Approved For Release 2'
*
Ik
DATE|
15 April
1985
REPLY TO
ATTN OF,
DIA/DT
•96-00788R001 5001 60009-1
UNITED STATES GOVERNMENT
memorandum
DIA/GC
subject,
proposed
Statement
of
Consent
TO!
GC
1.
(S/NF/WNINTEL)
Attached
is
a
revised
Statement,
of
Consent
prepared
I AW
Procedure
13,
DoD
Directive
5240. 1-R
for
use
by
participants
in
the
DIA
DRAGOON ABSORB
Project.
The
Statement
of
Consent
was
prepared
in
accordance
with
guidelines
issued
by
the
Department
of
Health
and
Human
Services.
Specifically,
guidelines
under
section
46.116*,
Subpart
A,
Part
46,
Title
45,
Code
of Federal Regulations were
used
to prepare
the
statement.
2.
(U)
Request
your
review
of
the
Statement
of
Consent
for
compliance with
DoD Directive
5240. 1-R
3.
(U)
POC
is
LTC Brian
Enel
1.
Statement
of
Consent
2.
CFR
(extract)
Buzby,
AVN 923-7829/2656.
BRIAN BUZBY
LTC,
US Army
SGI J
DT-5A
CLASSIFIED
BY:
DIA/DT
DEC LAS:
OADR
'"/AHNING NOTICE!
SENSITIVE
i-i 'T.LUGENCE SOURCES fiNBj
METHODS INVOLVgQ
.•Lisable to imEmmmmms
Approved For Release 2003/09/09
: CIA-RDP96-00788R001 5001 6000^ »-*»
OPTIONAL FORM NO. IO
SECRET
FPMR(41 CFR) (01-11.6
901CMI4
STATEMENT OF CONSENT
DIA
PROJECT PARTICIPANT
Da te
1.
(S/NOFORN/WNINTEL)
I,
voluntarily
accept
assignment
to
the DIA
""
"
and
fully
understand
that:
- ^
a.
(S/NOFORN/WNINTEL)
*
Counsels
have
determined
that
the
DDAP
constitutes
exper imentac .on
on
human
subjects.
As
required
by
Procedure
of
DoD Directive
5240. 1-R,
the Deputy
Secretary
of Defense
has
granted
approval
for
the
conduct
of DDAP activities.
b.
(S/NOFORN/WNINTEL)
The mission
of
the
DDAP
is
to
collect
intelligence
information
through
the
use
of
pscychoenerget ic
methodology.
Development
and
use
of
DDAP
operational
intelligence
collection
personnel
will
be
accomplished
with
special
training
based
on
mission
requirements
.in
accordance
with
established
procedures
c
.
(C/NOFORN)
Assignments
in
DDAP
are
governed
by
the
sensitivity
and
degree
of
expertise
required
for
the
position.
I
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
DDAP
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.
e.
(S/NOFORN/WNINTEL)
I
understand
that
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.
However,
I
understand
further
that
potential
for
injury
during
some
training
cannot
be
conclusively
ruled
out.
CLASSIFIED BY:
DIA/DT
DECLAS
:
OADR
fuel
Approved For Release
•YARNING NOTICE:
SE&fS'tllVa’
m.UGENCE SOURCES.ANU
Approved For Release
'6-00788R001 5001 60009-1
«
»
f.
( S/NOFORN/WNINTEL)
I
may
temporarily
choose
not
to
particpate
in
the
project
at
specific
times,
or
permanently
discontinue
participation
without
prejudicial
effect.
Termination
will
be
affected
by
notifying
the
Commander,
Prototype
Operational
Group
(POG)
,
DSSP,
or
his
designated representative.
2.
(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.
3.
(C/NOFORN)
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
.
Signature
(Witness)
Signature
(Par t i c i pantj
Name,
Rank /Grade
~
Name,
Rank/Grade
-
Soc fal
Sec urity~Numb e r
~
5oc lal
Secur i ^"Number
Approved For Release 2003/09/09
: CIA-RDP96-00788R001 5001 60009-1
Approved For Release
6-00788R001 5001 60009-1
DEFENSE INTELLIGENCE AGENCY
WASHINGTON, D.C. 20301-6111
STATEMENT OF CONSENT
DIA SUN STREAK
PROJECT PARTICIPANT
Date
1.
(S/NOFORN/WNINTEL)
I,
voluntarily
accept
assignment
to
the
DIA
SUN
STREAK
PROJECT
- (DSSPy
and
fully
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
of
DoD
Directive
5240
. 1-R,
the Deputy
Secretary
of Defense
has .granted
approval
for
the
conduct
of
DSSP activities.
b.
(S/NOFORN/WNINTEL)
The
mission
of
the
DSSP
is
to
collect
intelligence
information
through
the
use
of
pscychoenerget ic
methodology.
Development
and
use
of
DSSP
operational
intelligence
collection
personnel
will
be
accomplished
with
special
training
based
on
mission
requirements
in
accordance
with
established
procedures
c.
(C/NOFORN)
Assignments
in
DSSP
are
governed
by
the
sensitivity
and
degree
of
expertise
required
for
the
position.
I
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
pat terns --such
as
branch
schooling
and
assignment
opport uni ties --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.
e.
(S/NOFORN/WNINTEL)
I
understand
that
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.
However,
I
understand
further
that
potential
for
injury
during
some
training
cannot
be
conclusively
ruled
out.
CLASSIFIED BY:
DIA/DT
DECLAS:
OADR
Approved For Release 2003AJ9/M
1? ©lA^^6-d6788R001 5001 60009-1
SECRET
v '.'.({KING NOTICE:
SENSITIVE’
,T.LUGENCE SOURCES ANQ
Approved For Release
6-00788R001 5001 60009-1
f.
(S/NOFORN/WNINTEL)
I
may
temporarily
choose
not
to
part icpate
in
the
project
at
specific
times,
or
permanently
discontinue
participation
without
prejudicial
effect.
Termination
will
be
affected
by
notifying
the
Commander,
Prototype
Operational
Group
(POG)
,
DDAP
,
or
his
designated representative.
2.
(S/NOFORN/WNINTEL)
As
a
participant
in
DDAP,
and
I AW
DoD
Directive
5240. 1-R,
I
consent
to
tape
recording,
monitoring
and
transcribing
of
all
training
and
operational
interviews
in
which
I
arn
involved
as
an
integral
part
of
the
DDAP 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
DDAP,
with
the
understanding
that
these
tape
recordings
and
transcripts
are
property
of
the
United
States Government.
3.
(C/N0F0RN)
I
hereby
acknowledge
receiving
formal
counseling
concerning
my
assignment
to
DDAP.
’
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
DDAP
is
voluntary
and
that
at
my
request
I
may
at
any
time
be
reassigned
without
fear
of
adverse personnel
action.
S i gna t u r e ~JT4 fn e s s )
Name,
Rank 7 Grade
Social
Security
Number-
Signature
(Participant)
Name,
Rank /Grade
Social
Secur ity Number
Approved For Release 2003/09/09
: CIA-RDP96-00788R001 5001 60009-1