CIA-RDP96-00789R002100270010-9

0
SECREI
>Approved For Release 2000/08/08 : CIA-RDP96-00789R002100270010-9
DEFENSE INTELLIGENCE AGENCY
WASHINGTON DC 20301 6411
STATEMENT OF CONSENT
DIA SUN STREAK PROJECT PARTICIPANT
Date:
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.
b. (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 Group (POG), 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
SPECIAL ACCESS REQUIRED
DECLASSIFY ON OADR
CLASSIFID BY
Mulitiple sources
HANDLE VIA SKEET CHANNELS ONLY
Approved For Release 2000/08/08 : CIA-RDP96-00789R002100270010-9
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Approved For Release 2000/08/08 : CIA-RDP96-00789R002100270010-9
and/or damage to participants' reputation) to project personnel
beyond risks to which they would ordinarily be exposed in their
daily lives.
Howc or, I understand further that potential for
injury coripe
DSS/-related activities cannot be conclusively ruled
ou. .
I
temporarily choose not to particpate in the
project :
I.
without
prejudic
ffect. Termination or temporary declination
specifi.
imes, or permanently discontinue participation
will be affected
F.
notifying the Commander, POG, DSSP or his
designated repres
ive.
2.
(S/SK)
As
icipant in DSSP, and IAW DOD 5240.1-R, I
consent to video
audio recording, monitoring and transcribing
of all training
operational interviews in which I am in any way
involved as part
the DSSP mission.
I understand that these
recordings are stuje
to being monitored and/or transcribed by
third parties not
rwise involved in operations or training.
3.
(C/NOFORN)
acknowledge receiving separate counseling
concerning my assignment to DSSP.
Fundamental training and
operacional procedures and their purposes, as well as any attendant
discomforts, risks, and benefits have been explained to me.
Signature (Witness)
Signature (Participant)
ame, Rank /Grade
Name, Rank/Grade
Social Security Number
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 20 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.
Mandatory or Voluntary Disclosure:
Information is disclosed on
voluntary basis, bat withholding information will render it
impossible to grant in individual access to or participation in the
program.
Approved For Release 2000/08/08 : CIA-RDP96-00789R002100270010-9
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