MICC Access_Request_Template.docx
DOCX document 107 KB Posted
- Attached to
- NTC 25-09 Requirement 1000 Gallon Fuel Trucks
- Solicitation number
- W911YN-25-Q-A024
About this file
This document is a Contractor/Commercial Vendor Access Request Memorandum from Fort Irwin, California, dated July 7, 2023. The access request is specifically for Robert A. Johnson, who requires installation access from August 14, 2017 to October 27, 2017. The document outlines detailed identification requirements for installation access, including acceptable forms of identification such as enhanced driver's licenses, passports, DA Form 1602, and other federal identification documents.
The memorandum provides comprehensive guidance on ID requirements, noting that non-REAL ID Act compliant state-issued driver's licenses must be accompanied by supplementary identity documents. The point of contact for this access request is Mrs. Joan Smith, who can be reached at joan.r.smith.civ@mail.mil. The document is part of a privacy act process under HSPD-12, designed to validate the trustworthiness of individuals requesting access to the National Training Center (NTC) and Fort Irwin.
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| File | Type | Posted |
|---|---|---|
| List of Questions with Answers.pdf | ||
| Solicitation - W911YN25QA024.pdf |
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Text version
DEPARTMENT OF THE ARMY
YOUR AGENCIES LETTER HEAD
FORT IRWIN, CA 92310-5000
REPLY TO
ATTENTION OF
(Office symbol) 7 July 2023
MEMORANDUM FOR DIRECTORATE OF EMERGENCY SERVICES
SUBJECT: Fort Irwin Contractor/Commercial Vendor Access Request
1. This office requests that the below named individual(s), employed by (Company/Organization name), be granted access to Fort Irwin. The purpose for access is (state purpose, project name etc.) conducted at (e.g. Bldg. #, site location).
| PRIVACY ACT STATEMENT | ||
| AUTHORITY: | HSPD-12 | |
| PRINCIPAL PURPOSE: | To record names, signatures, and other identifiers for the purpose of validating the trustworthiness of individuals requesting access to NTC & Ft. Irwin, CA. NOTE: Records may be maintained in both electronic and/or paper form. | |
| ROUTINE USES: | None. | |
| DISCLOSURE: | Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or prevent further processing of this request. |
| NAME |
| DL/ID #, State |
* See below for Non-REAL ID Act Compliant States Period of Required Access
| Commencing |
| Ending |
| Last |
| First |
| MI |
| mm/dd/yyyy |
| mm/dd/yyyy |
| Johnson |
| Robert |
| A |
| U5174444, CA |
| 08/14/2017 |
| 10/27/2017 |
* REAL ID Act. Unless they bear the imprint `Enhanced Driver's License/Enhanced Identification Card', state issued DLs and ID's from states which are non-REAL ID Act compliant or do not have a current extension must be accompanied by a supplementary identity document for installation access or an escort will be required.
Click here to determine the status of each state/territory. (https://www.dhs.gov/current-status-states-territories) Click here for a list of acceptable supplementary identity documents.
The following are other acceptable forms of ID for visitor installation access: DA Form 1602 (Civilian ID Card and Gold Star Family), a valid US passport or passport card, or a Transportation Worker Identification Credential (TWIC). Form I-766 with a photograph (Employment Authorization Document) or a valid foreign passport with I-551 stamp or with INS Form I-94 or I94A are also acceptable forms of ID however these visitors require 24/7 escort by their sponsor. DLs/ IDs with the imprint `Not for Federal Identification' ARE NOT acceptable forms of ID and an escort will be required.
1. POC is Mrs. Joan Smith at joan.r.smith.civ@mail.mil or 760-380-XXXX.
| Digital/Original Signature |
| Full Name |
| Title |
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