Attachment 03 - NCIC Screening and Pass Request.pdf

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Attached to
Cable Television Programming and Related Services at Offutt AFB
Solicitation number
FA460024Q0086
Issued by

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This document appears to be an attachment titled "NCIC Screening and Pass Request" related to a federal contract opportunity. It is a spreadsheet that contractors must use to provide personal information (name, date of birth, driver's license, SSN, work schedule, etc.) for their personnel who require access to Offutt Air Force Base to perform contracted work. The information collected is used to conduct National Crime Information Center (NCIC) background checks and issue base passes. Providing this information is voluntary, but failure to do so will result in denied base access. The document outlines the legal authority, restrictions on information use, and exemptions from OMB licensing requirements.

The related federal contract opportunity is for "Cable Television Programming and Related Services at Offutt AFB." This is a solicitation for ongoing base-wide cable TV programming, installation, repair, maintenance, and troubleshooting services across 727 cable drop locations in 52 buildings. The contract will be funded by multiple units on the base, each with their own annual purchase requests. The full scope of work is outlined in the attached Performance Work Statement.

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Other files

File Type Posted
Amendment 0003 - Attachment 01 - Performance Work Statement (PWS) - Offutt AFB Cable TV.pdf PDF
Amendment 0003 - Cable Building and Drops Worksheet - 9.13.24.xlsx XLSX spreadsheet
Amendment 0003 - Cable TV - Combined Synopsis Solicitation - 9.13.24.pdf PDF
Amendment 0002 - Cable TV - Combined Synopsis Solicitation - 9.13.24.pdf PDF
Amendment 0002 - Attachment 05 - CaTV Bldgs and Drops - 9.9.24.xlsx XLSX spreadsheet
Amendment 0002 - Attachment 01 - Performance Work Statement (PWS) - Offutt AFB Cable TV.pdf PDF
Attachment 01 - Performance Work Statement (PWS) - Offutt AFB Cable TV.pdf PDF
Attachment 02 - Cable TV - Pre-Solicitation Q_A - 8.21.24.pdf PDF
Attachment 04 - Offutt Base Map.pdf PDF
Cable TV - Combined Synopsis Solicitation - 8.26.24.pdf PDF

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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

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