CIA-RDP96-00789R002600160023-2

Approved For Release 2000/08/08 .; CIA-RDP96-00789R00260016
LIGENCE /
160023-2
STATEMENT OF CONSENT
DIA SUN STREAK PROJECT PARTICIPANT
SG1J
Date:
19 May1988
1. (S/NOFORN/WNINTEL)
accept assignment to the
understand that:
voluntarily
and fully
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 the use of
psychoenergetics
methodology.
Development of DSSP
will
be
accomplished with special training based on mission requirements.
c.
(C/NOFORN)
I :
Assignments
in DSSP are governed by the
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.
NOT RELEASABLE TO FOREIGN NATIONALS
SECRET
Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160023-2
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Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160023-2
b.
(S/NOFORN/WNINTEL)
I
may temporarily choose not to
participate in the project 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 DOD
Directive 5240.1-R, I
consent to tape recording, monitoring and
transcribing of all
training and operational 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.
I 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.
4.
(S/NOFORN/WNINTEL)
I
further consent to participate in any
noninstrusive biomonitoring
activities
that are necessary
for
project mission accomplishment.
5.
(U)
I hereby acknowledge receiving formal counseling concerning
my assignment to DSSP.
Basic training and operational 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 the Commander, POG, or other appropriate
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 of adverse
personnel action.
SG1J
SG1J
SIGNATURE:
SG1J
SIGNATURE:
SG1J
657
G8-09
Grade
rade
Umber
Social Security Number
SGFOIA3
SGFOIA3
Secretary
POSITION
POSITION
Project Oficer
SECRET
Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160023-2
.

Approved For Release 2000/08/08 : CIA-RDP96-00789R002600160023-2
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 2000/08/08 : CIA-RDP96-00789R002600160023-2
.