Form DD2249 PENTAGON FACILITIES ACCESS ENROLLMENT FORM

CUI (when filled in)
OMB No. 0704-XXXX
Expires: YYYYMMDD

PENTAGON FACILITIES ACCESS ENROLLMENT FORM

The principal purpose of this form is to collect information used to provide perimeter swipe access to facilities protected by the Pentagon Force Protection Agency. The information is
used to conduct a National Crime Information Center (NCIC) check and is input into a PFPA access control system. The completed DD Form accompanies the individual seeking facility
access to the applicable credentialing office, so that PFPA can process their application and generate the appropriate access card [Common Access Card (CAC) or Pentagon Facilities
Alternative Credential (PFAC)]. The information submitted will be maintained in accordance with the Privacy Act of 1974. A Privacy Act Statement is provided on page 2 of this form.

TYPE OF REQUEST (X one):
Common Access Card (CAC) Enrollment
Pentagon Facilities Alternative Credential (PFAC) Enrollment: for vendors, custodians, press etc. requiring physical access only.

SECTION I - APPLICANT INFORMATION
1. LAST NAME

2. FIRST NAME

3. MIDDLE INITIAL

4. DATE OF BIRTH

5. SSN

6. SEX (X one)
a. Male

b. Female

7. RACE (X one)
a. American Indian or Alaska Native

b. Asian

d. Hispanic or Latino

e. Native Hawaiian or Other Pacific Islander

c. Black or African American
f. White

8. DOD AFFILIATION (X one)
a. Military Service Member

b. Civilian

c. Contractor

d. Press

f. Concessionaire

g. Custodial

h. Other (Specify)

e. Foreign

9. IS APPLICANT A U.S. CITIZEN? (X one)
a. Yes
b. No (If "No"):

i. Immigration Number

iii. Expiration Date
(YYYYMMDD)

ii. Country

NEEDS DD67
SECTION II - BACKGROUND INVESTIGATION DATA - Authorizing Official (AO) Use ONLY

10. BACKGROUND INVESTIGATION (BI) INITATED:
i. Month

ii. Year

SECTION III - ACCESS REQUEST INFORMATION - Authorizing Official (AO) Use ONLY

11. ASSIGNED DOD COMPONENT (X one and list component)
a. Office of the Secretary of Defense (e.g. P&R, A&S)
b. Defense Agency (e.g. DISA, DMA)
c. Field Activity (e.g. OEA, WHS)
d. Military Service (list Branch of Service)
e. Other (Specify)

12. BUILDING ACCESS REQUESTED (X each one that applies)
a. Pentagon with Mark Center Business Hours. (If Mark Center 24/7 access is needed, Mark Center must be also be checked)
b. Mark Center 24/7 Access with Pentagon Business Hours. (If Pentagon 24/7 access is needed, Pentagon must be also be checked)
c. Suffolk Building
d. Polk/Taylor Building
NOTE: DHHQ and OLC must be approved by the facility's respective security office.
13. DOES THE APPLICANT NEED TO ESCORT OTHERS TO PERFORM OFFICIAL DUTIES? (X one)

a. Yes

b. No

14. JUSTIFICATION

15. PASS EXPIRATION DATE (YYYYMMDD) For CACs: date must not
exceed expiration. For PFACs: date must not exceed 1 year.

16. REASON FOR ISSUANCE
(X one)

a. Initial

b. Renewal

c. Name Change

17. AUTHORIZING OFFICIAL
a. Name (Last, First, Middle Initial)

b. Signature

DD FORM 2249, 20210812 DRAFT
PREVIOUS EDITION IS OBSOLETE.

c. Date Signed (YYYYMMDD) d. Telephone Number (include area code)

CUI (when filled in)

Controlled by: PFPA SSD
Page 1 of 2
CUI Category: PRVCY; OPSEC
LDC: DL(Component Security Manager or POC; PFPA)
POC: (703) 695-2266

