2025 NCIC Screening Pass Request.pdf_safe.pdf
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- Solicitation number
- FA460026Q0066
About this file
This is a Contractor/Vendor NCIC Screening & Pass Request Spreadsheet for Offutt Air Force Base (AFB) administered by the 55th Security Forces Squadron (SFS).
The form serves as a template for requesting security clearance and base access passes for contractor and vendor personnel requiring entry to Offutt AFB. Required information includes employee full name, date of birth, driver's license/ID number, state, Social Security number, work schedule details (days, hours, start and end dates in MMDDYYYY format), and country of citizenship. The requesting company must provide the company name, address, company representative name and phone number, and identify the sponsoring agency/unit with the base sponsor's name and phone number. The form requires security screening through NCIC (National Crime Information Center) and mandates that all listed personnel present REAL ID Act-compliant driver's licenses, state IDs, or approved alternate forms of photo identification upon arrival at the Offutt AFB Visitor Control Center. For non-U.S. citizens or visitors, additional signature approval from 55 WG/IP (55th Wing Intelligence and Plans) is required. The form includes fields for contract number and contract start/end dates, and requires authorization signatures from either the Unit Commander or Security Manager. Personally Identifying Information (PII) collected is authorized under 10 U.S.C. 8013, DoD 5200.2R, and AFI 33-202, with information maintained by local Security Forces Authority and access restricted to personnel responsible for contract administration and official DoD duties.
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Text version
Contract#:
Contract Start/End Dates: Unit Commander or Security Manager Sig Block
Full Name Country of Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Start Date - End Date (MMDDYYYY) Citizenship
Personally Identifying Information (PII) being collected by this form is authorized for collection under provisions of 10 U.S.C. 8013, Secretary of the Air Force, DoD 5200.2R, DoD Personnel Security Program; AFI 33-202, Computer Security, Information will be maintained by local Security Forces Authority while access requirements exist. Information access is restricted to personnel responsible for contract administration, or otherwise needed in the performance of official DoD duties. Information will be properly disposed of when its required use has been concluded.
Providing this information is voluntary; however, failure to provide all of the required data shown on the spreadsheet will result in denial of entry to the installation. This information is exempt from OMB licensing under provisions of AFI 33-324, Information Collections and Reports Management Program; Controlling Internal, Public, and Interagency Air Force Collections, paragraphs 3.16.11 and 3.16.16.3.
55 SFS CONTRACTOR/VENDOR NCIC SCREENING & PASS REQUEST SPREADSHEET
Date of Birth
Offutt AFB Sponsoring Agency / Unit:
Base Sponsor's Name:
Base Sponsor's Phone #:
Request Date:
Work Schedule
Company Name:
Company Address:
Company Representative Name:
Company Representative Phone Number:
NOTE:
Security Manager will ensure all listed personnel are briefed that they must present a REAL ID ACT compliant drivers license, or state ID, or an approved alternate form of photo identification upon arrival at Offutt AFB Visitor Control Center.
Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors
Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors
File details come from the government source that posted it. Updated .