CBP Short Term Contractors- Visitor Form_BLANK (1).xlsx
XLSX spreadsheet 71 KB Posted
- Attached to
- Construction Manager as Constructor (CMc) Services for the Land Port Of Entry (LPOE), Fort Fairfield, ME
- Solicitation number
- 47PB0025R0016
About this file
The file is a CBP Short Term Contractors Visitor Form template designed for capturing detailed visitor information when short-term contractors access U.S. Customs and Border Protection (CBP) facilities. The template requires comprehensive personal details for each visitor, including full name, social security number, date of birth, current address, occupation, citizenship status, and identification numbers. Submission requires a mandatory 72-hour advance notice to SMDSECURITYSERVICESBRANCH@cbp.dhs.gov or fax to 202-344-1860, with strict security protocols mandating government-issued photo ID, check-in/check-out procedures, and constant visitor escort (one escort per 1-4 visitors).
The template includes privacy act notices and emphasizes security requirements, with warnings that unauthorized unescorted presence in CBP spaces will result in immediate security reporting and removal. The form provides space to document up to 84 individual visitors, allowing for multiple contractor entries. Visitors must undergo a minimum security check prior to accessing CBP facilities, and failure to provide complete information may result in access denial. The form is structured to capture critical personal and administrative information to ensure controlled and documented access to secure government spaces.
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Text version
Short Term Contractors Template
| CBP Short Term 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 Phone Mobile
| 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 | Social Security Number | DOB MM/DD/YYYY | Current Full Address | Occupation | POB (City, State/ Country) | U.S. Citizen (Y/N) | A#, Visa#, Passport # (If NON-USC | |
| Passport # Required) | DL State Issued | Drivers |
License #
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| 7 |
| 8 |
| 9 |
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| 11 |
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| 21 |
| 22 |
| 23 |
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| 25 |
| 26 |
| 27 |
| 28 |
| 29 |
| 30 |
| 31 |
| 32 |
| 33 |
| 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.
| # | Last Name(s) | First Name | Middle Name | Social Security Number | DOB MM/DD/YYYY | Current Full Address | Occupation | POB (City, State/ Country) | U.S. Citizen (Y/N) | A#, Visa#, Passport # (If NON-USC | |
| Passport # Required) | DL State Issued | Drivers |
License #
| 34 |
| 35 |
| 36 |
| 37 |
| 38 |
| 39 |
| 40 |
| 41 |
| 42 |
| 43 |
| 44 |
| 45 |
| 46 |
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| 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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