VR-219_Visit_Request_Form.xlsx

XLSX spreadsheet 50 KB Posted

Attached to
Firing Range Lead Extraction Federal contract opportunity
Solicitation number
DJF-19-2100-PR-0007091
Issued by
Department of Justice Federal Bureau of Investigation Headquarters Division

About this file

Visit Request Form 219 - (Maximum 4 People per company) Must submit via email to ecaldwell2@fbi.gov no later than 08/26/2019 @ 3:00 PM (eastern time).

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Text version

Visit Information

SEC-219Visit Request Form
v2.4 112015One-Day Escorted Visits: 1-10 Visitors

Save a copy of this form to your local computer before completing sections I-IV. Once the udpated form has been saved email the completed form directly to your CSO for processing at least 24-48 hours in advance of the visit. Personnel with FBI-issued SACS badges or agency-issued IC Badges need not be listed. Repeat visitors may be required to pass a clearance or undergo a Limited Background Investigation for continued access. Escorts must be listed in Section IV, one escort for every five visitors. Visits must be approved by a Unit Chief or higher. The sponsor must: 1) have a SACS badge, 2) complete all lines on this page on the secret network only, 3) conduct indices checks on foreign nationals, 4) NOT forward the form to any of the visitors. FBI personnel requesting information from individuals in order to complete this form should provide those individuals with a copy of the Privacy Act Notice available at the link on the bottom of this form. Red triangles provide additional guidance. For more than 10 guests, use the Group Visit Request form.

* Notice to Sponsor: Visitors should be reminded of the PED policy, including no wireless, Bluetooth, cameras, or laptops (unless approved by security).

I. Sponsor's Information
Sponsor's Name:
Kyle Malo: This is the lead person responsible for advising all sponsored visitors of FBI policy, restrictions. Must complete all sections of this form prior to submitting to their CSO.EddCaldwellSponsor's Phone Number: 0
FirstLast
Sponsor's Division:FFDApproving Unit Chief (or higher):

cmcoffey: Visitors will be approved by the Unit Chief (or equivalent) that supervises the sponsor, unless the sponsor is a GS-15/SES themselves.

II. Visit Details
Visit Date:29-Aug-19Level of classified info being shared:

kmalo: For classified meetings, the visitors must also have a valid VAR on record with SecD, verifying their clearance. This must be submitted at least three (3) days prior to the visit. See your CSO for details on passing clearances.

UnclassifiedLocations/Rooms to be Visited:Range 1Unclassified21-Aug-196:00 AM6:00 AM
Arrival Time:12:30 PMMeeting Description:

kmalo: Please briefly describe the purpose of the meeting.

Firing Range Lead Extraction Site VisitSecret22-Aug-196:15 AM6:15 AM
Departure Time:2:30 PMTop Secret23-Aug-196:30 AM6:30 AM
SCI (any level)24-Aug-196:45 AM6:45 AM
III. Visitor Information25-Aug-197:00 AM7:00 AM
Last NameFirst NameMiddle NameProfessional Affiliation

Kyle Malo: Personal guests are restricted to certain event such as Family Day, retirements, special events. Use this field to note the visitor's professional affiliation (agency, company, organization, etc.)

SSN
(Passport # for foreigners)DOBCitizenshipCountry of BirthForeign Nat'l Indices Checks

Kyle Malo: The sponsor is responsible for conducting Indices checks on all foreign national guests. Mark N/A for US Citizens.

How: Access Sentinel (icon located on your desktop). In the top left area, under the search field, select the "UNI" box and enter the subject's name in the search field. If you discover any FBI investigations regarding the subject, discuss those finding with the CSO. If nothing negative is discovered, simply enter "Negative Results" in the field.26-Aug-197:15 AM7:15 AM
ExExampleJohnQuillFrench Embassy123-45-67897-Jan-70FranceFranceNegative Results27-Aug-197:30 AM7:30 AM
Click to Sort by NameFirstMiddleClick to Sort by AffiliationSSNDOBCitizenshipCountryResults28-Aug-197:45 AM7:45 AM
129-Aug-198:00 AM8:00 AM
230-Aug-198:15 AM8:15 AM
331-Aug-198:30 AM8:30 AM
41-Sep-198:45 AM8:45 AM
52-Sep-199:00 AM9:00 AM
63-Sep-199:15 AM9:15 AM
74-Sep-199:30 AM9:30 AM
85-Sep-199:45 AM9:45 AM
96-Sep-1910:00 AM10:00 AM
107-Sep-1910:15 AM10:15 AM
IV. Escorts (1 to 5 ratio)V. Foreign National Policy Acknowledgement8-Sep-1910:30 AM10:30 AM
Last NameFirst NamePhone Ext.Sponsor MUST adhere to the following:Sponsor's Initials:

