SECTION_L,_Appendix_E_-_PIADC_NCIC_Form.docx

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Attached to
PIADC Center-Wide Support Program (CWSP) - Solicitation Federal contract opportunity
Solicitation number
HSHQPD-17-R-00002
Issued by
Department of Homeland Security Office of Procurement Operations

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SECTION L, APPENDIX E - PIADC NCIC FORM

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HSHQPD-17-R-00002

Appendix E – PIADC National Crime Information Center (NCIC) Form

Plum Island Animal Disease Center

National Crime Information Center (NCIC) Form

For all NCIC forms, allow 5 working days for processing prior to visitor arrival

Date:

Name of PIADC Sponsor

Date of Visit:

TYPE ONLY in the table below (handwritten forms will NOT be accepted)

Name (Last, First, Middle)
US Citizen
Country of Origin
Place of Residence
Date of Birth (mm /dd/yyyy)
*Social Security Number
Telephone Number
Gender

Please e-mail this document to PlumIslandSecurity@st.dhs.gov

*For your personal security, please DO NOT send your personal identifiable information (the information contained within this document) to any other number or e-mail address. The information provided in this form is used by law enforcement personnel only.

For questions or concerns, please contact:

PIADC Federal Officer (631) 323-3390 or PlumIslandSecurity@st.dhs.gov

For Official Use Only

This document contains sensitive information exempt from mandatory disclosure under the Freedom of Information Act, 5 U.S.C 552(b) (2). Do not release without prior approval by the Department of Homeland Security.

NCIC Form

File Plan # 403-258-003c

Rev. Date: 8/12/15a image1.jpeg

File details come from the government source that posted it. Updated .