55 SFS NCIC Screening Pass Request.pdf

PDF 365 KB Posted

Attached to
Quarters 16 Generator Installation Offutt AFB, NE Federal contract opportunity
Solicitation number
FA460025B0003
Issued by
Department of the Air Force Air Combat Command

About this file

Written by GovTribe AI ·

This document is a 55 SFS Contractor/Vendor NCIC Screening & Pass Request Spreadsheet for Offutt Air Force Base, specifically for the USTRATCOM (J43) sponsoring agency. The form is designed to collect personally identifiable information (PII) for contractors or vendors requiring base access, with fields for full name, date of birth, driver's license, state identification, work schedule, and U.S. citizenship status. The contract number is FA4600-25-B-0003, with contract start/end dates currently listed as "TBD". The spreadsheet includes legal language noting that providing information is voluntary, but failure to do so will result in denial of installation entry, and that the information will be maintained by local Security Forces Authority with restricted access.

View the file

Other files for this federal contract opportunity

Other files attached to Quarters 16 Generator Installation Offutt AFB, NE, newest first.
File Type Posted
OF 1419A Abstract Continuation Sheet 2-4.pdf PDF
OF 1419A Abstract Continuation Sheet 4-4.pdf PDF
OF 1419 Abstract of Offers - 1-4.pdf PDF
OF 1419A Abstract Continuation Sheet 3-4.pdf PDF
Bid Abstract - Certified.pdf PDF
Q16 RFI 001 - Attachment 01.pdf PDF
Q16 RFI 001 - Gov Response.pdf PDF
Q16 RFI 001 - Attachment 02.pdf PDF
Solicitation Amendment - FA460025B00030004.pdf PDF
Solicitation Amendment FA460025B00030004 SF 30.pdf PDF
DSC03160.JPG JPG image
DSC03158.JPG JPG image
DSC03157.JPG JPG image
DSC03156.JPG JPG image
DSC03155.JPG JPG image
DSC03159.JPG JPG image
Solicitation Amendment FA460025B00030003 SF 30.pdf PDF
Site Visit Attendance Roster.pdf PDF
DSC03163.JPG JPG image
DSC03162.JPG JPG image
DSC03161.JPG JPG image
Conformed Solicitation - FA460025B00030003.pdf PDF
Solicitation Amendment FA460025B00030001 SF 30.pdf PDF
Solicitation Amendment FA460025B00030002 SF 30.pdf PDF
Solicitation - FA460025B00030002.pdf PDF
Solicitation Amendment 001 FA460025B00030001 SF 30.pdf PDF
Solicitation - FA460025B00030001.pdf PDF
Drawings.pdf PDF
Wage Determination.pdf PDF
Specifications.pdf PDF
Show all 30

On GovTribe

Work with this file on GovTribe

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Full Name U.S. Citizen Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Dates (MMDDYYY) Yes / No

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:

Contract#:

Contract Start/End Dates:

