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The CG-7421G form, also known as the Direct Access Work-Life Management System User Account Authorization, is a vital tool for U.S. Coast Guard personnel seeking access to the system used for managing various work-life programs. This form must be filled out online or printed and completed neatly, ensuring that all necessary information is accurately provided. Key aspects of the form include essential details such as the user's name, rank, employee ID, and contact information, which help in identifying the individual requesting access. Additionally, the form outlines specific roles for which access is being requested, such as Family Advocacy Specialist or Substance Abuse Program Manager. An authorizing official must review and approve the access, affirming that it is based on an official need. Moreover, the user is required to sign a declaration acknowledging their understanding of the authorization limitations. Attention to details is paramount, as improper completion may delay the process. By following the guidelines, personnel can ensure they gain the necessary permissions to effectively perform their duties while adhering to security protocols.

Col Example

Please fill out online or print neatly!

U.S. DEPARTMENT OF HOMELAND SECURITY

U. S. Coast Guard CG-7421G (Rev. 10/20)

DIRECT ACCESS WORK-LIFE MANAGEMENT SYSTEM

USER ACCOUNT AUTHORIZATION

1. User’s Name (Last, First, MI.) (Please print or type)

 

2. Rank/Rate:

3. Employee ID #

 

 

 

 

4. Dept ID & Unit Name (Include Staff Symbol)

5. Area Code & Phone Number:

6. e-Mail address:

 

 

 

 

7. User Role Description:

 

WIMS User Access Approval:

 

Family Advocacy Specialist

 

Please see “How to complete and route the User Access Form (CG-7421G)

 

at https://cg.portal.uscg.mil/units/ppc/RoboHelp/DAGP/WIMS/WIMSUserAccess.pdf for

 

 

Family Advocacy Program Manager

 

the approval process and listing of authorized approvers

Family Resource Specialist

 

Direct Access User Roles:

 

Special Needs Program Manager

 

 

 

Direct Access user roles and access are administered separately. Please

Substance Abuse CDAR

 

 

complete form CG-7421G for changes/additions to Direct Access user roles.

Substance Abuse SAP

 

 

Revocation:

 

Substance Abuse Program Manager

 

 

Sexual Assault Specialist

 

Direct Access Roles are automatically terminated upon PCS, separation,

 

retirement, reassignment of duties (Fleet-Ups) and change of organization

Sexual Assault Program Manager

 

(inter-office transfer).

 

Critical Incident Stress Management Specialist (CISM)

Users who have been reassigned (PCS, Change of Department IDs) will

 

 

CISM Program Manager

 

retain Self-Service access.

 

Employee Assistance Specialist

 

The user role termination process is kicked off by submission of a PCS

Employee Assistance Program Manager

 

 

departing endorsement. If the member submits a new access form, and it is

Workplace Violence & Threatening Behavior Specialist

processed by PPC before the SPO submits the PCS departing

endorsement, the system will terminate the new access. Please be sure to

Workplace Violence & Threatening Behavior Program Manager

submit transactions in a timely manner.

Victim Witness Specialist

 

If Revocation is due to reasons other than those listed above contact PPC

Victim Witness Program Manager

 

 

Customer Care via on-line trouble-ticket at https://dcms.uscg.afpims.mil/ppc/ccb/

__________________________(Other Role, not listed above)

or https://cg.portal.uscg.mil/units/ppc/SitePages/Contact%20Us.aspx or via

 

 

email at PPC-DG-CustomerCare@uscg.mil

8. Authorizing Official (Signature & Typed or printed name, Rank, Title (HSWL Product-Line Manager (PLM) (Field Office Supervisor)) & Phone

Number):

I certify that the access I have authorized is based on an official need. I'm aware of the general functionality I have authorized and I'm aware of what this will allow this member to complete. If this is for a contractor, the Contracting Officer’s Technical Representative (COTR) signs as AO.

