean Cut Pants.. 3. ndustrial Shirt Long Sleeves Short Sleeves 15. Sur Coat Wflip Out Liner 16. Baseball Cap, Fully Lined Navy PRVACY ACT STATEMENT: Auth PL 86 36: GNSA09: Auth for 4. Blazer requesting SSN: EO 9397; nto will be used (Principally) SSN used to Gray identify indiv, Sizes used to determine correct uniform size; (Routinely) NSA', BlanKet Routine Uses. found af 50 Fed Reg 22,584 (19851 Navy apply. Disci of nfo: Voluntary: Disci of SSN: Voluntary; Effect on indiv 5. Executive Slacks Gray if requested info not provided: Not providing SSN may delay issuance of uniforms. Not providing sizes may result in ill~fitting uniforms being issued. Your signature below' indicates you have read and Navy understand the a.bove 6. Tie Gray _...- 'REQUESTER _._...._. SUPERVSOR SGNATURE ~pproved for Release by NSA 0 UNFORM OFFCE FOA Case #4287 DATE FORM MAY 93 NSN: 754Q-FM w OOl-5402 (FormFlow. September 1999) COpy DESGNATON ""_1. White... Uniform.. Room... Yellow... nvoice ~~.~.. ~~

316 DOClD: SECURTY CLASSFCATON (if any) USE PERMT FOR POWDER ACTUATED FASTENNG SYSTEMS REFERENCES 1. Occupational Safety and Health Administration (OSHA) 29 CFR ; 29 CFR (d); NSTRUCTONS This perml! MUST be completed in its entirety by the Superintendent/Qualified/Competent Person. 2. American National Standards nstitute (ANS) A10.3. Safety Requirements for Explosive Actuated Tools; 3. U.S. Army Corps of Engineers EM E, Explosive-Actuated Tools. GUlpELNES n accordance with with EM E, Explosive.8ctuated (powder-actuated) tools shall meet the design requirements of ANS A10.3 Safety ReqUrements for Explosive-Actuated Tools_ Only qualified operators shall operate explosive-actuated tools. A qualified operator s one who has been trained by an authorized instructor, passed a wnnen examl'nation and possesses a qualified operator's card supplied by the manufacturer, issued and signed by both the instructor and tho operator. Each tool shall be provided with a lockable containef with the words "POWDER~ACTUATED TOOL" in plain sight on the outside and a notice reading ''WARNNG POWDER-ACTUATED TOOL TO BE USED ONLY BY A QUALFED OPERATOR AND KEPT UNDER LOCK AND KEY WHEN NOT N USE". Within the container shall be the operator's instruction and service manual; powder load and fastener charts; tool inpsection record, and service tools and accessories. POWDER ACTUATED PROJECT NFORMATON DATE (YYYYMMDD) TME DURATON LOCATON (Room, Core, etc.) DESCRPTON TYPE (HLT!, RAMSEr, etc.) SPECFC USE DESCRPTON PERSONS) PERFORMiNG WORK PRNTEDTYPED NAME SGNATURE DATE YYYYMMDD) w.. An nspection of the location ndcated above has been made by the Agency s Occupaltonal Safety Health Officer With the NSA Project Manager or an authorized NSA representative of the Project Manager. All regulations and precautions must be addressed to ensure full coml'liao,ej!'ilh lhe referen,ed OSHA, ANS and EM ,rllerla. Guidelines are referenced above. A separale perml1 shall be compleled for each period of operallon no longer han hlrly (30) consecllve days. This permll shall be forwarded 10 ME2 and Facllllies Se,urily notlaler han 48 hours prior 10 he slarl of he workday. OSHA REP PRNTEOfTYPEO NAME SGNATURE DATE (YYYYMMDD FORM D7245 APR 2002 \pproved for Release by NSA on'-' SECURTY ClASSFCATON i/any) h FOA Case #4287~ THS PERMT MUSTBE POSTED ON STE AND BE AVALABLE FOR NSPECTON

317 DO~ R~TATVE MSK PRVLEGE REGSTRATON REQUEST &end Completed Forms To, EKMS C8nlnll Facility P.O. Box 718 Finksburg, MO A. TRACKNG NUMBER FOR CENTRAL FACLTY USE ONLY (2QM2 Writ. n This Section) B. MANAGNG COMMAND AUTHORTY NFORMATON (ALL entries must be completed unless otherwise noted) COMMAND AUTHORTYEKMS /0 (SX.drr 1001indl. respoi'$i/j/.li.. ;/ feqljest tegards an M$K privilege without a DA COde, the User Rep's primary Command AuthOnfy must submit the!'aqucs!). (However, f the request regards an MSK privilege with a DAO code, th6 Commanct AuthOrity Who manages tm DAO must SUbmit the request). The Command Authorityspecified must be rqgistered with the EKMS Ce(l1ral Facility), NAME COMPLETE MALNG ADDRESS TELEPHONE (Commercial) (DSH t applicable) C. TRANSACTON TYPE D ADD D MODFY D DELETE (Choose J2M ONLY) D. USER REPRESENTATVE PRVLEGE NFORMATON E. MANAGNG COMMAND AUTHORTY APPROVAL EKMS e (Required) TVPE OF MSK PRVLEGE (Choose fjl!1e ONLY) D DAOCOOE DAO (Musl complet. DAO Coae below) LAST NAME (Rf1qui,.d when UHrR.p,...ntatllllRe/JlBnlJon Forms and MSK Privilege RfSl8U.tiOtl 'Dl'l'J. ere,ubmlrtud..t tml Slme rima (i., UH( Rflp 10 numw hh not )1ft bmn,"'gn~)). D FREE FORM DESCRPTON DAO CODE REFERENCE NUMBER ~'l!pulr.d if DAO "elll$tntuon form 1$ bei'lj,!submitted with thtt M K rlvil. Registration form, i.e., the OA codrt l& ndt yet 8!1signed) authorize the abol/e SGNATURE TTLE stated individual to order message signature key with the PRNTEOTVPED NAME DATE privileges indicated herein. FORM L6674 REV DEC 96 (Supersedes L6674 JUN 93 which s obsolele) NSN,7540 FM.ool 5414 pproved for Release by NSA FOA Case #4287

318 DOCD: USER REPRESENTATVE PARTTON PRVLEGE REGSTRATON REQUEST A. TRACKNG NUMBER FQA CENTRAL FACiliTY USE ONLY (!2Q1K Write n This Section) Send COmpleted Farms To: EKMS Co1"al Fscilily P.O. Box 718 Finksburg, MD B. MANAGNG COMMAND AUTHORTY (CA) NFORMATON (ALL entries must be completed.jnf:$s otherwise noted) COMMAND AUTHOR1TY/EKMS 10 (Six,,(lgit 10 of indiv r.spon$it!1$ lor lh", partitil;m ptlvnege, 1.8.,,eques" rljg,rd~an open partition privilege, the User Rep's primary Command Authority muat $ubmit the reql,lut. However, if the request reg.reb 8 closed partillon privilege, the Command Authority who manages the closed partiljon must submit the request. The Command Authorty specified mu..t be registered with the EKM$ Central Facility.') NAME COMPLETE MALNG ADORESS C. TRANSACTON TYPE (Choose 12M ONLY) TELEPHONE (Commercial) DADO D (OSN PPlkllbhl) MODFY D DELETE O. USER REPRESENTATVE URlEKMS 10 UR. ~~ ~A.ME (H':fU!.f1!l_Wl1('! ':'H~!,.p,.tl8111.t/~.~!!f1t""!,:orm6 Me submftfed.'ong with this form), 1.11., the UR "'ll1ot)'6t bellil rql8tered) TYPE OF PARTTON PFlVLEGE (ChOOU~ ONLY) D OPEN f:peclfy either Partition Code, " known, D CLOSED (Mu.t complete Partition Code below) or De. '/}'po to below) PARTTON CODe (Requirea for closed plrtitiq1 privil,ge, opt/om"'of' open partition privilege) PARTmON CODE REF. NO. (R"'Ulrod C,..od PetllOon R.gilll",ti()t't Forms arelhlng submltted.t the..me tim. &$ this form.'ncf,t plrtitlon code illnot )''t known.} (UR) PRVLEGE equpment TYPE PARTiTON APPLCATON (Ch...fJJJi. ONLY) NFORMATiON E. MANAGiNG COMMAND AUTHORTV APPROVAL D OPERATONAL D TEST KEY TYPE PRVLEGE (Ch"""elfi'll1 ONLY) (Ch...1fi'1 ONLY) D SEED ONLY D OPERATiONAL ONLY D SEED AND OPERATONAL 0 TypeOOType 1 MAXiMUM CLASSFCATiON OF KEY (Cltoo 1fi'1 ONLY) o UNCLASSFED D CONFDENTAL D SECRET o TOPSECRET ELECTRONC KEY REPLACEMENT (Ch...1fi'1 ONLY! DYES D NO SGNATURE authorize the above stated individual to order SONS key with the privileges indicated PRNTEOrrYPEO NAME DATE herein...- FORM L6678 REV DEC 96 (Supersede. L6678 REV SfP 94 which s obsolete) NSN: 7540-FM-G ~fproved for Release by NSA ~~ FOA Case #4287