Sponsoring Unit Security Manager or Commander Signature Block/Signature

Offutt AFB Sponsoring Agency Unit: J43 USTRATCOM
Company Name:
Base Sponsors Name: (Filled in by sponsoring agency)
Company Address:
Base Sponsors Phone: (Filled in by base sponsor)
Company Representative Name:
Request Date: (Filled in by base sponsor)
Last First MIRow1: Name
YearRow1: 19XX
MonthRow1: XX
DayRow1: XX
Drivers LicenseID Row1:
StateRow1:
SSANRow1: xxx-xx-xxxx
DaysRow1: N/A
HrsRow1: N/A
Dates MMDDYYYRow1: N/A
Yes NoRow1:
Last First MIRow2:
YearRow2:
MonthRow2:
DayRow2:
Drivers LicenseID Row2:
StateRow2:
SSANRow2:
DaysRow2: N/A
HrsRow2: N/A
Dates MMDDYYYRow2: N/A
Yes NoRow2:
Last First MIRow3:
YearRow3:
MonthRow3:
DayRow3:
Drivers LicenseID Row3:
StateRow3:
SSANRow3:
DaysRow3: N/A
HrsRow3: N/A
Dates MMDDYYYRow3: N/A
Yes NoRow3:
Last First MIRow4:
YearRow4:
MonthRow4:
DayRow4:
Drivers LicenseID Row4:
StateRow4:
SSANRow4:
DaysRow4: N/A
HrsRow4: N/A
Dates MMDDYYYRow4: N/A
Yes NoRow4:
Last First MIRow5:
YearRow5:
MonthRow5:
DayRow5:
Drivers LicenseID Row5:
StateRow5:
SSANRow5:
DaysRow5: N/A
HrsRow5: N/A
Dates MMDDYYYRow5: N/A
Yes NoRow5:
Last First MIRow6:
YearRow6:
MonthRow6:
DayRow6:
Drivers LicenseID Row6:
StateRow6:
SSANRow6:
DaysRow6: N/A
HrsRow6: N/A
Dates MMDDYYYRow6: N/A
Yes NoRow6:
Last First MIRow7:
YearRow7:
MonthRow7:
DayRow7:
Drivers LicenseID Row7:
StateRow7:
SSANRow7:
DaysRow7: N/A
HrsRow7: N/A
Dates MMDDYYYRow7: N/A
Yes NoRow7:
Last First MIRow8:
YearRow8:
MonthRow8:
DayRow8:
Drivers LicenseID Row8:
StateRow8:
SSANRow8:
DaysRow8: N/A
HrsRow8: N/A
Dates MMDDYYYRow8: N/A
Yes NoRow8:
Last First MIRow9:
YearRow9:
MonthRow9:
DayRow9:
Drivers LicenseID Row9:
StateRow9:
SSANRow9:
DaysRow9: N/A
HrsRow9: N/A
Dates MMDDYYYRow9: N/A
Yes NoRow9:
Last First MIRow10:
YearRow10:
MonthRow10:
DayRow10:
Drivers LicenseID Row10:
StateRow10:
SSANRow10:
DaysRow10: N/A
HrsRow10: N/A
Dates MMDDYYYRow10: N/A
Yes NoRow10:
Last First MIRow11:
YearRow11:
MonthRow11:
DayRow11:
Drivers LicenseID Row11:
StateRow11:
SSANRow11:
DaysRow11: N/A
HrsRow11: N/A
Dates MMDDYYYRow11: N/A
Yes NoRow11:
Last First MIRow12:
YearRow12:
MonthRow12:
DayRow12:
Drivers LicenseID Row12:
StateRow12:
SSANRow12:
DaysRow12: N/A
HrsRow12: N/A
Dates MMDDYYYRow12: N/A
Yes NoRow12:
Last First MIRow13:
YearRow13:
MonthRow13:
DayRow13:
Drivers LicenseID Row13:
StateRow13:
SSANRow13:
DaysRow13: N/A
HrsRow13: N/A
Dates MMDDYYYRow13: N/A
Yes NoRow13:
Last First MIRow14:
YearRow14:
MonthRow14:
DayRow14:
Drivers LicenseID Row14:
StateRow14:
SSANRow14:
DaysRow14: N/A
HrsRow14: N/A
Dates MMDDYYYRow14: N/A
Yes NoRow14:
Last First MIRow15:
YearRow15:
MonthRow15:
DayRow15:
Drivers LicenseID Row15:
StateRow15:
SSANRow15:
DaysRow15: N/A
HrsRow15: N/A
Dates MMDDYYYRow15: N/A
Yes NoRow15:
Last First MIRow16:
YearRow16:
MonthRow16:
DayRow16:
Drivers LicenseID Row16:
StateRow16:
SSANRow16:
DaysRow16: N/A
HrsRow16: N/A
Dates MMDDYYYRow16: N/A
Yes NoRow16:
Last First MIRow17:
YearRow17:
MonthRow17:
DayRow17:
Drivers LicenseID Row17:
StateRow17:
SSANRow17:
DaysRow17: N/A
HrsRow17: N/A
Dates MMDDYYYRow17: N/A
Yes NoRow17:
Last First MIRow18:
YearRow18:
MonthRow18:
DayRow18:
Drivers LicenseID Row18:
StateRow18:
SSANRow18:
DaysRow18: N/A
HrsRow18: N/A
Dates MMDDYYYRow18: N/A
Yes NoRow18:
Last First MIRow19:
YearRow19:
MonthRow19:
DayRow19:
Drivers LicenseID Row19:
StateRow19:
SSANRow19:
DaysRow19: N/A
HrsRow19: N/A
Dates MMDDYYYRow19: N/A
Yes NoRow19:
Last First MIRow20:
YearRow20:
MonthRow20:
DayRow20:
Drivers LicenseID Row20:
StateRow20:
SSANRow20:
DaysRow20: N/A
HrsRow20: N/A
Dates MMDDYYYRow20: N/A
Yes NoRow20:
Contract #: FA4600-25-B-0003
Contract End Date: TBD
Company Phone #:

File details come from the government source that posted it. Updated .