____________________________________________________________________________________________________________________

Signature AND PRINTED or TYPED Name,

Rank,

Title,

8a. Area Code & Phone (ext):

 

9. Date:

10.Approving Official (Signature & Typed or printed name, Rank, Title ( Work-life Division Chief/Deputy):

I certify that the access I have authorized is based on an official need. I'm aware of the general functionality I have authorized and I'm aware of what this will allow this member to complete. If this is for a contractor, the Contracting Officer’s Technical Representative (COTR) signs as AO.

____________________________________________________________________________________________________________________

Signature AND PRINTED or TYPED Name,

Rank,

Title,

10a. Area Code & Phone (ext):

 

11. Date:

 

 

 

 

AUTHORITY:

 

Privacy Act Statement

 

Executive Order 10450, 9397; and Public Law 99-474, the Computer Fraud and Abuse Act.

PRINCIPAL PURPOSE: To record names, signatures, and other identifiers for the purpose of identifying individuals requesting access to U. S.

ROUTINE USES:

Coast Guard (USCG) systems and information. NOTE: Records may be maintained in both electronic and/or paper form.

None.

DISCLOSURE:

Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or

 

prevent further processing of this request.

Acknowledgment: I understand that I am authorized to access the Direct Access system and that accessing it for purposes beyond the Scope of

Authorization is a violation of Federal law (18 U.S.C. 1030 et al) (Note: Refer to the Automated Information Systems (AIS) User Acknowledgement Form (CG-5500A), which is required for all U.S. Coast Guard AIS users, it contains the full Scope of Authorization and Acknowledgement.)

12. User's Signature:

13. Date:

U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-7421G (Rev. 10/20)

Email form to: PPC-DG- CustomerCare@uscg.mil

(only send page 1, do not send instructions)

CG-7421G (Rev. Oct 2020) (Reverse)

Please refer to “How to complete and route the User Access Form (CG-7421G) at https://cg.portal.uscg.mil/units/ppc/RoboHelp/DAGP/WIMS/WIMSUserAccess.pdf for additional/updated information.

Block Instructions

1Enter the user’s last name, first name and middle initial.

2Enter the user’s Rank (e.g. “CAPT”) or Rate (e. g. “YN1”) or GS paygrade (e. g. “GS7”)

3Enter the user’s employee number. The employee ID number can be found on the unit roster. Any member of the command that already has access to Direct-Access can access the unit roster and locate the employee’s employee ID number. Follow these steps to access the unit roster:

Select the following links on the Portal home page: Human Resources > Human Resources Reports > CG Unit Roster Report.

Follow the procedure guide at https://cg.portal.uscg.mil/units/ppc/PD/guides/Documents/SelfService/Command/Unit%20Roster.pdf to run the report.

4Enter the name of the unit the user is assigned, include the staff symbol if applicable.

5Enter the user’s business phone number, including the area code.

6Enter the user’s business e-mail address.

7Choose the appropriate user role from the list provided.

8Enter the Name, Rank, Title, and Phone number of the authorizing official (HSWL Regional Manager (RM) or Work-Life Supervisor).

9Enter the date the form was signed by the authorizing official.

10Enter the Name, Rank, Title and Phone number of the approving official. ( HSWL SC designated representative - Please see “How to complete and route the User Access Form (CG-7421G)” at https://cg.portal.uscg.mil/units/ppc/RoboHelp/DAGP/WIMS/WIMSUserAccess.pdf for additional/updated information).

11Enter the date the form was signed by the approving official.

12User signs here.

13Enter the date the form was signed by the user.

CG-7421G (Rev. 10.20) (Reverse)

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Work-Life Information Management System (WIMS)

Work-Life Program

Phone Number

Family Advocacy

202-475-5161

Special Needs

202-475-5160

Substance Abuse

202-475-5148

Sexual Assault

202-475-5163

Critical Incident Stress Mgmt

202 475-5156

Employee Assistance

202 475-5156

Workplace Violence & Threatening Behavior

202 475-5156

Victim Witness

202 475-5156

Note: In the event that HSWL SC designated representative is not available for signature you may contact Program at the above listed numbers for signature.

