Attachment 5 - Vetting Request for Site Visit.xlsx
XLSX spreadsheet 27 KB Posted
- Attached to
- Offutt AFB Grounds Maintenance Service Federal contract opportunity
- Solicitation number
- FA460021Q0009
About this file
This document contains a vetting request form and solicitation for grounds maintenance services at Offutt Air Force Base. The vetting request form is used to collect personally identifying information on contractors and vendors requiring access to the base to perform work. It requests names, dates of birth, citizenship status, identification numbers, work schedules and dates of access for security screening and approval. The related solicitation seeks grounds maintenance services at Offutt AFB, NE, as described in the attached solicitation document. The solicitation number is FA460021Q0009 and was issued by the Department of the Air Force Air Combat Command.
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Text version
Sheet1
| 55 SFS CONTRACTOR/VENDOR NCIC SCREENING & PASS REQUEST SPREADSHEET | ||||||||||
| 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. | ||||||||||
| Offutt AFB Sponsoring Agency / Unit: 55 CES CEOES | Company Name: | |||||||||
| Base Sponsor's Name: | Company Address: | |||||||||
| Base Sponsor's Phone #: | Company Representative Name: | |||||||||
| REQUEST DATE: 1/21/2021 | Company Representative Phone Number: | |||||||||
| Full Name | Date of Birth | Work Schedule | U.S. Citizen | |||||||
| Last, First, MI | Year | Month | Day | Drivers License/ID # | State | SSN | Days | Hrs | Dates (MMDDYYYY) | Yes / No |
Author: Insert one of the following ID numbers: State drivers license, state ID card, passport, or immigration card Monday Author: Mon-Fri Mon-Sat Mon-Sun 0800-1400 Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval 02/01/2021 only Author: Must not exceed 1 year
Author: Insert one of the following ID numbers: State drivers license, state ID card, passport, or immigration card
Author: Mon-Fri Mon-Sat Mon-Sun
Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Non U.S. Citizens require additional vetting and approal processes. Contact sponsor for more details.
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year Author: Use 24 hr clock format 24 Hr access requests must be coordinated through the 55 SFS/S-3 or S-3S for approval
Author: Must not exceed 1 year
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