VASS_Form.xls
XLS spreadsheet 45 KB Posted
- Attached to
- Herbicide Application & Hazard Tree Mitigation
- Solicitation number
- HQ0034-15-T-0245
- Issued by
-
DOD Washington Headquarters Service
About this file
VASS - Required for Site Visit
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Instructions
| RRMC Site-R Electronic Visit Request | ||
| Instructions: | ||
| To enter Visitor information, click on the "Visitor" tab below. | ||
| To return to these instructions, click on the "Instructions" tab below. | ||
| Send the completed file as an email attachment to the security manager of the organization you are visiting. | ||
| If you are visiting the RRMC Installation Staff, send completed form to: RRMCSEC@RRMC.ARMY.MIL as a digitally signed message. | ||
| If you cannot send digitally signed, print and sign the spreadsheet and fax it to (717) 878-2559 | ||
| To confirm your authorized signature. The fax and email must be sent within 15 minutes of each other. | ||
| All visits must be received by the RRMC Security Office 1 full workday in advance prior to the visit date. | ||
| Please be sure to type all information CORRECTLY and in the PROPER FORMAT as errors | ||
| in your data will cause delays in processing your request. For details on how to format data | ||
| in a field, hover the mouse pointer over the column heading. | ||
| DO NOT CUT AND PASTE NAMES INTO THE SPREADSHEET | ||
| DO NOT ADD ADDITIONAL INFORMATION, ADDITIONAL BLOCKS, SIGNATURES ETC. | ||
| DO NOT ALTER THE FORMAT OF THIS FORM OR IT WILL BECOME CORRUPTED | ||
| PRIVACY ACT STATEMENT | ||
| AUTHORITY: | 5 U.S.C Section 301; 10 U.S.C. Sections 1074(c)(1) and 1095(k)(2); 10 U.S.C chapter 147; 50 U.S.C. chapter 23; E.O. 9397; E.O. 10450, amended. | |
| PRINCIPAL PURPOSE(S) | ||
| ROUTINE USE(S) | To federal and state agencies and private entities, as necessary, on matters relating to utilization review, professional quality assurance, program integrity, civil and criminal litigation, and access to federal government facilities, computer systems, networks, and controlled areas. | |
| DISCLOSURE: | Voluntary; however, failure to provide information may result in denial of a Common Access Card, non-enrollment in the Defense Enrollement Eligibility Reporting System, refusal to grant access to DoD installations, buildings, facilities, computer systems and networks, networks, and denial of DoD benefits and priviledges if other wise authorized. (For contractor personnel only; failure to provide a social security number will not result in denial of card, enrollemnt in DEERS, access to facilties or networks, or if eligible for, receipt of DoD benefits and privileges other than non-emergency health care services.) | |
| Version 1.5 |
&CFOR OFFICIAL USE ONLY
DESTROY BY SHREDDER
Visitor
| Visitor Information | Investigation | Period of Visit | |||||||||||||
| SSN | Last Name | First Name | Middle Name | Suffix | Rank | Type | Date | Clearance | Date of Birth | Place of Birth | Citizenship | Organization | Organization to be Visited | From | To |
&CFOR OFFICIAL USE ONLY
DESTROY BY SHREDDING
Enter the visitors Social Security Number Enter the visitors Last name Enter the visitors First name Enter the visitors Middle name Enter a suffix to the visitors name (Jr., etc.)
Enter the visitors rank:
CIV for Civilian, or a military rank, such as MAJ, CPT, COL, etc.
Enter the visitors investigation type (NAC, NACI, SSBI, etc.)
Enter the date (MM/DD/YYYY) of the visitors background investigation Enter the visitors clearance (None, S, TS) Enter the visitors date of birth (MM/DD/YYYY) Enter the visitors place of birth Enter the visitors citizenship (US, CAN, UK, etc.)
Enter the visitors organization Enter the organization to be visited Enter the starting date of the visit
(MM/DD/YYYY)
Enter the ending date of the visit
(MM/DD/YYYY)
Vehicle
| Vehicle Access is requested for: | Period of Visit | Special Access is requested to: | |||||||||
| Plate Number | State | Year | Make | Model | Organization | Organization to be Visited | From | To | I | O | RT |
Enter the vehicle license plate number Enter the state the vehicle is registered in Enter the 4-digit (yyyy) model year of the vehicle Enter the make of the vehicle (Ford, Chevy, etc) Enter the model or type of vehicle (Truck, Van, Scooter, Sedan, etc.)
Enter the visitors organization.
Enter the organization to be visited.
Enter the starting date of the visit. (MM/DD/YYYY) Enter the ending date of the visit (MM/DD/YYYY) Place an X in a column if special access is required, otherwise leave it blank Place an X in a column if special access is required, otherwise leave it blank Place an X in a column if special access is require, otherwise leave it blank
File details come from the government source that posted it. Updated .