319 DOCD: USER REPRESENTATVE REGSTRATON REQUEST A. TRACKNG NUMBER PARENT ORGANZATON FOR CENTRAL FACLTY USE ONLY (QQ/'JQ Writ. n This Section) COMMAND AUTHORTY/EKMS 10 (Six digit td of individual serving as the managing Command Authority. The Command Authority specified must be registered with the EKMS Central B. Facility). MANAGNG NAME COMMANO AUTHORTY (CA) COMPLETE MALNG ADOAESS NFORMATON (ALL entries must be completed un'ess otherwise noted) Send Completed Forms To: EKMS System ManagO( P.O. Box 718 Finksburg, MD ll718 TELEPHONE (Commerical) (DSN if app"cabltj) 0 ADD (Enler the EKMS 10 in Block 0 below. This /0 must be assigned by the Regis/ration Authority (RA)). C. 0 REASSGN ONE USER REP. TO A NEW TRANSACTON TYPE 0 MODFY COMMAND AUTHORTY (Enler six-digit ccxje (Choose f2:jjl ONLY) in Sse/on F) 0 DELETE (BeneticJllO enter Pnm..ry USSf AepresenlalNe nto in D REASSGN ALL USER REPRESENTATVES Block D10 CnsJJe correct User Rep is deleted from EKMS Central TO A NEW COMMAND AUTHORTY (Enter Facilily database, NOTE: DeJeliCil duromalically deletes all the User six-digit code in Section F) Rep key ordering (.)!lvi/cges for /flat User Rep.} D. PRMARY USER REPRESENTATVE NFORMATON (ALL entries must be completed UnleS$ otherwise noted) E. USER REPRESENTATVE NFORMATON (Optionat) EKMS 10 ($ixwdjglt 10 required for Modify, 06Jete, 'nd Rtu.. sign On.rer Rep. rues,s 0i'Y) NAME ORGANZATON COMPLETE MALNG AODRESS USER REP. MAX OPEN PAR1TTON DEFAULT VALUE (ChooH ONE Only) (Max. ~lm Partition Default Valw determines N 'utomlltic s$$f!:"ment 0 t4ft t:jt1fal,jjt ()pert P.rtltiQtf PrM~lS i'of0oijf.r. NO : f User Rep ""ing.drjed will be orderint TUolJ key the o.r.ult V.lu. fijf JJJ2'i:i $hould th chftckfh:l.) D D TYPE 1 (User Rep will Blltomalicaly receive Type f Default Q:en Partilian Privilege$. f any 01 me MESSAGE ADDRESS DetalJlt Open Pat1illOO Privileges are no desired lor tnis User Rep,;tlu must suomit a nwis«! User Rep Partition Privilege RCfJia/ra1ioo Form indicalirlg the appropriate changes. ThiS k)f(7 sloud be sljbmittedal(xlg TELEPHONE(C~me~~Q (DSN if,pplicable) W/1/'1 l/'e User Rep Regislratiofl Form' 1ST ALTERNATE NONE User Rep will tiqreceive dl'ildealj/t Optn Pffirjoo PrMJeges. NAME (fppa/nted, enter name. NOTE: t 1$ strongly f6cofflmfjnded t 1.$t an'.lternu to en$ure uninterrupted $VPPfiJlt.' TELEPHONE(C~me~~~ NAME (OSN f.pplfc.ble) 2ND ALTERNATE TELEPHONE (CommereiaQ (DSN il.pptlcllb/e) FORM L6661 REV DEC 96 (Supersedes L6661 REV SfP 94 which is obsolete) (over) NSN: 7540 FM.Q pproved for Release by NSA FOA Case#4287

320 DOCD: (continued) COMMAND AUTHORTYEKMS 10 (Six-digit id 01 New Comme.nd Authority to whom the User Rep(s) is to be reassigned, The Command Aulhorfty specified must be registered with the EKMS Central Facility). NAME 1 F. NEW COMMAND AUTHORTY NFORMATON (Required QtlJ.r f tr.ns.cllon type (n Block C) s "REASSGN") SGNATURE COMPLEte MALNG AODRESS G. MANAGNG COMMAND TELEPHONE (Commericat) SGNATURE (indillidulllin Section BJ (DSH f.ppllcabl.) AUTHORTY PRNTEDrrYPED NAME DATE APPROVAL FORM L6661 REV DEC 96 - Reverse NSN: 1540-FM

321 DO~.flil~f ~;VlHATVE STU- PRVLEGE "R'EG'lSTFt.«trl'Orlt 'AEQUEST (Use Form L6682-c for additional registrations) send Completed Forms To: EKMS Central Facility P.O. Box 718 Finksburg, MD A. TRACKNG NUMBER FOR CENTRAL FACLTY USE ONLY (12Sl..!D Write n This Sec,ion) COMMAND AUTHORlTY/EKMS 10 (Six-digit D of individual responsible for the STU 1f/ privilege (i.e.. managing Command AlJihorify for the DAO that the STU privilege is to be associated). ihe Command Authority specified must be B. registered with the ckms Central Facility). MANAGNG NAME COMMAND AUTHORTY (CAl NFORMATON COMPLETE MALNG ADDRESS (ALL entries must oe completed unless olherwise noted) C. TRANSACTON TYPE Choose QJJJl ONLY) TELEPHONE (Commercial) (DSH t appiaable) 0 ADD PRVLEGE (Enler SiNllgll/O of User Rep and slx digt DAO code n Section 0 0 below) MODFY PRVLEGE (Enler he slx.<figlt User Rep 10 and.x-dlgit DAO code n section D. Modify other in(afma'jon in section D.s applicable) 0 DELETE PRVLEGE (Enler th. six digit User Rep 10 andslx-diglt OAO code n Section D Q idenlify lhe STU /11 privilege. Enter lhe C/a.s 6 Code f prfvllege s 10 be deleled) USER AEPRESENTATVE!EKMS D NAME (t UserRep Registr.tion Forms lind ST~HPrlvll6gt R"9'5fr.,lon FortM lire be'ng submlutd.t th" ume time (l.t., the U., ReprHenttltJf hu not)'let bee" fffj8teffldj nterthfl t nslm 01 the User Rep receiving this privilege) DAOCODE OACl CODE AEFERENCC!.NUMBEA (fq40 1/og/B...Ofl Form ""STU- 1lll'rlVi[;'lb Rft/isrnUon FOfm ' being,uljmlttth.t the'mne 11m. (.. (), 0 Co. h.. not yol bun".'gmltl),.ntwth Code R.. D. No. from 1ft. DAO Registr."'on form th" PfJrfalns to thisprlvu.,.} USER REPRESENTATVE PRVLEGE AUTHORZED KEY TYPE (Choose ONE SlCtion Only) (NOTE: fkms STU Key;$ usftd to support 1M UfD) NFORMATON otype 2, Type 1 Seed o 0 EKMS STU otype 2, Type 1 seed Type 2 Only (ALL informalion Type 1 Operational privileges dasiled o EKMS STU privileges desired Required unless MAXMUM CLASSFCATON REOURED FOR TYPE 1 D1J.r (ChOOH ONE Only) otherwise noted) D Unclassified Confidential Secret Top Secret E. MANAGNG COMMAND AUTHORTY, FORM L6682 REV DEC 96 (Supersedes L66S2 REV SEP 114 which S obsolele) NSN: 7540 FM OO D CLASS 6 CODE ~ OPTONAL (f" Class 6 code privilege ORDEFlNG CLA$SFCATON RESTRCTON LEVELS (OCRLt) w i$ to bf slsociated with the DAO Code above, enter the REQURED F CLASS 6 CODE BLOCK S COMPLETED (DW:retel'w.h two digit Class 6 Code) must". chosqn (i'.'1top Sec,.tsfJectioo will NOTe".b,. tha ordefmg SGNATURE (ndividual in Sectio" B) 01 Class 6 k.y.t u. c. S,nd T. You MUST.tPffC1'!:1 C, S lind T ifyou Wlt"t to om.rclass 6 k.y.t ellch c..,#flcation PR1NTEOfTYP D NAME ~pproved for Release by NSA ~~lte APPROVAL FOA Case # Ent.ring 0'" DCRL will min" ttlat thl.s DAo tjnd Ct.u 6 Cede Cn Olly be Ordertld.t that one cl'$slfielltiof'/ 'elv"') 0 D Unclassified Secret 0 D Confidential Top Secret

