EAL Form.pdf

283 KB Posted

Attached to
RENOVATE/CONVERT 50th 49th SQ OPS, B230
Solicitation number
FA302226R0007
Issued by

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Written by GovTribe AI ·

This is an Entry Authorization Listing (EAL) form used by Columbus Air Force Base for visitor and guest access control. The form is classified as Controlled Unclassified Information (CUI) and is submitted to the 14th Security Forces Squadron (14 SFS/S5B).

The form captures essential visitor information including full name, driver's license number and state, home address, full Social Security Number, and date of birth. Event details required include the event name/company, building number, start date and time, and expiration date (maximum six months). The sponsor must identify authorized gate entry points (East, South, or Vehicle Inspection Area) and provide point of contact information including grade/rank, name, duty phone, and on-call phone number with a mandatory signature. The form includes a Privacy Act Statement citing AFI 31-101 authority and explaining that collected information is used to authorize entry, notify sponsors of visitor arrival, monitor installation visits, and provide entry validation documentation. EALs must be submitted in digital format only (as of January 8, 2026) to the Visitors Control Center at least three duty days prior to the event. Sponsors are held responsible for all actions taken by guests and must notify the Event Control Center at (662) 434-7128 upon event conclusion to certify all guests have departed the installation. The form includes multiple blank rows for listing personnel with the instruction to annotate "///LAST ITEM///" below the final name.

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COLUMBUS AFB FORM PAGE OF

CONTROLLED UNCLASSIFIED INFORMATION (CUI)

CUI

ENTRY AUTHORIZATION LISTING (EAL) AUTHENTICATED DATE (SFS use only)

PRIVACY ACT STATEMENT

AUTHORITY: AFI 31-101, Base Defense Operations

PURPOSE: Information collected by Security Forces personnel will be used to authorize entry to persons shown on the entry request for the specific purpose provided by the sponsor. Information will also be used to notify persons designated as the visitor sponsor of arrival and other pertinent information relating to entry on the installation. Information will be used to monitor installation visits and provide entry authority with a source document to validate authorized entry.

Information can be stored manually or digitally and will be removed as a current information resource when its purpose has been served.

ROUTINE USES: In addition to those disclosure generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C 522a(b)(3) as follows:

The ‘Blanket Routine Uses’ published at the beginning of the Air Force’s compilation of systems of records notices apply to this system.

DISCLOSURE: Disclosure of requested information is optional. Failure to provide all or parts of information requested can result in denial of installation entry.

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

TO

14 SFS/S5B

TODAYS DATE

ADDRESS OF EVENT BUILDING NUMBER OF EVENT

START DATE (DD MMM YYYY) START TIME (HHMM)

NAME OF EVENT AND/OR COMPANY EXPIRATION DATE (Max of 6 months)

AUTHORIZED GATE FOR ENTRY (Check all that apply)

EAST SOUTH VEHICLE INSPECTION AREA

POC GRADE/RANK POC LAST NAME POC FIRST NAME POC SIGNATURE (Mandatory)

DUTY PHONE NUMBER ON CALL PHONE NUMBER SFS AUTHENTICATION SIGNATURE

INSTRUCTIONS: Please list personnel (WE WILL ONLY ACCEPT DIGITAL EALS AS OF 8 JAN 2026). EALs will be turned in to the 14th Security Forces Squadron, Visitors Control Center (Bldg. 99), at least 3 DUTY days prior to the event. Any questions can be directed to the Visitors Center at 434-3161 / 434-7133 or by email at 14SFSS5B@us.af.mil.

BY SPONSORING ALL INDIVIDUALS BELOW ON COLUMBUS AFB, YOU WILL BE HELD RESPONSIBLE FOR ALL ACTIONS TAKEN BY EAL GUESTS/VISITORS. THIS CAN INCLUDE TERMINATION OF SPONSOR PRIVILEGES AND ADMINISTRATIVE DISCIPLINARY ACTIONS.

BE SURE TO ANNOTATE “ ///LAST ITEM/// ” BELOW FINAL NAME ON EAL

Sponsors must notify the ECC (662) 434-7128 at the conclusion of the event and certify that all guests have departed the installation.

LAST, FIRST, MI

DRIVER’S

LICENSE NUMBER /

STATE

HOME OF

RECORD

ADDRESS

FULL SSN DATE OF BIRTH

DD MMM YYYY

COLUMBUS AFB FORM PAGE OF

CONTROLLED UNCLASSIFIED INFORMATION (CUI)

CUI

Authenticated By: (Rank, LAST, FIRST / Office Symbol):

SFS use only

Signature:

SFS use only

LOCATION OF EVENT: Columbus AFB Pool, Independence Dr, Columbus, MS 39705
LOCATION PHONE NUMBER: B948
START TIME HHMM: 10:00 CDT
NAME OF EVENT ANDOR COMPANY: Repair Kiddie Pool Site Visit
POC GRADERANK: E-3
POC LAST NAME: Sabado
POC FIRST NAME: McGil Jan
DUTY PHONE NUMBER: 662-434-3266
ON CALL PHONE NUMBER:
LAST FIRST MIRow1:
DRIVERS LICENSE NUMBER STATERow1:
HOME OF RECORDD ADDRESSRow1:
FULL SSNRow1:
DATE OF BIRTH DD MM YYYYRow1:
LAST FIRST MIRow2:
DRIVERS LICENSE NUMBER STATERow2:
HOME OF RECORDD ADDRESSRow2:
FULL SSNRow2:
DATE OF BIRTH DD MM YYYYRow2:
LAST FIRST MIRow3:
DRIVERS LICENSE NUMBER STATERow3:
HOME OF RECORDD ADDRESSRow3:
FULL SSNRow3:
DATE OF BIRTH DD MM YYYYRow3:
LAST FIRST MIRow4:
DRIVERS LICENSE NUMBER STATERow4:
HOME OF RECORDD ADDRESSRow4:
FULL SSNRow4:
DATE OF BIRTH DD MM YYYYRow4:
LAST FIRST MIRow5:
DRIVERS LICENSE NUMBER STATERow5:
HOME OF RECORDD ADDRESSRow5:
FULL SSNRow5:
DATE OF BIRTH DD MM YYYYRow5:
LAST FIRST MIRow6:
DRIVERS LICENSE NUMBER STATERow6:
HOME OF RECORDD ADDRESSRow6:
FULL SSNRow6:
DATE OF BIRTH DD MM YYYYRow6:
LAST FIRST MIRow7:
DRIVERS LICENSE NUMBER STATERow7:
HOME OF RECORDD ADDRESSRow7:
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DATE OF BIRTH DD MM YYYYRow7:
LAST FIRST MIRow8:
DRIVERS LICENSE NUMBER STATERow8:
HOME OF RECORDD ADDRESSRow8:
FULL SSNRow8:
DATE OF BIRTH DD MM YYYYRow8:
Check Box1: Off
Check Box2: Yes
Check Box3: Off
LAST FIRST MIRow14:
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Date2_af_date:
Date5_af_date: 4/16/26
Date6_af_date: 4/15/26
Date7_af_date: 3/31/26
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