Application Number/Date: 136669 11118/2012 Page 1 of2 FLTMPS Access Request Form For Reserve Military Personnel For

Official Use Only This Report Contains Privacy Sensitive Data. Any misuse or unauthorized disclosure may result in both civil or criminal penal ties. Svstem(s) Selected: FLTMPS EPM IRast Num: 136669 App Dt: 11/18/2012 UIC: N89297 NR TACTICAL SOUADRON 1194 ILocation: SAN DIEGO CA Status: MILITARY - DRILLING RESERVE USN Name: DEGUZMAN SHEILA C CS3 I Pending UIC: N/ A Job ITRAINING PETTY OFFICER tritle: Phone: 61943703827 IDSN: EMail: SHEILA.CASTANEDA@NAVY.MIL ICode/Dept/Div: Reason For DESIGNATED TO PERFORM THE JOB OF TRAINING PETTY OFFICER FOR VTC-11. Access to FLTMPS Priv. Act Trainina Comol: Y ant's Signature: } Authorizing L4uth. Officer's Name: KAHENY JOHN IRank/Grade: 0-4 Officer Auth. Officer's Phone: Auth. Officer's Job Title: ITRAINING OFFICER Auth. Officer's EMail PETER.KAHENY@NAVY.MIL Address: *** Mandatory *** Government/Military Supervisor authorizing access to Personnel/Privacy Data Course Completion Reporting Requested CO/X~{O;~ mU1~ .. !?!:_~~~~~ o,!fl~JIJt7fR rl)t~lVf/ Signature: j I~; ?_--?""--'-~"''- LCOC ('ONeill J'~ /~,,#'~ . Applicant requires access to Privacy Act Data: Yes --, No -Note: By checking "Yes" above, I confirm that I have read the legal notices be low and the applicant requires access to Privacy Act data in the performance of his/her duties. He/she has completed Privacy Act Information Assurance training as required by the Privacy Act of 1974, SECNAV 5211.5E and the Computer Security Act. Course Completion Reporting: I hereby acknowledge applicant requires access to the FLTMPS Learning Event Completion Module. Upon approval he/she will enter completions for GMT, NADAP, NLDP among other courses available within module for all personnel assigned to UIC(s). Yes -- No -- Is your activity responsible for accessing SSN's for Ot her UIC's not under your chain of command?----"L Privacy Act: No Additional UIC' s Requested Are you responsible for Processing Course Completions for: Your activity"'L Othe r Commands J'L Course Completion Processing: No Additional UIC's Requested

Priv. Act Data Rqsted: Y

VBSS Rqsted: N

Applic

GENERAL NOTICES: 1. Accounts subject to termination when inactive for a period of 90 days. 2. Accounts no longer needed: The Government/Military supervisor is responsible for making sure that the NTMPS office is notified of accounts no longer needed. Fax or phone this information to one of the numbers listed below. 3. GS-5 and E-4 and below applicants must obtain either the Commanding Officer's or Executive Officer's signature prior to submission of application. 4. Account setup notification will be sent via E-mail.This process may take up t o 10 working days. 5. The NTMPS Account/Access will remain enabled while the user is attached to th e current activity or for a period not to exceed 2 years. Once an account expire s a new application will have to be submitted. https://ntmpsweb.nwptf.nuwc.navy.mil/oars_net/HardCopy F orm.aspx?GenF orm=N 11118/2012 l _ Application Number/Date: 136669 11118/2012 Page 2 of2 LEGAL NOTICES: 1. NTMPS, a Department of the Navy system, contains personnel information that i s protected under the Privacy Act of 1974. Such information is for Official Use Only and any misuse or unauthorized disclosure of such information may result in both civil and criminal penalties. Whenever an authorized NTMPS user no longer requires access to the system, the account must be relinquished. 2. Use of NTMPS is monitored to ensure compliance with applicable laws and regul ations. This site has security measures in place to protect the loss, misuse, an d alteration of information under its control. Personnel granted access to NTMPS who misuse/abuse their account are subject to the penalties established under t he Privacy Act of 1974. 3. READ the warning screen which appears when logging into NTMPS. 4. Authorized NTMPS users shall not allow others to use their account. Anyone wh o does, is subject to immediate termination of their account in addition to pena lties established under the 1974 Privacy Act. 5. Downloading data from NTMPS and/or FLTMPS for the purposes of uploading into another application or database is NOT AUTHORIZED and is a violation of the Priv acy Act of 1974. This unauthorized use will result in the immediate termination of your account and is subject to appropriate disciplinary action. Fax completed application to: 1-850-452-1868 (Commercial), 922-1868 (DSN), or 1866-200-9279 (toll free in US) If unable to fax form, you may email scanned, and signed application form and at tach it (PDF format) to: NTMPS.SUPPORT@NAVY.MIL

For assistance contact the NTMPS Support Office at: 1-850-452-1867 (Commercial), 922-1867 (DSN), or 1-866- 438-2898 (toll free in US) NTMPS NETC/NUWC Approval Signature: Date Approved: Office Unlimited [ 1 ILimited [ 1 !Activity [ 1 Restricted [ 1 ICourse Com pletion [ 1 Use Onlv Access Level: Application NumberlDate: 136669 11118/2012 https://ntmpsweb.nwptfnuwc.navy.mil/oars_net/HardCopy F orm.aspx?GenF orm= N 11118/2012 [-' ---~----