STATEMENT OF CONSENT DIA SUN STREAK PROJECT PARTICIPANT

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00792R000600160002-3
• Release Decision: RIFPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: November 4, 2016
• Document Release Date: May 16, 2000
• Sequence Number: 2
• Publication Date: May 10, 1985
• Content Type: CONT

rr
oved For Release 2000/08/09 : CIA-RDP96-00792R000600160002-3
DEFENSE INTELLIGENCE AGENCY
WASHINGTON. D.C. 20301.6111
STATEMENT OF CONSENT
DIA SUN STREAK PROJECT PARTICIPANT
1. - (S/SK) I, voluntarily accept
assignment to the DIA SUN STREAK PROJECT DSSP) and fully understand
that:
a. (S/SK) The DSSP is an experimental program that applies
psychoenergetics research,to intelligence activities. Specifically,
the mission of the DSSP is to collect intelligence information
through the use of psychoenergetic technology. Psychoenergetics is
the process by which an individual perceives, communicates with,
and/or perturbs characteristics of a designated target, person, or
event remote in space and/or time from that individual by mental
means. Development and use of DSSP operational intelligence
collection personnel will be accomplished in accordance with
established procedures. The Deputy Secretary of Defense has granted
approval for the conduct of DSSP activities in accordance with
Procedure 13, DoD 5240.1-R.
h. (C/NOFORN) Assignments in DSSP are governed by the type and
degree of expertise required for the position, and are made
according to individual capability and experience, regardless of
rank or previous position. I understand that I may at any time ask
questions of the Commander, Prototype Operational Croup (POC), DSSP
or other appropriate project personnel relating to areas unclear to
me. Additionally, I understand that my participation in DSSP is
voluntary and that at my request I may at any time be reassigned
without fear of adverse personnel action. The nature of my
involvement in DSSP' along with associated records will be protected
under project security measures.
c. (S) Upon my assignment to the DSSP, the primary,
consideration will be the Project's mission and operational
requirements. I understand that this may consequently delay normal
career development patterns such as branch schooling and assignment
opportunities, and that these disruptions may prejudice future
promotion and assignment potential; however, I have been assured
that every effort will be made to preclude the adverse effects
mentioned above on my career.
d. (S/SK> I understand that there is no demonstrated risk of
permanent or, temporary injury (including physical, psychological
CLASSIFID BY Mulitiple sources
DECLASSIFY ON OADR
H A N D L E V I A S K E ET C H A NNE L S 0 N L Y
Approved For Release 2000/08/0,
SPECIAL ACCESS REQUIRED
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and/or damage to participants' reputation) to project personnel
beyond risks to which they would ordinarily be exposed in their
daily lives. However, I understand further that potential for
injury during DSSP-related activities cannot be conclusively ruled
out.
f. (S/SK) I may temporarily choose not to particpate in the
project at specific times, or permanently discontinue participation
without prejudicial effect. Termination or temporary declination
will be affected by notifying the Commander, POG, DSSP or his
designated representative.
2. (S/SK) As a participant in DSSP, and IAW DoD 5240.1-R, I
consent to video and/or audio recording, monitoring and transcribing
of all training and operational interviews in which I am in any way
involved as part of the DSSP mission. I understand that these
recordings are subject to being monitored and/or transcribed by
third parties not otherwise involved in operations or training.
3. (C/NOFORN) I hereby acknowledge receiving separate counseling
concerning my assignment to DSSP. Fundamental training and
operational procedures and their purposes, as well as any attendant
discomforts, risks, and benefits have been explained to me.
Signature (Witness) Signature Participant
Name, Rank/Grade Name, Rank/Grade
Social Security' Num er . Social Security Number
DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a)
1. Authority: Title 10, U.S.C. Section 8012; Title 44, U.S.C.,
Section 3101 and EO 9397.
2. Principal Purpose: To maintain a record of those individuals
who have executed statements of informed consent as participants in
DSSP.
3. Routine Uses: The Social Security Number is to be used to
identify the individual, and the information is to be retained
strictly within the program.
4. Mandatory or Voluntary Disclosure: Information is disclosed on
a voluntary basis, but withholding information will render it
impossible to grant an individual access to or participation in the
program.
Approved For Release 2000/08/09; GttA-RDP96-00792R000600160002-3