Attachment_4_-_Request_for_Visit_Authorization_to_Rome_Research_Site.pdf

RRS FORM 31, MAY 2010 Prescribing Directive RRSI 31-402

AUTHORITY: 10 U.S.C. 8013, 44 U.S.C. 3101, and EO 9397 PRINCIPAL PURPOSE: To record personal information on an individual whose duty performance requires entry into Air Force facilities.

SSN: Used for further identification of an individual. DISCLOSURE IS VOLUNTARY: Failure to disclose the information and SSN would result in not being allowed entry.

Rev. 20 MAY 15

REQUEST FOR VISIT AUTHORIZATION TO ROME RESEARCH SITE

1. Date:

2. Name of Company or Organization (complete name):

8. Zip Code:7. City, State:6. Street Address:

4. Office Symbol (if government): 5. Type of Visit (check one): Classified Unclassified

Name(s) of Visitor(s): SSN: Date of Birth: Place of Birth: Country of

Citizenship:

Date

Naturalized:

Naturalization

No:

If Not a Citizen, Permanent Alien Resident

No./Expiration Date:

State and DL #::

NOTE: To include more people on one visit request, use the space provided on reverse.

10. Purpose of Visit:

11. Date or Period in which the Visit is Valid (Not to exceed 1 Year):

12. Point of Contact at Rome Research Site to be Visited (This is not the Security Office):

Phone:Name: Office symbol:

13. Point of Contact at your organization:

Phone:Name:

14. SIGNATURE – FOR CLASSIFIED VISIT: (Certification is made here that the above named individual(s) have a Security Clearance with type & date provided under Item 9.) Facility Security Officer or Security Manager (ONLY): SIGNATURE FOR CLASSIFIED VISIT

15. SIGNATURE – FOR UNCLASSIFIED VISIT: (Certification is made here that the above named individual(s) citizenship has been verified & information provided under item 9.) Facility Security Officer, Security Manager or Human Resources Officer: SIGNATURE FOR UNCLASSIFIED VISIT

Personnel without a security clearance verified in advance will not be admitted into any classified areas or discussions. All visitors are required to be citizens of the United States. No exceptions will be made to waive the requirements for a security clearance for classified visits.

Hand carrying of a Security Clearance is not permitted.

Please let us know when the visit authorization for a group or an individual is no longer required, as we are obligated to cancel outstanding visit requests.

INSTRUCTIONS: When completed & certifications are made in either Item 14 or 15 Fax/Mail this form to:

Mailing Address: AFRL/RIOF Bldg. 3, West Wing, 525 Brooks Rd.

Rome, NY 13441-4503

Fax this form to: AFRL/RIOF Fax# (315) 330-3378 or DSN: 587-3378

To confirm receipt of this visit request please dial (315) 330-2916 NOTE: All visitors will need to show a picture ID (driver’s license, military or government ID).

9.

FA8751-17-R-0033

Attachment 4

RRS FORM 31, MAY 2010 Prescribing Directive RRSI 31-402

AUTHORITY: 10 U.S.C. 8013, 44 U.S.C. 3101, and EO 9397 PRINCIPAL PURPOSE: To record personal information on an individual whose duty performance requires entry into Air Force facilities.

SSN: Used for further identification of an individual. DISCLOSURE IS VOLUNTARY: Failure to disclose the information and SSN would result in not being allowed entry.

Rev. 20 MAY 15

Item 9 Continued: ADDITIONAL VISITOR INFORMATION

Name(s) of Visitor(s): SSN: Date of Birth: Place of Birth: Country of

Citizenship:

Date

Naturalized:

Naturalization

No:

If Not a Citizen, Permanent Alien Resident

No./Expiration Date:

State and DL #::9.

FA8751-17-R-0033

Attachment 4