Attachment_3_FY18_Wake_Island_Site_Arrival_Request_Form_2018_05_01.docx

WAKE ISLAND SITE ARRIVAL REQUEST

1 Jan 18

5. PURPOSE OF VISIT (BE SPECIFIC):

2 Jan 18

8. WAKE ISLAND GOVERNMENT POINT OF CONTACT:

9. CITIZENSHIP: |X|U.S. |_|OTHER (_______________)

10. FINANCIAL INFORMATION

8b. SUPPORTING CONTRACT NUMBER:

8c. IAA NUMBER :

8d. FUND CITE (Govt Only):

8e. BILLING ADDRESS (Contractor Only):

11. MEANS OF TRAVEL: |X| AMC |_| OTHER (____________________)

12. TRAVELER INFORMATION:

4.

5.

6.

1. Wake Island Medical Doctor, medical clearance must be obtained by all personnel, except for active duty and prsc members, before entry to Wake Island can be approved. Travlers need to request the Wake Island Medical Questionaire from the DoD office sponsoring their visit or their on island Wake Island POC. Recommend completed medical questionaires be submitted to the Wake Island Doctor (wakedoctor@remotemedical.com) / Phone: (808)424-2455/ FAX: (808) 424-2127) 30 calendar days prior to date of travel.

2. The PACAF Regional Support Center (PRSC) Det 1 Commander approves entry to Wake Island. All Site Arrival Request (SAR) forms must be e-mailed or hand carried to the PRSC Det. 1 Commander 14 Calendar DAYS prior to date of travel from Joint Base Pearl Harbor Hickam (JBPHH). FAILURE TO MEET TIMELINES MAY AFFECT ENTRY APPROVAL. A copy of the approved SAR will be emailed back to the Visitors POC or OPR provided in block 1. SARs are valid for dates originally requested, and a new SAR must be submitted and approved if travel dates are changed. EXCEPTION: Departure dates can be corrected on island before the Det. 1 Commander signs prior to the traveler’s departure.

3. EACH INDIVIDUAL LISTED IN BLOCK 10 IS RESPONSIBLE FOR SECURING THEIR OWN TRAVEL ORDERS AND TRANSPORTATION. Contact your local Traffic Management Office (TMO) or the JBPHH Travel Management Office at (808) 448-0747 or hckm.tmo@navy.mil for reservations on the governmen charter aircraft from JBPHH to Wake Island. Usually there is a charter flight every two weeks. However, this is subject to change. For Space “A” Flight Information contact the Hickam AMC Terminal at (808) 449-6833.

4. CFSI PERSONNEL: PLEASE WORK WITH YOUR PERSONNEL OFFICE FOR TRAVEL ARRANGEMENTS.

ARRIVAL APPROVAL: DATE:

For ROBERT C. GIBSON, Capt, USAF COMMANDER, Det 1, PACAF Regional Support Center

COMM: 808-424-2468

DSN: 315-424-2468

FAX: 808-424-2143

Email: robert.gibson.34@us.af.mil

HOW TO COMPLETE THE SITE ARRIVAL REQUEST FORM

BLOCK 1: ENTER REQUESTER’S NAME (THIS IS THE INDIVIDUAL SUBMITTING THE EA TO PRSC DET 1) BLOCK 1A: ENTER COMMERCIAL OR DSN PHONE NUMBER OF THE REQUESTER (COMM: XXX-XXX-XXXX AND/OR DSN XXX-XXX-XXXX)

BLOCK 1B: ENTER REQUESTER’S EMAIL ADDRESS (JOHN.DOE@US.AF.MIL)

BLOCK 2: ENTER DATE OF THE REQUEST (DD-MMM-YY)

BLOCK 3: DEFINE PURPOSE OF VISIT (SUPPORTING EXERCISE XYZ FOR THE ABC AGENCY, PROVIDING X SERVICE AS A SUBCONTRACTOR TO Y INC., OR SOMETHING SIMILAR—BE DESCRIPTIVE BECAUSE THIS IS HOW THE DETACHMENT WILL VALIDATE THE NECESSITY OF THE INDIVIDUAL TO COME TO WAKE ISLAND.)

