US. House of Representatives
Privileged Account Authorization Form HISFORM 16.02

 

Section 1: Authorization
I understand the responsibilities and risks associated with the use of this Privileged Account.

User First Last Name:

Information System(s):

 

Privileged User Date

Section 2: Signatory Authority
As the Authorizing Of?cial for the system, I have made an assessment of the trustworthiness of the
Privileged User listed above prior to establishment of a Privileged Account for that person.

I have assessed the risk of the prospective Privileged Account holder via background check
processes outlined in HISPOL 16;

I have veri?ed that a trustworthiness determination has been made on behalf of this shared
resource by another Member (use only for shared Resources employed by multiple Members)

I understand the risks associated with the establishment of this Privileged Account, and authorize the
creation of this Privileged Account.

Full Name:

 

Authorizing Of?cial Date

US. House of Representatives
Authorizing Of?cial (AO) Designation Form HISFORM 16.01

 

Section 1: Designation
I do hereby designate the following individual as an Authorizing Of?cial (A0) for the purpose of
administering and managing Privileged Accounts.

Full Name:

Information System(s):

(Proposed) Authorizing O?icial: I understand the risks associated with the establishment of
Privileged Accounts and responsibilities of my role as set forth in HISPOL I 6.

 

Authorizing Official Date

Section 2: Quali?cations and Responsibilities.
The quali?cations associated with this important role include:

1.
2.
3.

4.

Suf?cient responsibility to assess risk for the of?ce or organization;

Must be a US. House of Representatives (?House?) employee; and

Must be employed by the organization or of?ce for which the designee will authorize Privileged
Accounts.

Suf?cient trustworthiness and judgment to administer and minister Privileged Accounts.

The responsibilities for this important role include, but are not limited to:

l.

2.
3.
4

Ability to assess risks associated with implementing any Privileged Account.

Ability to make determinations concerning potential abuse of Privileged Accounts.

Proper monitoring and record keeping of Privileged Accounts in accordance with HISPOL 0016.
Coordination with CyberSecurity representatives in their responsibilities in managing Privileged
Accounts across the House.

Ensuring training requirements are met for themselves and all Privileged Users designated by
their of?ce or organization.

Other responsibilities as deemed necessary to ensure the security of the House enterprise.

Section 3: Signatory Authority
As the Hiring Authority for I af?rm that I understand the nature of
selecting this individual as Authorizing Of?cial for the creation and management of Privileged Accounts.

Hiring Authority's Name:

 

 

 

Hiring Authority Date