322 DOCD: U.S. GOVERNMENT CVLAN DENTFCATON CARD APPLCATON Previously issued /D card, MUST BE RETURNED with your application. SSUNG AUTHORTY USE ONLY SSUE DATE EXPRATON DATE SERAL NUMBER Privacy Act Stalement: AUlh: Pub. Law 86 36: Records System: GNSA09; NSA's Blanket Routine Uses found al58 Fed. Reg. 10,531 (1993) apply to this information. Auth for requesting SSN: EO nfo will be used to issue a U.S. Government Civilian dentification Card to applicant. Disclosure of information, including SSN, is voluntary. Failure to furnish the requested information: 10 card may nof be issued. Your signature below' indicates you have read and understand the above. TO BE COMPLETED BY APPLCANT NAME (Last, First, Middle) SSN DATE OF 6/RTH OFFCE PHONE HEGHT WEGHT HAlA COLOR EYE COLOR 'SGNATURE COMPLETE THS SSCTQN ONLY F RE-APPLYNG OUE TO A LosrrsroJJ:'lO CARD. PLEASE EXPLAN HOW THE LOSS/THEFT TOOK PLACE AND PROVDE A COPY OF THS APPLCATON TO SECURTY. CONTRACTOR'S COMPANY TO BE COMPLETED BY POc/COR JUSTFCATON FOR. SSUANCE OF D FORM P7029 NOV 96 NSN 7Sao FM

323 DOCD: j VEHCLE CHECK LST ("U-Drive t" Vehicles) SPACE NUMBER mansportalion Services Use Only) NSTRUCTONS Use this form to report any problems or concerns you may have about this vehicle. f you use this form, remove from book and give to dispatcher on duty when vehicle is returned. DATE ADMN NO,' VEHCLE TAG NUMBER OPERATONAL PROBLEMS VSUAL DAMAGE COMMENTS NAME ORG, NON SECURE PHONE NUMBER FORM K75JO REV MAR 98 (Supersedes K7530 JAN 94 which is obsolete) NSN: 7540-FM L_ ~ SZE: 5-112" X 8-1/2" ppr'oved for Release by NSA FOA Case # 4287

324 DOClD: r , VEHCLE DALY LOG PARKNG SPACE NUMBER ADMN NO. TAG NUMBER TYPE VE:HCLE ORG o LEASED NEXT LUBRCATON DOWNED MLES DATE "ATENTON: The bnef guidelines below are to alert our customers of informaton that wll protect them from government fraud, waste, and abuse, Violation penalties, detailed guidelines, and exceptions are provided in each vehicle log book. YOl,Jr signature below ndicates you have read and understand the following: 1, Government contractors may not sign-out or drive any government vehicle 2. Government vehicle shall not be taken to an employee's home, 3. Lunch stops should be avoided whenever possible. 4. SmOking is ::/.Qpermitted in any government vehicle. 5. Seat belt lawls require seal belts be worn by all occupants at a/times. 6. Parking and traffic violations are the sofe responsibility of the driver. DSPATCHER USE ONLY CUSTOMER USE ONLY DSPATCHER SHOP TME TME ENDNG FUEL DATE SGNATURE! DAYS OUT.. ODOME (1/4,1/2 N NTALS TER 3/4, F) LAST ENTRY FROM PREVOUS FORM K4874 'OPERATOR SGNATURE -, L FORM K4B74 REV JUN 98 (Supersedes K4874 REV OCT 89 which s ObSOlete) NSN: 7540 FM QOl-344$ (DV9f) SZE: 5 112" X 8 1/2" pproved for Release by NSA FOA Case # 4287

325 DOClD: , ~ , DSPATCHER USE ONLY (continued) CUSTOMER USE ONLY DSPATCHER TME TME ENDNG FUEL 'OPERATOR DATE SGNATURE! SHOP ODOME- (1/4, 112 NTALS DAYS OUT N SGNATURE TER 3/4, F) MONTHLY MLEAGE TOTAL NO SHOP DAYS NO, O.E DAYS FORM K4874 REV JUN 98 Reverse "Signature ndicates you have read and understand L N$N: 7540 FM-001 ';:W45 statement on front ideof hls form. ~ SZE: 5-1/2" X 8-112"

326 .- r::.o~.sf',.r.c1~~ OFFCAL,. user REPORTNG PHONE ADMN,""P. PONT NO. Picll.O! DESTNATON NO, VEHCLE COLOR TAG NUMBER DRVER'S NAME Nama 0', Up Reh,lrrl O~ '0 '1ME...,...'..._..-._m._... _m....,-,._.."'--- FORM K6&l8 APR 94 NSN: 1540 f:m-qol hfproved for Release by NSA ~~ FOA Case #4287._. _.....-_.._..----_.-.

327 DOClD: r UNCLASSFEDl'l"etJe L DRVER (Printed Name) (Las/) DRVER's LCENSE NuMBER STATE o ~ MAKE a TAG NUMBER ~ DATE (YYYYMMDO) LOCATON OFFCER (Las'. F'rSf, M) FORM G72348 MAY 2002 NSN 7540 FM OOH"'" National Security Agency Police VEHCLE REJECTON RECORD 1STATE REASON FOR REJECTON (First) 008 (YYYYMMDD) MODEL COLOR TME lid NUMBER SECURTY CLASSFCATON (if any) (M) -, NO. OF OCCUPANTS UNCLASSFEDlfjft'FF' 6K:~6e.....J r UNCLASSFEDflF61:19 SECUFl1Y Cl,ASSFCATON (i/.dllr7y) , PRVACY ACT STATEMENT: Auth fo( collecting info reqjoolod on form is contained in SO U.S.C. 402 note, fa usc 13, and 40 USC318 (soc); EO 12333; 32 C,F:R. 226; and DoD Dir NSA's Blanket Routine Uses Qund at sa Fed. Reg, (1993) and the specific uses found in GNA07 apply 10 this inlo. Auth for requesting SSN S EO nfo will be used (primarily) 10 document rrwestigatory activity conducted pursuant 10 Section 11 0/ the NSA Act 0/1959, as amended, and other applicable law, Provision of requested information is voluntary unless expressly actvised O1t1erwise. o Suspect nol/fled of PrtvilCy Act Statement REMARKS FORM G1234B MAV 2002 SECURTY CLASSFCATON (i/4lfl}oj AEVEASE UNCLASSFEDNF61:19 L.J SZE 3" X 5" BEGE HEAVY WEGHT CARDSTOCK pproved for Release bv NSA FOA Case #4287

328 DOCD: STATE-AD-USA. STATE VEHCLE SHPMENT FORM (For Shipment Originating in the United States) AD o USA Compleat this form (type or print) in triplicj)le and maillhesigned origimaj 10 the United Slams Despar.ch Agmt indicated below in tem 2. ReULin duplicate: for your rtference and return third copy to your Transponation Office. Read Auromobile nformation Guide Oll reverse U,S, DespatCh Agent 0 U.S. De.spao:h All"o, ParkWAy Towers. Bldg. B, 2200 Broeoing Hwy.. Rm U.S. Route. SOUln Ualtimo.., MD selin, NJ Tel' (A...410) Tel: (Are, 201) U.S. Despatch Agent 0 U.S. Despatch Ageot 2800 S. 192 Stn:ct. Suite 108 P.O, Boa , 0.0. Mail'a<i1il)' Seattle, Wash Miami, FL T<' (Are, 2(6) Tel, (A",a 305) EMPLOYEE NAME AND ADDDRESS Employee No. 4, NAMe AND ADDRESS OF P6RSON HAVNG PHYSCAL CUSTODY OF vehcle WHEN RtiADY POR SHPMENT, f OTHER THAN EMPLOYEE l>.:lle ufdeparture frum U.S.: Telepnone Number Home: Office: Telephone Number Home: Office, 5. FSCAL DATA FOR TRAVBL A, Trv!. "urb. No B. Trwl. Aurh. Dllte C. Fund D.A~ol B. Dbliplion Number ~. AUTHORiZeD ORGN 7. POST OF ASSGNMENT 8. MAKe OF AUTOMOBLE 9. YEAR AND MODDL 10. COLOR 11. o 2 DOOR 12.VBGHT 13. MOTOR AND/OR VEHCLE DENTFCATON NUMBER o 4DOOR 14. ACCESSORES 1'CLUDED N AUTOMOBLE o Heator o Air-eonditioncr o Radio o Jael< D Sill" Wheel and"", o Tools 0 Thpe Deck 0 Mirrors 0 Wipers o Huboop, o Floor Mat o Lishter o Seatbehs D Other (Specify): 15. DELVERY ARRANGEMENTS (E.ttler datt ~efj ~hirlf! lnjormtlt;on GlliJt (H nnf!'s~) A. will dri~ vc;:hicle (0 the port. a. Vehicle will b.: shipped from the Washington. D,C. McltopoDtan Area. C. Vehicle will be shipped from a poinl outside of.he Washioglon, D,C. MelropOlilan Area. 0, Vehicle: will be: shipped (rom factory. 16. DOCLARED VALUE OF VBHCLE 17. SGNATURB 18. DATE (ruj/or imllratlr't' pllfpo,'.;ej) Dol. Wlhlrl vailabl< FORM JF NSA PtameM.ter S.O ScpJembe,998 pproved for Release by NSA FOA Case # 4287

