Foreign National Security Access Form (Barkley Dam_Aug 2022).pdf

Nashville District Corps of Engineers *Foreign National (FN)

Pre-Bid Meeting or Site Visit Request Form

This Request Form is for non-U.S. Citizens, including permanent residents requesting approval to attend a pre-bid meeting or site visit at one of the Nashville District (LRN) sites.

LRN Pre-Bid Meeting or Site Visit POC: __________________________________

Date the Request is Being Submitted (mm/dd/yyyy) ___________________

FULL Name (As Listed on Passport) __________________________________________ (Last, First, Middle)

Date of Birth (mm/dd/yyyy): ______________ Citizenship (Country): ______________

Passport #: __________ Project Site to be Visited:Barkley Dam, KY 42801

Date of Proposed Visit (mm/dd/yyyy) 08/__/2022

In Case of Questions, Please Provide Phone Number: __________________________

Approved Verification Documents:

Passport (unexpired or expired) Certificate of U.S. Citizenship (INS Form N-560 04 N-561) Certificate of Naturalization (INS Form N-550 or N-570) Unexpired foreign Passport with I-551 stamp or attached INS Form I-94 indicating unexpired employment authorization Alien Registration Receipt Card with photo (INS Form I-151 or I-551) Unexpired Temporary Resident Card (INS Form I-688) Unexpired Employment Authorization Card (INS Form I-688A) Unexpired Reentry Permit (INS Form I-327) Unexpired Refugee Travel Document (INS- Form I-571)

This completed form and legible color copies of two of the verification documents listed above should be submitted to the LRN Pre-Bid Meeting or Site Visit Point of Contact (POC) to be forwarded to the LRN Security Management Office (LRN-SM) at least two (2) weeks prior to the proposed visit. Forms submitted less than two (2) weeks prior to the requested date may not receive approval for participation.

For questions regarding the process or acceptable verification documents, contact one of the individuals listed below:

Tracy Dorrough, Security Technician, 615-736-7397 (Primary Security POC) Jay Klinger, District Security Chief, 615-736-2185

PRIVACY ACT STATEMENT

Information is solicited in accordance with Title 10, US Code Section 552 and is used to provide information necessary in preparation for a pre-bid meeting or site visit and to verify positive identification of visitor. Solicited information is voluntary; however, failure to provide information may result in access being denied.

*NOTE: The form for current LRN FN Contractors is available at: http://www.lrn.usace.army.mil/BusinessWithUs/ Contracting/Contract Security Requirements/LRN Foreign National Contractor Request Form

12/5/2016

W912P522B00123 Tentative Site Visit Barkley Dam Smithland, KY 42801

Kathryn Pascual