55SFS NCIC Screening Pass Request.pdf_safe.pdf
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- Solicitation number
- FA460026Q0098
About this file
This document is a Contractor/Vendor NCIC Screening & Pass Request Spreadsheet for Offutt Air Force Base (AFB).
The form is used by the 55th Security Forces Squadron (55 SFS) to collect personally identifiable information (PII) from contractor and vendor personnel requiring base access. Required data fields include full name, date of birth, driver's license or state ID number, Social Security number, work schedule details (days, hours, start and end dates in MMDDYYYY format), and country of citizenship. The spreadsheet also captures sponsoring agency/unit information, base sponsor details, company information, and company representative contact information. All listed personnel must be briefed to present a REAL ID Act-compliant driver's license, state ID, or approved alternative photo identification upon arrival at the Offutt AFB Visitor Control Center. For non-U.S. citizens, additional approval from 55 Wing/International Programs (55 WG/IP) is required. The form requires signature blocks from the Unit Commander or Security Manager and, for non-U.S. visitors, the 55 WG/IP office. PII collection is authorized under 10 U.S.C. 8013, DoD 5200.2R, and AFI 33-202, with information maintained by local Security Forces while access requirements exist. The form is exempt from OMB licensing under AFI 33-324.
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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 .