Fillable Site Visit Visitor Application.pdf

Visitor Application Information

Full Legal Name (Last, First, Middle)

Previously issued PIV Access Card (Yes or No) PIV card is not required for site visit attendance.

US Citizen (Yes/No) If Not US Citizen Country of Birth

Lawful Permanent Resident Company Name Company Phone Number Company Address

Once completed please e-mail this document to the NBAF Sponsor:

For your personal security, please DO NOT send personally identifiable information (the information contained within this document) to any other e-mail address.

You should password protect and encrypt this form when returning it to NBAF and send the password in a separate email.

To password protect this document, follow the instructions below:

FOR PC: Select File tab, then select Protect Using Password; select Viewing; create a Password;

reenter the Password to verify, then click on Apply.

FOR MAC: Select File tab, then select Export, and click on Encrypt; create a Password; reenter the Password to verify, then click Save.

For your personal security this form will be destroyed immediately upon completion of access request process.

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.

Controlled// SP-SPIIWhen filled out, 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 USDA.

Contract / Project: