Attachment 4 Site Visit RRS Form 31.pdf

The information herein is for Official Use Only which must be protected under the freedom of Info Act (5 U.S.C. 552) and/or the Privacy Act of 1974 (5 U.S.C. 552a) 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.

REQUEST FOR VISIT AUTHORIZATION TO AFRL/RI INFORMATION DIRECTORATE

1. Date:

2. Name of Company or Organization (completename):

5. Zip Code:4. City, State:3. Street Address:

6. Type of Visit (check one): Classified Unclassified

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

8. Purpose of Visit:

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

10. Point of Contact at AFRL/RI to be Visited (This is not the Security Office):

Phone:Name: Office symbol:

11. Point of Contact at your organization:

Phone:Name:

12. SIGNATURE – FOR CLASSIFIED VISIT: Facility Security Officer ,Security Manager or Human Resources Officer.

SIGNATURE FOR CLASSIFIED VISIT

13. SIGNATURE – FOR UNCLASSIFIED VISIT: Facility Security Officer, Security Manager or Human Resources Officer: SIGNATURE FOR UNCLASSIFIED VISIT

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 knowwhen the visit authorization for a group or an individual is no longer required, asweare obligated to cancel outstanding visit requests.

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 #::

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

Bldg. 3, West Wing, 525 Brooks Rd.

Rome, NY 13441-4503

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).

Visitors are required to preregister for DBIDS through the DMDC Website:

https://dbids-global.dmdc.mil/portal/

7.

RRS FORM 31, JUNE 2017 Prescribing Directive RIOI 16-402 Rev. 06 NOV 18

The information herein is for Official Use Only which must be protected under the freedom of Info Act (5 U.S.C. 552) and/or the Privacy Act of 1974 (5 U.S.C. 552a 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.

Item 7. Continued: ADDITIONAL VISITOR INFORMATION

RRS FORM 31, JUNE 2017 Prescribing Directive RIOI 16-402 Rev. 06 NOV 18

7.

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 #::