Attachment 10 - Base Access Request Form - DRAFT.pdf

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UNESCORTED ACCESS REQUEST

(Per JBSANANTONIOI 31-1131)

JBSANANTONIO 7 20190821

"FOUO, This document contains information exempt from mandatory disclosure under the FOIA. Title 5 U.S.C. 552 (b) (6) applies.

This document also contains personal information that is protected by the Privacy Act of 1974 and must be safeguarded from unauthorized disclosure."

SPECIAL SECURITY REQUIREMENTS: IAW AFMAN 31-113, paragraph 3.7.1.3.3, "It is the sponsoring organization's responsibility to ensure the visit is properly recorded and documented...and the local AFOSI unit is notified when foreign visitors arrive and depart the installation.

On the day of visit and when the foreign visitors have departed the installation, email AFOSI, at AFOSI.Det403@us.af.mil indicating time of arrival and departure from the installation.

The following information has been provided to aid in the completion of the Unescorted Access Request.

Section I: Sponsor Information.

Block 1. Title The sponsors title (ie; Mr., Ms., Mrs., or associated rank of Military/GS employee).

Block 2. Last Name, First Name MI (Full name of sponsor, use format assigned). Block 3. Duty Phone (Office number you can be reached at during business hours). Block 4. Cell/Home Phone (Phone number you may be reached at during requested access times for your guests).

Block 5. DoD ID Number (Assigned number on your DoD ID Card-This is required to fully identify you in DBIDS).

Block 6. Organization/Home Address (If you are sponsoring for a government purpose use your organization. If it is for personal reasons use your home address).

Block 7. Email Address (email submissions will be sent encrypted utilizing a .mil email address).

Section II: Access Details.

Block 8. Category for Access (Check the category of your guest). Block 9 Location (Check which location(s) in the JBSA area you are requesting your guests to have access to – Must be a valid need for entry to these locations. Contractor/Vendors must provide contract number stating access locations are required). Block 10. Time Frame From Date (Start date of visit/contract, etc…) To Date (End date of visit/contract, etc…) From Time (Start time of visit or if continual access, start time each day) To Time (End time of visit or if continual access, end time each day) Days of Week (Days of week entry is required - If visiting select day(s) visit will take place, if continual access is required – actual days of work required to be present)

Block 11. Reason for Access. Provide specific reason for access (ie; Meeting, Tow Truck, Pop-A-Lock, Taxi, Wedding, Family visit, etc…).

Block 12. Identify the Visiting Organization, Name of Event or if Contractor: Company Name (Prime and Sub Contractor), Contract Number and Contract Period.

Block 13a, b, c: Sponsor completes each block. Must be legible when completed manually.

Section III: Visitor Center Use Only.

Section IV: Foreign Disclosure Office Use Only.

Section V: Guest Information.

Foreign visitors must be processed through the Foreign Disclosure Office. Email completed form to 502SRG.MAS.JBSA_ForeignRequest@us.af.mil For more than 20 visitors [Special Event] use continuation sheets).

Block 16. Fill in the blocks [alphabetical order] for all visitors 18 years of age or older.

Last Name, First Name MI (Full name of visitor, use format assigned).

DOB: Date of Birth (Use format assigned).

Country (Country of birth for foreign visitors).

ID Type: Must be a valid form of photo ID. Below are acceptable forms. Use the corresponding number when making your selection.

1 = Driver's License 2 = State Identification Card 3 = Veteran's Identification Card 4 = Passport/Visa 5 = Permanent Residence Card 6 = US Citizenship & Immigration Services

ID Number (The associated number assigned to the ID Type) Country of Issue (Country where identification was issued) State of Issue (State where identification was issued) If a tracking number is assigned, the sponsor will relay the number to their guest(s) for announcement at a visitor center. This will allow the Visitor Center Personnel to track completed paperwork for issuance of an access credential.

AUTHORITY: Title 10, United States Code 8012. PRINCIPAL PURPOSE: To assist security personnel in establishing a fitness determination through the identity proofing and vetting process. ROUTINE USES: To be utilized by personnel requesting to obtain guest installation access pass for unescorted access to Joint Base San Antonio (JBSA) installations for 1 -30 days or for special one-time events. DISCLOSURE: Disclosure of the requested information is voluntary; however, failure to provide information may result in denial of request or the refusal by the 802 Security Forces Squadron, Installation Access Control Section to permit access to the installation.

IV. FOREIGN DISCLOSURE OFFICE (FDO) USE ONLY

III. VISITOR CENTER USE ONLY

I. SPONSOR INFORMATION

1. TITLE

2. LAST NAME, FIRST NAME, MI

3. DUTY PHONE

4. ALTERNATE CONTACT NUMBER

5. DOD ID NUMBER

6. ORGANIZATION/HOME ADDRESS

7. EMAIL ADDRESS

II. ACCESS DETAILS

8. CATEGORY OF ACCESS

9. LOCATION

10. TIME FRAME

(Ex: Pizza Delivery/.Non Driver Status)

11. REASON FOR ACCESS (Be Specific) 14a. TRACKING NUMBER 14b. RECEIVED DATE 14c. VETTED DATE 14d. POSTED DATE (For EAL Use) 14e. ECP POSTED LOCATION (For EAL Use) 15a. CASE NAME 15b. VETTED DATE 15d. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF VERIFIER

12. CONTRACTED COMPANY SPONSORED OR SPECIAL EVENT NAME

15e. SIGNATURE 13b. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF SPONSOR 13d. SIGNATURE 14g. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF VERIFIER 14h. SIGNATURE 13a. DATE OF SIGNATURE 14f. DATE OF SIGNATURE 15c. DATE OF SIGNATURE

V. GUEST INFORMATION

16. Enter information for all persons 18 years of age or older (in alphabetical order). Refer to page 1 for instructions.

Last Name, First Name, MI

DOB (DD/MMM/YY)

Country of Birth

ID

Type

ID

Number Country of Issue State of Issue VCC Use Only 11.0.1.20130826.2.901444.899636 Ascending