DLA_Form_1818.pdf

DLA Form PDF 101 KB Posted

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AFICA IAC CS TATs
Solicitation number
FA8075-14-R-0001
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PRIVACY ACT STATEMENT

VISIT NOTIFICATION

1. ACTIVITY TO BE VISITED

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:DEFENSE LOGISTICS AGENCY

8725 JOHN J. KINGMAN ROAD

FT BELVOIR, VA 22060-6220

Section 21, 50 U.S.C. 781 et seq.; Executive Order 10450.

To control access to and movement on DoD installations, buildings, or facilities.

Used by General Services Administration Protective Service Personnel for access control and for any of the Blanket Routine Uses published by DLA.

Voluntary. However, failure to provide all the requested information may result in refusal to grant access to the installation, building, or facility.

DLA PRIVACY ACT SYSTEM NOTICE S500.50 DLA-I APPLIES

SECTION I

2. NAME OF REQUESTOR/PREPARER 4. TELEPHONE3. OFFICE CODE

5. DATE(S) OF VISIT 6. POINT OF CONTACT (at facility to be visited) 7. POC TELEPHONE

8. PURPOSE OF VISIT

SECTION II

9.

NAME(S) OF VISITOR(S)

(Last, First, MI)

10.

GRADE/RANK

11.

SSN

12.

DATE OF BIRTH

13.

STATE /COUNTRY OF

BIRTH

14.

CLEARANCE/DATE

GRANTED

15.

TYPE OF INVESTIGATION/

DATE

16. TYPED NAME OF SECURITY REPRESENTATIVE

SECTION III

18. ACTIVITY 19. TELEPHONE NUMBER 20. DATE17. SIGNATURE OF SECURITY REPRESENTATIVE

DLA FORM 1818, JUL 96 (EG)

FROM: TO:

PDF (DLA)

RequesterName:
OfficeCode: IAC
FacPOC: Daniel Peat or Melinda Rozga
Phone:
POCPhone: (703) 767 -9112/9122
VisitedActivity: Defense Logistics Agency Headquarters Auditorium (Andrew T. McNamara Complex) for the Defense Technical Information Center Information Analysis Center (DTIC IAC) organization sponsored event.
VisitPurpose: To attend the Information Analysis Center (IAC) Cyber Security Technical Area Tasks (CS TATs) $2.4B acquisition "Industry Day" being held in the Defense Logistics Agency Headquarters Auditorium (Andrew T. McNamara Complex)
DateTo: 27 May 2014
Visitor:
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DateFrom: 27 May 2014
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tcsControl:
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