Pre- Bid NCIC Screening and Pass Request - Template.pdf

PDF 221 KB Posted

Attached to
Breathing Air Compressor Federal contract opportunity
Solicitation number
FA460024Q0016
Issued by
Department of the Air Force Air Combat Command

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This document is a Pre-Bid NCIC Screening and Pass Request Template for a federal contract opportunity. It outlines the required information and process for contractors/vendors to obtain access badges for Offutt Air Force Base in order to perform work under a federal contract.

The template includes fields for collecting personally identifiable information such as name, date of birth, social security number, driver's license details, and citizenship status. This information is required for the Air Force to conduct National Crime Information Center (NCIC) background screenings and issue base access passes. The document specifies that providing this information is voluntary, but failure to do so will result in denied base access. It also notes the legal authorities and privacy protections governing the collection and handling of this data.

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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

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Comapny Name:
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Sponsoring Squadron: 55 CES
Sponsor's Name: Arpad Lepper GS-11, Asst. Fire Chief
Sponsor's Phone Number: 294-3778
Request Date: 14 May 2024
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