J-Form 4-2019 SSLA AAMDS Access Form.pdf

NSF DEVESELU / AAMDS ACCESS REQUEST FORM

FOR OFFICIAL USE ONLY

For AAMDS space access, fill out parts 1-4. For SSL-A access and NSF space access, fill out parts 1, 2, 3 and 5.

The approved form will be sent to NSFD Security for processing.

PART 1:

NEW ☐ RENEWAL ☐ UPDATE ☐ REMOVAL ☐

PART 2:

JPAS Verified: Yes ☐ No ☐

PART 3: Digital Signature for JPAS

NAME

(LAST, FIRST, MIDDLE)

DOD ID

NUMBER

ORGANIZATION START &

END

DATE

ESCORT REQUIRED?

(FILLED OUT BY

TAO OR NSF)

1.

2.

3.

4.

5.

PART 4:

AAMDS ACCESS

This applies ONLY to access inside the RDH, RSB and LME/VUEs

☐ AA Basic Visit ☐ AA Basic Work ☐ AA VLS

☐ AA Radar ☐ AA Crew ☐ AA All

☐ AA Supply ☐ AA C4I ☐ AA GM

PART 5:

NSF ACCESS

This applies for SSL-A entry and NSF controlled spaces

☐ SSL-A Basic Access ☐ ECF M07A (COMM)

☐ ECF M01A (Front Door) ☐ ECF M10A (Side Door)

☐ ECF M13 (Gate / Turnstile) ☐ ECF M11A (Dispatch 2)

AAMDS Approver Signature NSF Approver Signature