B451 Chiller Circuit Repair Site Visit Access List.pdf

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B451 Chiller Circuit Repairs
Solicitation number
FA460026Q0006
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This document is a Offutt Air Force Base Entry Authority List (55 SFS Form 31) for a specific site visit event. The event details include a Bldg. 451 Chiller Circuit Repair Site Visit scheduled for 12/11/2025, with a time frame of 1300-1400 hours. The event sponsor is John Dodson (CIV) with a contact phone number of 402-232-2931. The form is designed to track and authorize installation entry for visitors, requiring detailed personal information such as legal name, gender, date of birth, driver's license number, and U.S. citizenship status. The document is marked FOUO (For Official Use Only) and includes a Privacy Act Statement explaining the purpose and use of the collected information by Security Forces personnel.

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FOUO OFFUTT AIR FORCE BASE ENTRY AUTHORITY LIST

Page of 55 SFS Form 31 (10 Apr 2015)

Event Name

Start and End Time for Each Day of Event Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Date(s) of Event (Expires Immediately After Event ) Location of Event

Sponsor Name and Rank Sponsor Phone Number(s)

PRIVACY ACT STATEMENT

Authority: 10 U.S.C. 8013 and Executive Orders 13478 and 9397 as amended.

Purpose: Information collected by Security Forces personnel will be used to authorize installation entry to persons shown on the entry authority listing for the specific purpose provided by the sponsor. Information will also be used to notify person(s) designated as the visitor sponsor of arrival and other pertinent information relating to entry on the installation.

Routine Uses: Records may be disclosed to applicable Federal, State, or local agency charged with the responsibility of investigating or prosecuting a violation or enforcing/implementing a statute, rule, regulation, order issued pursuant thereto.

Disclosure: Disclosure of requested information is voluntary. Failure to provide all or parts of information requested can result in denial of installation entry. System of records number F031 AF SF B, Security Forces Management Information System (SFMIS), Defense Biometric Identification Systems (DBIDS) applies.

**DO NOT MODIFY FORMAT**

Approval Stamp (55 SFS Use Only)

Signature of Authenticator (55 SFS Use Only)

Legal Name of Guest:

(Last, First, MI)

Gender:

(M/F)

DOB:

(1962 Jan 11)

Driver’s License# State Issued

(M19GO62BLU / MI)

United States Citizen

(Yes / No)

Tuesday:
Wednesday:
Thursday: 1300-1400
Friday:
Saturday:
Sunday:
Sponsor Name and Rank: John Dodson CIV
Name 1:
Gender 1:
DOB 1:
DL 1:
Citizen 1:
Name 2:
Gender 2:
DOB 2:
DL 2:
Citizen 2:
Name 3:
Gender 3:
DOB 3:
DL 3:
Citizen 3:
Name 4:
Gender 4:
DOB 4:
DL 4:
Citizen 4:
Name 5:
Gender 5:
DOB 5:
DL 5:
Citizen 5:
Name 6:
Gender 6:
DOB 6:
DL 6:
Citizen 6:
Name 7:
Gender 7:
DOB 7:
DL 7:
Citizen 7:
Name 8:
Gender 8:
Citizen 8:
DOB 8:
DL 8:
Name 9:
Gender 9:
DOB 9:
DL 9:
Gender 10:
DOB 10:
DL 10:
Citizen 10:
Name 10:
Citizen 9:
Name 11:
Gender 11:
DOB 11:
DL 11:
Citizen 11:
Name 12:
Gender 12:
DOB 12:
DL 12:
Citizen 12:
Name 13:
Gender 13:
DOB 13:
DL 13:
Citizen 13:
Name 14:
Gender 14:
DOB 14:
DL 14:
Citizen 14:
Gender 15:
DOB 15:
Citizen 15:
Name 15:
Name 16:
Gender 16:
DOB 16:
DL 15:
Citizen 16:
DL 16:
Name 17:
Gender 17:
DOB 17:
DL 17:
Citizen 17:
Gender 18:
Name 18:
DOB 18:
DL 18:
Citizen 18:
Monday:
Sponser Phone Number: 402-232-2931
Event Name: Bldg. 451 Chiller Circuit Repair Site Visit
Date of Event: 12/11/2025
Location of Event: Bldg. 451

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