Authorization to Store/Process NASA Information on an External ...

National
Aeronautics and
Space
Administration
<strong>Authorization</strong> <strong>to</strong> S<strong>to</strong>re/<strong>Process</strong> <strong>NASA</strong>
<strong>Information</strong> on an External System
<strong>NASA</strong> CENTER
SYSTEM NAME
AUTHORIZATION
SSP NUMBER (Per ITS-HBK-2810.02-07)
SECURITY CATEGORIZATION (Per FIPS 199 Security Impact Level)
SYSTEM OWNER (Name)
E-MAIL ADDRESS
I hereby authorize the use of this external system for s<strong>to</strong>ring and/or processing <strong>NASA</strong> information, for a period not
<strong>to</strong> exceed 36 months or the occurrence of a significant change, whichever comes first.
This external system has met the IT security requirements defined in <strong>NASA</strong> ITS HBK-2810.02-04 and any
remaining risks are at an acceptable level <strong>to</strong> adequately assure the IT security of the <strong>NASA</strong> information being
s<strong>to</strong>red and/or processed.
E-MAIL ADDRESS
ACCOUNTABLE OFFICIAL (Signature)
<strong>NASA</strong> ACCOUNTABLE OFFICIAL
NAME ORG TELEPHONE
DATE
ADDENDUM (Any Additional Constraints, Conditions, etc.)
ADDENDUM (Signature)
DATE
<strong>NASA</strong> FORM 1776 MAR 11 PREVIOUS EDITIONS ARE OBSOLETE.
NRRS 2/27.E
INSTRUCTIONS ON PAGE 2

INSTRUCTIONS FOR FILLING OUT NF 1776
AUTHORIZATION
<strong>NASA</strong> CENTER: Choose your <strong>NASA</strong> Center from the pull down menu.
SYSTEM NAME: Enter your system's name.
SSP NUMBER (Per ITS-HBK-2810.02-07): Per ITS-HBK-2810.02-07, enter the SSP Number.
SECURITY CATEGORIZATION (Per FIPS 199 Security Impact Level): Per FIPS 199 Security Impact Level,
choose one of the following - Low, Moderate, or High - from the pull down menu.
SYSTEM OWNER: Enter the name of the System Owner.
E-MAIL ADDRESS: Enter the e-mail address of the System Owner.
<strong>NASA</strong> ACCOUNTABLE OFFICIAL
E-MAIL ADDRESS: Enter the e-mail address of the <strong>NASA</strong> Accountable Official.
NAME: Enter the name of the <strong>NASA</strong> Accountable Official.
ORG: Enter the organization for the <strong>NASA</strong> Accountable Official.
TELEPHONE: Enter the phone number of the <strong>NASA</strong> Accountable Official.
ACCOUNTABLE OFFICIAL SIGNATURE: This is the signature line for the <strong>NASA</strong> Accountable Official.
DATE: Enter the date of the signature.
ADDENDUM: Enter any additional constraints or conditions.
ADDENDUM SIGNATURE: If addendum was added, please sign here.
DATE: Enter the date of the signature.
<strong>NASA</strong> FORM 1776 MAR 11 PREVIOUS EDITIONS ARE OBSOLETE.