SIAD-1246R Visitor Request Form.pdf

FOR OFFICIAL USE ONLY

PRIVACY ACT STATEMENT

AUTHORITY: Title 5 U.S.C. Chapters 53, 55 and 81; Title 10 U.S.C. Chapters 11, 61-73; Title 37 U.S.C.; GAO Manual for Guidance of Federal Agencies, Title 6, Chapter 4, para. 4.2.B.2; and E.O. 9397

PRINCIPAL PURPOSE: To provide commanders and law enforcement officials with means by which information may be accurately identified.

ROUTINE USES: Your social security number is used as an additional/alternate means of identification to facilitate filing and retrieval.

Those with U.S. Government issued I.D. cards (ex. CAC/PIV/DD Form 2, etc.) are not required to complete this form.

DISCLOSURE: Disclosure of your social security number is voluntary. However, failure to provide the information requested may delay or prevent approval of your request. Deliver this/these document(s) directly to the intended recipient. DO NOT drop off with a third-party.

STATE :

HOME PHONE NUMBER :

POC PHONE NUMBER :

NAME :

(Last, First, Middle)

SSN : - -

DRIVER'S LIC. # :

HOME ADDRESS :

DATE OF BIRTH :

EYE COLOR :

WEIGHT :

PLACE OF BIRTH :

WORK PHONE NUMBER :

POC AT SIERRA :

SIAD Form 1246, Rev 24 Oct 2018

FOR OFFICIAL USE ONLY

PREVIOUS EDITION IS OBSOLETE.

___________________________________FOR OFFICIAL USE ONLY____________________________________________________

ACCESS GRANTED : Yes Escort Required No Driving

+ For Picture Taking, Contact Your Point of Contact at SIAD. (All Camera Passes Are Processed Through The Pass and ID Office.)

L.E. Division CLETS/NCIC Date: VCO/NCIC Operator:

Notes:

aka :

SEX :

HAIR COLOR :

HEIGHT :

CITIZENSHIP :

(USA, US National, Visa, Perm. Resident, Temp. Worker, etc.)

Denied

S I E R R A A R M Y D E P O T V I S I T O R R E Q U E S T F O R M

Camera Required, Please State Reason :

PURPOSE OF VISIT :

AREA(S) TO BE VISITED :

DATE OF ARRIVAL :

ORGANIZATION :

(State or Country)