J-15_Non-Mariner_Maintenance_Contractor_Vetting_Sheet_(Rev_8_(v4)_20_Sep_2017).xlsx

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USNS MATTHEW PERRY MID TERM AVAILABILTY FY 18
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N32205-18-R-4254
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USNS MATTHEW PERRY MTA FY 18 J-15

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Sheet1

Ship Name:MSC/EPIC FORCE PROTECTION REQUEST SUBMISSION TEMPLATE (Non-Mariner Maintenance Contractor) (Revision 8 (v4)- 20 Sep2017)
Ship Flag:FOUO-PRIVACY SENSITIVE. ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Submission Date:EMAIL 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
Contact Info:CONTACT INFORMATION OF PERSON WHO SUBMITTED REQUEST (Phone or Email).
PRIVACY ACT STATEMENT (1974)
AUTHORITY:SECNAVINST 5211.5E, E0 9397.
PRINCIPAL PURPOSE(S):To enable U.S. Navy (MSC) to screen personnel against relevant El Paso Intelligence Center (EPIC) databases in support of unescorted access to vessels over which MSC has control.
ROUTINE USE(S):The information below will be used to ensure the protection and safety of MSC and DOD personnel and assets, and may be furnished to other EPIC vetted personnel or DoD Law enforcement components who have a "Need to Know" the Information in the performance of their duties.
DISCLOSURE:Voluntary; however, failure to provide information may affect the approval of, or type of access to MSC vessels.
LAST NAMEFIRST NAMEMIDDLE NAMERATING or POSITIONCOMPANY NAMEVISIT START DATE

Lewis, Peter J CIV MSC, N341: Screening is good for a maximum of 30-day period

DATE OF BIRTH SSN (USA Only) CDR Buck McDermott: Social Security Number

(US Only)PASSPORT #NATIONALITY
no dashes)(Country listed on Passport)
0SMITHROBERT(If Applicable)AB/CONTOPCO/CONTRACTING CO.MM/DD/YYYYMM/DD/YYYY123456789123456789(Country listed on Passport)
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