329 DOClD: CONDTON OF VEHCLE YOu are responsible for ensuring that your vehicle is in a serviceable and safe operating condition prior to shipment. We recommend that you have the vehicle serviced, i.e" lubricated, washed, and radiator checked and filled with an antifreeze solution. To reduce pilferage, remove detachable items such as hubcaps, cigarette lighters, radio antennas, etc. Do not place household or personal effects in the vehicle. Only those items that ordinarily accompany a vehicle, e.g., spare tire and lools, should be stowed in the vehicle. Mirrors and wipers m.y..st remain on the vehicle and ignition, trunk. and gasoline~cap keys l1us1 accompany it..sl:!jeelng NSTRUCTONS Mail this form to the U.S. Despalch Agency alleasl 2 weeks before the dale that you want your car shipped. Aliow 5 days lor receipt of form then lelephone the Despatch Agency. You and the Agent will decide on a firm shipping date and make final arrangements for pickup. f the Shipping date selected falls after your departure, yau must provide the Despatch Agent with the name, address, and telephone number al he person having custody of he car (tem 4 on reverse side). The Department cantlot pay fof the storage of a vehicle. f it becomes necessary to store your vehicle, you pay_ you change your plans concerning pickup point or the delivery date 01 the car, the Despatch Agent and the driveway firm must be notified af the change at once. You are responsible lar ali expenses incurred for a second pickup 01 your car if you fail to provide this nformaton. EXPLANATON OF TEM 15 DELVERY ARRANGEMENTS A. Vehicle Will Be Driven fo Port by Traveler: ndicate the date yau wili be able to deliver the vehicle to the port. The U.S. Despatch Agent arranges to provide the necessary papers and delivery nstructions when you telephone. B. Vehicle Will Be Shipped From the Washington, D,C. Metropolijan Area: ndicale date vehicle will be available for shipment. After completing procedures set forth above, final arrangements for pickup should be made directly with driveaway servioe. C. Vehicle Will Be Shipped From a Point Outside the Washington, D.C. Metropolitan Area: (Excepl new vehicle shipped from factory See D, below.) ndicafe the date vehicle will be available for shipment. The U.S. Despatch Agent will provide the documents and indicate which carner to contact. D. \!ehicle Will Be Shipped From Factory: nstruct the manufacturer to notify the U.S. Despatch Agent when the vehicle is available for shipment. Upon receipt of this information the U.S. Despatch Agent will furnish the manufacturer with Shipping instructions and arrange shipment to your post.!.n.sub..aj!.q.e Because of the limited loss and/or damage liability ($500 per unit) provided by steamship carriers, we recommend that employees obtain automobile marine nsurance. However, the Government does not pay insurance premium costs. nquiries concerning the shipment of motor vehicles should be addressed to the following. Enclose a completed copy of this form: Departmenl af State Transportation Operations (TDfTO) Washoogton. D.C Agency for nternational Development Travel and Transportation Division Washington, D.C United Slates nlormation Agency Transportation Branch (loa/stl Washington, D.C NOTE A GOVERNMENTTRANSPQRTATON REQUEST (SF-1169) MAY NOT BE USED TO SHP A MOTOR VEHCLE FORM JF 49 - Reverse: 6 90 NSA Fr.uneM~kerSO September 1998

330 DOCD: DEPARTURE DATE LENGTH OF STAY COUNTRY SENT EMBASSY (Date) RECEVED FORM P4602 APR 83 VSA REQUEST NSN: 7540 FM MUST BE PRNTED ON PNK PAPER AND CUT TO SZE 3 X 5 pproved for Release by r~sa FOA Case # 4287

331 DOCD: VSTOR REQUEST START DATE (MMtlO/YVVV) Privacy M. Sta_: \llllmrity "" collocllng nlormallon reque_ on 1ha torm cantil_in 50 usc. section 402 note; 50 U.S.C : and E-.tMl Olde' NSA~ Blankll Roollno U... found at 58 Fed. Reg. 10,531 (1993) a' Ylt aa the specffic UM enumerated in GHSA03 apply to l.hi inform.tion, Authority 10f requeattng SSN s Emcutl e Order The requhted lntorrntkm will be used to assist in processing visitors for ~8. to Agency nformation and faciltie&. Your dlclon of~ information. including ssn. is voluntary. HoweYer, talbj'" lo 1urnish the req..sted f'orl"rltion, 0t1!t' lhan S$N. mill)' delay the proceulng Of yoljf viaitor(.). END DATE (MMOOVVVV) TME OF ARRVAL (. (1. '3;00) GAres (Please use VCC Eas. Of vee NOr1'l msteao' Of GH1. GH2A or GH2B) DCANX 0 FANXVCC DGH5 DGH8 o DORSEY RD. 0 FNKSBURG 0 GH 6 0 GH 10 OK.9 ONBP OR&E o TORDELLA OVCCEAST o VCC NORTH PONT OF CONTACT (las') (Firs') (M) SSN (.g ) ORG NON-sECURE PHONE (nc/udo Atoo Codo) APPROVAL AUTHORTY NAME (las,) (First) (M) SSN (.g !1'189) POSTON CLEARANCE STANDARD ACCESSES o UNCLEARED o CONFDENTAL o SECRET o TOP SECRET OS! OTK OG DB ADDTONAL ACCESSES (Lst an applicablfl) SPECAL PROCESSNG o NONE 0 DECAL NEEDED VSTOR NAME (ust) (First) o NCS BADGE NEEDED (M) SSN (.g ) DATE OF BRTH (MWO l'yyvv) U.S. CTZENSHP DYES ONO BRANCH OF SERVCE o NONE VSTOR REPRESENTS VSTOR NAME (ust) o ARMY COUNTRY OF CTZENSHP (Roquitod for non U.S. CUz./11 onty) (First) AFFLATON o CV 0 ML OCONT OARFORCE o COAST GUARD 0 MARNE 0 NAVY VP VSTOR GRADE FlANK OR POSTON o PRVLEGED VSTOR (M) SSN (.g '189) DATE OF BRTH (MWClDYYYY) us CTZENSHP DYES ONO BRANCH OF SERVCE o NONE VSTOR REPRESENTS VSTOR NAME (lasr) COUNTRY OF CiTZENSHP (RoquitVd for """ U.S. Clt/zolll only) o ARMY (Fif'$t) AFRLlATlON o CV 0 ML OCONT OARFORCE ocoast GUARD 0 MARNE 0 NAVY VP VSTOR GRADE FlANK OR POSTON o PRVLEGED VSTOR (M) SSN (.g '189) DATE OF BRTH (MNTJOVYVV) US. CTZENSHP DYES ONO BRANCH OF SERVCE o NONE VSTOR REPRESENTS VSTOR NAME (Last) COUNTRY OF CTZENSHP (R<lQultVd for "on U.S. Cizons only) o ARMY (First) AFRLATON o CV 0 ML 0 CONT o AR FORCE o COAST GUARD 0 MARNE 0 NAVY VP VSTOR GRADE RANK OR POSTON o PRVLEGED VSTOR (M) SSN (.g '189) DATE OF BRTH (MMlXYYvv) US. CTZENSHP DYES ONO BRANCH OF SERVCE COUNTRY OF CTZENSHP (Roquilod for """ U.S. CiRzo/ll onty) AFFLATON o CV 0 ML 0 CONT [JNONE [JARMY OARFORCE [J COAST GUARD [] MARNE 0 NAVY VSTOR REPRESENTS VP VSTOR GRADE RANK OR POSTON o PRVLEGED VSTOR FORM G24S0 REV MAY 2001 (SUpersoilo. (;2450 REV NOV87 which s o/j$ooo) Approved for Release by NSA or bi FO!\. Case # 4287"

332 DOClD: VSUAL REPORTS (Medical Records) AUBe't 3m Report Along Here And Succeeding On Above Linea Ailach 2nd Report With Top A Thl' Line Atlach 1at Report Along Left Margin With Top At This Line ~ ", 11 z, ;:, :.' 1:' <,,,,, pproved for Release by NSA, FOA Case # 4287,, FORM P3021 APRL 85 NSN: 754o-FM.Q