CUI (when filled in)
PRIVACY ACT STATEMENT
AUTHORITIES: 10 U.S.C. 2674, Operation and Control of Pentagon Reservation and defense facilities in National Capital Region; 32 CFR 234, Conduct on the
Pentagon Reservation, as amended; DoD Directive (DoDD) 5105.68, Pentagon Force Protection Agency (PFPA); DoDI 5200.08, Security of DoD Installations
and Resources and the DoD Physical Security Review Board (PSRB); DoDI 5525.19, DoD Identity Matching Engine for Security and Analysis (IMESA) Access to
Criminal Justice Information (CJI) and Terrorist Screening Databases (TSDB); DoD Manual 5200.08 v3, Physical Security Program: Access to DoD Installations;
OSD Administrative Instruction 30, Force Protection on the Pentagon Reservation; Directive-Type Memorandum (DTM) 09-12, Interim Policy Guidance for DoD
Physical Access Control; E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE: To collect information used to provide perimeter swipe access to facilities protected by the Pentagon Force Protection Agency, to
include running a National Crime Information Center (NCIC) check.
ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, these records may specifically be
disclosed outside of DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3), including as follows: To contractors, grantees, experts, consultants, students, and
others performing or working on a contract, service, grant, cooperative agreement, or other assignment for the federal government when necessary to
accomplish an agency function related to this system of records. To the appropriate Federal, State, local, territorial, tribal, foreign, or international law
enforcement authority or other appropriate entity where a record, either alone or in conjunction with other information, indicates a violation or potential violation of
law, whether criminal, civil, or regulatory in nature.
A complete list of routine uses may be found in the applicable System of Records Notice (SORN), DPFPA 01, “Pentagon Facilities Access Control System” at
https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570581/dpfpa-01/.
DISCLOSURE: Voluntary; however, failure to provide such information may result in restricting the applicant's access to PFPA-protected facilities.

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-XXXX, is estimated to average seven 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. 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.

INSTRUCTIONS
SECTION I – APPLICANT INFORMATION
1. LAST NAME: Enter last name of applicant requesting Common Access Card (CAC) or Pentagon Facilities Alternative Credential (PFAC) issuance/
enrollment. PFAC is authorized for those who require physical access and DO NOT qualify for a CAC.
2. FIRST NAME: Enter first name of applicant
3. MIDDLE INITIAL: Enter middle initial of applicant
4. DATE OF BIRTH: Enter date of birth of applicant in format YYYYMMDD
5. SSN: Enter social security number of applicant
6. SEX: Select the appropriate sex of applicant
7. RACE: Select the appropriate race of applicant
8. DOD AFFILIATION: Select the appropriate DoD affiliation of applicant
i The DoD Affiliation applies to the role in which the applicant is requesting access. For example, if an applicant is a contractor or civilian but is
requesting access to the Pentagon, or any of its facilities, to fulfill his/her duties as a service member, then he/she would check box A.
9. U.S. CITIZEN: Select whether or not applicant is U.S. Citizen. If “No”, please provide more details
i Immigration Number: Applicant’s immigration number
ii Country: Applicant’s primary country of citizenship
iii Expiration Date: Expiration date of applicant’s immigration card/green card in format YYYYMMDD

NEEDS DD67

SECTION II – BACKGROUND INVESTIGATION DATA – AUTHORIZING OFFICIAL (AO) USE ONLY
10. BACKGROUND INVESTIGATION (BI) INITATED:
i Month: Enter month the applicant's background investigation was initiated
ii Year: Enter year the applicant's background investigation was initiated
SECTION III – ACCESS REQUEST INFORMATION
11. ASSIGNED DOD COMPONENT: Mark applicant’s assigned component then specify which agency
12. BUILDING ACCESS REQUESTED: Mark each facility that the applicant will need access.
13. ESCORT: Select whether or not the applicant is permitted to escort visitors throughout the facility.
14. JUSTIFICATION: Provide justification for applicant’s need to escort to perform official duties
15. PASS EXPIRATION DATE: Enter pass expiration date for CACs and PFACs in format YYYYMMDD
i For CACs: date must not exceed expiration
ii For PFACs: date must not exceed 1 year
16. REASON FOR ISSUANCE: Select the reason for issuance of CAC or PFAC enrollment
17. AUTHORIZING OFFICIAL: Enter the contact information for authorizing official (AO) who is permitted to sign and approve facility access for an
organization.
i The authorizing official is always a government employee and typically an organization’s security manager; however, in some cases, this can vary.

DD FORM 2249, 20210811 DRAFT
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

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