ATC SUBMITTAL

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AUTHORITY TO CONNECT (ATC) SUBMITTAL FORM - DSN

Device Information

* = Required Fields

1a. Switch Function* (ie: RSU, SMEO, EO, MFS, PBX, etc.)
Other (Use this box if not found in list above)*
1b. Manufacturer*
1c. Model *
1d. Software Release*
1e. Planned Date of Installation*
1f. Estimated Completion Date of Installation*
1g. Is Product on APL?

Certification and Accreditation Information

2a. Does facility/site hold current Certification and Accreditation that identifies and covers the equipment that connection authority is being requested for (DoD Instruction 5200.40 / 8510.01) (Local DITSCAP/DIACAP)) ? *
2b. If so, what type? *
2c. What is the effective date of current certification? *
2d. What is the expiration date of current certification? *

Information Assurance Manager

Contact Information
3a. IA Manager's Last Name: *
3b. IA Manager's First Name: *
3c. Commercial Phone: *
3d. Commercial Phone Ext:
3e. DSN Phone: *
3f. DSN Ext:
3g. IA Manager's Email *

Facility Information/Place of Installation

4a. DoD Component *
4b. Organization *
4c. Office Symbol or POC
4d. Unit or Street Address 1 *
4e. Unit or Street Address 2
4f. City or APO or FPO *
4g. List Station or Base
4h. State or AE or AP Code *
4i. Zip Code *
4j. Country
4k. Theatre *

Designated Approval Authority

Contact Information

5a. DAA's Last Name *
5b. DAA's First Name *
5c. DAA Rank or Grade *
5d. DAA's Commercial Phone
5e. DAA's Commercial ext
5f. DAA's DSN Phone *
5g. DAA's DSN ext
5h. DAA's Email *
Switch Point of Contact Information

 
6a. POC's Last Name *
6b. POC's First Name *
6c. POC's Title/Rank *
6d. POC's Grade
6e. POC's Commercial Phone
6f. POC's Commercial ext
6g. POC's DSN Phone *
6h. POC's DSN ext
6i. POC's Email *
6j.Group Email Address
6k.. Additional Information/Comments?

Contact UCCO Office

DSN DIRECTORY