3pDP Membership Request Form

Company Information:
Your Company or Organization Name: (Required)	Company is required.
Mailing Address (Required)	Mailing address is required.
City/state/zip (Required)	City, State, Zip is required.
Telephone Number (Required)	Company phone is required.
Sponsoring State Agency:
Agency Name (Required)	Sponsoring State agency is required.
Primary Contact Name (Required)	Primary Contact Name is required.
Primary Contact Phone (Required)	Primary Contact Phone is required.
Primary Contact email (Required)	Primary Contact eMail is required. Enter valid eMail address.

Product Information:
Product Name (Required)	Product Name is required.
(Required) Product Information: Brief Description of Product: (MUST include how it will interface with existing FMCSA software systems.) Please state if this product is protected by patents, copyrights, or other intellectual property safeguards. Disclosure of proprietary information is not required.
Product Description is required.
You may only use 2000 characters.
User Information: (Complete once for each account requested)
User 1
Name (First, Middle, Last) (Required)	Name is required.
Job Title (Required)	Job title is required.
email (Required)	eMail is required.
Telephone Number (Required)	Phone is required. Enter Valid Phone Number (xxx)xxx-xxxx
Alternate Phone Number
User 2
Name (First, Middle, Last)
Job Title
email	Enter Valid eMail
Telephone Number
Alternate Phone Number
User 3
Name (First, Middle, Last)
Job Title
email	Enter Valid eMail
Telephone Number
Alternate Phone Number
User 4
Name (First, Middle, Last)
Job Title
email	Enter Valid eMail
Telephone Number
Alternate Phone Number
User 5
Name (First, Middle, Last)
Job Title
email	Enter Valid eMail
Telephone Number
Alternate Phone Number

Interconnection Security Agreement
This Interconnection Security Agreement (ISA) describes the connection of third-party software development group and the Federal Motor Carrier Safety Administration (FMCSA). This third-party can be an individual, a State government agency, or a private company, provided the third-party is employed by, contracted to, or otherwise sponsored by a State government agency which is obligated to provide data to the FMCSA.

General Information/Data Description
3pDP provides a source of information necessary to enable software to correctly and safely interface with FMCSA software applications and data systems.

Data Sensitivity
3pDP may contain sample data sets for use in testing. No Personal Identity Identifiers (PII) of any kind will exist in this data. Any data seen in this site is to be considered confidential and private. In some cases 3pDP may have information for developing software to enable enactment of new functionality that has not yet been made public knowledge. These items will be noted and must be kept confidential. This type of information is protected by both the Freedom of Information Act and the Privacy Act. The following Federal guidelines and mandates were used in formulating system designs to ensure compliance with government security regulations:
Privacy Act of 1974 Computer Security Act of 1987 OMB Circular A130, Management of Federal Information Sources Computer Matching and Privacy Act of 1988 OMB Circular A123, Management and Accountability Control

Information Exchange Security
3pDP enables software development groups to test data transfers to specially configured test areas. This is done to prevent sample data from contaminating the production data used for safety measurements of the motor carrier industry.

Trusted Behavior Expectations
Each 3pDP user must complete or already have on file a signed FMCSA Rules of Behavior form and must abide by the policies stated within.

Formal Security Policy
The 3pDP Site will be monitored routinely for actions in conflict with the FMCSA Rules of Behavior. 3pDP has a discussion forum which is a first for the agency. Participation in this forum is open to all 3pDP users and will be monitored for appropriate conduct. Users must abide by the FMCSA password policy. Accounts that are not used for a period of 90 days will be disabled.

Incident Reporting
The FMCSA Security Team will monitor and report incidents in accordance with FMCSA procedure.

Specific Equipment Restrictions
No specific equipment restrictions exist. The FMCSA 3pDP server is located on the FMCSA Wide Area Network and housed at the U.S. Department of Transportation, John A. Volpe National Transportation Systems Center in Cambridge, Massachusetts. The Point-of-Contact is FMCSA Technical Support at 617 494 3003 or by email at fmctechsup@volpe.dot.gov

Signature and Certification
If you do not already have a signed FMCSA Rules of Behavior form on file, please complete the on-line Rules of Behavior Form.

Each applicant needs to feel out a Security Request Form. Please fax to [(617)494-3057].

Certification: By checking the box below, you certify that: You have read, signed, and returned the FMCSA Rules of Behavior form, (one for each person from your agency or company wishing an account) That you will abide by the conditions contained within, That you are an employee of, are contracted to, or otherwise sponsored by, a FMCSA State Partner agency, That you acknowledge the Intellectual Property Rights of the FMCSA and it’s contractors You are not a citizen, national, or resident of, and are not under control of, the government of Cuba, Iran, Sudan, Libya, North Korea, Syria, nor any country to which the United States has prohibited export. You will not download or otherwise export or re-export the Programs, directly or indirectly, to the above mentioned countries nor to citizens, nationals or residents of those countries. You are not listed on the United States Department of Treasury lists of Specially Designated Nationals, Specially Designated Terrorists, and Specially Designated Narcotic Traffickers, nor are you listed on the United States Department of Commerce Table of Denial Orders. You will not download or otherwise export or re-export the Programs, directly or indirectly, to persons on the above mentioned lists. You will not use the Programs for, and will not allow the Programs to be used for, any purposes prohibited by United States law, including, without limitation, for the development, design, manufacture or production of nuclear, chemical or biological weapons of mass destruction. You agree that neither the programs nor any direct product thereof will be exported, directly, or indirectly, in violation of these laws, or will be used for any purpose prohibited by these laws including, without limitation, nuclear, chemical, or biological weapons proliferation.
Agreement
YES, (Required) I accept the Terms and Rules of Behavior and I acknowledge that I have reviewed and understood the agreement and that a signed Rules of Behavior Form is on file or is being submitted in conjunction with this application.

Select "Yes" to accept the agreement..

Exit Without Accepting Agreement

3pDP Membership Request Form

Company Information:

Sponsoring State Agency:

Product Information:

User Information: (Complete once for each account requested)

User 1

User 2

User 3

User 4

User 5

Interconnection Security Agreement

General Information/Data Description

Data Sensitivity

Information Exchange Security

Trusted Behavior Expectations

Formal Security Policy

Incident Reporting

Specific Equipment Restrictions

Signature and Certification

Certification: By checking the box below, you certify that:

Agreement