Information System Security Manager (ISSM)
Name: Click here to enter text.
Organization: Click here to enter text.
Address: Click here to enter text.
Phone: Click here to enter text.
Email: Click here to enter text.
Click here to enter text.
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System Administrator/Network Administrator (SA/NA)
Name: Click here to enter text.
Organization: Click here to enter text.
Address: Click here to enter text.
Phone: Click here to enter text.
Email: Click here to enter text.
Data Transfer Agent (DTA)/Trusted Download
Name: Click here to enter text.
Organization: Click here to enter text.
Address: Click here to enter text.
Phone: Click here to enter text.
Email: Click here to enter text.
Transfer Risk Level (High or Low): Click here to enter text.
Physical Environment Facility/System LAYOUT (Blueprint Diagram)
Include diagram as an attachment.
Personnel Authorizations
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