N6660420Q0056_FY19 Base Access Request.pdf

Visitor Request Information

A visit request is mandatory for all visitors to NUWC Division Seneca Lake, government and civilian, regardless of the duration or classification of the visit. Access to NUWC Division Seneca Lake will not be granted under any circumstances without a valid visit authorization request on file. All visits to NUWC

Division Seneca Lake are assumed to be classified unless otherwise stated.

Visit requests not meeting these requirements will be rejected and access will not be granted.

JPAS (Minimum of (3) days processing time is required)

Use of JPAS (Joint Personnel Adjudication System is the preferred method for submitting visit requests.

For visits, the SMO (Security Management Office) is: 41917

Include the Contract Number in the space allocated for the POC Phone Number

Questions may be addressed to the NUWCDIVSL Security at 315-536-4280

EMAIL (Minimum of (7) days processing time is required)

For companies or agencies not on JPAS, a visit request must be EMAILED to:

englebert.dobbertin@navy.mil & jennine.campana.ctr@navy.mil

The request is required to be on COMPANY LETTERHEAD

Company or Organization Name – include complete address, phone number, fax number and

CAGE code

Visitor’s full name (Last, First, Middle) –(As it appears on government issued ID-i.e.-Driver’s

License)- Do not use nicknames

Visitor’s Full Social Security Number – This information is protected by the Privacy Act of ‘74

Visitor’s Date of Birth Visitor’s Place of Birth (city/state)

Visitor’s Citizenship Individual’s Level of Clearance Access – This information is verified using JPAS (If you do not have a clearance put “N/A”)

Visitor’s Email Address Technical Point of Contact (POC) at NUWCDIVNPT-Seneca Lake Detachment (include name and telephone number) (Usually Base Manager: Bud Dobbertin #315-536-4280)

Specific Date(s) of Visit (include the year) –Visit dates can not last more than 1 year in duration

Specific Purpose of Visit (to include the classification of the visit)

Contract number for non-governmental activities (put N/A if this does not apply to you)

Name, Title and Signature of authorizing company official (may NOT be one of the listed visitor-unless you are a one-person company)

Questions may be addressed to the NUWCDIVSL Security at 315-536-4280

Principal Purpose: Information is obtained under EO 11652 to identify personnel working at activities where unescorted access to the facility may be required.

Routine Use: Information, including the social security number, date and place of birth, is used in verifying the individual’s identity and security clearance level. The information may be disclosed to those at the activity responsible for verifying clearance and unescorted access authorization.

Disclosure: Completion of a visit request authorization, including the disclosure of your social security number and date/place of birth is voluntary. Failure to provide all information, including the social security number and date/place of birth, may serve as a basis to deny access to the facility.

NUWCDIVNPT-Seneca Lake Detachment 50 Main Street Dresden, NY 14441 mailto:englebert.dobbertin@navy.mil mailto:jennine.campana.ctr@navy.mil