S02 D.2.2 Contractor Request Form – Foreign National.pdf

CONTRACT INFORMATION

Department of Veterans Affairs VHA 106A WMC HROO PerSec Contractor Team

FOREIGN NATIONAL CONTRACTOR REQUEST

(Email to: VHAWMCPerSecContractor@va.gov)(Make sure it is encrypted or password protected)

VA Contracting Officer Name & Email:

COR Name & Email:

Contract End Date (Including Options):

VISN & Station#:

Purchase/Task Order or Contract Number:

Contractor Position Description:

Investigation Level (SAC/Tier 1/Tier 2/Tier 4):

Contract Company Name (Subcontractor):

Contract Company Address:

Contractor POC Name & Phone:

Contractor POC Email:

Contracting Officer/COR Signature:

***This signature verifies that an official contract is in place prior to processing the applicants for badging***

Contractor Personal Identifiable Information

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VHA 106A WMC HROO PerSec Contractor Team VHAWMCPerSecContractor@va.gov

VHA 106A WMC HROO PerSec Contractor Team SERVICES

OVERVIEW

The VHA 106A WMC HROO PerSec Contractor Team offers comprehensive services which ensures that contractor security requirements are met in accordance with DCSA and federal regulations from initiation to completion.

Communication is maintained between the team POC, the contracting officer, the contracting officer representative (COR) and the contracting company point-of-contact at all times during the process. Due to PII concerns, Only personnel listed on the WMC Contractor Request Form will be sent statuses from the Team POC. If another entity requires this information, they must work through the CO, COR or Company

POC. This service provided includes the below:

Fingerprint adjudication:

o This involves a thorough background screening and adjudication of fingerprint along with any self- declared information. After the results are confirmed or adjudicated, the National Criminal History Check (NCHC) Form will be sent to all contacts via email.

Existing investigations:

o Verifying existing investigation information and collecting the required documents for reciprocity.

The required documentation would include the OF306 Form and Self-Certification Form. These documents would be provided upon confirmation of investigation through the DCSA data base.

New investigations:

o Upon receipt of the Contract Security Services Request Packet and all required documents our office will enter each applicant into the eApp system, review, return or release, and monitor the investigation progress through completion.

PIV Badges:

o Our office can only adjudicate PIV badges at this time. The COR/Program Manger on the contract or local personnel must sponsor the contractor/s in the USAccess portal prior to adjudication by this office.

To begin the process, please follow the below guidelines:

1. Upon notification of contract award, ensure applicants are sponsored for prints in USAccess then make an appointment for prints at their local VA fingerprint office they must bring 2 forms of ID to their appointment.

2. Contracting officers, CORs/Program Manger complete and digitally sign the WMC Contractor Request Form form in its entirety. All information is required. The packet will be rejected if this form is not complete or does not contain the CO/COR/Program Manager signature.

3. Have employees complete all required documentation based on their risk level.

4. Submit complete packet to VHAWMCPerSecContractor@va.gov encrypted. Incomplete packets will be rejected and returned. Complete packets will be assigned to a team member within 2 to 4 business days dependent on workload. Subject line for the request submission email should be formatted as shown below.

a. New Request Packet - Contracted Company 36C00000D0000 / 999-C202222

b. Status Request – Contracted Company 36C00000D0000 / 999-C20222 submitted on

00/00/0000

5. Do not submit new requests and additions more than once as this will result in duplicate assignments and wasted time. If you have not received a response to your request within 2-4 business days, send a status request to the mailbox using the above format.

6. If there is a change in the contracted personnel (resignation, declined appointment, etc.) immediately notify the team member handling your request. The cancellation must be submitted via email.

7. Send any additions to our team member that is assigned the contract. We cc the sender of this packet on that assignment so that you can work directly with that team member on all associated actions to include re-issuances, turnover, questions, concerns, statuses, etc. If the packet is already assigned and was not forwarded to the assigned member, we will reject that packet. This is so that we can assign the new contracts as fast as possible for you.

mailto:VSC.Security@va.gov mailto:VSC.Security@va.gov

VHA 106A WMC HROO PerSec Contractor Team

Foriegn National CONTRACT SECURITY SERVICES REQUEST - INSTRUCTIONS

Purpose: The Contract Security Services Request is submitted to VHA 106A WMC HROO PerSec Contractor Team to initiate the contract security verification process. By submitting this request, our office will ensure that everyone listed have been fingerprinted, the fingerprints are adjudicated, if necessary, background investigations are initiated or existing background investigations are current and PIV badges are adjudicated. This form should be completed and signed by the contracting officer. Please refer to the instructions below when completing the Contract Security Services Request.

