OPNAVINST 1420.1B
14 DEC 09
Section 4 to
Chapter 8 of
Enclosure (1)
8-44
SECTION 4
STA-21 APPLICATION DATA LETTER
(Use only if application is not submitted via the Web site)
PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974 (Public Law 93-579),
this notice informs you of the purpose for collection of
information on the forms referenced in this instruction. Please
read it before completing the form.
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 10 U.S.C.
Section § 32, 504,505, 507,532, 552, 978, 1201, 1202, 4346, 2122,
12209, 12241; E.O. 9397.
PRINCIPAL PURPOSES: Information collected by this form will be used to
determine applicant's qualifications for commission in the U.S. Navy
and programs leading to commission. The authority governing this
collection is Privacy Act Systems of Record Notice N01070-3, Navy
Military Personnel Records System; N01420-1, Enlisted to Officer
Commissioning Programs; NM06150-6, Medical Readiness Reporting System
(MRRS). These notices can be downloaded at
http://privacy.navy.mil/privacy/noticenumber/
.
SAFEGUARDS: Password controlled system, file, and element access based
on predefined need-to-know. Physical access to terminals, terminal
rooms, buildings and activities' grounds are controlled by locked
terminals and rooms, guards, personnel screening and visitor registers.
Password complexity, expiration, minimum length, and history will
assist in assuring only appropriate personnel have access to client
data.
RETENTION: The collected information provided is FOR OFFICIAL USE ONLY
and may become a permanent part of your service record. Records which
have not been merged in the military personnel record are destroyed
after 2 years.
ROUTINE USES: To obtain background and medical information from the
application to determine applicant’s qualifications and medical fitness
for commission and programs leading to commission, appointment and
retention in the Armed Forces. The DoD 'Blanket Routine Uses' that
appear at the beginning of the Navy's compilation of system of record
notices apply to this system.
DISCLOSURE: Providing information on this form is voluntary. However,
failure to provide the requested information as well as the Social
Security Number may result in denial of appointment into the United
States Navy. If after you are appointed, it is found that you
concealed a record, you may be discharged from the U.S. Navy as a
fraudulent appointment and may be subject to a fine and/or
imprisonment. All collected personal data will be safeguarded pursuant
to the rulemaking of the Privacy Act of 1974 (5 U.S.C. § 552a) and/or
the personal privacy exemptions of the Freedom of Information Act [5
U.S.C. § 552(b)(6) and/or (b)(7)(C)], as applicable.