kmalo: Only applicable if the sponsor is hosting any foreign nationals.

Kyle Malo: This is the lead person responsible for advising all sponsored visitors of FBI policy, restrictions. Must complete all sections of this form prior to submitting to their CSO.

Kyle Malo: The sponsor is responsible for conducting Indices checks on all foreign national guests. Mark N/A for US Citizens.

How: Access Sentinel (icon located on your desktop). In the top left area, under the search field, select the "UNI" box and enter the subject's name in the search field. If you discover any FBI investigations regarding the subject, discuss those finding with the CSO. If nothing negative is discovered, simply enter "Negative Results" in the field.

cmcoffey: Visitors will be approved by the Unit Chief (or equivalent) that supervises the sponsor, unless the sponsor is a GS-15/SES themselves.

kmalo: For classified meetings, the visitors must also have a valid VAR on record with SecD, verifying their clearance. This must be submitted at least three (3) days prior to the visit. See your CSO for details on passing clearances.

kmalo: Please briefly describe the purpose of the meeting.

9-Sep-1910:45 AM10:45 AM
1Foreign nationals, regardless of title or position, must be escorted at all times. SCIF access is prohibited unless coordinated with the CSO and with Division Head approval. Escorts must ensure all space is sanitized in advance of the visit and that all employees in the area are aware of the visitor’s presence. Access to any FBI system/ computer is prohibited. Access via this form is only valid for one-day visits. See IOD and your CSO for multi-day visit protocol. All visitors to FBI buildings and facilities must provide identification in compliance with the standards outlined in the REAL ID Act, which establishes minimum requirements when using state-issued identification for accessing federal facilities.10-Sep-1911:00 AM11:00 AM
211-Sep-1911:15 AM11:15 AM
Privacy Act Notice
This form is for official use only. Personal information about individuals contained on this form is subject to the Privacy Act of 1974, as amended, and should be viewed only by FBI personnel with a valid need-to-know.12-Sep-1911:30 AM11:30 AM
Detailed Guidance:Access and Visitor Control Policy (4.2.8 covers Escort Requirements)
Foreign National Access Policy13-Sep-1911:45 AM11:45 AM
14-Sep-1912:00 PM12:00 PM
15-Sep-1912:15 PM12:15 PM
16-Sep-1912:30 PM12:30 PM
17-Sep-1912:45 PM12:45 PM
18-Sep-191:00 PM1:00 PM
19-Sep-191:15 PM1:15 PM
20-Sep-191:30 PM1:30 PM
21-Sep-191:45 PM1:45 PM
22-Sep-192:00 PM2:00 PM
23-Sep-192:15 PM2:15 PM
24-Sep-192:30 PM2:30 PM
25-Sep-192:45 PM2:45 PM
26-Sep-193:00 PM3:00 PM
27-Sep-193:15 PM3:15 PM
28-Sep-193:30 PM3:30 PM
29-Sep-193:45 PM3:45 PM
30-Sep-194:00 PM4:00 PM
1-Oct-194:15 PM4:15 PM
2-Oct-194:30 PM4:30 PM
3-Oct-194:45 PM4:45 PM
4-Oct-195:00 PM5:00 PM
5-Oct-195:15 PM5:15 PM
6-Oct-195:30 PM5:30 PM
7-Oct-195:45 PM5:45 PM
8-Oct-196:00 PM6:00 PM
9-Oct-19No visits past 6pmAfter 6pm, see CSO
10-Oct-19
11-Oct-19
12-Oct-19
13-Oct-19
14-Oct-19
15-Oct-19
16-Oct-19
17-Oct-19
18-Oct-19
19-Oct-19
20-Oct-19
21-Oct-19

