NCIC Screening and Pass Request.pdf

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Attached to
Unfired Pressure Vessel (UPV) Inspections
Solicitation number
FA460024Q00030001
Issued by

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This document is a NCIC Screening and Pass Request Spreadsheet used for a federal contract opportunity. The spreadsheet collects personally identifiable information (PII) from contractor/vendor personnel, including name, date of birth, driver's license information, social security number, and work schedule, in order to conduct National Criminal Information Center (NCIC) screening and issue installation access passes for Offutt Air Force Base. The information is collected under the authority of 10 U.S.C. 8013 and DoD regulations. Providing this information is voluntary, but failure to do so will result in denied installation access.

The related federal contract opportunity is for Unfired Pressure Vessel (UPV) Inspections at Offutt AFB, under Solicitation Number FA460024Q00030001. This is a 100% Small Business Set-Aside requirement under NAICS Codes 238220 and 236220. The contractor shall provide inspection services and parts replacement in accordance with the attached Performance Work Statement. Questions are due by 15 April 2024, with answers available by 17 April 2024. Offers are due by 22 April 2024.

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Other files

File Type Posted
Site Visit MFR.pdf PDF
52.212-1 ADDENDUM.docx DOCX document
52.212-2 ADDENDUM.docx DOCX document
Solicitation - FA460024Q00030001.pdf PDF
52.212-1 ADDENDUM.docx DOCX document
UPV Inspection Project PWS rev 1.docx DOCX document
SCA Wage Determination.pdf PDF

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Contract#:

Contract Start/End Dates: Unit Commander or Security Manager Sig Block

Full Name Country of Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Start Date - End Date (MMDDYYYY) Citizenship

Personally Identifying Information (PII) being collected by this form is authorized for collection under provisions of 10 U.S.C. 8013, Secretary of the Air Force, DoD 5200.2R, DoD Personnel Security Program; AFI 33-202, Computer Security, Information will be maintained by local Security Forces Authority while access requirements exist. Information access is restricted to personnel responsible for contract administration, or otherwise needed in the performance of official DoD duties. Information will be properly disposed of when its required use has been concluded.

Providing this information is voluntary; however, failure to provide all of the required data shown on the spreadsheet will result in denial of entry to the installation. This information is exempt from OMB licensing under provisions of AFI 33-324, Information Collections and Reports Management Program; Controlling Internal, Public, and Interagency Air Force Collections, paragraphs 3.16.11 and 3.16.16.3.

55 SFS CONTRACTOR/VENDOR NCIC SCREENING & PASS REQUEST SPREADSHEET

Date of Birth

Offutt AFB Sponsoring Agency / Unit:

Base Sponsor's Name:

Base Sponsor's Phone #:

Request Date:

Work Schedule

Company Name:

Company Address:

Company Representative Name:

Company Representative Phone Number:

NOTE:

Security Manager will ensure all listed personnel are briefed that they must present a REAL ID ACT compliant drivers license, or state ID, or an approved alternate form of photo identification upon arrival at Offutt AFB Visitor Control Center.

Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors

Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors

Sheet1

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