BLOCK 4: ENTER DATE OF ARRIVAL (DD-MMM-YY)

BLOCK 5: ENTER DATE OF DEPARTURE (DD-MMM-YY)

BLOCK 6: ENTER GOVERNMENT POC ON WAKE ISLAND (MAY BE MILITARY OR CIVILIAN)

BLOCK 7: CHECK CITIZENSHIP, IF FOREIGN THEN ALSO ENTER THE COUNTRY OF CITIZENSHIP FOR THE INDIVIDUAL. CREATE TWO EA FORMS IF NECESSARY FOR MIXED CITIZENSHIP GROUP TRAVEL—ONE FOR U.S. WITH MULTIPLE INDIVIDUALS AND A SEPARATE ONE FOR FOREIGN NATIONALS.

BLOCK 8A: CHECK YES OR NO TO BEING CHARGED FOR MEALS AND LODGING—IF THE CHARGE IS SOLELY FOR MEALS OR LODGING, CHECK YES AND ADD THE STATEMENT “MEALS ONLY” OR “LODGING ONLY”.

BLOCK 8B: ENTER YOUR CONTRACT NUMBER IF YOU ARE WORKING ON THE ISLAND AS CONTRACT SUPPORT

BLOCK 8C: ENTER YOUR ISSA NUMBER

BLOCK 8D: IF YOU ARE TRAVELLING ON ORDERS, ENTER YOUR ACCOUNTING CLASSIFICATION FROM YOUR ORDERS.

BLOCH 8E: ENTER YOUR COMPANY’S BILLING ADDRESS

BLOCK 9: CHECK AMC FOR GOVERNMENT CONTRACTED AIRCRAFT (EXAMPLE ROTATOR) OR AIR FORCE AIRLIFT. CHECK OTHER FOR ANY AIR TRANSPORTATION NOT COVERED UNDER AMC AND DEFINE IT.

BLOCK 10: GENDER, ENTER M FOR MALE, F FOR FEMALE (USED FOR LODGING).

GRADE, MILITARY (E-#, WO-# OR O-#), CIVIL SERVICE (WG-#, WS-#, GS-#, SES-#, ETC.) AND BLANK FOR

ALL OTHERS

· IF THE TRAVELER HAS A CAC CARD, ENTER THE DOD ID NUMBER ON THE BACK, IF NOT THEN

· ENTER THE U.S. DRIVER’S LICENSE NUMBER AND STATE OF ISSUE (USED FOR SECURITY VETTING)

· IF THE TRAVELER DOES NOT HAVE A U.S. DRIVER’S LICENSE, THEN ENTER THEIR PASSPORT NUMBER AND COUNTRY OF ISSUANCE (USED FOR SECURITY VETTING) ORGANIZATION/COMPANY, ENTER THE ORGANIZATION OR COMPANY THE TRAVELER IS EMPLOYED BY

READ AND MEET THE TIMELINE REQUIREMENTS BELOW BLOCK 10. FAILURE TO MEET THESE TIMELINES MAY RESULT IN THE TRAVELER NOT OBTAINING THE REQUIRED AUTHORIZATION. EMAIL REQUESTS TO THE DET 1 SECURITY MANAGERS OR PACAF.PRSC.DET1@US.AF.MIL

PLEASE REVIEW AND ENSURE THE TRAVELER HAS THE APPROPRIATE DOCUMENTATION PER THE FOREIGN CLEARANCE GUIDE (HTTPS://WWW.FCG.PENTAGON.MIL/) TO RE-ENTER THE UNITED STATES FROM WAKE ISLAND.

REVISION 05/01/2018 – ALL OTHER REQUEST FORMS ARE NOT VALID, PLEASE USE THIS FORM.

PERSONAL DATA – PRIVACY ACT OF 1974.