Attachment I - SECNAV FORM 5512.pdf
PDF 2 MB Posted
- Solicitation number
- N4008526R0020
About this file
This document is a Department of the Navy Local Population ID Card/Base Access Pass Registration form (SECNAVINST 5500.35) used to control physical access to Department of Defense installations and facilities. The form serves as an identity proofing and registration document for individuals requiring access to DOD, Department of the Navy, or U.S. Marine Corps installations and controlled information areas.
The registration collects comprehensive personal identification information including name, date of birth, citizenship status, race, gender, and physical descriptors (height, weight, hair color, eye color). Applicants must present approved identity source documents such as U.S. passports, state-issued driver's licenses, Social Security numbers, or alien registration documents to establish identity. The form captures employment activity information, including employer name and address, supervisor details, and work hours/days. Applicants must disclose prior felony convictions and certify their understanding that the ID card must be returned upon expiration or employment termination. The form includes authorization language permitting disclosure of information to designated contractors, Federal agencies, and foreign governments for access control purposes, as well as authorization for background checks by the National Crime Information Center (NCIC) and local records checks. The Base Registrar Person completes identity verification and NCIC checks, with final access determination authority resting with the Base Commanding Officer. The OMB control number is 0703-0061 with an expiration date of July 31, 2027.
View the file
Other files
Show all 32
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CUI (when filled lnj 0MB 0703-0061 Exp· 31 July 2027
SECNAVINST 5500.35
DEPARTMENT OF THE NAVY LOCAL POPULATION ID CARD/BASE ACCESS PASS REGISTRATION
PRIVACY ACT STATEMENT:
AUTHORITY: 10 U.S.C. 113, Seccetary of Defense: OoD Directive 1000.25, OoD Personnel Identity Protection (PIP) Program; DoD instruction 5200.08, Security of DoD installations and Resources and the OoD Physical Security Review Board (PSRB): DoO 5200.08-R. Physical Security Program; DoD Directive 5200.27, Acquisition of Information Concerning Persons and Organizations not Affiliated with the Department of Defense (Exception to policy memos): Directive-Type Memorandum (OTM) 09-012, Interim Policy Guidance for DoO Physical Access Control; DTM 14-005, DoD Identity Management Capability Enterprise Services Application (IMESA) Access lo FBI National Crime Information Center (NCICI Files; and E.O. 9397 (SSN), as amended: OPNAVINST 5530.14E, Navy Physical Security and Law Enforcement Program; Marine Corps Order P5530.14, Marine Corps Physical Security Program Manual.
SORNNM05512-2 Badge and Access Control System Records and OMDC 16. Identity Management Engine for Security and Analysis (IMESA): http://dpcld.defense.gov/Privacyl SORNslndex
PURPOSE(SI: To control physical access to Department of Defense (OoO). Department of the Navy (DON) or U.S. Marine Corps lnslallations/Units controlled information, installations facilities, or areas over which OoO, DON, or U.S. Marine Corps has security responsibilities by identifying or verifying an individual through the use of biometric databases and associated data processingftnformation services for designated populations for purposes of protecting U.S./Coalitionlallied govemmenVnational security areas of responsibility and information: to issue badges, replace losl badges, and retrieve passes upon separalion: to maintain visilor statistics: collect information to adjudicate access to facility; and track the entry/exit times of personnel.
ROUTINE USE(S): To designated contractors, Federal agencies, and foreign governments for the purpose of granling Navy officials access to their facility.
DISCLOSURE: Providing registration information is voluntary. Failure to provide requested information may result in denial of access to benefits, privileges, and DoD installations.
facildies and buildings.
IDENTITY PROOFING AND APPLICANT INFORMATION
1. LAST NAME:
I 2
. FIRST NAME:
3. MIDDLE NAME:
5. RACE □AMERICAN INOIAN 0< ALASKA
(Check one or more): NATIVE □ASIAN □ BLACK or AFRICAN AMERICAN
6. SEX □MALE
(Check one):
□FEMALE
7. DATE OF BIRTH: 8. CITY OF BIRTH:
4. NAME SUFFIX:
0 Jr. 0 Sr. D I 0110111 0 IV
□ HISPANIC OR LATINO
NATIVE HAWAIIAN
(JM;ITE □ OR OTHER PACIFIC
ISLANDER
9. STATE OF BIRTH:
10. BIRTH COUNTRY.
11. US CITIZEN (Check): □ YES D
12. DUAL CITIZENSHIP: □YES 0NO NO CITIZENSHIP IF OTHER THAN US (Country) :
U.S. Citizen Minimum Documentation Required:
By Birth- Social Security No and/or State ID/Drivers License.
Naturalized - Certification Number, Petition Number. Date. Place and Court. United States passport number. Social Security No and/or State ID/Drivers License.
Derived - Parent's certification number. Social Security No and/or State ID/Drivers License.
Allen Minimum Documentation Required:
Registration Number, Expiration date, Date of entry, Port of entry.
13. IDENTITY SOURCE 14. DOCUMENT 15. ISSUED BY
DOCUMENTS PRESENTED: NUMBER: STATE/COURT:
D Social Security No.
D State ID/Drivers License
D Passport No.
□ Certification Number and Petition Number
□ Derived - Parent's Certification Number:
D Alien Registration No.
Date of Entry:
OTHER APPROVED IDENTITY SOURCE DOCUMENTS:
19. WEIGHT 20. HEIGHT 21. HAIR COLOR (Check one):
(Pounds): (Inches}: 0 Blond □ Brown □ Black D Gray □ D V\lhite □ Silver □ Auburn □ Bald
23. HOME ADDRESS (Include city, state, zip code);
24. BASE SPONSOR'S NAME:
SECNAV 5512/1 (April 2025) CUI (when filled lnj
16. ISSUED BY 17.ISSUED; 18. EXPIRES·COUNTRY:
United States
United States
United States
United States
I Port of Entry:
22. EYE COLOR (Check one):
Red D Brown 0 Green □ Blue □ Hazel 0 Black 7 Gray n Violet n Unknown
HOME PHONE (Include Area Code), SPONSOR PHONE (Include Area Code)'
Con•olt<S by· DoN CUI C•l•'10'Y PRIICY lOC:FEOCON POC· Lt'Ron Uvr«tnct teron.a.lawr
George Colley - NAVFAC Yorktown ROICC 757-636-7215
File details come from the government source that posted it. Updated .