Attachment 8 Fillable Site Visit Visitor Application.pdf
PDF 371 KB Posted
- Attached to
- Repairs on the Liquid Effluent Decontamination Systems (EDS) and Thermal Tissue Autoclaves (TTA)
- Solicitation number
- 12805B24Q0177
About this file
This document is an Attachment 8 Site Visit Attendee Visitor Application related to a federal contract opportunity.
The key details are: This is a fillable form for individuals to provide personal information to attend a site visit for a solicitation issued by the USDA Agricultural Research Service for repairs on the Liquid Effluent Decontamination Systems (EDS) and Thermal Tissue Autoclaves (TTA) at the NBAF facility in Manhattan, KS. The solicitation number is 12805B24Q0177. The form requires the visitor's name, whether they have a PIV access card, citizenship status, company information, and directs the visitor to password protect and encrypt the form before emailing it to the NBAF sponsor. The form states the information will be used for internal purposes to facilitate visitor processing and will be destroyed after the access request process is complete.
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Text version
Attachment 8 Site Visit Attendee Visitor Application Information
RFQ12805B24Q0177
Name (Last, First, MI)
Previously issued PIV Access Card
(Yes or No) PIV card is not required for site visit attendance.
US Citizen (Yes/No)
If Not US Citizen Country of Birth
Company Name
Company Phone Number
Company Address
Once completed please e-mail this document to the NBAF Sponsor: justin.schlegel@usda.gov
For your personal security, please DO NOT send personally identifiable information (the information contained within this document) to any other e-mail address.
You should password protect and encrypt this form when returning it to NBAF and send the password in a separate email.
To password protect this document, follow the instructions below:
FOR PC: Select File tab, then select Protect Using Password; select Viewing; create a Password; reenter the Password to verify, then click on Apply.
FOR MAC: Select File tab, then select Export, and click on Encrypt; create a Password; reenter the
Password to verify, then click Save.
For your personal security this form will be destroyed immediately upon completion of access request process.
PRIVACY ACT STATEMENT The Privacy Act, 552a, requires that federal agencies inform individuals, at the time information is solicited from them, whether the disclosure is mandatory or voluntary, by what authority such information is solicited, and what uses will be made of the information. The collection of this information is authorized by EO 9397, 6 USC 341, 44 USC 3101, and EO 12958. Provision of the information concerning foreign visits is mandatory under the provisions of EO 12958. Failure to provide it may impact planned visits. Use of this information is for internal purposes to facilitate visitor processing.
Controlled// SP-SPIIWhen filled out, this document contains sensitive information exempt from mandatory disclosure under the Freedom of Information act, 5 U.S.C. 552 (b)(2). Do not release without prior approval by USDA.
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File details come from the government source that posted it. Updated .