Attachment_5_-_AFRC_form_10735 _Visit_Request_-_U.S._Citizens.pdf

PDF 45 KB Posted

Attached to
Remove and Replace B4820 125KVA Uninterruptable Power Supply Federal contract opportunity
Solicitation number
NND16571098E
Issued by
National Aeronautics and Space Administration Armstrong Flight Research Center

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Attachment 5 - AFRC Form 10735 Visit Request - U.S. Citizens

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Visit Request - U.S. Citizen When completed this form contains PII (Personal Identification Information). This information must be encrypted when electronically transmitted. If the form is printed, it must be covered by a SBU (Sensitive But Unclassified) coversheet, form number NF1686.

Paperwork Reduction Act Statement This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 2700-0158 and expires on 08/31/2017. We estimate that it will take five (5) minutes to read the instructions, gather the facts, and answer the questions. Send only comments regarding the time estimate to: james.p.nicholas@nasa.gov.

AFRC 10735Rev: 3.7Only the current revision will be accepted.

INSTRUCTIONS

Instructions

1. Seventy two (72) hours advance notice is required for all visit requests.2. For unescorted access please fax (661-276-2732) proof of your security clearance or verification of a completed background investigation (NACI).3. All personal visits must be escorted.4. ALL visits must be approved by the Employee's Branch Chief or higher, or the Contract Employee's CO, COTR or TM.

Instructions - 1. Seventy two (72) hours advance notice is required for all visit requests.

2. For unescorted access please fax (661-276-2732) proof of your security clearance or verification of a completed background investigation (NACI).

3. All personal visits must be escorted.

4. ALL visits must be approved by the Employee's Branch Chief or higher, or the Contract Employee's CO, COTR or TM.

TYPE OF VISIT

Type of Visit

SITE TO BE VISITED

Site To Be Visited

VISITOR INFORMATION

Visitor Information 1.

Visitor Information - #1 2.

Visitor Information - #2 3.

Visitor Information - #3

APPROVAL

Approval

1. Visitors must show picture identification on arrival.

2. Sponsors are responsible for visitors while at AFRC.

3. Visit requests that do not indicate escorted or unescorted will be assigned an escorted visit.

4. For classified visits,visitors are required to have their clearance sent in advance to:

Armstrong Flight Research Center
Attn: Visitor Control, P.O. Box 273
Edwards, CA 93523-0273
or FAX to 661- 276- 2732

1. Visitors must show picture identification on arrival.

2. Sponsors are responsible for visitors while at AFRC.

3. Visit requests that do not indicate escorted or unescorted will be assigned an escorted visit.

4. For classified visits,visitors are required to have their clearance sent in advance to:

Armstrong Flight Research Center Attn: Visitor Control, P.O. Box 273 Edwards, CA 93523-0273 or FAX to 661- 276- 2732

* SUBJECT TO PRIVACY ACT OF 1974

When not under the continuing control and supervision of a person authorized access to such material, it must be, as a minimum, maintained under locked condition.

* SUBJECT TO PRIVACY ACT OF 1974

When not under the continuing control and supervision of a person authorized access to such material, it must be, as a minimum, maintained under locked condition.

8.2.1.3144.1.471865.466429

Type of Visit - Escorted:
Type of Visit - Unescorted:
Type of Visit - Classified:
Visitor Information - #1 - Full Name of Visitor:
Visitor Information - #1 - Date of Birth:
Visitor Information - #1 - Company Name:
Visitor Information - #1 - Dates of Visit:
Visitor Information - #1 - Place of Birth (City, State, Country):
Visitor Information - #1 - Citizenship:
Visitor Information - #1 - Driver License Number and State of Issue:
Visitor Information - #2 - Full Name of Visitor:
Visitor Information - #2 - Date of Birth:
Visitor Information - #2 - Company Name:
Visitor Information - #2 - Dates of Visit:
Visitor Information - #2 - Place of Birth (City, State, Country):
Visitor Information - #2 - Citizenship:
Visitor Information - #2 - Driver License Number and State of Issue:
Visitor Information - #3 - Full name of visitor:
Visitor Information - #3 - Date of Birth:
Visitor Information - #3 - Company Name:
Visitor Information - #3 - Dates of Visit:
Visitor Information - #3 - Place of Birth (City, State, Country):
Visitor Information - #3 - Citizenship:
Visitor Information - #3 - Driver License Number and State of Issue:
Visitor Information - Name of Sponsor to be Visited:
Visitor Information - Sponsor Extension:
Visitor Information - Name of Sponsor to be Visited - Driver License Number and State of Issue:
Visitor Information - Date of Request:
Purpose of Visit:
Approval - Branch Chief (or higher), CO, COTR or TM (print name):
Approval - Branch Chief (or higher), CO, COTR or TM Signature:
Approval - Branch Chief (or higher), CO, COTR or TM Date:
Site To Be Visited - Bldg. 703: 0
Site To Be Visited - Bldg. 703: 0
Approval - Special Instruction:
Visitor Information - Name of Requestor (if different than sponsor):
Visitor Information - Name of Requestor Extension:
Visitor Information - Name of Requestor Date:

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