Fillable DD Form 2930 PIA Sections 1-2 (Advanced Distributed Learning Initiative)

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DD Form 2930 PIA Sections 1-2 (Advanced Distributed Learning Initiative)

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DD FORM 2930 NOV 2008
Page 1 of 15
PRIVACY IMPACT ASSESSMENT (PIA)
For the
SECTION 1: IS A PIA REQUIRED?
a. Will this Department of Defense (DoD) information system or electronic collection of
information (referred to as an "electronic collection" for the purpose of this form) collect,
maintain, use, and/or disseminate PII about members of the public, Federal personnel,
contractors or foreign nationals employed at U.S. military facilities internationally? Choose
one option from the choices below. (Choose (3) for foreign nationals).
(1) Yes, from members of the general public.
(2) Yes, from Federal personnel* and/or Federal contractors.
(3) Yes, from both members of the general public and Federal personnel and/or Federal contractors.
(4) No
* "Federal personnel" are referred to in the DoD IT Portfolio Repository (DITPR) as "Federal employees."
b. If "No," ensure that DITPR or the authoritative database that updates DITPR is annotated
for the reason(s) why a PIA is not required. If the DoD information system or electronic
collection is not in DITPR, ensure that the reason(s) are recorded in appropriate
documentation.
c. If "Yes," then a PIA is required. Proceed to Section 2.
DD FORM 2930 NOV 2008
Page 2 of 15
SECTION 2: PIA SUMMARY INFORMATION
a. Why is this PIA being created or updated? Choose one:
New DoD Information System
New Electronic Collection
Existing DoD Information System
Existing Electronic Collection
Significantly Modified DoD Information
System
b. Is this DoD information system registered in the DITPR or the DoD Secret Internet Protocol
Router Network (SIPRNET) IT Registry?
Enter DITPR System Identification Number
Yes, SIPRNET
Enter SIPRNET Identification Number
No
c. Does this DoD information system have an IT investment Unique Project Identifier (UPI), required
by section 53 of Office of Management and Budget (OMB) Circular A-11?
Yes
No
If "Yes," enter UPI
If unsure, consult the Component IT Budget Point of Contact to obtain the UPI.
d. Does this DoD information system or electronic collection require a Privacy Act System of
Records Notice (SORN)?
A Privacy Act SORN is required if the information system or electronic collection contains information about U.S. citizens
or lawful permanent U.S. residents that is retrieved by name or other unique identifier. PIA and Privacy Act SORN
information should be consistent.
Yes
No
If "Yes," enter Privacy Act SORN Identifier
DoD Component-assigned designator, not the Federal Register number.
Consult the Component Privacy Office for additional information or
access DoD Privacy Act SORNs at: http://www.defenselink.mil/privacy/notices/
or
Date of submission for approval to Defense Privacy Office
Consult the Component Privacy Office for this date.
DD FORM 2930 NOV 2008
Page 3 of 15
e. Does this DoD information system or electronic collection have an OMB Control Number?
Contact the Component Information Management Control Officer or DoD Clearance Officer for this information.
This number indicates OMB approval to collect data from 10 or more members of the public in a 12-month period
regardless of form or format.
Yes
Enter OMB Control Number
Enter Expiration Date
No
f. Authority to collect information. A Federal law, Executive Order of the President (EO), or DoD
requirement must authorize the collection and maintenance of a system of records.
(1) If this system has a Privacy Act SORN, the authorities in this PIA and the existing Privacy Act
SORN should be the same.
(2) Cite the authority for this DoD information system or electronic collection to collect, use, maintain
and/or disseminate PII. (If multiple authorities are cited, provide all that apply.)
(a) Whenever possible, cite the specific provisions of the statute and/or EO that authorizes
the operation of the system and the collection of PII.
(b) If a specific statute or EO does not exist, determine if an indirect statutory authority can
be cited. An indirect authority may be cited if the authority requires the operation or administration of
a program, the execution of which will require the collection and maintenance of a system of records.
(c) DoD Components can use their general statutory grants of authority (“internal
housekeeping”) as the primary authority. The requirement, directive, or instruction implementing the
statute within the DoD Component should be identified.
DD FORM 2930 NOV 2008
Page 4 of 15
g. Summary of DoD information system or electronic collection. Answers to these questions
should be consistent with security guidelines for release of information to the public.
(1) Describe the purpose of this DoD information system or electronic collection and briefly
describe the types of personal information about individuals collected in the system.
(2) Briefly describe the privacy risks associated with the PII collected and how these risks are
addressed to safeguard privacy.
h. With whom will the PII be shared through data exchange, both within your DoD Component and
outside your Component (e.g., other DoD Components, Federal Agencies)? Indicate all that apply.
