Entry_Authorization_Letter_(EAL).docx

Event Name

IRH MX and Repair Site Visit

Start and End Time for Each Day of Event

0900-1100

PRIVACY ACT STATEMENT

Authority: 10 U.S.C. 8013 and Executive Orders 13478 and 9397 as amended.

Purpose: Information collected by Security Forces personnel 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, Security Forces Management Information System (SFMIS), Defense Biometric Identification Systems (DBIDS) applies.

**DO NOT MODIFY FORMAT**

Approval Stamp (55 SFS Use Only)

Signature of Authenticator (55 SFS Use Only)

Legal Name of Guest:

(Last, First, MI) Gender:

(M/F)

DOB:

(1962 Jan 11) Driver’s License# State Issued

(M19GO62BLU / MI)

United States Citizen (Yes / No)