Who is authorized access?

Only Coast Guard personnel assigned duties in one of the 8 respective areas identified above can be granted access to the system.

How to complete the Direct Access Work-Life Management System User Account Authorization (CG-7421G)?

The individual requiring access completes blocks 1 through 7, and signs in block 12. The HSWL Regional Manager (RM) or Work-Life Supervisor will complete block 8. Then pages 1 and 2 of CG-7421G will be sent electronically or scanned via email to the HSWL SC designated representative.

The HSWL SC designated representative will review and approve access and then submit the signed form to PPC Topeka.

PPC Topeka will then grant user access to the system.

Direct Access II Functional Roles on CG-7421G

User access to the system and approval of the Functional Roles within WIMS lies with the Regional Program Manager and HSWL SC Work-Life Division staff. For example, if you were assigned as the Family Advocacy Specialist (FAS), you would be able to see all FAP cases within the entire Coast Guard. However, you would not be able to see details for Substance Abuse, Special Needs or other program area cases. Listed below are the Functional Roles that appear on CG-7421G, and that can be granted:

oFamily Advocacy Specialist o Family Resource Specialist o Substance Abuse CDAR

Revised: 10/7/2020

1

oSubstance Abuse SAP

oSexual Assault Specialist

oCritical Incident Stress Management Specialist (CISM)

oEmployee Assistance Specialist

oWorkplace Violence & Threatening Behavior Specialist

oVictim Witness Specialist

An individual could have multiple Functional Roles depending on their position within the organization (e.g. Special Needs and Family Advocacy). In this example, you would have access to both Special Needs and Family Advocacy cases. If this situation arises, the individual can request both roles using one CG-7421G.

Program Managers and HSWL Service Center Work-Life Program POCs will have access to all cases within their respective programs.

oFamily Advocacy PM

oSpecial Needs PM o Substance Abuse PM o Sexual Assault PM

o Critical Incident Stress Management PM o Employee Assistance PM

o Workplace Violence & Threatening Behavior PM o Victim Witness PM

Revised: 10/7/2020

2

Form Characteristics

Fact Name Fact Detail
Form Purpose This form, CG-7421G, is used for granting user account authorization in the Direct Access Work-Life Management System.
Governing Authority It operates under the authorities of the Privacy Act Statement and Public Law 99-474, which is the Computer Fraud and Abuse Act.
Required Information Users must provide their name, rank, employee ID, department ID, phone number, email address, and user role description.
User Roles Roles include Family Advocacy Specialist, Substance Abuse Program Manager, and several others focused on employee assistance and workplace violence.
Authorization Process The form must be signed by an authorizing official and an approving official to validate the access request.
Timely Submission Users are encouraged to submit the form promptly to avoid delays or access issues, especially when transferring or terminating roles.
User Acknowledgment Users must acknowledge that accessing the system beyond authorized purposes is a violation of federal law.
Access Revocation User roles are automatically terminated upon certain events, such as PCS (Permanent Change of Station) or retirement.
Electronic Submission The completed form should be emailed to PPC-DG-CustomerCare@uscg.mil, and only the first page should be sent without instructions.
Contact for Assistance For issues related to access, users may reach out via the designated online trouble ticket or directly through listed contact numbers.

Guidelines on Utilizing Col

Filling out the Col form requires attention to detail to ensure all necessary information is submitted correctly. Follow the steps below to complete the form accurately.

  1. Print the form or fill it out online as prompted.
  2. In Block 1, enter the user's last name, first name, and middle initial. Ensure that the name is printed clearly.
  3. In Block 2, specify the user’s rank (e.g., “CAPT”), rate (e.g., “YN1”), or GS paygrade (e.g., “GS7”).
  4. In Block 3, input the employee ID number. This can be found on the unit roster accessed via the appropriate links on the Portal home page.
  5. In Block 4, enter the name of the unit to which the user is assigned, including the staff symbol if applicable.
  6. In Block 5, provide the user’s business phone number, including the area code.
  7. In Block 6, fill in the user’s business email address.
  8. In Block 7, choose the appropriate user role from the provided list.
  9. In Block 8, the authorizing official needs to sign and print their name, rank, title, and phone number.
  10. In Block 9, write the date the authorizing official signed the form.
  11. In Block 10, the approving official must enter their signature, name, rank, title, and phone number.
  12. In Block 11, note the date the approving official signed the form.
  13. In Block 12, the user must sign the form.
  14. In Block 13, enter the date the user signed the form.

