Form NAVSEA 5500/1 NAVSEA 5500/1 NAVSEA Visitor's Sign In/Sign Out Sheet

NAVSEA
VISITOR'S SIGN IN/OUT SHEET

OMB CONTROL NUMBER: 0703-0055
OMB EXPIRATION DATE: XX/XX/XXXX

PRIVACY ACT STATEMENT:

1. AUTHORITY: 10 U.S.C. 5013, Secretary of the Navy; 10 U.S.C. 5041, Headquarters, Marine Corps; OPNAVINST 5530.14E, Navy Physical Security and Law Enforcement Program; Marine Corps Order P5530.14, Marine Corps
Physical Security Program Manual, SORN NM05512-2 http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Article-View/Article/570444/nm05512-2/
2. PRINCIPLE PURPOSES(S): To control physical access to DoD, Department of the Navy (DON) or U.S. Marine Corps Installations/Units controlled information, installations, facilities, or areas over which DoD, DON or USMC has
security responsibilities by identifying or verifying an individual through the use of biometric databases and associated data processing/information services for designated populations for purposes of protecting U.S./Coalition/allied
government/ national security areas of responsibility and information; to issue badges, replace lost badges and retrieve passes upon separation; to maintain visitor statistics; collect information to adjudicate access to facility; and
track the entry/exit times of personnel.
3. ROUTINE USES: In addition to those disclosures generally permitted under 5 U.S.C. 552a (b) of the Privacy Act of 1974, as amended, these records contained therein may specifically be disclosed outside the DoD as a routine
use pursuant to 5 U.S.C. 552a (b) (3) as follows: To designated contractors, Federal agencies, and foreign governments for the purpose of granting Department of the Navy officials access to their facility.
4. DISCLOSURE: Voluntary. However, failure to provide requested information may impact eligibility for access to the facility.

DATE

NAME (PRINT)

PHONE OR EMAIL

OFFICE CODE

PURPOSE OF VISIT

TIME IN

TIME OUT

ESCORT

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services,
Executive Services Directorate, Directives Division, 4800 Mark Center Drive, East Tower, Suite 03F09, Alexandria, VA 22350-3100 [OMB CONTROL NUMBER: 0703-0055]. Respondents should be aware that notwithstanding any other provision of
law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR RESPONSE TO THE ABOVE ADDRESS.
Responses should be sent to Commander, Naval Sea Systems Command (SEA 00P) 1333 Isaac Hull Ave SE. Washington Navy Yard DC 20374

NAVSEA 5500/1

PREVIOUS EDITION IS OBSOLETE