3. Base Entry Request.pdf
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- Attached to
- Design and Build Back Up Generator
- Solicitation number
- FA489726Q0005
About this file
This is a form used by Mountain Home Air Force Base (MHAFB) to request Installation Access Passes for visitors. The 366 SFS Form 30, effective March 2025, is submitted by a DoD sponsor to the 366 SFS/Visitor Control Center (VCC) to request base access for an individual visitor.
Sponsors must submit requests at least two weeks prior to the requested access date, with failure to meet this 14-day timeline potentially resulting in access delays. The form requires the visitor's full legal name, Social Security number, date of birth, driver's license or federal/state-issued ID number, purpose of visit (with contract number required for one-year passes), specific dates and hours of access needed, days of the week required, and employer or sponsor information including email and duty phone. For foreign visitors, the form requires passport number and country of origin, visa number if applicable, and additional identification as needed. Sponsors must certify awareness of visitor procedures, including that visitors cannot access base facilities like the BX or commissary, and that the sponsor is responsible for visitor conduct. The VCC reviews the request and approves or disapproves it after conducting background checks, NCIC wants and warrants checks, criminal history checks, and local file checks. For foreign visitors, OSI coordination is required. The document is classified as Controlled Unclassified Information (CUI) once completed and must be shredded if no longer needed.
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Text version
CUI
MEMORANDUM FOR 366 SFS/Visitor Control Center (VCC)
FROM:
(Sponsor’s Printed Name and Grade)
SUBJECT: Base Visitor Request/Request for Installation Access Pass
1. The below listed individual is requesting issuance of an Installation Access Pass for the reason/time period listed. This letter is submitted IAW MHAFB base access requirements.
REQUEST MUST BE SUBMITTED TO VCC TWO WEEKS BEFORE ACCESS IS REQUESTED
TYPE OR FILL OUT LEGIBLY OR APPLICATION WILL NOT BE PROCESSED
FAILURE TO MEET THE 14-DAY TIMELINE MAY RESULT IN ACCESS DELAYS.
2. The individual (Visitor) has been informed that a background check will be conducted, and that disclosure of the below information is voluntary; however, failure to do so could result in them being denied access to the installation.
3. I (Sponsor) am aware of visitor procedures and understand visitors are not allowed the same privileges as DoD members or family members (BX, Commissary, etc.). I am aware that I am responsible for the conduct of my visitors while on MHAFB and of possible actions that could be taken in response to incidents/violation of policies. Visitors are not authorized to drive on the installation without a valid driver’s license. Violations of policies, to include unauthorized use of base facilities, may result in loss of visitor(s) base access.
(Sponsor’s Printed Name and Grade) (Sponsor’s Signature or DIGITAL WITH DODID #) (Date)
1. FULL LEGAL NAME (FIRST, MIDDLE, LAST)
M F
3. SSAN 4. OPERATORS LICENSE NUMBER AND STATE (SEE NOTE) 4A. FEDERAL/STATE ISSUED ID NUMBER AND STATE (SEE NOTE)
5. PURPOSE OF VISIT (NOTE: CONTRACT NO. REQ'D FOR 1 YEAR PASSES) 6. DATE OF BIRTH (YYYY/MM/DD)
7. DATE(S) OF VISIT OR CONTRACT DATES 8. HOURS OF BASE ACCESS NEEDED 9. DAYS REQUIRED S S M T W T F
10. EMPLOYED BY (CONTRACTORS) OR SPONSORS NAME AND EMAIL (VISITORS) 11. SPONSORS DUTY PHONE
FOREIGN VISITORS/PERSONNEL
12. PASSPORT NUMBER & COUNTRY OF ORIGIN (SEE NOTE) 13. VISA NUMBER (IF APPLICABLE) (SEE NOTE) 14. ADDITIONAL IDENTIFICATION (IF APPLICABLE)
FOREIGN VISITOR (SEE NOTE) YES NO
US CITIZEN/LEGAL RESIDENT (SEE NOTE) YES NO
NOTE: Foreign visitors must produce a Form I-551 or passport with a I-551 stamp as indicated in DoDM 5200.08V3/AFMAN 31-101V3 to be considered a “ US
Resident.” Foreign visitors in possession of a REAL ID Act compliant state driver’s license or an Enhanced Driver’s License/Enhanced Identification Card
(EDL/EID) ARE NOT considered US residents for base access purposes.
366 SFS/VCC: Approved/Disapproved
(VCC Representative Printed Name and Grade) (Signature or DIGITAL WITH DODID #) (Date)
OSI Coordination (For Foreign Visitors Only)
(OSI Representative Printed Name and Grade) (Date)
PRIVACY ACT STATEMENT: Authority: 50 U.S.C 797 and DOD Directive 5400 B
PRINCIPAL PURPOSES: To identify personnel requesting visitor access to MHAFB, to include unofficial visitors and/or family members of DoD personnel, who will be vetted using standard base access vetting procedures.
ROUTINE USES: Information will be used by SFS and OSI to conduct a background check, NCIC wants and warrants and criminal history check, and local files check.
DISCLOSURE IS VOLUNTARY: Failure to provide the information could result in the individual being denied base access. This letter of request will be sent to 366 SFS/VCC two weeks prior to the date the individual concerned requires the pass.
DISPOSITION: This document is for CUI once completed, if this document is no longer in use shred it for protection of the contents.
366 SFS FORM 30, Mar 2025 (Prescribed by 366 FW BSP) (Previous Versions are Obsolete)
CUI
MUST SELECT ONE
MUST SELECT ONE
Untitled
| Date: |
| 1 FULL LEGAL NAME FIRST MIDDLE LAST: |
| 3 SSAN: |
| 4 OPERATORS LICENSE NUMBER AND STATE SEE NOTE: |
| 4A FEDERALSTATE ISSUED ID NUMBER AND STATE SEE NOTE: |
| 5 PURPOSE OF VISIT NOTE CONTRACT NO REQD FOR 1 YEAR PASSES: |
| 6 DATE OF BIRTH YYYYMMDD: |
| 7 DATES OF VISIT OR CONTRACT DATES: |
| 8 HOURS OF BASE ACCESS NEEDED: |
| 10 EMPLOYED BY CONTRACTORS OR SPONSORS NAME AND EMAIL VISITORS: |
| 11 SPONSORS DUTY PHONE: |
| 12 PASSPORT NUMBER COUNTRY OF ORIGIN SEE NOTE: |
| 13 VISA NUMBER IF APPLICABLE SEE NOTE: |
| 14 ADDITIONAL IDENTIFICATION IF APPLICABLE: |
| VCC Representative Printed Name and Grade: |
| Date_2: |
| OSI Representative Printed Name and Grade: |
| Date_3: |
| Sponsors Printed Name and Grade: |
| M: Off |
| Sun: Off |
| Sat: Off |
| Mon: Off |
| Tue: Off |
| Wed: Off |
| Thurs: Off |
| Fri: Off |
| A: |
| I: |
| S: |
| L: |
| F: Off |
| YES 1: Off |
| NO 1: Off |
| YES 2: Off |
| NO 2: Off |
File details come from the government source that posted it. Updated .