&"Calibri,Bold"&KFF0000PII: DO NOT PRINT or RETAIN COPY

&"Calibri,Bold"&KFF0000PII: DO NOT PRINT or RETAIN COPY https://formsportal.fbinet.fbi/forms/fd1028/Policy%20and%20Guidance%20Library/0750DPG.pdfhttps://formsportal.fbinet.fbi/forms/FD1028/Policy%20and%20Guidance%20Library/0172D.htmlhttps://intranet.fbinet.fbi/DO/FD/SO/Pages/Real%20ID.aspxhttps://go.fbinet.fbi/DO/FD/OSO/Documents/Personnel%20and%20Industrial%20Security/Visitor%20Privacy%20Act%20Notice.pdfhttps://intranet.fbinet.fbi/DO/FD/SO/Pages/Real%20ID.aspxhttps://intranet.fbinet.fbi/DO/FD/OSO/Pages/Real%20ID.aspx Security Use Only

VISITOR SIGN-IN REGISTER

Sponsor:EddCaldwellVisit Date:29-Aug-19
Sponsor Ext:0Anticipated Arrival Time:12:30 PM
Sponsor Division:FFD
Visitor InformationCSOACU Security Specialist:Visitor Signature
LastFirstProfessional AffiliationStatusACU
Emp.FSS
CheckNCIC CheckBadge

Number

000
000D
000
000
000
000
000
000
000
000

CSO Notes: ACU Notes lists

Unclassified
Secret
Top Secret
SCI (any level)
21-Aug-196:00 AM6:00 AM
22-Aug-196:15 AM6:15 AM
23-Aug-196:30 AM6:30 AM
24-Aug-196:45 AM6:45 AM
25-Aug-197:00 AM7:00 AM
26-Aug-197:15 AM7:15 AM
27-Aug-197:30 AM7:30 AM
28-Aug-197:45 AM7:45 AM
29-Aug-198:00 AM8:00 AM
30-Aug-198:15 AM8:15 AM
31-Aug-198:30 AM8:30 AM
1-Sep-198:45 AM8:45 AM
2-Sep-199:00 AM9:00 AM
3-Sep-199:15 AM9:15 AM
4-Sep-199:30 AM9:30 AM
5-Sep-199:45 AM9:45 AM
6-Sep-1910:00 AM10:00 AM
7-Sep-1910:15 AM10:15 AM
8-Sep-1910:30 AM10:30 AM
9-Sep-1910:45 AM10:45 AM
10-Sep-1911:00 AM11:00 AM
11-Sep-1911:15 AM11:15 AM
12-Sep-1911:30 AM11:30 AM
13-Sep-1911:45 AM11:45 AM
14-Sep-1912:00 PM12:00 PM
15-Sep-1912:15 PM12:15 PM
16-Sep-1912:30 PM12:30 PM
17-Sep-1912:45 PM12:45 PM
18-Sep-191:00 PM1:00 PM
19-Sep-191:15 PM1:15 PM
20-Sep-191:30 PM1:30 PM
21-Sep-191:45 PM1:45 PM
22-Sep-192:00 PM2:00 PM
23-Sep-192:15 PM2:15 PM
24-Sep-192:30 PM2:30 PM
25-Sep-192:45 PM2:45 PM
26-Sep-193:00 PM3:00 PM
27-Sep-193:15 PM3:15 PM
28-Sep-193:30 PM3:30 PM
29-Sep-193:45 PM3:45 PM
30-Sep-194:00 PM4:00 PM
1-Oct-194:15 PM4:15 PM
2-Oct-194:30 PM4:30 PM
3-Oct-194:45 PM4:45 PM
4-Oct-195:00 PM5:00 PM
5-Oct-195:15 PM5:15 PM
6-Oct-195:30 PM5:30 PM
7-Oct-195:45 PM5:45 PM
8-Oct-196:00 PM6:00 PM
9-Oct-19No visits past 6pmAfter 6pm, see CSO
10-Oct-19
11-Oct-19
12-Oct-19
13-Oct-19
14-Oct-19
15-Oct-19
16-Oct-19
17-Oct-19
18-Oct-19
19-Oct-19

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