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Procedures for Non-Federal Users Application Form

For all nonfederal employees who are users of the PLGR's, here are some guidelines that must be performed in order for an expeditious process. Below is an example on how to fill out an Non-Federal User Form, along with a brief description of procedures. At the end of this category are two blank forms in PDF format that can be downloaded. These forms have been officially approved and cannot be changed or altered in any way or form.

Remember every user is obligated to fill out this form before attaining access to the PLGRs. If this is not met, that user will refrain from any use of the PLGRs. Also all paperwork must be submitted within 30 days, along with prior notification to the Agency Coordinator, no exceptions. Failure to comply will be grounds for revocations of User access and will result in removal from total access to the Federal PPS program.

3. Non-Federal User Form

Applies to Nonfederal personnel that want to be a user. This basically means a user wants to temporarily borrow a PLGR from a custodian. Each user is required to comply with the following examples and instructions:

1) Section I and II is an example of a fully completed form.

a) Section I reveals Identification of Non-Federal User, Identification of Federal Supervision and Identification of Receiver & Storage or Part I, II and III.
b) Section II reveals Certification Statements and Approval or Part IV and V.
c) Section III reveals Security Notice/Certification form. This is for your records only and should be filed with the Non-federal form.

2) Part I, II and III:

a) Fill this form out completely leaving nothing blank.
b) Enter N/A (not applicable) in places that don't apply to you.
c) State birth certificate under Type of Proof.
d) File proof of citizenship along with this form with your custodian.
e) Check only one under Status.

3) Part IV and V:

a) The custodian of that PLGR must sign and date under Coordinator/Custodian.
b) The user must also sign and date under Custodian/User.

4) SEND the original and proof of citizenship to the Agency Coordinator.

The Agency Coordinator will review the forms and sign off on them. The forms will be sent back to the GPS Center Coordinator or the GPS Field Station Coordinator to be filed. Also the GPS Center Coordinator or the GPS Filed Station Coordinator will maintain a users log sheet.

NOTES:

1) If an individual is born outside the U.S. and their parents are U.S. citizens or has been naturalized as a U.S. citizen, that individual is considered a U.S. citizen.

2) The Agency Coordinator will examine all Non-federal User Forms and either approve or disapprove each form.

Approved:
Individuals in this group have submitted their forms successfully and no inquiries will be made.

Disapproved:
Individuals in this group have insufficiently completed their form(s). You will be notified about the problem and will have to fax / submit an updated form.

Blank Non-Federal User Application (PDF file)

Blank Security Notice Application (PDF file)

Please note: PDF versions of of these blank forms require version 7.0 of the Adobe Acrobat Reader in order to view them. Users should download a free copy of Acrobat Reader 7.0.

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Comments, questions or suggestions? Send email to: rspengle@usgs.gov