Within the DoD Component.
Specify.
Other DoD Components.
Specify.
Other Federal Agencies.
Specify.
State and Local Agencies.
Specify.
Contractor (Enter name and describe the language in the contract that safeguards PII.)
Specify.
Other (e.g., commercial providers, colleges).
Specify.
DD FORM 2930 NOV 2008
Page 5 of 15
i. Do individuals have the opportunity to object to the collection of their PII?
Yes
No
(1) If "Yes," describe method by which individuals can object to the collection of PII.
(2) If "No," state the reason why individuals cannot object.
j. Do individuals have the opportunity to consent to the specific uses of their PII?
Yes
No
(1) If "Yes," describe the method by which individuals can give or withhold their consent.
(2) If "No," state the reason why individuals cannot give or withhold their consent.
DD FORM 2930 NOV 2008
Page 6 of 15
k. What information is provided to an individual when asked to provide PII data? Indicate all that
apply.
Privacy Act Statement
Privacy Advisory
Other
None
Describe
each
applicable
format.
NOTE:
Sections 1 and 2 above are to be posted to the Component's Web site. Posting of these
Sections indicates that the PIA has been reviewed to ensure that appropriate safeguards are in
place to protect privacy.
A Component may restrict the publication of Sections 1 and/or 2 if they contain information that
would reveal sensitive information or raise security concerns.
DD FORM 2930 NOV 2008
Page 7 of 15
SECTION 3: PIA QUESTIONNAIRE and RISK REVIEW
a. For the questions in subparagraphs 3.a.(1) through 3.a.(5), indicate what PII (a data element
alone or in combination that can uniquely identify an individual) will be collected and describe
the source, collection method, purpose, and intended use of the PII.
(1) What PII will be collected? Indicate all individual PII or PII groupings that apply below.
Name
Other Names Used
Social Security Number (SSN)
Truncated SSN
Driver's License
Other ID Number
Citizenship
Legal Status
Gender
Race/Ethnicity
Birth Date
Place of Birth
Personal Cell Telephone
Number
Home Telephone
Number
Personal Email Address
Mailing/Home Address
Religious Preference
Security Clearance
Mother's Maiden Name
Mother's Middle Name
Spouse Information
Marital Status
Biometrics
Child Information
Financial Information
Medical Information
Disability Information
Law Enforcement
Information
Employment Information
Military Records
Emergency Contact
Education Information
Other
If "Other," specify or
explain any PII
grouping selected.
(2) What is the source for the PII collected (e.g., individual, existing DoD information
systems, other Federal information systems or databases, commercial systems)?
DD FORM 2930 NOV 2008
Page 8 of 15
(3) How will the information be collected? Indicate all that apply.
Paper Form
Face-to-Face Contact
Telephone Interview
Fax
Email
Web Site
Information Sharing - System to System
Other
(4) Why are you collecting the PII selected (e.g., verification, identification, authentication,
data matching)?
(5) What is the intended use of the PII collected (e.g., mission-related use,
administrative use)?
b. Does this DoD information system or electronic collection create or derive new PII about
individuals through data aggregation? (See Appendix for data aggregation definition.)
Yes
No
If "Yes," explain what risks are introduced by this data aggregation and how this risk is mitigated.
DD FORM 2930 NOV 2008
Page 9 of 15
c. Who has or will have access to PII in this DoD information system or electronic
collection? Indicate all that apply.
Users
Developers
System Administrators
Contractors
Other
d. How will the PII be secured?
(1) Physical controls. Indicate all that apply.
Security Guards
Cipher Locks
Identification Badges
Combination Locks
Key Cards
Closed Circuit TV (CCTV)
Safes
Other
(2) Technical Controls. Indicate all that apply.
User Identification
Biometrics
Password
Firewall
Intrusion Detection System
(IDS)
Virtual Private Network (VPN)
Encryption
DoD Public Key Infrastructure
Certificates
External Certificate Authority
(CA) Certificate
Common Access Card (CAC)
Other
DD FORM 2930 NOV 2008
Page 10 of 15
(3) Administrative Controls. Indicate all that apply.
Periodic Security Audits
Regular Monitoring of Users' Security Practices
Methods to Ensure Only Authorized Personnel Access to PII
Encryption of Backups Containing Sensitive Data
Backups Secured Off-site
Other
e. Does this DoD information system require certification and accreditation under the DoD
Information Assurance Certification and Accreditation Process (DIACAP)?
