Atch__26_-_Form20SP.STANDARDSensitiveEquipmentPropertyRequest.pdf

STANDARD - SENSITIVE EQUIPMENT/PROPERTY REQUEST

(SNL Use Only)

I. USE AND REMOVAL No.

Name: Sponsoring Org.: SS#: XXX-XX- Clearance Level

(Last) (First) (Middle Initial) Q L

Location of Work: ROBINS AFB Duties Requiring Permit: End Date: Top Secret Not to exceed one year Secret

Uncleared

DISTRIBUTION: MAIN GATE

II. SENSITIVE EQUIPMENT

Make, Model and Serial/Property Number(s) Make, Model and Serial/Property Number(s) Binoculars/Range Finders: Other- please specify

Laptop/Computer (no camera):

Associated Media:

Electronic Equipment Cell/Smart Phones (no camera)

--includes all associated cables, power cords and peripherals

IV. SIGNATURES

Permit User Signature: Date:

Authorizing Official: Date:

Robins AFB Representative

Approved: Date: Revised 05/17/2016

Robins AFB Security Representative RAFB FORM #20 - Standard

III. PROPERTY/NON-SENSITIVE EQUIPMENT/MEDICAL DEVICES

ROBINS AIR FORCE BASE

WARNER ROBINS, GEORGIA

INSTRUCTIONS FOR COMPLETING AND SUBMITTING THE FOLLOWING

SENSITIVE EQUIPMENT/PROPERTY REQUEST - RAFB#20S/P:

Self-explanatory and must be filled out completely, legibly, and signed by the “Permit User”. Faxed forms will only be accepted if typed in a compatible font or completed in legible handwriting. This form is processed for authorizations to include any type of government or company-owned sensitive/non-sensitive equipment or property as well as associated media required in the performance of official duties.

Personal property is NOT authorized; however, exceptions for medical devices will be authorized on a case-by-case basis.

This form is not applicable for equipment or associated media with enabled camera/video functions.

A permanent laminated “white” card will be issued for requests exceeding 90-days. All other requests will be processed and authorized as a “HANDCARRY”; hardcopy form will be carried throughout the visit duration.

The SNL Security Representative will verify form information is complete; incomplete forms will be returned to the permit user and/or authorizing organization for correction.