Current_EPIC_FORM_-_L_5.xlsx

XLSX spreadsheet 23 KB Posted

Attached to
USS FRANK CABLE (AS 40) ROH/DD Federal contract opportunity
Solicitation number
N32205-16-R-4406
Issued by
Department of the Navy Military Sealift Command

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From the source

Current EPIC Form for travel to Guam

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Sheet1

Ship Name:USS FRANK CABLEMSC/EPIC FORCE PROTECTION REQUEST SUBMISSION TEMPLATE (Revision 7 - 07AUG2013)
Ship Flag:USFOUO-PRIVACY SENSITIVE. ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Submission Date:11/3/16EMAIL SUBJECT LINE to read: FOUO - PRIVACY SENSITIVE - EPIC - PM[#] [PM POC (first 3 letters)] - [SHIP NAME] - [list TYPE (ie CREW, CONTractors, etc)].
Submitted by:Examples: FOUO - PRIVACY SENSITIVE - EPIC - PM5 HUN - BRITTIN - CREW ; FOUO - PRIVACY SENSITIVE - EPIC - MSC OVE - LARAMIE - CONT
PRIVACY ACT STATEMENT (1974)
AUTHORITY:SECNAVINST 5211.5E, E0 9397.
PRINCIPAL PURPOSE(S):To enable NCIS and U.S. Navy (MSC) to screen personnel with unrestricted access to MSC personnel facilities, resources and/or DOD cargo over which MSC has control against relevant databases.
ROUTINE USE(S):The information will be used to ensure Force Protection of MSC and DOD personnel and assets, and may be furnished to other Navy personnel or other components of DOD who have a need for the Information in the performance of their duties.
DISCLOSURE:Voluntary; however, failure to provide information may affect clearance to work under MSC contracts.
LAST NAMELAST NAME 2FIRST NAMEMIDDLE NAMEDATE OFSSN

CDR Buck McDermott: Social Security Number

PASSPORTNATIONALITYRATING orCOMPANY NAMEVisit Dates
(no spaces,(leave blank if(complete with(NMN - if noBIRTH(no spaces,NUMBER(Country listedPOSITION(Day Month Year)
no dashes)not applicable)no initials)middle name)(MMDDYYYY)no dashes)(no spaces, no dashes)on Passport)
no dashes)
0/SAMPLESMITHROBERTNMN12301981%MISCSN123456789$123456789USAAB/CONTMILITARY SEALIFT CMD1-21 March 2013
1/SUBJECTCHENAULTANTHONYNMN06081960%MISCSN308745765$N/AUSACONTRACTORTECNICO CORP.12-31 JANUARY 2014
2/SUBJECTHARMONIIITHOMASJOSEPH01211969%MISCSN227024962$N/AUSACONTRACTORTECNICO CORP.12-31 JANUARY 2014
3/SUBJECTHOPSONGARYALTON12181959%MISCSN259046234$N/AUSACONTRACTORTECNICO CORP.12-31 JANUARY 2014
4/SUBJECTHOUGLANDIIBENJAMINLEE05081992%MISCSN226655543$N/AUSACONTRACTORTECNICO CORP.12-31 JANUARY 2014
5/SUBJECTPARSONLORETTADENISE03201967%MISCSN228295080$N/AUSACONTRACTORTECNICO CORP.12-31 JANUARY 2014
6/SUBJECTRODRIGUEZALBERTNMN04221952%MISCSN119444304$N/AUSACONTRACTORTECNICO CORP.12-31 JANUARY 2014
7/SUBJECT%MISCSN$
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Sheet2

Sheet3

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