Once the form is completed, email the first page to the designated customer care email address provided on the form, ensuring that instructions are not included in the submission.

What You Should Know About This Form

What is the purpose of the CG-7421G form?

The CG-7421G form is designed for U.S. Coast Guard personnel to request user access to the Direct Access Work-Life Management System. It ensures that only authorized individuals can access sensitive information related to various work-life programs.

Who can fill out the CG-7421G form?

Only Coast Guard personnel assigned to specific duties within certain work-life program areas may fill out this form. These areas include family advocacy, substance abuse, sexual assault, and others. It's intended for those who need access as part of their official responsibilities.

What information is required to complete the form?

To properly complete the CG-7421G form, the user needs to provide their name, rank or rate, employee ID, department ID and unit name, phone number, email address, and specific user role information. It is important to ensure clarity and accuracy when filling in these details.

What happens after the form is submitted?

After the form is completed, it must be signed by the user and the appropriate authorizing and approving officials. The signed form is then submitted electronically or via email to the HSWL Service Center for review. Once approved, the user's access to the system will be granted by PPC Topeka.

Can access be revoked?

Yes, access to the system can be revoked automatically upon certain actions like PCS (Permanent Change of Station), separation, retirement, and reassignment of duties. If revocation is for other reasons, the individual should contact PPC Customer Care for guidance.

What if the user experiences an issue with the access request?

If an issue arises during the access request process, users should create an online trouble ticket through the Customer Care portal or reach out via email. There are resources available to help resolve any problems that may occur.

How can one ensure a quick processing time of the form?

To expedite processing, ensure that the form is filled out completely and accurately. Submitting it in a timely manner is crucial, especially before any official endorsement actions that might interfere with access approvals.

What is the importance of the Privacy Act Statement included in the form?

The Privacy Act Statement is essential for informing users about how their information will be used. It explains the legal basis for collecting this data and emphasizes that providing personal information is voluntary, although it may impact processing if not submitted.

Common mistakes

When filling out the Col form (CG-7421G), individuals often make a range of mistakes that can lead to delays in processing. One common error is not providing the user’s name in the proper format. Users should enter their last name, first name, and middle initial, but many omit the middle initial or do not format their name as specified. Such oversights can cause confusion and necessitate corrections.

Another frequent mistake relates to the Employee ID number. Some individuals may forget to include it or provide an incorrect number. This ID, essential for identification within the system, is typically found on the unit roster. Failure to include the correct Employee ID can halt the approval process, as the system relies on this information for authorization.

Additionally, errors occur when entering the e-mail address. Users might mistype their e-mail or include a personal account instead of their work e-mail. This mistake is critical, as communication regarding access is sent via this address, and any discrepancies can lead to missed correspondence.

Completing the user role description often presents challenges. Individuals sometimes select the wrong role from the provided list. It is crucial to choose the role accurately, as this determines the level of access granted. If the incorrect role is chosen, it may require resubmission of the form, delaying access to the intended system features.

Another area where mistakes are made involves the authorizing official's information. Users may leave out necessary details, such as the official's rank or title. Incomplete entries in this section can complicate the validation process, as the information is meant to confirm that access was appropriately authorized.

Signatures are also a frequent source of errors. Some individuals forget to sign their names, or they may not print or type their names correctly. Each signature is a confirmation of understanding and agreement to the terms outlined in the form. Missing signatures can result in disqualification of the submission.

On the date line, individuals often place the wrong date or omit it altogether. Ensuring that the date accurately reflects when the form was signed by the appropriate officials is essential for accurate record-keeping and processing.

