04. NCIC Form FINAL 050316.xlsx
XLSX spreadsheet 34 KB Posted
- Solicitation number
- 70RSAT22RFI000003-Site_Visit_Invitation
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Sheet1
| Plum Island Animal Disease Center (PIADC) |
| National Crime Information Center (NCIC) Form |
| For all NCIC forms, allow 5 working days for processing prior to visitor arrival |
| Date: | Name of PIADC Sponsor |
| Date of Visit: |
| TYPE ONLY in the table below (handwritten forms will NOT be accepted) | |||||||
| Name (Last, First, Middle) | US Citizen | Country of Origin | Place of Residence | Date of Birth (mm /dd/yyyy) | *Social Security Number | Telephone Number | Gender |
| Once completed please e-mail this document to PlumIslandSecurity@st.dhs.gov |
| *For your personal security, please DO NOT send your personal identifiable information (the information |
| contained within this document) to any other number or e-mail address. It is suggested that you password protect this form when returning the form to PIADC and including the password in an additional email. |
| The information provided in this form is used by law enforcement personnel only. |
| For questions or concerns, please contact: |
| PIADC Federal Officer (631) 323-3390 or PlumIslandSecurity@st.dhs.gov |
| FOR OFFICIAL USE ONLY |
| This document contains sensitive information exempt from mandatory disclosure under the Freedom of Information Act, 5 U.S.C 552(b) (2). Do not release without prior approval by the Department of Homeland Security. |
| PRIVACY ACT STATEMENT |
| The Privacy Act, 552a, requires that federal agencies inform individuals, at the time information is solicited from them, whether the disclosure is mandatory or voluntary, by what authority such information is solicited, and what uses will be made of the information. The collection of this information is authorized by EO 9397, 6 USC 341, 44 USC 3101, and EO 12958. Provision of the information concerning foreign visits is mandatory under the provisions of EO 12958. Failure to provide it may impact planned visits. Use of this information is for internal purposes to facilitate visitor processing. |
NCIC Form File Plan # 403-258-003c Rev. Date: 5/3/16
FOR PC: To password protect this document, follow the instructions below:
- Click on the File Tab
- To the right of the Info Tab, Click on Protect Workbook
- Click on Encrypt with Password
- Create Password
- Reenter Password
- Save Workbook
FOR MAC: To password protect this document, follow the instructions below:
- Open the workbook that you want to protect.
- On the Review tab, under Protection, click Passwords.
- In the Password to open box, type a password, and then click OK.(The Password to Modify box is optional)
- In the Confirm Password dialog box, type the password again, and then click OK.
- Click Save
Drop down
| US Citizen | Gender |
| Yes | Female |
| No | Male |
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File details come from the government source that posted it. Updated .