HOSC ACCOUNT REQUEST FORM

HCR No. (for internal use only):

/

Date:

Section I: General Information

Check one:

/

X

/

New account

/

Modifications to existing account

/

Change in account owner

Account Owner Name: / Phone Number:
(first name) (MI) (last name)
Organization & Operating Location: / AMS, POCC@ JSC& CERN / Email:
SectionII: Account Types / Expiration Date: / (if applicable)
Account Access: / X / Single User / Multi-User (complete Multi-User section on back of form)
Project Name: / AMS-02 / Purpose of Account: / Monitor Payload Operations
Desired System(s):
EHS: / (Att. 1) / IVoDS: / X
PPS: / (Att. 2) / PDSS:
MPS/EPC: / X - HOPS / (Att. 4) / DR/Droid:
MPV/OSTPV/iPV: / DR/WinPlot/Samba:
Firewall/VPN: / HOSC Institutional: / (Att. 4,5)
Admin Portal: / X / Other: / (specify)
ACCOUNT OWNER RESPONSIBILITY ACKNOWLEDGMENT
Account Owners are responsible for the actual use and protection of their computer account(s) and shall not compromise the security of the systems by doing any of the following: Using passwords that are part of a pattern (i.e. April, May, etc.), “trivial” passwords (i.e. MSFC, NASA, etc.) either wholly or partially composed of any common words, names, numbers, abbreviations, or acronyms associated with the user or the user's occupation;contain the name of any automated product or application; a dictionary word; a simple keyboard pattern (i.e. QWERTY); or prefixed by a single digit whereas the removal of that digit would result in an invalid password; recording password in such a manner or location in which it can be compromised by another person; entering any software that is not certified free of viruses or any contaminates into the system; or leaving unsecured terminals unsupervised or with a non-authorized user.
Unauthorized use of the computer accounts and computer resources to which I am granted access is a violation of Section 799, Title 18, U.S. Code; constitutes theft; and is punishable by law. I understand that I am the only individual to access these accounts and will not knowingly permit access by others without written approval. I understand that my misuse of assigned accounts, and my accessing others’ accounts without authorization is not allowed. I understand that these systems and resources are subject to monitoring and recording. I further understand that failure to abide by these provisions may constitute grounds for termination of access privileges, administrative action, and/or civil or criminal prosecution.
Account Owners are responsible for reporting any changes which affect their access request forms (including the addition or deletion of users on multi-user accounts), and are responsible for reporting any suspected or observed access control violations and complying with security regulations. Upon deletion of any users on multi-user accounts, the account password must be changed. Any users who are not U.S. citizens must fill out the Non U.S. Citizen Information section on the back of this page. International Partners are subject to provisions specified in applicable Intergovernmental Agreements.
I / hereby certify that I shall comply with the above statements.
(Account Owner Name - please print) / U.S. Citizen? / Yes / No(complete Non U.S. Citizen Info on back)
Account Owner Signature / Date
Supervisor / NASA Sponsor Signature / Date
For Internal Use Only:
USERID/Account Name(s):
For NASA Approval Only:
NASA System Management / Date
For Implementer Use Only:
Senior SYSCON; System Manager; DBA; HACM / Date
NON U.S. CITIZEN INFORMATION
For any users who are not U.S. citizens, the following information is required for access to HOSC systems. (use separate sheet if necessary)
Full Name (Please Print): / Male / Female / Date of Birth (MM/DD/YY): / Place of Birth (City, Country):
(First name) (MI) (Last name)
Residence Address: / Citizenship: / Dual Citizenship (Country): / Social Security # (if applicable):
Passport Number: / Passport Expiration Date: / Passport Country of Issue:
Visa Number: / Visa Expiration Date: / Your Title on the Project:
Employer/Company Name: / Employer/Company Address (City, Country only):

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Verification Code Assignment Form

Each account team member must submit a caller verification code that will be used to authenticate all HOSC account users when they call in for an account password or help. ** This code is separate from your account password and may be any alpha and/or numeric combination.

Each individual user should generate a verification code that should be something familiar, yet private, to the individual so that it can be easily recalled by if required for authentication. The code must be individually faxed or mailed to the HOSC. Account owners should not collect verification codes from team members and submit as a consolidated input (this would compromise individual code privacy).

A user's verification code is valid for all accounts so only one code is required per user. Do not send in another verification code if you already have one on file, unless you have forgotten it. The latest verification code received will be used in place of any previous verification codes sent.

Name:
Company/Affiliation
Location: / AMS POCC, CERN, GENEVA, SWITZERLAND
Phone:
Email:
Project/Program: / ALPHA MAGNETIC SPECTROMETER (AMS-02)
My caller verification code assignment is:
(must be a minimum of four alpha-numeric characters)

If you forget your caller verification code, we will need some additional verification to protect your online information. Please create a private verification question in the space below along with your response. Do not use Personally Identifiable Information (PII) for this question/response.

Verification question
Response

ACCOUNT OWNER RESPONSIBILITY ACKNOWLEDGMENT

Account Owners are responsible for the actual use and protection of their computer account(s) and shall not compromise the security of the systems by doing any of the following: Using passwords that are part of a pattern (i.e. April, May, etc.), “trivial” passwords (i.e. MSFC, NASA, etc.) either wholly or partially composed of any common words, names, numbers, abbreviations, or acronyms associated with the user or the user's occupation;contain the name of any automated product or application; a dictionary word; a simple keyboard pattern (i.e. QWERTY); or prefixed by a single digit whereas the removal of that digit would result in an invalid password; recording password in such a manner or location in which it can be compromised by another person; entering any software that is not certified free of viruses or any contaminates into the system; or leaving unsecured terminals unsupervised or with a non-authorized user.

Unauthorized use of the computer accounts and computer resources to which I am granted access is a violation of Section 799, Title 18, U.S. Code; constitutes theft; and is punishable by law. I understand that I am the only individual to access these accounts and will not knowingly permit access by others without written approval. I understand that my misuse of assigned accounts and my accessing others’ accounts without authorization is not allowed. I understand that these systems and resources are subject to monitoring and recording. I further understand that failure to abide by these provisions may constitute grounds for termination of access privileges and/or other administrative action.

Account Owners are responsible for reporting any changes which affect their access request and are responsible for reporting any suspected or observed access control violations and complying with security regulations. International Partners are subject to provisions specified in applicable Intergovernmental Agreements. By signing below, the user confirms understanding and acknowledges compliance of the above statement.

Signature / Date

Fax Completed form with cover sheet to Attn: HOSC Account Manager (+1) 256-544-8629

Or Mail Completed form to Stephanie Wilburn, Mailstop: Suite EO60, Marshall Space Flight Center, AL 35812

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