55SFS NCIC Screening Pass Request.pdf_safe.pdf
PDF 54 KB Posted
- Attached to
- B456, NAOC Lower Lot Fence & Power Installation
- Solicitation number
- FA460026Q0105
About this file
This is a Contractor/Vendor NCIC Screening & Pass Request Spreadsheet for Offutt Air Force Base (AFB), maintained by the 55th Security Forces Squadron (55 SFS). The form is used to request security clearance and visitor passes for contractor and vendor personnel requiring access to Offutt AFB.
The spreadsheet collects personally identifiable information (PII) including full name, date of birth, driver's license/ID number, state, Social Security number, work schedule (days and hours), employment dates in MMDDYYYY format, and country of citizenship. The form requires information about the sponsoring agency/unit at Offutt AFB, the base sponsor's name and phone number, the requesting company's name and address, and the company representative's name and phone number. Personnel are required to present a REAL ID Act-compliant driver's license, state ID, or approved alternate photo identification upon arrival at the Offutt AFB Visitor Control Center. The spreadsheet spans three pages with rows for multiple contractor/vendor personnel entries. Each submission requires signatures from the Unit Commander or Security Manager, and non-U.S. visitors require additional approval from 55 WG/IP (55th Wing/International Programs). PII collection is authorized under 10 U.S.C. 8013, DoD 5200.2R, and AFI 33-202, with information maintained by local Security Forces Authority and restricted to personnel responsible for contract administration.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .