2.02b_Attachment_SECNAV_5512_FORM.pdf

This is a Department of the Navy Local Population ID Card/Base Access Pass Registration Form (SECNAV 5512/1) used to collect identity proofing and applicant information for individuals seeking physical access to Department of Defense (DoD), Department of the Navy (DON), or U.S. Marine Corps installations and controlled facilities.

The form requires applicants to provide complete identity and biographical information including name, date of birth, citizenship status, race, gender, physical descriptors (height, weight, hair color, eye color), home address, and contact information. Applicants must present acceptable identity source documents from specified lists (List A for identity and employment authorization, List B for identity, and List C for employment authorization) to establish eligibility. The form collects employment activity information including employer name and address, supervisor details, work hours, and work days. A critical requirement is that applicants must acknowledge understanding that they are required to return their Local Population Identification Card to the Base Pass Office upon expiration or employment termination. The form includes sections for prior felony convictions and requires applicants to authorize the DoD/DON and other federal agencies (including the FBI, DSS, and DHS) to obtain necessary information from government and state agencies for vetting purposes. A Base Registrar Person completes identity proofing, conducts National Crime Information Center (NCIC) checks, and performs local records checks before making a final determination on access. The form includes standard Privacy Act disclosures and federal penalty warnings regarding false statements, with estimated completion time of ten minutes per response.