[Author name, address, email]
[Date]
Defense Office of Prepublication and Security Review [Current address / submission portal]
Re: Request for security review: [title of work] ([book manuscript / article / screenplay / podcast script / testimony / social-media post series])
Dear Review Officer:
I submit the enclosed [work], [number] pages, for prepublication security review under [my nondisclosure agreement(s) dated ___ and] DoD Instruction 5230.09 and DoD Instruction 5230.29.
1. Author. I served as [position(s)] at [organization(s)] from [dates]. I held [level] clearances [and was indoctrinated into special access programs]. The work concerns unidentified anomalous phenomena (“UAP”) and related government activities.
2. Intended publication. [Publisher / outlet], with an expected publication date of [date]. [If a deadline exists, state it and request expedited review.]
3. Sources. The work relies on [my personal knowledge; public sources listed in the enclosed bibliography; official records released by the Department of War, the National Archives, or Congress]. Where the work states facts that have been officially acknowledged, I have identified the official source in the enclosed annotation table so that review can proceed efficiently.
4. Request for itemized reasons. If any portion is found to contain classified information, I request that the decision (a) identify each passage required to be deleted or modified; (b) state for each the classification level and the basis under Executive Order 13526 or other authority; and (c) indicate whether a proposed alternative wording would be acceptable. See McGehee v. Casey, 718 F.2d 1137 (D.C. Cir. 1983). [For a former employee or contractor:] Because I am no longer employed by the Department, I understand the review of this work is “to ensure that information [I] intend to release to the public does not compromise national security as required by [my] nondisclosure agreements.” DoDI 5230.09 ¶1.2.g. Please identify separately any suggested change that is not based on classified or controlled unclassified information, so that I can consider it as a suggestion and not as a condition of clearance.
5. Official acknowledgment. Information that has been officially disclosed is not properly classified merely because it appears in my work. The annotation table identifies statutes (e.g., 50 U.S.C. §§3373, 3373b; Pub. L. No. 118-31, §§1687, 1841-1843; Pub. L. No. 119-60, §§1671-1673), AARO reports, released records, and sworn testimony of officials that disclose the information in question.
6. Other review offices. [If the work may contain information under the jurisdiction of another agency (e.g., an intelligence agency or DOE), please coordinate with that agency, and tell me if I must submit separately.]
7. Timeline. Please confirm receipt and the expected completion date. I understand DOPSR aims to complete review within [current published period]; please notify me if the review will take longer.
I will not publish the work until I receive your determination. Please direct questions to me at [contact].
Sincerely, [Name]
Enclosures: Manuscript; annotation table of official sources; copies of relevant nondisclosure agreements (if available)