Attachment_4_-_Access_Applications_Instructions_(01Feb12).docx

INSTRUCTIONS FOR COMPLETING THE ASG-KU PMO FORM 190-16.01

Instructions for ASG-KU PMO Form 190-16.01 (Access Applications- 01FEB12) – Enclosure 1 ENCLOSURE 1 – Required for all applicants requesting Access

Section I – Demographics:

Blocks 1 – 3: Last Name, First Name, and Middle Name/Suffix Self Explanatory Block 4: Passport Number and Expiration Self Explanatory Block 5: Foreign Identification Number Kuwait Civil Identification Number or Country of Origin Identification Number Block 6: Date of Birth Self Explanatory Block 7: Height Enter height in inches Block 8: Weight Enter weight in pounds Block 9: Gender Self Explanatory Block 10: Eye Color Self Explanatory Block 11: Hair Color Self Explanatory Block 12: Title/Position Enter exact Job Title Block 13: Rank/Grade i.e. GS-11E or Contractor Block 14: Citizenship/Nationality Enter country of citizenship. If holds dual citizenship, the applicant must list BOTH countries Block 15: Race Enter one of the following:

A – Asian / Pacific Islander / anyone from the Asian continent or Pacific Islands B – Black N – Native American / Alaskan Native W – White / Caucasian / Anglo / European Descent U - Unknown Block 16: Address Type Enter the type of address that will be listed in Blocks 17 – 19 Blocks 17 – 19: Address, City, State, Zip Code and Country Enter the address of the type checked in Block 16 Block 20: Home Phone Number Enter the Land Line Phone Number (if applicable) Block 21: Mobile Phone Number Self Explanatory Block 22: Work Phone Number Enter phone number of the applicant’s work or office Block 23: DSN Phone Number Enter DSN Number (if applicable)

Section II – Access Information

Block 24: Purpose of Application Mark the box that applies to the applicant Blocks 25 – 27: Work Hours, Dates Requested and Work Days Self Explanatory

Section III – Company/Contract Information

Block 28: Employer Enter the primary company that the applicant is employed with Block 29: Department/Section Enter the Department and/or Section of the applicant is assigned to Block 30: Work Location of Employee Enter the location where the applicant works, i.e. Building Number, Zone Location, etc Block 31: Project Name/Task Order Enter all information as applicable Blocks 32 – 33: Supervisor Name and Work Number Enter the name of the applicant’s immediate supervisor and the contact number Block 34: US Military Contract Number Enter the complete contract number Block 35: Contract Expiration Date Self Explanatory Block 36: Contract Period Base year of contract plus option years (i.e. Contract expires 30Sep2011, plus 3 option years: Expiration 30Sep2014) Block 37: Primary Contract Company (if applicable) If individual is a subcontractor, enter the Primary Contract Company Name Block 38: Primary Contract Company Contact Information (if applicable) Enter Telephone number, email and/or mailing address of Primary Contract Company Block 39: Name of Primary Contract Company Representative (if applicable) Print name of individual that can be contacted for questions concerning the subcontract Block 40: Signature of Primary Contract Company Representative (if applicable) Signature of individual who has reviewed application for subcontractor Block 41: Subcontract Number (If applicable) Block 42: Point of Contact (POC) for Subcontract Company (if applicable)

Section IV – Requesting Authority (RA) Information and Recommendation

Blocks 43 – 49: RA Last Name, First and Middle Name, Rank/Grade or Equivalent, Unit/Organization, Work Number, Mobile Number and E-Mail Address Enter the information for the Directorate/Contracting Officer Representative (COR) for the applicant.

Block 50: Signature and Date The signature must be of the individual listed in Blocks 43 – 49, must be original and match the Signature Card the IAO has on file. The applicant must process within thirty (30) days of the application being signed.

Block 51: Areas of Access Mark those areas the applicant is authorized to have access to based on the terms of the contract or orders. The RA must initial all areas required. Special Areas such as Bag Farms can be listed in Block “Other”.

Block 52: Personal Access in Force Protection Condition (FPCON) Mark the authorized FPCON level for the applicant. The RA must initial the block for verification and provide written justification in Block 55 for FPCON Delta. (RA initials required).

Block 53: Vehicle Access in Force Protection Condition (FPCON) Mark the authorized FPCON level for the applicant’s vehicle access. The RA must initial the block for verification and provide written justification in Block 55 for FPCON Delta. (RA initials required).

Block 54: Escort Privileges The RA must initial the block and provide written justification in Block 55 for escort privileges. This is primarily assigned to Supervisors, Project Managers, Human Resources personnel, and Emergency Essential positions. (RA initials required).

Block 55: Areas, Gates and Base Access (other Remarks) Enter justification for Blocks 51 – 54, or other area requests. (RA initials required).

Block 56: Expiration Date Recommended date for IA card expiration; cannot be greater than one (1) year. (RA initials required).

Section V – IA Card Holder Acknowledgement

Blocks 57 – 60: Names (Printed), Signature and Date Applicant must read and acknowledge IA Card Holder Responsibilities, then print, sign and date before IA Card can be issued

Section VI – Access Office Use Only

Blocks 61 – 74: DO NOT WRITE IN THIS AREA

Section VII – Screening Office Use Only

Blocks 75 – 77: DO NOT WRITE IN THIS AREA

OTHER IMPORTANT INFORMATION:

1. If you are a Western Contractor, begin your renewal process with Pass & ID 30 days before the expiration date of your IA card.

2. If you are a Foreign National Contractor, begin your renewal process with Pass & ID 45-60 days before the Expiration of your IA card.

3. All Foreign Nationals must have an interview by the Screening Office prior to being processed for access.

4. All signatures and initials must be present on the application and must be original before anyone can be processed for access.

5. The applicant is responsible to provide all documents listed in Enclosure 2 at the time of processing or the application will be denied.

6. Original Passport must be presented at the time of processing.

7. Escorted Access Requests must be turned in 48 hours in advance for processing.

8. Exceptions to Policy may require additional screening and/or interview.

9. Exceptions to Policy may take three (3) days or more to process depending on the authority that must approve it.