Attachment 8 NPTU VARF Form 5521.pdf

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Attached to
NPTU Inspection of Air Receivers
Solicitation number
FA441825Q0007
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Attachment 9 Questions and Answers 2.pdf PDF
REV 1 FA441825Q0007 Combined Synopsis Solicitation.pdf PDF
Attachment 3 REV 1 RFQ Fill-in Sheet.pdf PDF
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Attachment 6 Images.pdf PDF
Attachment 5 Questions and Answers.pdf PDF
Attachment 4 WD 2015-4427 Rev 29 dated 12.23.2024.pdf PDF
FA441825Q0007 Combined Synopsis Solicitation.pdf PDF
Attachment 2 Statement of Work.pdf PDF
Attachment 3 RFQ Fill-in sheet.pdf PDF
Attachment 1 Provisions and Clauses.pdf PDF
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NAVAL NUCLEAR POWER TRAINING

UNIT (NNPTU)

VISIT REQUEST

☐ REPLY REQUIRED

☐ REPLY IF DENIED

DATE (DDMMMYYYY)

DEGREE OF ACCESS:

☐ ESCORTED

☐ UNESCORTED

CURRENT BASE ACCESS:

☐ YES

☐ NO (SUBMIT BASE ACCESS REQUEST)

FROM: ADDRESS AND CONTACT NUMBER TO: NNPTU

ATTN: COMMAND SECURITY MANAGER

1260 SNOW POINTE ROAD

GOOSE CREEK, SC 29445

843-794-5997

843-794-

PURPOSE OF VISIT:

ARRIVAL DATE:

(DDMMMYYYY)

DEPARTURE DATE:

(DDMMMYYYY)

SPECIFIC WORK LOCATION:

ROUTE TO WORK LOCATION:

NAME, RANK,

TITLE/POSITION

SOCIAL SECURITY

NUMBER

DATE OF BIRTH

(DDMMMYYYY)

PLACE OF

BIRTH

NATIONALITY

IF DUAL CITIZEN ANNOTATE

COUNTRY

CLEARANCE &

INVESTIGATION DATE

☐ US CITIZEN

☐ DUAL CITIZEN

☐ IMMIGRANT ALIEN

☐ US CITIZEN

☐ DUAL CITIZEN

☐ IMMIGRANT ALIEN

☐ US CITIZEN

☐ DUAL CITIZEN

☐ IMMIGRANT ALIEN

NAME, RANK TITLE OF NPTU SPONSORING STAFF MEMBER: SIGNATURE

DATE

(DDMMMYYYY)

TO BE COMPLETED DAY OF VISIT BY DERIVATIVE CLASSIFIER (DC)

AFTER WORK SITE REVIEW AND CERTIFICATION FOR MOD LV1 AREAS

NAME SIGNATURE

RANK DATE

(DDMMMYYYY) 843-794-

SECURITY MANAGER USE ONLY

☐ APPROVED

☐ DENIED

☐ BLUE

☐ GREEN

☐ ORANGE

☐ PINK V

☐ WHITE E

☐ RED E

(NR NOTIFIED)

ACCESS EXPIRES

AT 2400

NAME

TITLE

DATE APPROVED

SIGNATURE

NPTU FORM 5521 (OCT 22)

NPTU POC INFORMATION:

NAME:

TITLE:

DEPT:

REPLY REQUIRED: Off
REPLY IF DENIED: Off
DATE DDMMYYYY:
ESCORTED: Off
UNESCORTED: Off
YES: Off
NO SUBMIT BASE ACCESS REQUEST: Off
FROM ADDRESS AND CONTACT NUMBER:
PURPOSE OF VISIT:
ARRIVAL DATE DDMMMYYYY:
DEPARTURE DATE DDMMMYYYY:
SPECIFIC WORK LOCATION ROUTE TO WORK LOCATION:
NAME RANK TITLEPOSITIONRow1:
SOCIAL SECURITY NUMBERRow1:
DATE OF BIRTH DDMMMYYYYRow1:
PLACE OF BIRTHRow1:
US CITIZEN: Off
DUAL CITIZEN: Off
IMMIGRANT ALIEN: Off
CLEARANCE INVESTIGATION DATEUS CITIZEN DUAL CITIZEN IMMIGRANT ALIEN:
NAME RANK TITLEPOSITIONRow2:
SOCIAL SECURITY NUMBERRow2:
DATE OF BIRTH DDMMMYYYYRow2:
PLACE OF BIRTHRow2:
US CITIZEN_2: Off
DUAL CITIZEN_2: Off
IMMIGRANT ALIEN_2: Off
CLEARANCE INVESTIGATION DATEUS CITIZEN DUAL CITIZEN IMMIGRANT ALIEN_2:
NAME RANK TITLEPOSITIONRow3:
SOCIAL SECURITY NUMBERRow3:
DATE OF BIRTH DDMMMYYYYRow3:
PLACE OF BIRTHRow3:
US CITIZEN_3: Off
DUAL CITIZEN_3: Off
IMMIGRANT ALIEN_3: Off
CLEARANCE INVESTIGATION DATEUS CITIZEN DUAL CITIZEN IMMIGRANT ALIEN_3:
NAME RANK TITLE OF NPTU SPONSORING STAFF MEMBER:
DEPT:
NAME:
DC NAME:
TITLE:
NUMBER:
DC_NUMBER:
DC TITLE:

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