FOREIGN VISITOR INFORMATION SHEET.docx

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Advanced Research and Development of Chemical, Biological, Radiological, and Nuclear Medicine Countermeasures
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BARDA-CBRN-BAA-12-100-SOL-00011
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Registration for foreign nationals who plan to attend the conference. Please follow the instructions on the information sheet for submission instructions.

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FOREIGN VISITOR INFORMATION SHEET

The Hosting Official/Organization must request approval for foreign visitation from PSC (brenden.cottrell@psc.hhs.gov) and OSSI (OSSI-FV@hhs.gov), at least five (5) business days in advance of a proposed visit. This includes visits to any component, regional or field office, where a foreign national’s access to the facility or space is reviewed and authorized by the PSC Security Office.

FOREIGN VISITOR INFORMATION

VISITOR FULL NAME

GENDER

COUNTRY OF ORIGIN AND CITIZENSHIP

PLACE OF BIRTH

DATE OF BIRTH

PASSPORT NUMBER

PASSPORT ISSUE DATE

PASSPORT EXPIRATION

COUNTY THAT ISSUED PASSPORT

DIPLOMATIC IMMUNITY

YES or NO

HOSTING OFFICIAL INFORMATON

DATE AND TIME OF VISIT
Thursday, May 3, 2012, 2:00pm-4:00pm
PURPOSE OF VISIT
Pre-proposal Conference
BUILDING AND ROOMS BEING VISITED
Hubert H. Humphrey Building, Room
HOSTING OFFICIAL’S NAME
Glynis Fisher
HOSTING OFFICIAL’S AGENCY
DHHS
HOSTING OFFICIAL’S PHONE NUMBER
(202) 260-1880
HOSTING OFFICIAL’S BUILDING AND ROOM NUMBER
409 3rd St., SW, Suite 400
NAME AND PHONE NUMBER OF ESCORT
Multiple members of ASPR/AMCG and BARDA

For questions please contact Yolanda Dowe at yolanda.dowe@hhs.gov or 202-384-5095.

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