Attachment_C_Form_W3000-72.pdf

ATTACHMENT C

WAPA Form 3000-72 Foreign National Data Card

DE-SOL-0006424

INSTRUCTIONS FOR PREPARING Foreign National Data Card for Unclassified Foreign

Visits and Assignments to WAPA (WAPA F 3000-72#- 6-03)

Routing of Form:

1. Requestor- Meeting host initiates the form at least 30-45 days before planned visit

2. Regional Manager (or Acting Official) for approval signature

3. Original to Regional Safety and Security Office (The Safety and Security office reviews and sends to Pam Moody- CSO)

4. Pam Moody (CSO- A7700) (Conducts required back-ground checks and approves visit)

5. Approval sent to Regional Safety and Security Officer

6. Regional Safety and Security Officer notifies host and front desk personnel of approval/denial

To allow time for background checks, this form must be completed at least 30 days for non-sensitive countries visitors, and 45 days for visitors from sensitive countries.

For more information and a list of sensitive countries go to:

http://www.cso.wapa.gov/cpo/3700/SECURITY/fva.htm

(Failure to complete this approval process may result in denial of visit.)

Section A – PERSONAL DATA INFORMATION

BLOCK 1. Employee name: Last name; first name, middle name BLOCK 2. Select Male or Female: Place a check mark in the appropriate box BLOCK 3. Country of Birth: Spell out. No abbreviations BLOCK 4. City of Birth: Spell out. No abbreviations BLOCK 5. Permanent Address: Self-explanatory BLOCK 6. Date of Birth: Month/Day/Year BLOCK 7. Social Security Number: Self-explanatory BLOCK 8. Country of Citizenship: Spell out. No abbreviations BLOCK 9. Passport/Visa/Immigration Number: One must be supplied BLOCK 10. Country of Issue of Passport/Visa/Immigration Number BLOCK 11. Expiration Date: of above issued document Month/Day/Year

Section B – EMPLOYMENT DATA

BLOCK 12. International Agreement Code: If one exists the visitor will know it. Not required.

BLOCK 13. Current Employer/Business Name: Self-explanatory BLOCK 14. Business Address: Self-explanatory

Section C – VISIT DATA INFORMATION

BLOCK 15. Buildings/Sites to be Visited: Be specific (note: Must be escorted by host at all times) BLOCK 16. Request Date: Date host is submitting this request for approval BLOCK 17. Name and Signature of DOE Host: Must be a supervisor BLOCK 18. Purpose of Visit: State clear purpose BLOCK 19. Technological Area: Be very specific- DO NOT abbreviate BLOCK 20. Start Date of Visit: Month/Day/Year BLOCK 21. End Date of Visit: Month/Day/Year BLOCK 22. Authorized SES Manager Signature: Regional Manager or SES.

BLOCK 23. Authorized Approval Signature Pam Moody –visit not approved without this signature

WAPA F

3000-72#

(6/03)

FOREIGN NATIONAL DATA CARD

FOR UNCLASSIFIED FOREIGN VISITS AND ASSIGNMENTS

TO WESTERN AREA POWER ADMINISTRATION

Please print clearly

Personal Data SECTION A

1. Name of Visitor: (Last) (First) (Middle)

2. Male Female

3. Country of Birth: 6. Date of Birth: 8. Citizenship:

4. City of Birth: 9. Passport/Visa/Immigration Numbers:

7. Social Security Number:

5. Permanent Address: 10. Country of Issue:

11. Expiration Date:

Employment Data SECTION B

12. International Agreement Code: 13. Current Employer/Business Name:

14. Business Address:

Visit Data SECTION C

15. Buildings/Sites to be Visited:

16. Request Date: 17. Name and Signature of DOE Host:

18. Purpose of Visit:

19. Technological Area (Be very specific):

20. Start Date of Visit: 21. End Date of Visit:

22. Authorized SES Manager - Signature:

Date:

23. Security Office Approval - Signature:

Date:

Section C – VISIT DATA INFORMATION