333 DOCD: Standard Form lobo Revised April 1002 Departmenl of Treasury TFRM 2, ' Department, establishment, bureau. or office receiving iunds VOUCHER FOR TRANSFERS BETWEEN APPROPRATONS AND/OR FUNDS VOUCHER NO SCHEDULE NO, BLL NO PAD BY Department. establishment. bureau, or office charged ORDER NO DATE OF auan UNT PRCE AMOUNT ARTCLE OR SERVCES DELVERY TTY COST PER DOLLARS AND CENTS Remittance in payment hereof shol.jld be sent to- TOTAL ACCOUNTNG CLASSfiCATON - OlJi<e Rectivin. Funds CERTFCATE OF OFFCE CHARGED cmiry hallh' ahove arlicles were received and accepted or the services perfonned as slaled and should be charged 10 the appropnation(s) an<llor fund~s) as indicated below; or thut the advance payment is approved and should be paid as indicated, _. (Date)... _---~-_._~~._ _... ~~~~... (Authorized administrative or cerlifying officer) --._ * ** ~-----~** *... (Title) ACCOU\lTNG Cl.ASSFCATON - Office Charged Paid by Check No NSN: PrevOUS Edtions Are Usable NSA FrameMaker October 1998

334 mm..mo... mmm... DOClD: r~ ~ L WAREHOUSE LOCATON PROBLEM REPORT locatio' "._." f-- Wrong or no N$N laoo on location Wrong or no NSN label on Slock Unrt 01 ssue Stl'J(:k 1'101 in assigned location More than one open box Trash in locatlon OTHER... PROBLEM (5) CORRECTED BV NVENTORY FORM J62 REN MAR 95 NSN; 7540-FM OO _ Mixed Sloe\( DATE BY Unsafe or poor slacking 01 material $i<:dl: lalling off pallet HooAyOOtTlbing O!' irregular layer quantities Shell life explted Boxes slackoo with NSN, dabit, and CltJanlity information hidden - -, J pproved for Release by NSA FOA Case #4287

335 DOCD: WORK REQUEST PROJECT NAME DATE RECEiVED (MM-OHYj REQUESTER DESRED DATE (1iJA.DD- VY) SHOP ORDER NUMBER DATE SHOP CAN DEUVER JOB "lame REQUESTER NAME SD ORG PHONE (SoCU,") (No-&tcu«J) BULDNG ROOM (Last) (First) (Ml (l-rigit n,""wj (fo-dqil number) PONT QF CONTACT NAME SD ORG PHONE (&e",") (NDt-Set:un) BULDNG ROOM (La.1i (FS) (M) 1741/*n,"""",) ('04g1_) NSPECTOR DATE COMPLETED RECEVED BY DATE DELVERED SPECAL NSTRUCTONS DESCRPTON Of WORK (ncl_ <1aWitJg nurn_,_,etc.) JUSTFCArlON FOR WORK REOUESTED APPROVAL SGNArURE T1'fLE SHOP AUTHORZATON DAre FORM H106 REV OCT 2000 ($u",, Hl06 REV NOV!S»1icttis_) (Approved for Release by NSA orl b FOA Case #428771

336 DOClD: D FURNTURE FORM REQURED WORK REQUEST FOR: D ELECTRONC EQUPMENT o G6210 o J51BO... CHECK APPLCABLE TEM DATE ORDER (Received) (Scheduled) o DELVERY o PCKUP o MOVE ORG NAME LOCATON NON$ECURE PHONE FROM: TO: OTY NOMENCLATURE REMARKS certify that the action indicated MOVE SGNATURE DATE above has been accomplished. COMPLETED FO~ CONTRACTOR MATERAL PCKED UP FROM 5715 MATERAL RECEVED BY FOAM J4481 REV JUN 2000 (Supersedes J4481 REV DEC 88 which S obsolete) NSN: 7540 FM OO pproved for Release by NSA FOA Case #4287

337 DOCD: SECURTV CLASSFCATON (if any) WORK SCHEDULE CHANGE RECORD PRVACY ACT STATE:.MENT: Authority for collecting nformation requestad on this form is contained n 10 U.S.C. sec and 50 U.s.C. sec. 402 note. NSA's Blanket Routine uses found at sa Fed, Reg. 10,531 (1993) as well as thq specific uses found in GNSAOB, GN$A09. and GNSA11 a.pply to this information. Authority for requesting your Social Security Number (SSN) is Executive Order The requested information will be used to record the number of hours an employee "S SCheduled to wor1< each day during a pay period when those hours differ from the organizational default schedule. Your disclosure of requested information. including SSN, is voluntary. However, failure to furnish the requested information other than SSN may delay or prevent processing of your work schedule change request EMPLOYEE D (SSN NAME ACT(VTY ORO EFFECtivE DATE (YYMMDD) T & A STATUS cooe (kactivo, P-Penaing Separation, AWSCODE PLATOON ROTATNG CODE X-DeceaserJ Employee) PAY PEROD TOUR DF DUTY WEEK 1 SUNDAY PAY SUN MON TUE WED THU FR SAT (Check One) YES NO SHFT NGHT DFF WEEK 2 SHFT NGHT DFF STANDNG JON 1T' A DESTNATON FOR UNGRADED (WAGE) EMPLOYEES Q!:..Y AOTATNG SHFT HOURS (1) (2) (3) CERTFER'S SGNATURE DATE SUBMTTED (YYMMDD) FORM P6951 REV NOV 2001 (Supersedes PB951 JUN 95 which is obsolete) NSN: 7540 FM OO 5537 SECURTY CLASSFCATON (it any) pproved for Release by NSA FOACase#4287

338 DOCD: WRANGLER SOFTWARE BULD REQUEST OR RFC NUMBER ORO ORG. COOE DO NOT USE FOR "em" USE ONLY NSTALL 0 8EFOFlE DAFTER 1BULJ) NUMBER PAT; PROMOTED TO GET DATE PROMOTED io GEM DELETE PROMOTE TO GEff level PROMOTE TO GEA1 L.EVEL MODULE NAME -,...- REVSON PASS M204 COPy COpy VERfY (M204 Modules~ NUMBER VERFY COPY DEL WORD _..':'''4 y DELGA N DElS TO TO LB TO LLfB LB GET Lie MPORT VERFY MPORT VERFY LB MOVE LB HOLD MOVE LB m.._.. h_. FoRM H7288 REV Fea 95 (SupersBd9s H72i38 JUL 94 which S obsolete) NSN: 154lJ FM Q0J.5484 ~pproved for Release by NSA ~~ FOA Case#42871

339 DOCD: WRANGLER SOFTWARE BULD REQUEST (Non-M204) DR AFe NUMorn NSTALL D MODULE NAME BEFORE DAFTER ORO ORG CODE COM (Compile) = (A ASM; (P) - PL ; (F- FORTRAN; (0) - OTHER 00 NOT USE FOR "CM" USE ONLY BULD NUMBER (DATE ROMQTEO TO GET DAlE 'FlOMOTED TO GEA COpy (C) f DELETE (0) 'COM LNK ED. PROMOTE TO GET LEVEL PROMOTE TO GEA1 LEVEl. REV PASS copvro w VERFY COPVTO w 3 m VERFY w ~ 3 ~ ~ ~.= oc _...'-'-' NO WORD til <0 til ~ ~ a i ~ 0 y oc N,,~ ~~ ~ c.~ ~ i3 ~ ~~ ~ ~ ~ ~ ~ 00 ~tii ~!:::::; ii~ ~~ ~ 3 ~U :J 5 iii 13lf1 WZ Zo >~ ~~ i :Jfa ~j;t ~~ ~~ ~~ ~w u (Non-M204 Modules QlYl,Y) ~ 0 w ~o ~......_....-c- FOAM H7288A REV FEB 95 (Supersedes H7288A JUL 94 which is obsolete) NSN: 7$40-FM-oQ ~?proved for Release by NSA ~q FO Case # 4287,

340 DOCD: SECURTY Cl,ASSF"CATON NOTE: Form MUSTBEPR/NTEDon pink paper il used electronically!!! WRANGLER SOFTWARE CHANGE ORDER TASK NUMBER PR TTLE De Du DATE (Log n) 1.10 DATA PAGE (Due) OF ORG CODE ORG' DATE PREPARED APPROVED BY 2 TEMS AFFECTED (DO NOT USE AT THS TME) (DO NOT USE AT THS TME) 4 CHANGE A6SrRACT 5 SOURCE CODE CHANGr;:S (1apelOisk File D NO.) -=::-- ~=: ---_hpproved for Release by r~sa 0-,/ _ DYES 0 NO FOA Case #4287 BLOCK 6 CHANGE? FORM H7290 JUL 94 NSN: 7540 FM securty CLASSFCATON

