NCIC Screening and Pass Request.pdf

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Attached to
Dock Elevator Installation at Offutt AFB
Solicitation number
FA460025B0002
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This document is a 55 SFS Contractor/Vendor NCIC Screening & Pass Request Spreadsheet for Offutt Air Force Base (AFB). The form is designed to collect personally identifying information (PII) for contractors and vendors seeking base access, with specific requirements for security screening. Key details include mandatory fields such as full name, date of birth, driver's license/ID number, work schedule, and country of citizenship. The spreadsheet emphasizes that all listed personnel must present a REAL ID ACT compliant driver's license or approved alternate photo identification upon arrival at the Offutt AFB Visitor Control Center.

The document outlines specific data collection authorization under U.S. Code and Department of Defense regulations, noting that providing information is voluntary but failure to do so will result in denial of base entry. The form includes spaces for base sponsor information, company details, and multiple rows to list individual contractors or vendors. There are additional pages to accommodate a larger number of personnel, with a special note that non-U.S. visitors require an additional 55 WG/IP signature block for approval.

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Contract#:

Contract Start/End Dates: Unit Commander or Security Manager Sig Block

Full Name Country of Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Start Date - End Date (MMDDYYYY) Citizenship

Personally Identifying Information (PII) being collected by this form is authorized for collection under provisions of 10 U.S.C. 8013, Secretary of the Air Force, DoD 5200.2R, DoD Personnel Security Program; AFI 33-202, Computer Security, Information will be maintained by local Security Forces Authority while access requirements exist. Information access is restricted to personnel responsible for contract administration, or otherwise needed in the performance of official DoD duties. Information will be properly disposed of when its required use has been concluded.

Providing this information is voluntary; however, failure to provide all of the required data shown on the spreadsheet will result in denial of entry to the installation. This information is exempt from OMB licensing under provisions of AFI 33-324, Information Collections and Reports Management Program; Controlling Internal, Public, and Interagency Air Force Collections, paragraphs 3.16.11 and 3.16.16.3.

55 SFS CONTRACTOR/VENDOR NCIC SCREENING & PASS REQUEST SPREADSHEET

Date of Birth

Offutt AFB Sponsoring Agency / Unit:

Base Sponsor's Name:

Base Sponsor's Phone #:

Request Date:

Work Schedule

Company Name:

Company Address:

Company Representative Name:

Company Representative Phone Number:

NOTE:

Security Manager will ensure all listed personnel are briefed that they must present a REAL ID ACT compliant drivers license, or state ID, or an approved alternate form of photo identification upon arrival at Offutt AFB Visitor Control Center.

Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors

Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors

Sheet1

Name1:
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Comapny Name:
Company Address:
Company Rep Name: Tracy
Company Phone Number:
Sponsoring Squadron:
Sponsor's Name:
Sponsor's Phone Number:
Request Date:
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Citizenship:
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Start End Date:
Contract No:

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