7. Base Pass Request.pdf

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Maintain Airfield and Markings
Solicitation number
FA483025R0006
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This document is a Request for Installation Access form from the 23D Security Forces Squadron at Moody Air Force Base in Georgia. The form is designed to request base access passes for individuals, requiring detailed personal information including full name as it appears on a valid state ID, last 6 digits of SSN/DOB, organization/company/school name, and an expiration date not to exceed one year. The form requires a brief synopsis explaining the specific situation necessitating individual access to the installation. The document is marked "FOR OFFICIAL USE ONLY" and contains a warning that the information is Controlled Unclassified Information (CUI) protected under the Freedom of Information Act of 1996 and Privacy Act of 1974, with potential disciplinary or legal consequences for unauthorized disclosure.

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FOR OFFICIAL USE ONLY

DEPARTMENT OF THE AIR FORCE

23D SECURITY FORCES SQUADRON (ACC)

MOODY AIR FORCE BASE GEORGIA

MEMORANDUM FOR 23 SFS

FROM: Name of Company or Requesting Office

SUBJECT: Request for Installation Access

1. I am requesting a pass for the following people to Moody AFB for the purpose of

Full Name: as they appear on their valid state ID.

Last 6 of

SSN/DOB

Organization/Company /School Name:

Expiration Date:

(not to exceed 1yr)

2. Brief synopsis of the situation: (explain the situation that requires the individual to have access to the installation).

First M. Last Name, Rank, USAF Duty Title

Attack · Rescue · Prevail The information here is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1996 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in disciplinary action, criminal and/or civil penalties.

Full Name as they appear on their valid state IDRow1:
Last 6 of SSNDOBRow1:
OrganizationCompany School NameRow1:
Expiration Date not to exceed 1yrRow1:
Full Name as they appear on their valid state IDRow2:
Last 6 of SSNDOBRow2:
OrganizationCompany School NameRow2:
Expiration Date not to exceed 1yrRow2:
Full Name as they appear on their valid state IDRow3:
Last 6 of SSNDOBRow3:
OrganizationCompany School NameRow3:
Expiration Date not to exceed 1yrRow3:
Full Name as they appear on their valid state IDRow4:
Last 6 of SSNDOBRow4:
OrganizationCompany School NameRow4:
Expiration Date not to exceed 1yrRow4:
Full Name as they appear on their valid state IDRow5:
Last 6 of SSNDOBRow5:
OrganizationCompany School NameRow5:
Expiration Date not to exceed 1yrRow5:
Full Name as they appear on their valid state IDRow6:
Last 6 of SSNDOBRow6:
OrganizationCompany School NameRow6:
Expiration Date not to exceed 1yrRow6:

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