Attch_F,_Base_Access_memo_H68.doc

For Official Use Only (FOUO)

CUT and PASTE INTO YOUR COMPANY LETTERHEAD HERE

(Insert date)

MEMORANDUM FOR 96 SFS/S-5B

FROM: INSERT COMPANY/UNIT NAME

SUBJECT: Request for Badge/Pass

1. The following individuals require access to Eglin AFB, (Main) to perform official duties at HANGER 68. There duties will include (Give brief description of what their duties will be). All work will begin on ___(date)_____and will be accomplished by __(expiration date)__. The contract number is __________.

2. The individuals listed have been briefed that while on the installation they must comply with all local laws and policies. The failure to comply will result in loss of base access. Each individual understands that they must go to the Security Forces Pass and Registration office to receive their contractor identification badge/pass. They further understand they must have a valid driver’s license/Identification card, proof of current registration and insurance while driving on the installation.

3. When first arriving to the installation the following individuals will need (Pick one) an escort to area of work or visit, no escort or will need to call sponsor before being allowed access to the installation.

4. I understand it is the unit/company responsibility to collect the badges of terminated employees and to collect the badges at the conclusion of the work that was to be accomplished. Further, I understand that we are responsible to turn the badges/passes in to the Security Forces Pass and Registration office as soon as all work is complete.

A maximum of five individuals per Memorandum. Remove this information before printing.

5. The government sponsor of the following individual(s) is:

Full name/Rank/DoD ID or SSN

Contract Specialist

AFTC/PZIO

Duty Phone

INSTRUCTIONS: Submit completed requests via encrypted email to 96sfs.s5b.passandreg@us.af.mil and allow 3 business days for processing. Note: Requests coming from outside DoD will use AMRDEC SAFE to send encrypted requests. Log in as a Non-CAC User at https://safe.amrdec.army.mil/SAFE .

PRIVACY ACT STATEMENT

Authority: 10 U.S.C. 8013, Secretary of the Air Force; 18 U.S.C. 922 note, Unlawful Acts note referring to the Brady Handgun Violence Prevention Act; 28 U.S.C. 534 note, Judiciary and Judicial Procedures, note referring to the Uniform Federal Crime Reporting Act; 42 U.S.C. 10601 et seq., Crime Victims Fund; and Amendment to Lautenberg, 18 U.S.C. 922(d) (9) Unlawful Acts; DoD Directive 7730.47, Defense Incident-Based Reporting System (DIBRS); Air Force Instruction 31-203, Security Forces Management Information System; and E.O. 9397 (SSN), as amended.

Purpose: Provides a direct interface with the National Crime Information Center (NCIC) and Integrated Automated Fingerprint Identification System (IAFIS) as hosted by the Federal Bureau of Investigations (FBI) via the Criminal Justice Information System (CJIS).

Routine Use: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, these records contained therein may specifically be disclosed outside the Department of Defense (DoD) as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: To the Department of Justice for criminal reporting purposes and as required by the Brady Handgun Violence Prevention Act.