REQUEST FOR SECURITY APPROVAL OF LIAISON ONE-TIME BASIS NON-CIA EMPLOYEES(Sanitized)

• Document Type: CREST
• Collection: NGA Records (Formerly NIMA)
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78B04770A002900030019-9
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: December 28, 2016
• Document Release Date: August 26, 2005
• Sequence Number: 19
• Publication Date: October 4, 1965
• Content Type: FORM

Approved- Release 2005/11/21: CIA-RDP78BOA002960~30619
REQUEST FOR APPROVAL OF LIAISON
(Submit i
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DATE
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be returned to requester)
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TO Chief, Employee Activity Branch, PSD/OS
SUBJECT: Request for Security Approval of Liaison
J on a continuing basis one-time basis
CIA EMPLOYEES
NON-CIA EMPLOYEES
NAME
EXT.
OFFICE
RANK
i
NAME
EXT.
OFFICE
NAME
EXT.
OFFICE
NAME
EXT.
OFFICE
NAME
EXT.
OFFICE
BRIEF DESCRIPTION OF LIAISON, COMMENTS, KNOWN BIOGRAPHICAL AND CLEARANCE INFORMATION
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CLASSIFICATION OF MATTER TO BE DISCUSSED
TOP SECRET SECRET CONFIDENTIAL
OFFICE/DIVIS ON/STAFF AUTHORIZED SIGNATURE
IOM/BLDG/EXT.
Security approval is granted for contact at the
security classification level indicated. This approval
does not waive any other authorization requirements
contained in Agency Regulations regarding dissemination
of intelligence and intelligence information.
Authorization for liaison contact expires one year
from date. Any change in employment status of individ-
ual named invalidates this approval.
FOR THE DIRECTOR OF SECURITY:
Declass Review by NGA.
DATE CHIEF, PERSONNEL SECURITY DIVISION
25
_ CIA 123 E D I T I ON S PR E Vpepproved For Release 2005/11 4'1'ssC1~4 [9P`~8BA417170A0029 0
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