341 DOCD: DATA, ~LE CHANGES (Tape/Di;;/( File 10 No) FORM H7290 JUL 94 - Reverse NSN: 7540 FM SECURTY CLASSFCATON

342 DOClD: SECURTY WRANGLER TASKNG REQUEST O DSCREPANCY (Blue Paper) O REQUEST FOR CHANGE (Yellow Paper) NsmUCONS TO ORGNATOR 1. Check appropriate block below. 2. Complete front side of form. 3. Forward to CM. 4. f used electronically. form MUST BE PRNTED on blue paper for Discrepancy and yellow paper for Request of Change!! F'P""AQ='E:=========== OF TASK NUMBER DATE (Task) (Required) --.J ~1:S:U~BM:':TT~E:O:BY::::::::::::::::::::::*:COA""G:===r~~PH~O;:;N_~E~~~~~~~~~~...l:o:AT:E::::::::::::::::::::: 2 TTLE - 3SUBSYSTE'MS AFFE'CTED pproved for Release by NSA FOA Case # 4287 FORM H7287JUL 94 NSN: 7540 FM =Blue 754Q-FM : Yellow SECURTY CLASSFCATON ", m_.._.. _

343 DOCD: ANALYTC EVALUATON RECEVED 6V ORG PHONE DATE EVALUATED BY ORG PHONE DATE ESTMATED TME TO COMPLETED (MiMhOurS) COMMENTS APPROVAL COMMENTS o EMERGENCY DYES o MMEDATE o NO 5. WPB APPROVAL o ROUTNE OATE RECEVED DATe FORM H7287 JUL 94 Revers. NSN: 7540 FM = Blue 7540 FM = Yellow SECURTY CLASSECATON

344 JA~'ftaNAi! lfsea2representatve STU- PRVLEGE REGSTRATON REQUEST (Continuation to Form L6682).. 'rrrackng - F. NUMBER FOR CENTRAL FACLTY USE ONLY (!JQ.tJQ Write n This Secllon) a MANAGNG COMMAND AUTHORTY D (Six-digit fo ofcommand Authority COMMANO responsible lor rhe STU i privilege. The Command Aulhorlly AUTHORTV (em speciffed must be registered with the EKM$ Central Facility) NFORMATON TRANSACTON TYPE (Choose One ONLY) send Completed Form. TO: fkms Centra' Facility P.O. Box 718 FinkSburg, MD MAX. CLASS. USER REPEKMS D AUTHORZfD KEY CLASS 6 OROERNG TYPE 1 CAO CODEtREF NO. TYPf PRDDUCT CODE CLA5S.RESmC. LAST NAME (Choose One Section ONLY OPT. LEveLS ONLY) (Choou On.) ADO 10 ~'."2.""",.",,, u U 0jCOOr Type 1 Oplf.UQnal o EKMS STU-. C C MODFY NAME REF. NO. Type 2, Type 1 hed 5 5 o EKMS STU l OELETE Ty.-20rNy T5 T5 ADO 10 0,6.0 CODE Type a, Type 1 SRd U U Type 1 Oper.1Or'll1 o EKMSST1J...ll C C MOOF~ NAME REF. NO. TyPt 2, Typt' Seed 5 5 D EKMSSTU DELETE Type 2 ONy T5 T5 ADO DAOCODE Type 2. 'l'ype 1 Seed U u Type 1 0Mr.Jon 1/ o ECMS STU 11l C C MODFY NAME REF. NO. Type 2, Type 1 seed S 5 o EKMSSTu-m DELETE H. TYpe 2Only TS STU- AOO 10 DtO CODE Type 2, Type 1 Seed U u Type 1Oper.11<lNl1 o ECMSSTU 1Jl C C prvleges MODFY NAME REF. NO. Type 2, Type 1 SHd n s s EKMS STU-U1 OE,ETE Type 2 Only TS T5 ADO 10 DAO CODE TyPtl2. Type 1 SHd 1l'pe U u 1 OpeorltlltH1.ll o EKMSSTU 1ll C C MODFY NAME REF. NO. Type 2. Type 1 SoHd 5 5 o EKMS STU-ll OELETE lvpe2 Only T5 T5 ADO MODFY OE,ETE ADO Yj ld Type 2. Type 1 SMd U U Type 1 Oper.lonel o E(MSSTU-ll C C NAME REF. NO. Type 2. Type 1 seed 5 5 CJ EKMS STV."" TyPf T5 ~ Onl)' T5 D DAO CODe Type 2, Type 1Sllltd U U Type 1 Opel1ll10nal o EKMS STU-m C c MODFY NAME REF. NO. Type 2. Type 1 seed o EKM$ SfU ld 5 S DELETE Typl) 2 Only 15 T5 ADD MODFY OE,ETE OAOCODE 'lype 2. TYpe 1 Seed U U 1)pe 1 Oper*lloNll o EKMS STU C C NAME REF. NO. Type:2, Type 1 S-l'ld 5 5 o EKMS STU- Type 2 Only T5 T5 10 SGNATURE (ndividual n Section B). MANAGNG COMMANO AUTHORT~ PRNTEDTYPED NAME DATE APPROVAL FORM L6682 c REV DEC 96 (Supersedes L6682 c REV SOP 94 which is obsolete) NSN: 7540 FM OO ~roved for Release bj' \JSA ~~ 2-J2:,Z007 FOA Case # 4287,

345 DOClD: FNANCAL RECORD RELEASE AUTHORZATON STATEMENT OF RGHTS Fed...' law prol8cls ihe privacy of your financial records. Belol'l~ banks, SlNngs and loan allllciaticns. Cltldlt L'lClllll, Ctdlt card issuer$, or ether financlallnslilullcns may give finandallnlolmation about you til afederal agency. certain pnx:edurea mulll be followed. CONSENT TO FNANCAL RECORDS You may be 8$k.ed to c;onsem 10 1e llnan<:lallnslltljllon maldng yaur financial rec:or:s _ila:le fd the ~nrnent. You may wihhold your consent, and your c:cnsent is not required as a Cl:l1ditlon at dolng bus".. with anyfinanclellnstillltion. 1f)'llU give your C:OlliGlll, t can be rllvllk.ed in writing al at'/ time before your recotdll are dlsc:ldlled. Furlhermore. at'/ a:llselit you g1vllls effective for only three months. and your financial inlltitulion must keep a record of the in&linces in whlch it discolllls your flnanc:aj inonnation. W!THOUT'1PUSCONSENT Without your consent. a federal agency that wants to see )'lul" financial records may do 10 ordlllllfly only by means 01 a BWful subpoena. summons, formal writll1 rllquesl, or search wanant lor thai purpose. Generaly, the federal agilllcy l'lll give ycu lldvance notice a! its request for your rlcolds l!lllaining why 1e infcllll'llllfon is being lloull1 and 1li"ll you ha.v object n COU'l. The federal agency must also send you copies at CC1urt cbc:uments C be prepared by you wlfh inllrliclklns far filling them out. Whle flese procedures will be kepi as simple as pollsillle, you may wanild c:onsuil an alfornlly before Mdng a chalenge10 a federal agency's requllsl. EXCEPTON n some circumstances, afederal agen<:y may Ctlllin financial n!ormalonl'l-=' omthcut advnee 'Cllice or your c:onsent. n most of these cases, the fectllllll agency wiu be required go caur lor D obtain )'llz rec:on:li-mthoul ~ng you nollee belorehan:l. n flese instanoes.lhe c:ourt wllll1lllkil the Govlrnment shaw'fla /s kmlstigaiion and requllllt for)'llul" rec:on:ls are proper. When the reason for the delay of noliee no longer 4ldsl&, you willllljsjy be llltfild1hal your rec:on:ls-..oblllited. TRANSFER OF NBlBMAllON Generally. a federal acency!hlt obtains your fll'lllllcllll rllcotds is ptll/lillled from tanferril'g lhem tolll'lolller federlllll8/cy unless n certifies in writing thai file transfer is proper and sends anotice to ~u 1haycu records have been sent to another 1Qen<:y. PE!'f llls ij ttle lectal'lll agency or finanoallnstitlltion violaltla the Flight to Financial Privacy Ac., you rllly RUe for camalles or seek c:omplrance with the law. you win. you my be repaid ~ur omey'stel and Clll. RE EASE AUTHORlZAnON Pursuant 10 seclkln 8404(1) of the Right 10 Financial Prvacy fld. crll1178,, havlng reed the up/lnl1on of my rfwrts lbove. hereby authorize the ndicated F1nanciallnstitUtiCn to release these financial rec:ofl: any and..past or present checking indio' draft acccunts. past or presenlllllvings accol.ll1llll, past or pr~ loans or applica1lcllli for loans, pas or pr'llent oredft or cred"d card acccunts and any ofler financial rec:ord mantaned by lle below descrllldffnatlclal inslllullon, to an rjvllllllgaflile of file Depll11en of Defense..... The disclosect records wlr be used by the Dper1rneni of Det\lliln ~ and ec:olllili defbrmina1iclllll and in rejated personnel actions where S8QJiy represents a rellmu1l and lllid 8llllYldof file dllermination by file Dtipabliell c Defc1se. understand 1at \hill authol ization ltliy bertmlklld by me in writing at any time before my rllcclld&, ll dlllllcribed billow. are dlclo$8(l, and!hal this authqr~ation is valid lor no rnon than three mon!ll fj'llm the date of my 1lgnature... PRTEDNAME _Sl,..,ClN.';\ Rli TELEPHONE (om..) ~.n_ A1u Codo} 1_DA'Tl! /Dio:_MoN/l, l_", -r:=~_:_:_..,.,..~: _ FNANCiAL NSTTUTON (0-1 (Ndto&s) pproved for Release by NSA roja Case # 4287 &N CertlfTt:at. on RWfSf s/d.1!

