Attachment_6_RRS_Visit_Authorization_Rqst.pdf

PDF 77 KB Posted Aug 19, 2019

Attached to: Upgrade Force Protection, Tanner Hill Federal contract opportunity
Solicitation number: FA875119BA007
Issued by: Department of the Air Force Materiel Command Research Laboratory

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Attachment 6 - Site Visit Authorization Form

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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).

FA8751-19-B-A007

ATTACHMENT 6

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.

1 Date:

2 Name of Company or Organization complete name:

4 Office Symbol if government:

Check Box1: Off

Check Box2: Off

6 Street Address:

7 City State:

8 Zip Code:

Names of VisitorsRow1:

SSNRow1:

Date of BirthRow1:

Place of BirthRow1:

Country of CitizenshipRow1:

Date NaturalizedRow1:

Naturalization NoRow1:

If Not a Citizen Permanent Alien Resident NoExpiration DateRow1:

Clearance LevelRow1:

Names of VisitorsRow2:

SSNRow2:

Date of BirthRow2:

Place of BirthRow2:

Country of CitizenshipRow2:

Date NaturalizedRow2:

Naturalization NoRow2:

If Not a Citizen Permanent Alien Resident NoExpiration DateRow2:

Clearance LevelRow2:

Names of VisitorsRow3:

SSNRow3:

Date of BirthRow3:

Place of BirthRow3:

Country of CitizenshipRow3:

Date NaturalizedRow3:

Naturalization NoRow3:

If Not a Citizen Permanent Alien Resident NoExpiration DateRow3:

Clearance LevelRow3:

Names of VisitorsRow4:

SSNRow4:

Date of BirthRow4:

Place of BirthRow4:

Country of CitizenshipRow4:

Date NaturalizedRow4:

Naturalization NoRow4:

If Not a Citizen Permanent Alien Resident NoExpiration DateRow4:

Clearance LevelRow4:

10 Purpose of Visit:

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

Name:

Phone:

Office symbol:

Name_2:

Phone_2:

Names of VisitorsRow1_2:

SSNRow1_2:

Date of BirthRow1_2:

Place of BirthRow1_2:

Country of CitizenshipRow1_2:

Date NaturalizedRow1_2:

Naturalization NoRow1_2:

If Not a Citizen Permanent Alien Resident NoExpiration DateRow1_2:

Clearance LevelRow1_2:

Names of VisitorsRow2_2:

SSNRow2_2:

Date of BirthRow2_2:

Place of BirthRow2_2:

Country of CitizenshipRow2_2:

Date NaturalizedRow2_2:

Naturalization NoRow2_2:

If Not a Citizen Permanent Alien Resident NoExpiration DateRow2_2:

Clearance LevelRow2_2:

Names of VisitorsRow3_2:

SSNRow3_2:

Date of BirthRow3_2:

Place of BirthRow3_2:

Country of CitizenshipRow3_2:

Date NaturalizedRow3_2:

Naturalization NoRow3_2:

If Not a Citizen Permanent Alien Resident NoExpiration DateRow3_2:

Clearance LevelRow3_2:

Names of VisitorsRow4_2:

SSNRow4_2:

Date of BirthRow4_2:

Place of BirthRow4_2:

Country of CitizenshipRow4_2:

Date NaturalizedRow4_2:

Naturalization NoRow4_2:

If Not a Citizen Permanent Alien Resident NoExpiration DateRow4_2:

Clearance LevelRow4_2:

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