CIA-RDP96-00789R002600160012-4

OF
DE
ENSE
YITED
STATES OF
OCCDET
Approved For Release 20000/08/081: CLARDP96-00789R002600160012-4
DEFENSE INTELLIGENCE AGENCY
WASHINGTON, D.C. 20301-6111
STATEMENT OF CONSENT
DIA SUN STREAK PROJECT PARTICIPANT
SG1J
Date :
28 march 1985
-
voluntarily
and fully
1.
(S/NOFORN/WNINTEL)
I,
accept assignment to the DIA
understand that :
a.
(S/NOFORN/WNINTEL)
The DIA and DoD General Counsels have
determined that the DSSP
constitutes experimentation on human
subjects. As required by Procedure 13 of DoD Directive 5240.1-R,
approval for project activities has been granted by the Deputy
Secretary of Defense.
b.
(S/NOFORN/WNINTEL)
The aim of the DSSP is to develop highly
skilled personnel who are capable of conducting professional level
intelligence/counterintelligence operations
through
use
of
psychoenergetic methodology. Development of DSSP personnel will be
accomplished with special training based on mission requirements.
c.
(C/NOFORN)
£
Assignments
in DSSP
are governed by the
I
sensitivity and degree of expertise required for the position.
will be assigned in accordance with my capabilities and experience,
regardless of my rank or previous position.
Due to the nature of
training involved, the duration of my participation is indefinite.
Records of my involvement will be available to project personnel,
but otherwise protected under project security measures.
d.
(C/NOFORN)
The primary consideration
in any career
development
or assignment action
will
be DSSP mission and
operational
requirements .
I
understand
that exemption,
interruption, or delay in normal career development patterns -- such
as branch schooling and assignment opportunities -- may prejudice
future promotion and assignment potential.
I have been assured,
however, that every effort will be made to preclude the adverse
effects listed above on my career .
2. (U)
PSYCHOENERGETICS (PE) include various processes by which
individuals
psychically
interact
with objects, locations, and
organisms.
a .
(U)
I understand that while there is no demonstrated risk
of permanent or temporary injury (including physical, psychological
and/or damage to participants' reputation) to project personnel
beyond risks to which they would ordinarily be exposed in their
daily lives, the potential for injury during some training cannot be
conclusively ruled out.
CLASSIFIED BY :
DIA, DT
Approved For Release 2000108687
SABLE TO FOREIGN NATIONALS DECLAS :
OADR
DR96-00789R002600160012-
SECRET
WNINTEL
₹

.
Approved For Release (2000/08/08 \ CIA-RDP96-00789R002600160012-4
b.
(S/NOFORN/WNINTEL)
I may temporarily choose not to perform
PE
at
specific times, or permanently discontinue participation
without prejudicial effect.
Termination will be affected by
notifying the DSSP Manager or in his absence, his designated acting
DSSP Manager.
3.
(S/NOFORN/WNINTEL)
As a participant in DSSP, and IAW
I consent to tape recording, monitoring and transcribing of all
operational and training, interviews
in which I am involved as an
integral 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.
waive any claim or right of ownership to all tape recordings and
transcripts made in conjunction with DSSP, with the understanding
that these tape recordings and transcripts are property of the
United States Government.
I
4.
(S/NOFORN/WNINTEL)
I
further 'consent to participate in any
nonintrusive biomonitoring activities that are necessary for project
mission accomplishment.
5.
(U) I hereby acknowledge receiving formal counseling concerning
my assignment to DSSP.
£
Basic operational and training procedures
and their purposes, as well as attendant discomforts, risks, and
benefits have been explained to me. I understand that I may at any
time ask questions of project personnel relating to areas unclear to
me.
I further understand that my participation in DSSP is voluntary
and that at my request I may at any time be reassigned without fear
ofS@FOIA& personnel action.
Social Security Number
Unit/Organization
Position
SGFOIA3
Signature:
1
SGFOIA3
Social Security Number
SSPD, MI Bn (S), 9022 MIGP
Unit/Organization
Position
Approved For Release 2000/08/08 - CIA-RDR96-00789R002600160012-4
SECRETO
CTILT

4
SECDCT
Approved For Release 2000/06/08 : CIA-RDP96-00789R002600160012-4
DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C.
552a)
1.
Authority :
Title 10, U.S.C. Section 3012.
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 2000/08/08 .GIA-RDF96-00789R002600160012-4
"SECRET

Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160012-4
Protection of Human Sutypes
in Research
Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160012-4