2.2.1 SOW Exhibit B.xlsx
XLSX spreadsheet 40 KB Posted
- Solicitation number
- 20155238
About this file
This file is a Contractor Information Sheet template for short-term visitors to U.S. Customs and Border Protection (CBP) facilities. The form is used to collect and vet information about contractor personnel who need temporary access to CBP locations, specifically for visitors requiring escort during their visit.
The sheet requires submission of comprehensive visitor information including full names, dates of birth, citizenship status, place of birth, passport details, visa information, driver's license numbers, and Social Security numbers for all contractor personnel. A designated CBP employee must serve as the visitor escort, with one escort required for every four visitors, or potentially a one-to-one ratio depending on vetting status. Requests must be submitted to the Office of Professional Responsibility at SMDSECURITYSERVICESBRANCH@cbp.dhs.gov or faxed to 202-344-1860 at least 72 hours prior to the visitor's arrival. All visitors must present a valid U.S. Government-issued photo identification and check in and out at the security desk upon arrival and departure. The form accommodates up to 84 visitor entries and includes a Privacy Act Notice indicating the data collection is conducted under Public Law 93-579 for security clearance purposes, with denial of access possible if required information is not provided.
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Text version
Short Term Contractors Template
| CBP Contractor Information Sheet | |
| Date Submitted: | From: |
| Contract Company Information | CBP Agency Information |
| Contract Company Name | CBP Location Address (Location, Building, Floor, Room #) |
Contract Company Address Visitor Escort Full Name (DHS/CBP Employee Only)
Contract Company POC (First & Last Name) Phone Number Email
On Site Contractor POC (First & Last Name) Phone Number Phone Office Mobile Office
| Date(s) and | |||||
| Time(s) of Visit | From Date | Time | To Date | Time |
| Purpose of Visit: | ||||||||||||||||||
| Provide all below information | ||||||||||||||||||
| # | Last Name(s) | First Name | Middle Name | DOB MM/DD/YYYY | U.S. Citizen (Y/N) | POB (City, State/ Country) | Occupation | Address | A Number | Exp Date | Visa Number | Exp Date | Passport Country | Passport # | Exp Date | Social Security Number | DL State Issued | Drivers |
License #
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| 7 |
| 8 |
| 39 |
| 40 |
| 41 |
| 42 |
| 43 |
| 44 |
| 45 |
| 46 |
| 47 |
| 48 |
| 49 |
| 50 |
| 51 |
| 52 |
| 53 |
| 54 |
| 55 |
| 56 |
| 57 |
| 58 |
| 59 |
| 60 |
| 61 |
| 62 |
| 63 |
| 64 |
| 65 |
| 66 |
| 67 |
| 68 |
| 69 |
| 70 |
| 71 |
| 72 |
| 73 |
| 74 |
| 75 |
| 76 |
| 77 |
| 78 |
| 79 |
| 80 |
| 81 |
| 82 |
| 83 |
| 84 |
| SUBMISSION: The Office of Professional Responsibility requires a mandatory submission of 72 hours prior to arrival of visitor(s) in order for any visitor to be considered for approval. Email request to SMDSECURITYSERVICESBRANCH@cbp.dhs.gov or fax to the Office of Professional Responsibility, ATTN: Security Management Division at 202-344-1860. |
NOTICE: All visitors must present a U.S. Government issued Photo Identification Card. All visitors must check in at the Security Desk upon arrival and check out at the desk upon departure. Visitor escorts are responsible for constant escort of visitors. The designated escort must accompany visitors at all times, to include returning visitors back to the front desk upon departure. Any visitors found in U.S. Customs and Border Protection space without an escort will be immediately reported to security and escortedout of CBP space. One escort must be provided for every four visitors (1-4), depending on Vetting status one escort may be required for evey person (1-1).
PRIVACY ACT NOTICE: This information is provided to PL 93-579 (Privacy Act of 1974). The purpose of this document is provide information necessary for a minimum security check prior tolimited authorized access to U.S. Customs and Border Protection facility. Failure to provide this information may result in denial of access.
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