SECNAV 5213/1 for OPNAV 5510/423

SECNAV 5213-1 (Exp 11/31/2019)
SECNAVINST 5213.16

SSN REDUCTION REVIEW
DATE COMPLETED:

EMAIL
SUBMIT
Form Number:

Submission for (Check one):

FORM

IT SYSTEM

DRAFT OPNAV 5510/423

SHARE DRIVE / WEB PORTAL

Requiring Document:

OPNAVINST 5510.165B

Form Revision Date:
SECTION 1
TO BE COMPLETED BY FORM ORIGINATOR/SPONSOR. Forms that collect and retrieve by SSN/PII must be covered by a System of Record
Notice (SORN), be call for within a requiring document, and have Privacy Act Officer approval for Privacy Act Statements. Return
completed packages that contain the SSN Reduction Review Form, Justification, and if need the DD 67 to the
cognizant forms manager.
1. Is the form covered by a System of Record Notice (SORN)?
a. If yes, what is the SORN number?
DUSDI 01-March

22, 2019; 84 FR 10803

YES

NO

b. If no, contact the Privacy Act Officer for instructions.
YES

NO

YES

NO

b. If no, contact the Privacy Act Officer for instructions.
3. Is the SSN Field needed?

YES

NO

a. If no, complete DD67 to request revision of the form.
4. Could an alternative to the SSN be used?

YES

2. Does the form contain a Privacy Act Statement (PAS)?
a. If yes, has the PAS been approved by a Privacy Act Officer?

NO

a. If yes, complete DD67 to request revision of the form.
YES

NO

a. If yes, is the SSN field masked or truncated?

YES

NO

b. If no, could it be?

YES

NO

YES

NO

YES

NO

YES

NO

5. Is this form electronic?

6. Is this form part of an IT system?
a. If yes, what is the IT System name and DITPR DON ID?
b. If yes, does the IT System mask or truncate the display of the SSN on the form?
c. If no, Could it be?

YES

7. Is Justification Memorandum for the Record attached?

NO

CONTACT INFORMATION - IT System Owner or Form Originator/Sponsor
Name, Code, Mailing Address

Office Telephone Number:

OPNAV N2N6
2000 Navy Pentagon
Washington, DC 20350

703-601-1196
E-mail Address

Jordan.p.Hersch.civ@us.navy.mil

SECTION 2 TO BE COMPLETED BY PRIVACY ACT OFFICER

To verify information given in Section 1 is accurate, is in compliance with Privacy Act Regulations, and meets requirements of the
SSN Reduction Plan.
1. Is Privacy Act Statement (PAS) correct?

YES

NO

2. If there is not a PAS, is one needed?

YES

NO

3. If a PAS needed, what is the correct PAS? (Originator/owner of form/IT system will work with the Privacy Act Officer to draft a PAS if needed) (Field will expand
to fit typed data))

4. Is the System of Records Notice (SORN) number cited in Section 1 correct?

YES

NO

5. Does a SORN need to be initiated?

YES

NO

YES

NO

(Determination of need for SORN will be worked between the originator/owner of form/IT system and Command Privacy Act Office)

6. Is use of SSN Justification Form complete and approved?
APPROVED
DISAPPROVED

Mr. Richard Strong
Privacy Act Officer Printed Name

STRONG.RICHARD.ROLAND.1 Digitally signed by
STRONG.RICHARD.ROLAND.1030871673
030871673
Date: 2023.04.03 13:57:10 -04'00'
Privacy Act Officer Signature

03 Apr 2023
Date

SECTION 3 - COMMAND FORMS MANAGER
APPROVED
DISAPPROVED

Forms Manager Printed Name

SECNAV 5213/1 (REV Oct 2019)

Forms Manager Approval Signature

Date:
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SECNAV 5213-1 (Exp 11/31/2019)
SECNAVINST 5213.16
NOTES:

(1) For IT systems / applications, this completed SECNAV 5213/1 will be posted in the DOC tab of DITPR DON / DADMS respectively.
(2) For forms, post the date this SECNAV 5213/1 is approved in Naval Forms Online https://navalforms.documentservices.dla.mil/web/public/home.
and maintain the SECNAV 5213/1 in the form's history/case file.
(3) Approved share drive / web portal forms will be maintained locally by the share drive / web portal owner.

SECNAV 5213/1 (REV Oct 2019)

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SECNAV 5213-1 (Exp 11/31/2019)
SECNAVINST 5213.16

SSN USE REVIEW AND JUSTIFICATION FOR FORMS

12 Oct 2022
Date

MEMORANDUM FOR THE RECORD
Subj: JUSTIFICATION FOR THE USE OF THE SOCIAL SECURITY NUMBER (SSN)
1. What is the purpose of this form?

The purpose of this form is to collect information both regarding concerning behavior that could lead to an
insider threat incident, as well as information regarding the subject of the alleged in the form.

2. Why is collection of the SSN necessary?

Collection of the SSN is necessary in order to validate the subject listed in the form. Without a SSN it would
be difficult or impossible in some cases to validate that the person alleged in the form is the correct person.
At times alerts received have similar names, or names that are common and thus it becomes impossible to
ascertain if a “John Doe” is the correct “John Doe”. Additionally the SSN is used to validate an individual’s
security clearance.

3. List the acceptable use criteria for the SSN (found at this link: http://www.doncio.navy.mil/ContentView.aspx?ID=1833)

Law Enforcement, National Security and Credentialing: Almost every law enforcement application must be
able to report and track individuals through the use of the SSN. This includes, but is not limited to, checks
of the National Crime Information Center, state criminal histories and Federal Bureau of Investigation
records checks.
Security Clearance Investigation or Verification: The initiation, conduct or verification of security clearances
requires the use of the SSN. The SSN is the single identifier that links all the aspects of these
investigations. This use case is also linked to other Federal agencies that continue to use the SSN as a
primary identifier.
4. If collection of the SSN is no longer necessary and a unique identifier can be substituted for the SSN or the SSN can be eliminated,
on what date will either the substitution or elimination occur?

At a time no later than 90 days after which the SSN is no longer required.

Commanding Officer

SECNAV 5213/1 (REV Oct 2019)

Command/Activity

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