Leased Space Access.docx

OMB No. 2120-0595

Department of Transportation Federal Aviation Administration Leased Space Unescorted Access Questionnaire In response to Announcement/ Lease Contract #:

697DCM-24-L-00048

Jonesboro, AR

Date: MM/DD/YYYY

Paperwork Reduction Act Burden Statement

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0595. Public reporting for this collection of information is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

Purpose: The purpose of this questionnaire is to gather information to identify the unescorted access needs of the potential lessor’s employees and contractors so the FAA may determine the appropriate background investigation requirements and PIV badging needs in the event of lease agreement.

Instructions: Lessor employees and contractors who need to access FAA leased space are required to be escorted while in FAA controlled space. If lessor employees and contractors need unescorted access due to the nature and frequency of the access please complete this questionnaire and return to the FAA Real Estate Contracting Officer.

· What is the estimated number of employees (to include contractor and subcontractor personnel) that will require unescorted access to FAA controlled space to support this lease? ___

· If available, attach a list of the personnel.

· Please provide the following information for each employee position (e.g. janitor, maintenance worker, repairman etc.) requiring unescorted access to support this lease:

Lessor Employee Position Category 1

· Position Title(s)_______________________________________

· Estimated number of employees in this category __________

· Will employees in this category require routine (defined as more than (1) day per week), access to FAA space for more than 180 days. YES ☐ NO ☐ Lessor Employee Position Category 2

· Position Title(s)_______________________________________

· Estimated number of employees in this category __________

· Will employees in this category require routine (defined as more than (1) day per week), access to an FAA facility for more than 180 days. YES ☐ NO ☐ Lessor Employee Position Category 3

· Position Title(s)_______________________________________

· Estimated number of employees in this category __________

· Will employees in this category require routine (defined as more than (1) day per week), access to an FAA facility for more than 180 days. YES ☐ NO ☐

Add additional employee positions as necessary:

Federal Aviation Administration Leased Space Access Questionnaire, 10/2022 FAA Form 4400-88 1 Federal Aviation Administration Leased Space Access Questionnaire, 10/2022 FAA Form 4400-88