Contractor_Personal_Info_List.pdf
PDF 612 KB Posted
- Attached to
- High Altitude Electromagnetic Pulse Mx & Support Federal contract opportunity
- Solicitation number
- FA4600-17-R-0008
About this file
Contractor personal Info List
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Q_&_A_1.docx | DOCX document | |
| Offutt_AFB_Entry_Authority_Listing.pdf | ||
| FA4600-17-R-0008_DRAFT_HEMP_Solicitation.pdf | ||
| Att_01_Wage_Determination.pdf | ||
| Att_03_PWS.pdf | ||
| Att_02_Local_Requirements.pdf | ||
| Site_Visit_Announcement.pdf | ||
| Att_04_HEMP_HMHS_Technical_Library_Notification.pdf | ||
| Att_05_SF328.pdf | ||
| Att_06_NDA_Agreement.pdf |
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Text version
CONTRACTOR PERSONAL INFORMATION LIST FOUO 10/18/2017
Name Last, First, Middle Initial
Social Security # 000 00 0000
Gender Male/Female
DOB
(1980 Jan 31)
Drivers License Number
State of Issue Company Name
Nationality/Passport #/Visa #/INS # (if non us citizen) Place of citizenship /Place of Birth
Citizenship date (if naturalized citizen)
Foreign continuous or routine contacts (name, country, relationship/method of contact) (list all) KP Point of
Contact
PRIVACY ACT STATEMENT Authority: 10 U.S.C. 8013 and Executive Orders 13478 and 9397 as amended (SSN). Purpose: Information collected by PMO Security will be used to authorize installation entry to persons shown on the entry authority listing for the specific purpose provided by the sponsor. Information will also be used to notify person(s) designated as the visitor sponsor of arrival and other pertinent information relating to entry on the installation. Routine Uses: Records may be disclosed to applicable Federal, State, or local agency charged with the responsibility of investigating or prosecuting a violation or enforcing/implementing a statute, rule, regulation, order issued pursuant thereto.
Disclosure: Disclosure of requested information is voluntary. Failure to provide all or parts of information requested can result in denial of installation entry. System of records number
F031 AF SF B, applies. Security Forces Management Information System (SFMIS)
FA4600-17-R-0008
Attachment 8
EAL Blank Template
File details come from the government source that posted it. Updated .