Confusion can arise when users try to navigate how to submit the form, leading to mistakes in knowing whom to send it to. Some might send only part of the form or include the instructions. It is important to follow submission guidelines meticulously to avoid delays.

Finally, a lack of attention to the Privacy Act Statement can be a missed opportunity for understanding the implications of their access. Users may overlook this section, which outlines their rights and responsibilities regarding the information provided in the form. Misunderstandings here can lead to unintentional violations of privacy and access protocols.

By being mindful of these potential mistakes, individuals can significantly improve the accuracy and efficiency of their submissions. Ensuring attention to detail in each section of the Col form is not just beneficial for oneself, but it also contributes to the overall effectiveness of the process within the organization.

Documents used along the form

The CG-7421G form is essential for U.S. Coast Guard personnel seeking access to the Direct Access Work-Life Management System. To support the completion and processing of this form, several other forms and documents are commonly used. Below is a list of these documents along with brief descriptions of each.

  • CG-5500A: Automated Information Systems User Acknowledgment Form - This form requires users to acknowledge their understanding of the scope of authorization for access to Automated Information Systems. It emphasizes the legal implications of accessing the system for unauthorized purposes.
  • Family Advocacy Program Authorization Form - This document facilitates the formal approval process for family advocacy specialists, ensuring they have the necessary permissions to access sensitive case information within the system.
  • Substance Abuse Program Access Request Form - Used to request access for individuals involved in the Substance Abuse Prevention Program, this form outlines specific requirements and authorizations pertinent to the substance abuse treatment process.
  • Employee Assistance Program Request Form - This form helps individuals access services related to workplace challenges, personal issues, or mental health support, outlining the procedures for requesting such assistance.
  • Sexual Assault Prevention and Response Form - This document is used to notify the appropriate authorities of incidents related to sexual assault, ensuring that victims receive timely and appropriate support and services.
  • Critical Incident Stress Management Authorization Form - This form is utilized when requesting access to Critical Incident Stress Management services, which provide support to personnel affected by traumatic events.
  • Workplace Violence Reporting Form - A structured document for reporting incidents of workplace violence or threatening behavior, ensuring that all claims are documented and addressed promptly.
  • Victim Witness Assistance Program Form - This form assists victims and witnesses in accessing support services during investigations, detailing their rights and available resources.
  • Direct Access User Role Change Request Form - This document is necessary for employees seeking to modify their user roles within the Direct Access system, ensuring the appropriate access level is maintained.
  • Contractor Access Authorization Form - Used by contractors needing access to the Coast Guard's systems. This form outlines specific responsibilities and authorization requirements for external personnel.

Understanding these supplementary forms is vital for a smooth application process when seeking access to the Direct Access Work-Life Management System. Each form serves a specific function, ensuring that users are appropriately authorized and that sensitive information is protected while allowing necessary access for various programs. Proper completion of these documents helps maintain the integrity of the Coast Guard's operations.

Similar forms

  • Access Request Form: Similar to the Col form, this document is used to request access to specific systems. Information such as user details and authorization signatures are required.

  • User Account Modification Form: Like the Col form, this document is utilized when a user needs to change their access level or role within a system. It also demands clear identification and authorizing signatures.

  • Confidentiality Agreement: This document ensures that users understand their responsibilities regarding information security. It is comparable to the Col form in that both require signature verification from the user and an approving official.

  • Service Agreement: This outlines the terms of service when accessing certain platforms. It is similar because it captures user details and needs official endorsement to validate the user's right to access.

  • Role Assignment Document: Used to outline the specific responsibilities assigned to a user. Much like the Col form, it necessitates signatures from both the user and a supervisor or manager.

  • Incident Report Form: This is filled out to document specific events that occur within a system. It resembles the Col form in that both include fields for user and authorizing details.

  • Security Clearance Application: Similar to the Col form, this document requires personal identification and must be authorized by an official, showing how individuals can access sensitive information.

