Attachment_0011_-_Instructions_for_ASG-KU_DES_Form_190-16.01_(17_Jul_2016).pdf

Enclosure 1A - Instructions for ASG-KU DES Form 190-16.01 (Access Applications- 17 Jul 2016)

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

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 –

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

Enter the Primary Contract Company Name Block 38: Primary Contract Company Contact Information

Enter Telephone number, email and/or mailing address of Primary Contract Company Block 39: Name of Primary Contract Company Representative

Print name of individual that can be contacted for questions concerning the contract Block 40: Signature of Primary Contract Company Representative

Signature of individual who has reviewed application for Prime Contractor Block 41: Subcontract Number (If applicable) Block 42: Point of Contact (POC) for Subcontract Company (if applicable)

Section IV – Appointed Authority (AA) Information and Recommendation

Blocks 43 – 49: AA 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.

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 AA must initial all areas required. Then line through all areas not authorized. (AA initials required).

Block 52: Personnel Access during FPCON

Indicate Charlie or Delta access and initial. Delta access requires Enclosure 2C Block 53: Vehicle Privileges

Indicate Yes, OR No if Applicant is authorized driving privileges. In order to request driving privileges during FPCON Delta Enclosure 2C must accompany the application. (AA Initial is required)

Enclosure 1A - Instructions for ASG-KU DES Form 190-16.01 (Access Applications- 17 Jul 2016)

Block 54 Escort Privileges Mark whether or not individual has escort privileges (AA initials required). OCNs require Enclosure 7, BATS Enrollment and DES Approval.

Block 55: AA Recommended IA Badge Expiration

Date COR/AA recommends IA Badge to expire (AA initials required)

Section V – Installation Access (IA) Card Holder Acknowledgement

Blocks 56 – 59: 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 60 – 73: DO NOT WRITE IN THIS AREA

Section VII – Screening Office Use Only

Blocks 74 – 76: DO NOT WRITE IN THIS AREA

ADDITIONAL INFORMATION:

1. If you are a Western Contractor, DES recommends you begin your renewal process with Installation Access 30 days before the expiration date of your IA card.

2. If you are a Foreign National Contractor, DES recommends you begin your renewal process with Installation Access 45-60 days before the expiration of your IA card.

3. All Foreign Nationals must have an interview by the ASG-KU S2/CI BATS Combined Screening Team (CST) prior to being processed for access.

4. All signatures and initials of Company and COR/AA must be present on the application before anyone can be processed for access.

5. The applicant is responsible to provide all documents IAW 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 3 business days in advance for processing.

8. Contractor CAC TDY requests are recommended to be turned in 72 hours in advance for processing

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

10. Exceptions to Policy may take an extended period to process depending on the authority (US Military) that must approve it.