TSA Form 2816A Foreign National Visitor Request - Individual

OMB control number: 1652-XXXX

Exp.: xx/xx/xxxx

DEPARTMENT OF HOMELAND SECURITY

Transportation Security Administration

FOREIGN NATIONAL VISITOR REQUEST – INDIVIDUAL

INSTRUCTIONS: To access TSA facilities within the U.S. and its Territories, Foreign Nationals must be vetted in accordance with TSA MD 2800.15, Foreign Visitor Management. DHS MD 11052, Internal Security Program, requires that Department Agencies report Foreign National Visitor Data to the DHS Chief Security Officer (CSO) via the DHS Foreign National Vetting System. The TSA office sponsoring the visit is responsible for obtaining the required vetting information from the foreign national and then submitting the information through one of two established procedures at least twenty (20) business days in advance of the visit. The primary procedure to request the vetting of foreign nationals is through the iShare online Security Appointment Center (SAC) Visitor Request Form. If the TSA sponsor cannot access the online SAC Form, then the sponsor is required to submit TSA Form 2816A, Foreign National Visitor Request - Individual, or for a group of foreign nationals of two or more, TSA Form 2816B, Foreign National Visitor Request - Group, at least twenty (20) business days in advance of the visit, to the Security Branch, Security Services and Assessments Division, OLE/FAMS to the following address: [email protected]. NOTE: This form is for internal TSA use only.
FOREIGN NATIONAL VISITOR DATA
Full Name (Family Name, followed by all other	names on passport) Country of Citizenship
Gender	Date of Birth Country of Birth
Passport Country	Passport Number Pas	sport Expiration Date
Employer	Country of Employer
Title or Position	Email Pho	ne Number
TSA SPONSOR DATA
Sponsor Name	Sponsor Title/Position
Sponsor Email	Sponsor Phone Number Alte	rnate Phone Number
Sponsor Organization/Location
Date of Request	Visit Start Date Visi	t End Date
TSA Escort	Escort Phone Number Esc	ort Email
If any of the following categories of information are requested to be shared with the visitors, the sponsor will be directed to the appropriate office(s) for further action.
CLASSIFIED NATIONAL SECURITY INFORMATION OT
Purpose of Visit
Location(s) of Visit (List all that apply)
FOR OFFICE OF SECURITY USE ONLY
Processed by (Name)	Date Entered into ISMS FNV Number

HER

Paperwork Reduction Act Statement: Through this voluntary information collection, TSA is gathering information to facilitate your request for access to TSA facilities. It is estimated that the total average burden per response associated with this collection is approximately 0.01667 hours. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The control number assigned to this collection is OMB 1652-xxxx, which expires xx/xx/xxxx. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to TSA PRA Officer, 601 S. 12th Street, Arlington, VA 20598-6011. ATTN: PRA 1652-xxxx.

TSA Form 2816A (6/17) rev. [File: 2800.0.1]

Previous editions of this form are obsolete.

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