Fillable Printable Unit Ration Card and Monitor System Application Form

Unit Ration Card and Monitor System Application Form

UNIT RATION CARD AND MONITOR SYS TEM APPLICATION

( For use of this form, see USFK REG 60-1; the proponent agency is FKJ1)

(SEE PRIVACY ACT STATEMENT ON REVERSE SIDE)

DATE RECEIVED BY IA : DATE RECEIVED BY J1:

UNIT INFORMATION

1. UNIT NAME

2. UIC/PAS CODE(S)

3. UN IT ADDRESS (INCLUDING APO)

4. LOCATION/INSTALLATION

5. UNIT RATION CARD HOLDER (Individual who will responsible for and accountabl e for the unit ration card)

PRIMARY ALTERNATE

NAME

GRADE/RANK/DEROS

PHONE NUMBER

POC SIGNATURE POC SIGNATURE

6. UNIT MONITORING POC (AT L EAST 1 POC REQUIRED)

(Individual who will responsible for viewing, managing and responding to ration violations within the unit.)

NAME

GRADE/RANK/DEROS

PHONE NUMBER

POC SIGNATURE POC SIGNATURE

7. UNIT COMMANDER POC (Com m ander, Director, Manager of the unit)

NAME

GRADE/RANK DEROS

PHONE NUMBER EMAIL

UNIT COMMANDER SIGNATURE

APPL ICATION DETAILS

8. REASON F O R SUBMISSION

FILLED BY FKJ1 PERSONNEL SYSTEMS BRANCH

UNIT NAME IN PIMSK ACTION COMPLETED BY

DATE

INITIAL

UPDATE

DELETE

USFK FORM 42-4-E, AUG 2011

PREVIOUS EDITION IS OBSOLETE. PAGE 1 OF 2

1. AUTHORITY:

2. PRINCIPLE USES:

3. ROUTINE USES:

4. MANDATORY OR VOLUNTARY

DISCLOSURE AND EFFECT OF INDIVIDUAL

NOT PROVIDING INFORMATION:

Executive Order 10450, 9397; and Public Law 99-474, the Computer

Fraud and Abuse Act.

To record names and signatures for the purpose of validating the

trustworthiness of individuals requesting access to Department of

Defense (DoD) systems and information. NOTE: Records may be

maintained in both electronic and/or paper form.

None.

Disclosure of this information is voluntary; however, failure to

provide the requested information may impede, delay or prevent

further processing of this request.

DATA REQUIRED BY PRIVACY ACT STATEMENT

USFK FORM 42-4-E, AUG 2011

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