346 'DOCD: NATONAl. SECURTY AGENCY CENTRAl. SECURTY SERVCE FORT Gl!ORG!: G, MtAOE, MA,RYt."NO fiOoo Date: _ SUBJECT: Certificate ofcompliance with the Rightto Financial Privacy Actof1978 Dear Financial Officer: certify, pursuanttq section 3403 (b) of the Right to Financial Privacy Act of 1978; 12 U.S.C et seq., that the applicable provisions ofthat statute have been complied with as to the consent ofthe individual identified on the reverse side ofthis fonn with regard to the following records: any and all past and present checking and/or draft accounts, past and present savings accounts, past and present loans or applications for loans, past and present credit or credit card accounts, and any other financial records maintained by you on said custqmer. Pursuant to Section 3417 (c) of the Right to Financial Privacy Act.of 1978, good faith reliance upon this certificate relieves your institution and its employees and agents ofany possible liability to the customer in connection with the disclosure ofthese financial records.. (bl (31-P.L ulj'cctor Office ofsecurity

347 PJWaey Act Sta'~l't\flnt Auth 101 requutlno nfo: 50 U.S.C J:ll: SO U.S.C (t;)(il: 115 U.S.C, 798: ano e.o lz , and ,\U", lot ORectJng YQl,U SSN S S.O NSA'i Blanket ROUWl Usn lound at AMPL ged. Reg, (1993) and lmapecfic:umltloundln GNSA01 UldGNSAO y 10 lh~,nformallon, ntortnlllon you p~ will bl uu(l (pntlellltjlv) 10 \\"l.';: '. moo' YOU'."".. " P,_ 1"""...\'01''''''''0' "'..."110'.,\\ ctildo:te Prol4le1te1 l"'ormation Wllhout UtlOriu\lQn. Your disc:ioeuro 01. rmalicn n'q,msted by hi DmlS vdunlary llul fill""" fq pravicle nton'natlql\. "'...' r than you' SSN, tny prtmj11 you from COlliMfl l::l:qs 't> PrO6Cled 'j mouon. ""RMllusailo provltkl 'tajl SSN may detly you ll'ol1'l QbW'tll'l\1 aa:llul0 follllc'led 11"'100000aClon, NATONAL SECURTY AGENCY Fort George.G. Meade, MO ACCESS TERMNATON AND DEBREFNG STATEMENT understand that even tholjlih my authol'iled access 10 Protected nformal/on is hertby lemtinated,,con{inue 10 be obligated. under ana in accordance With tne terms or the NSA Security Agreement' previou$ly executed, to preserve and safeguard the security of Protected nformallon. To l'$$i$t me in f'ecilliing the provisions of my continuing Obligations. have been advsed that an unsigned copy Of the N$A security Agreement that previously executed is avadable for review. 1. reamlttl my undel'5tanding that Protected nformation is information Obtained lu a result of my relationship with NSA which is dassified or in the process of a c1uslflcatlon determination pu1iuanl to the standaros of Executiv. Order Of any sucx:ua.or order. and implementing tegulltiofls, t includes, but il not limited 10, intelligence and intelligencerelated information, l80sitiv, c:omparl.n'lented information (irlformation concerning or demd from intehigence sources and metllods). and cryptologjc information (information concerning commllnicatiqtl$ ~rity,nd.jisnals iflleuigence. ;ncludif)(1 il1fol'malion which is ajso sensitive compartmenled information) protected b~ SediOll 798 o( Tille 1$, United stlte.t COdot. 2. understand that [ must retum to the Government all Proteded nformation 10 which may have obtained access during the course of my acct:!ll$ to Protl!!Cled nformallon under a contrad wrth the NSA. (( my ettlj)foymeot or otner "NitA witr'l the NSA, 3, reaffirm my agreement 10 submit for security review in acr;c;;m;1ance with NSNCSS RegulatiOr'l 10-83, 4NSNCSS Prepublication Review Procedure, alllnfonn.tiqn or matenals. including WOl1cs of fiction. U'liilll "ave prvpared for public disl::lo.ure which contain Of purport 10 contain, refer 10. or'r. based upon Protected nformation. N del'irled in paragraph 1 of the Terrni".tiQn Clnd Debrefing Statemenll understand MtlP'te term "Jlublic disclosure includes any dlsdosure 01 Protected nformation to one or more per$o'1s not auth0ri2:ed to have access 10 it n addition. agreq: (a) (b) to submit such information and materials for prepublication review; to make any required submissions prior Q discl,ssing the information or materials with, Of shovliing them tq anyone who is lo aultlori:l::ed to have aa;:ess to lhem; (c) no to disclose.$uetl information or materials 10 any person who is not authorized 10 have access to l'lom until have received written autho~ation from the NSA that such disclosure is pennitted; and (d) 10 assign to the United Slates. Govemment all rights. tiue i1d interest and all royalties. remuneration, or emoluments of whatever form that wiu or rnay rault from any disclosure, 'Ublic:atioo. or revelation of Protected nformation not consistent with!.'e terms of!he N$A Security Agreement. previously executed. understand that the purpose or the preputllication revtew procedure is to delermine whether milterial eontemptated for public disclosure contains proiected nfol"l'ntiol1 aod. ifso. to give the NSA an opportunity to prevent the public: disclosure ofsuch informaton. understand that the NSA is Obligated pursuant to the N$A Security Agreement. amin accordance with (1'le!erms ot NSAlCSS Regulatkln 1().(l3, to CQflduet ttle ptepublicatlon review irr 8 reasonaom time. to txlnsutl as necessary with me through rile te'lmlw process. and' 10 provide an opportunity for me to appeal initiallllview determination,. also understand l.tat as i. necesury to conduct my p8ll1oll8j affairs, may reveal unclassified informatlol1 as 10 where was employed, assigned or detailed with the NSA, the generic nalure of my emplovment, assignmenl or detail in aa::ardance with thl description provided fot in Annel( B 10 NSA/CSS Regulation 10-11_ 'Release or Und8$sified NSAiCSS nfof/nation," and the amount of salary received in connection therewith. underscand thai should exel'd.. discretion and care in revealing such informalioo and that by revealing such information have not violated the'nsa Security Agreement previol,lsly &ll:ecuted, 4. recognize that my exposllre to Protected nformation makes me a potenbal target for exploitation by foreign powers. affirm that will immediately repqtt to tne proper authorities any allel'jlpt Q solicit Proteeled nformation by a person not authorized by the UnillK1 Stales Govemmeollo receive such inlormauon. f in &he UnJted SW Understand may report such activilies to the NSA Ol'fice of Security, or to the Federal Bureau of nvestigation, f in an overseas area,, understand may report such activities to the Chief or Secunly Officer of an NSA field 5tation. 10 the Commander of ;;!ny U.S. military inst;lllalion, or to a SecuritY Otlice of the Department of State. 5. utlderstand that because have access to Protected nformation, my tn\1e1 through foreign areas may pose a c:ertain risl< 10 oational security. realintlat.though am no longer obligated to repcrt foreign travel to the Director of Security, NSA, ttl. rilk incurred in traveling to cef1ain are from both a personal safety and a countetlntellil)enc:e standpoint. remains high. This paragraph does. not apply to individuals who remain in an employee slatus, whose eligibility for access hs been suspended Q( whose efigibillty for access has been revok.ed and subsequentty.ppealed. 6. On the occa;ion of the termination of my access to Protected nformation. acknowledge ~ve read this Statement. lllnd my que$uons, if any, have! been answef'ed. certify that the debriefing otllcer made ayaiiable SectiOnS , 798, and 952 of Title 18. United States Code; section 421 through 426 and 183(b) of Tlle 50, Unite<:l States Code: PUblic law BB-290: pertinent ~ioo5 of executive CraM 129\5B, or any successor order: and NSA/CSS Regulation 10-83, -NSA/CSS PrepuWication RevN!w Prooedures: so thai may read them at thi$ time, if so choose. Also, have been giyen a copy of PrepublicatiOn Guiditlines explamil19 ttle procedurea for submitting Materials for security review, in accordance with NSA Regulation 1D-a3. 7, acknowledge lhilt received an oral debriefing ltal explained the foregoing points or information and obligation. 8. These restrictions are consislent With and do nol supersede. confllcl with or otherwise alter the employee obligations, rights or liabilities created by Executlve Otdet 12958; Section 7211 of Tltle: 5. United Slates Code (goveming disdo5ures 10 Congress): Section 1034 Of Tlle 10, United Stales Code, as amended by the Military Vlttislleblower Protection Act (gowming disdasure 10 Congress by membisfs at ns military): Section 2302Cb)(8) ot Title 5. Unittd Sttes Code, as amencle<l by the Whistleblower Protection Ad (goveming disclosures of illegality. wasle. fraud. abuse or public h".rth or Hfety threal1); the ntelligence denutin Protection Act of 1982 (50 USC 421 et seq.) (governing d~osure, thai could' expose confldential Government agents). and the s1alules which protect againsl discjo$ur8s that may compromise the national secutitv, including SeQions , al"ld 952 of Ttle: 18, United Slales C((.&. )flo Sect:lOn 4(bJ ofthe Subvers;\18 ActiVities Ad 0' 1$150 (50 usc SeetiOtl 783(b». Th$ dettln)lio'j$. t'equirements, oblig.alions. ri"tlts,.sanctiol5 and liabilitifi created by said EllfQJlve Order and listed stames are irlcorpcmued into this Agreement and are eontrojling. SGNATURE TYPEO OR PRNTEO NAME CNiLAN GRADE OR COMPANY SERAL OR SOCAL SECURTY NUMBER DATE ORG BREFNG OFFCER SGNATURE PRNTED NAME DATE FORM G170A REV APR 2001 (Supllt3eCl.s G170A REV JAN 01 whk:h,s obsolete) pproved for Release by NSA FOACase#4287