  • Training Verification Form: This form confirms that a user has completed necessary training before accessing a system. Like the Col form, it requires user information and official acknowledgment of their training status.

Dos and Don'ts

When filling out the Col form, there are specific practices that can help ensure a smooth and efficient process. Below is a list of things you should and shouldn't do.

  • Do complete all fields accurately and legibly.
  • Do double-check the required roles and authorizations before submission.
  • Do submit the form in a timely manner to avoid processing delays.
  • Do ensure that the appropriate officials sign the form where indicated.
  • Don't leave any mandatory field blank; incomplete forms may lead to rejection.
  • Don't submit the form without first reviewing the instructions thoroughly.
  • Don't provide false or misleading information; this can result in legal consequences.
  • Don't send the form without the required supporting documentation when necessary.

Misconceptions

  • Misconception 1: The form can be filled out casually.
  • Many individuals believe that the CG-7421G can be filled out without much attention to detail. In reality, it is crucial to fill out this form carefully to ensure that all necessary information is provided correctly. Inaccuracies can lead to delays in processing.

  • Misconception 2: Anyone can request access.
  • Some people might think that anyone can access the Direct Access Work-Life Management System. However, access is restricted to Coast Guard personnel assigned specific roles and responsibilities. Only those in designated positions can submit requests.

  • Misconception 3: Signature requirements are flexible.
  • It's a common belief that signature requirements on the form can be bypassed. This is not the case. Both the authorizing official and the approving official must sign off, ensuring that access is granted based on an official need.

  • Misconception 4: Revocation of access is automatic.
  • Some might think that a change in duty station or role automatically revokes access. While access is indeed terminated following certain events, such as PCS or reassignment, it is the responsibility of the member to submit the proper endorsements to initiate this process.

  • Misconception 5: The form submission process is straightforward.
  • People often assume that submitting the CG-7421G is a simple task. However, it requires navigating multiple channels, including obtaining necessary signatures and sending the form to specific representatives. This process must be carefully followed to avoid delays.

  • Misconception 6: Access roles are permanent.
  • Many individuals mistakenly believe that access roles, once granted, remain in place indefinitely. In fact, roles can change based on adjustments in responsibilities, and it may require completing a new CG-7421G form for updates.

  • Misconception 7: Information privacy is not a concern.
  • Some users might underestimate the importance of privacy regarding their information on the form. However, sensitive data must be handled with care as per the Privacy Act, and unauthorized access to this information poses significant legal ramifications.

  • Misconception 8: The CG-7421G can be submitted electronically in its entirety.
  • A prevalent misconception is that the entire form, including instructions, can be emailed. However, only the first page of the form should be submitted, requiring individuals to carefully adhere to the submission guidelines to ensure compliance.

Key takeaways

Filling out the U.S. Coast Guard CG-7421G form may feel daunting, but understanding a few key points can simplify the process significantly. Here are 10 essential takeaways to keep in mind:

  1. The form can be completed online or printed out. Ensure that it is filled out neatly if you choose the printed option.
  2. Correctly enter the user’s name as it appears on official documents. Accuracy is key for identification.
  3. Include the user’s rank or rate, such as "CAPT" or "YN1." This helps in classifying the user appropriately.
  4. Don’t forget the employee ID number. This can typically be found on the unit roster accessed via Human Resources on the Portal.
  5. While filling out the form, note the importance of including the business email address and phone number as they will be vital for future communications.
  6. Select the right user role from the options provided. Each role has specific access and permissions.
  7. Signature verification is crucial. Have the authorizing official sign in the designated area to confirm the need for access.
  8. Timeliness cannot be overstated. Submitting the transactions promptly ensures a smoother approval process.
  9. Remember that access is automatically terminated under specific circumstances, including separation or reassignment of duties. Always stay updated on your role status.
  10. Finally, if you encounter problems, don't hesitate to contact PPC Customer Care via email or their online support. Assistance is just a click away!

Using these tips, ensure you complete the CG-7421G form accurately and efficiently. Your attention to detail helps maintain vital access to resources and information.