Yes. Indicate the certification and accreditation status:
Authorization to Operate (ATO)
Date Granted:
Interim Authorization to Operate (IATO)
Date Granted:
Denial of Authorization to Operate
(DATO)
Date Granted:
Interim Authorization to Test (IATT)
Date Granted:
No, this DoD information system does not require certification and accreditation.
f. How do information handling practices at each stage of the "information life cycle" (i.e.,
collection, use, retention, processing, disclosure and destruction) affect individuals' privacy?
DD FORM 2930 NOV 2008
Page 11 of 15
g. For existing DoD information systems or electronic collections, what measures have been put in
place to address identified privacy risks?
.
h. For new DoD information systems or electronic collections, what measures are planned for
implementation to address identified privacy risks?
.
DD FORM 2930 NOV 2008
Page 12 of 15
SECTION 4: REVIEW AND APPROVAL SIGNATURES
Prior to the submission of the PIA for review and approval, the PIA must be coordinated by
the Program Manager or designee through the Information Assurance Manager and Privacy
Representative at the local level.
Program Manager or
Designee Signature
Name:
Title:
Organization:
Work Telephone Number:
DSN:
Email Address:
Date of Review:
Other Official Signature
(to be used at Component
discretion)
Name:
Title:
Organization:
Work Telephone Number:
DSN:
Email Address:
Date of Review:
DD FORM 2930 NOV 2008
Page 13 of 15
Other Official Signature
(to be used at Component
discretion)
Name:
Title:
Organization:
Work Telephone Number:
DSN:
Email Address:
Date of Review:
Component Senior
Information Assurance
Officer Signature or
Designee
Name:
Title:
Organization:
Work Telephone Number:
DSN:
Email Address:
Date of Review:
Component Privacy Officer
Signature
Name:
Title:
Organization:
Work Telephone Number:
DSN:
Email Address:
Date of Review:
DD FORM 2930 NOV 2008
Page 14 of 15
Component CIO Signature
(Reviewing Official)
Name:
Title:
Organization:
Work Telephone Number:
DSN:
Email Address:
Date of Review:
Publishing:
Only Sections 1 and 2 of this PIA will be published. Each DoD Component will maintain a central
repository of PIAs on the Component's public Web site. DoD Components will submit an electronic
copy of each approved PIA to the DoD CIO at: pia@osd.mil.
If the PIA document contains information that would reveal sensitive information or raise security
concerns, the DoD Component may restrict the publication of the assessment to include Sections 1
and 2.
DD FORM 2930 NOV 2008
Page 15 of 15
APPENDIX
Data Aggregation. Any process in which information is gathered and expressed in a summary form for
purposes such as statistical analysis. A common aggregation purpose is to compile information about
particular groups based on specific variables such as age, profession, or income.
DoD Information System. A set of information resources organized for the collection, storage, processing,
maintenance, use, sharing, dissemination, disposition, display, or transmission of information. Includes
automated information system (AIS) applications, enclaves, outsourced information technology (IT)-based
processes and platform IT interconnections.
Electronic Collection. Any collection of information enabled by IT.
Federal Personnel. Officers and employees of the Government of the United States, members of the
uniformed services (including members of the Reserve Components), and individuals entitled to receive
immediate or deferred retirement benefits under any retirement program of the United States (including
survivor benefits). For the purposes of PIAs, DoD dependents are considered members of the general public.
Personally Identifiable Information (PII). Information about an individual that identifies, links, relates or is
unique to, or describes him or her (e.g., a social security number; age; marital status; race; salary; home
telephone number; other demographic, biometric, personnel, medical, and financial information). Also,
information that can be used to distinguish or trace an individual's identity, such as his or her name; social
security number; date and place of birth; mother's maiden name; and biometric records, including any other
personal information that is linked or linkable to a specified individual.
Privacy Act Statements. When an individual is requested to furnish personal information about himself or
herself for inclusion in a system of records, providing a Privacy Act statement is required to enable the
individual to make an informed decision whether to provide the information requested.
Privacy Advisory. A notification informing an individual as to why information is being solicited and how such
information will be used. If PII is solicited by a DoD Web site (e.g., collected as part of an email feedback/
comments feature on a Web site) and the information is not maintained in a Privacy Act system of records, the
solicitation of such information triggers the requirement for a privacy advisory (PA).
System of Records Notice (SORN). Public notice of the existence and character of a group of records under
the control of any agency from which information is retrieved by the name of the individual or by some
identifying number, symbol, or other identifying particular assigned to the individual. The Privacy Act of 1974
requires this notice to be published in the Federal Register upon establishment or substantive revision of the
system, and establishes what information about the system must be included.
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Completed 25 January 2021

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