348 ACCESS TERMNATON STATEMENT understand that even though my authorized accf!lss to N$A is hereby terminated, /Xlfllinue to be obligated, un~r and in accortjance with the terms of the NSA Security Agreement previously e)(ecuted, to preserve aod safeguard htl security ot Protected nlonnation. To assist me in rek;;atling the provisions of my continuing obligations have been advised that an unsigned copy ot the NSA SltCurlty Agreement that previously executed 1$ available tor review. 1 reaffirm my understanding that Protected nformation is inlormatlon obtalrled as a resut1: of my relationship with NSA which is classitied or in the process 01 a classilical10n dell.(frminallon pursuanllo the slandardsol Executive Order Of any SllCceSSOf order, and implementing regulations. t includes, but is not limited 10, ntelligence and intelligencerelated information, sensitive compartmented information (inlormation oonceming or derived rom intelligence sources and methods), and crypologlc nformation (information oollci)rrling communications &e(;urity and signals intelligence:. including information which is aloo sensitive compartmented information) protected by Section 798 of Title 18, United States Code 2 the N$A understand tbt! must relurn to the government all Protected nformation to which may have otltained access during the course of my employment or other service with 3. reaflirrn my agreement 10 submit lor security review in accordance w~h NSAlCSS Regulation 10-63, ~NSAlCSS PreplJblica~on Review Procedure; all information or materials, including works of fiction, hat, have prepared for pl,jb!ic disclosure which contain or purport 10 contain, reler to, or are based upon Protected nformation. as defined in paragraph 1 Of this Terminations Statement. understand tt'lat the lerm "pl,tbllc disclosore" lncll,ldes any disclosure of Protected nformation to one or more persons not authorized to have access to it n addition, reaffirm my agreement: (a) (b) to submit such information and materials for prepublication review; to make any required submissions prior 10 discussing the inlannation Of materials with, or snowing them to anyone who is not auftlorizec110 have access to lhem: (C) not to disclose such information or malerials to any person who is nol authorlze<llo have access 10 hem until have received written autllorilation from the NSA that such disclosure ill permitted; ano (d) 10 assign to the United States Government all rights, litle and inlerest and all royalties. remuneralion, or emoluments of whatever lorm that wiu or may result from any disclosure, publication, or revelation of Protected nformation not consistent with the terms of the NSA Security Agreement previously executed. understand hatthe pljrpooe of the prepublication review proce<be is to determine whether material contemplated 'or public disctosl,lre contains Protected nformation and, it so, 10 give the NSA an OPPOJiul'lity 10 prevent the public disclosure of such inlormatiol'l. understand that the NSA is Obligated pursuant to lhe NSA Security Agreement, and in accol'dance with he terms of NSAlCSS regulalion 10 63, to conduct the prepubhcatkm review in a reasonable time, to consult as n~sa.ry With me through the revn process, and to provide an opportunity for me to appeal initial review determinations. also understand that, as is necessary 10 concluet my personal,"aln,;, may revelll undassifled informalion as to wnere was employed. assigned or detailed, the generic nature of my employment, assignment or detail in accordance With the descriptlons provided for in Annex e to NSNCSS RegUlation "Release Of Unclassified NSAlCSS nformation, and the amount Of salary received in connection Mrewith. uncrerstand thai should exercise discretion and care in r!vealing SUCh inlorrnalion and tha by revealing Such information have not violaled the NSA Security Agreemenll previously ellecuted 4. 1recognize thai my exposure to Protected nformation makes me a potential target lor exploitation by loreign powers affirm that will immediately report 10 the proper authorities any altempt to solicit Protected nformation by a person not auttlon'zed by the United States Govemment 10 receive such nformation. f in the Untied Slates, runderstancll may report such activities to the NSA Office of security, or to the FedElfal Bureau of nvestigation, f in an overseas area, understand may report such activities to lhe Chiet or Security Officer 01 an NSA lield stalion, 10 the Commander 01 any U,S, military nstallation, or to a security Office ot the Department of Slate 5 1understand that because have access to Protected nformation, my travel through foreign areas may pose a certain risk 10 national securi1y, realize that althooqh am flo longer obligated to report foreign travel to!he Direclor of Security, NSA, the risk incurred in traveling to certain areas, from both a personal safely and a C tjl'lerint81igence standpoint, remains high. This paragraph does not apply to individuals whq remain in an employee stalus, Whose eligibility for acces$ has been suspenqe(f or whom eligibility lor access has been revoked and subseqljenliv appealed 6. On ltle occasion of the termination of my access to Protected nformation. t acknowledge have read this Statement, and my questions, if any. have been answered. certify that the debriefing officer made available Sections 793, and 1924 of Title t8, United ~tes CQ~; Section 421 through 426 and 783(b) 01 Title 50, United States Code: Public Law ; perlinetlt sections of Executive Order 12958, or any StJCCe$$Or Older; and NSA/CSS Regulation 10-63, "NSAJCSS PrepUblication Review Prooedures," $0 that may rtad them at this lime, il so choose, Also, hava been given a copy 01 Prepublication Guidelines 9lCplaining the procedures for submilling malenals for security review, in accordance with NSA Regulation 10-63, 7. These restrictions are consistent with and do nol supersede, canlliet with or otherwise aller he employee obligations, rights or liabilities created by Executive Order 12958, SeCtion 7211 of Title 5, United Stales Code (golll/lrnlng disclosures 10 Congress); Section '03401 Title 10. Unlted Shues Code, as amerlded by th. Military Whilj:tleblOwe:r Protection Act (govef'ning disclosure 10 Congress by members oflhe military); Section 2302{b){8) 01 Title 5, United Slates Code, as amended by the Whistleblower Protection Act (governing disclosures of illegality, wasle, fraud, abuse or public health or safety threals); lhe ntelligence dentities Proleclion Act of 1982 (50 USC 421 el seq.) (governing disclosures lhat could e",pose confidential Government agents), and the slames which protect against disclosures that may compromise the national ~curity, including Sections 641,793, , and Title 18, United States COde, and Section 4(b) 01 the Subversive Activities Act (SO USC Section 7B3(b)), The definitions, requirements, Obligations, rights, sanclions and liabilities created by said Execulive Order and sled statutes ire incorporated into his Agreement and are COntrolling SGNATURE MLTARY SERVCE RANK TYPED OR PRNTED NAME SOCAL SECURTY NUMBER DATE BREFNG OFFCER SGNATURE PRNtEO NAME DATE FORM Gt70E REV APR 200' (Supersedes Gt,OE REV JAN 9' which,s obsojete) NSN 7540 FM OO' 3115 pproved for Release by NSA. 0., h FOA Case #4287 _