Attachment 5 Darb 4.pdf

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Privacy Act - 1974 as Amended Applies -- This communication may contain information which must be protected IAW DoD 5400.11R, AFI 33-119, AFI 33-129 and is "CONTROLLED UNCLASSIFIED INFORMATION (CUI)" 27 June 2023

DARB4

DOBBINS ENTRY ACCESS REQUEST FORM

(Pre-Authorization form to sponsor three (3) or more individuals for Special Events, Site Visits or etc.)

Processing Times: 7-business days for citizens and 15-business days for non-citizens

1. Sponsor Registered in DBIDS:

NOTE: All DoD ID Cardholders must be registered in DBIDS to sponsor a group of visitors/guests on Dobbins ARB.

2. Effective Date / Time of Visit:

3. Sponsor / Escort Full Name:

4. Expiration Date / Time of Visit:

5. Reason for Access:

6. Sponsor/Escort Contact Number:

7. Location (Building(s) or areas to be occupied):

8. Special Notes:

9. The individuals listed are a visitor/guest of: . I take full responsibility for the individuals and to the extent of my knowledge, these guests/visitors are trustworthy and reliable and do not possess any adverse character traits or exhibit any indications of aberrant behavior that would constitute an unreasonable risk to the health and safety of members assigned and working on Dobbins Air Reserve Base. I, therefore request that these guests/visitors be granted clearance for access to the installation upon satisfactory completion of their required criminal history/background check. I have briefed the listed individuals of the entry procedures required to enter DARB. My guests understand that upon entering the facility they may be required to submit to an installation entry point check. The driver must have a valid driver's license, proof of vehicle auto insurance, proof of vehicle registration and must abide by all base traffic instructions. Passengers must have valid photo identification. The use of seatbelts is mandatory on Dobbins ARB.

NOTE: The sponsor is required to complete the form and email to jimmy.flounory@us.af.mil, robert.purcell.6@us.af.mil, and 94sfs.vcc.visitorcenter@us.af.mil or hand deliver to the Visitor Control Center (VCC), Bldg 866. Also, if the sponsor is not registered in DBIDS at the time of submission, the request for access will not be accepted.

OFFICIAL USE ONLY:

Authenticated by Name, Rank/Grade Page _____ of _____ Distribution: Visitor Control Center (VCC), Gate 1, Barclay Gate, BDOC NOTE: Non-US citizens require 15 calendar days for proper vetting prior to entry.

Names will be listed in alphabetical order by Last Name

16. Type of Visitor:

18. Sponsor Organization:

19. Sponsor Name:

20. Time and Date of Visit:

21. Title of Event:

22. Sponsor Contact Number (Cell phone # preferred):

23. Last Name, First, MI

24. Citizenship

25. Last Four of SSN

26. Date of Birth

27. Driver's License Number

28. Driver's License State of Issue EXAMPLE: Smith, John D.

U.S.

1 Jan 1960 11223344556

GA

6.5.0.20220304.43