Contract Information Section

Contracting Officer & email: Please provide the post-award contracting officer handling this contract and their phone number.

COR/Program Manager Name & email: Please list the Contracting Officer Representative (previously the Contracting Officer Technical Representative) and email. The COR/Program Manger is the liaison between the contracting officer and contracted company.

Contract End Date: Please list the date in which the contract ends including all options to extend (for PIV badge expiration).

VISN & Station Number: Please indicate the VISN and facility station number where the work is being performed/facility to be billed.

Purchase Order, Task Order and Contract Numbers: Please list the purchase order number, task order or the contract numbers.

Contractor Position Description: Please provide a position title for all individuals (ex: physician, consultant, electrician).

Investigation Level: Please indicate the background security requirements as provided by the PDT (Position Designation Tool). This would include background screening or Fingerprint Only (SAC), low-level investigation (Tier 1), moderate-level investigation (Tier 2) and high-level investigation (Tier 4). Please note that PIV-I badges (contract under 180-days) require at minimum a SAC, full PIV badges (over 180-days) require a minimum a T1. If it is Tier 2 or 4, please provide a copy of the PDT to justify a higher-level investigation.

Contract Company Name: Please provide the name of the contracting company that will be providing the work under the task order. Please provide subcontractors in parenthesis.

Contractor Address: Please provide the contracting company address.

Contractor POC Name & Phone: Please provide the main point-of-contact for the contracting company and contact information. This person may be contacted to provide additional information or documents in the process. All communication with this individual will include the contracting officer and COR/Program Manager.

Contractor POC Email: Please provide the email address for the company point-of-contact. This email will be included in all correspondence regarding investigation and PIV processing.

Contracting Officer/COR/Program Manager Signature: All contracts must be signed by the contract specialist, contracting officer representative (COR) or Program Manger . This signature verifies that an official contract is in place prior to processing the applicants for investigation and badging.

VHA 106A WMC HROO PerSec Contractor Team

Foreign National CONTRACT SECURITY SERVICES REQUEST - INSTRUCTIONS

Purpose: The Contract Security Services Request is submitted to VHA 106A WMC HROO PerSec Contractor Team to initiate the contract security verification process. By submitting this request, our office will ensure that everyone listed have been fingerprinted, the fingerprints are adjudicated, if necessary, background investigations are initiated or existing background investigations are current and PIV badges are adjudicated. This form should be completed and signed by the contracting officer. Please refer to the instructions below when completing the Contract Security Services Request.

Foreign National Contractor Employee Information Section

For investigations to be conducted and eligiblity for a PIV credential, individuals must have lived in the United States for 3 consecutive years.

SSN: Please provide complete social security numbers for all individuals listed.

Employee Last Name: Please provide the legal last name of the individual working on this task order.

Employee First Name: Please provide the legal first name of the individual working on this task order.

Employee Middle Name: Please provide the legal Middle name of the individual working on this task order. Or NMN in there is not one.

DOB: Please provide date of birth for all individuals listed. (MM/DD/YYYY)

Marital Status: Provide marital status using the drop-down button.

Gender: Provide gender at birth

City Birth: Please provide city of birth.

Country of Birth: Please provide Country of birth.

Country of Citizenship: Provide country of citizenship.

Passport Number: Required for processing

Passport Issuance Country: Required for processing.

Passport Issuance Date: Required for processing.

Passport Expiration Date: Required for processing.

VISA Number: Must be correct VISA number: 8-character input: letter + 7 numbers which is in red text on the document (not the Control

Number or Annotation Number N-number).

VISA Expiration: Required for processing

Email Address: Please provide a valid email address for all individuals.

All background investigation request forms and supporting documents must be .pdf files and the below naming convention used:

Station #_last name last four of SSN_form name

Example:

573_Jones1234_REQ

573_Jones1234_306

573_jones1234_SC