BPA F 1400.22e Non-Employee Data in HRMIS

BPA F 1400.22e
(03-2022)
PRIOR VERSIONS UNUSABLE

U.S. DEPARTMENT OF ENERGY - BONNEVILLE POWER ADMINISTRATION (BPA)

NON-EMPLOYEE DATA IN HRMIS

OMB Control Number:1910-5188
Expiration Date:

The purpose of this form is to add information for non-BPA employees in the Human Resources management information system HRMIS. It must be completed if an ID badge and/or
computer log-on ID is required.
WHO SHOULD COMPLETE THE FORM?
Personnel, who are not BPA employees, but need ongoing access to BPA buildings or systems.
WHAT INFORMATION IS NEEDED?
All fields on the form are required.
IF I HAVE QUESTIONS, WHERE DO I GET HELP?
Send an e-mail to: Non-Government Employee Processing or call HR Help at 503.230.3230.
WHAT DO I DO WITH THIS FORM?
This form requests Personally Identifiable Information. It should be completed by the person who needs access and then returned to the COR. The COR will then submit the form to
HRSC via email to [email protected].
WHAT HAPPENS NEXT?
HRSC staff will input the data in HRMIS and complete the Resolve BUD ID task in Workflow Connection. Workflow Connection will notify other service providers
(COR, Identity and Access Management, Exchange Server, Space Management Services, Employee Badging, etc.) to support additional on-boarding activities.
WHAT ABOUT ENDING EMPLOYMENT?
When a non-government employee no longer requires access, or their period of employment ends, please notify the Access Revocation Team via email
([email protected]) or through the Logical Access Request System (LARS) within 24 hours of the effective date. The Access Revocation Team will ensure removal of physical/logical
access permissions

Official Use Only

BPA F 1400.22e
(03-2022)
PRIOR VERSIONS UNUSABLE

OMB Control Number:1910-5188
Expiration Date:

U.S. DEPARTMENT OF ENERGY - BONNEVILLE POWER ADMINISTRATION (BPA)

NON-EMPLOYEE DATA IN HRMIS

COR CAN SUBMIT THE FORM IN ONE OF THE FOLLOWING WAYS
1. Email to [email protected].
Privacy Act Statement:
Authority: 5 U.S.C. 1302, 2951, 3301, 3372, 4118, 8347, and Executive Orders 10450 amended by E.O. 12107, dated December 28, 1978 and DOE Order 205.1B, Chg 3,
dated 4.29.2014, cancels Chg 2.The order sets forth requirements and responsibilities for a Departmental Cyber Security Program (CSP) that protects information and
information systems for the DOE.
Purpose: BPA will use this information to establish a record and distinguish information from other people suitability and eligibility for access to BPA/DOE facilities.
Routine Uses: We do not disclose your information to third parties without your consent, except to fulfill the purpose for collection or as legally required. Records may be
disclosed to BPA employees and contractors, as required, in order to fulfill their job duties. Additional routine uses are listed in OPM/GOVT-1.
Disclosure: Providing the requested information is voluntary, however failure to provided requested information means that you may not be able to obtain access to BPA/DOE
facilities.

This section to be completed by a Non-Government Employee
1. Contractor Company's Name
2. Have you been employed at BPA, as an employee or contractor, at any time since 10/1/1996? No

Yes

If yes, specify the type of employment:

BPA Fed.Employee

Contractor

Provide the full legal name you used at the time:
4. Social Security Number

3. Full Legal Name (last, first, and middle) (must be exact name that is on SSN card)

5. Country of Citizenship

6. Date of Birth

8. Signature of Non-Government Employee

7. Gender
Male

Female

9. Date

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to ensure the security and safety of its employees, contractors, and facilities. The data you supply will be used by security personnel to provide employees access to specific physical sites. Public reporting
burden for this collection of information is estimated to average .10 hours per response, including the time for reviewing instructions, searching exiting data sources, gathering and maintaining that 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 this burden, to Office of the Chief Information Officer,
Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project (OMB control number 1910-5188), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC,
20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (OMB control number 1910-5188), Washington, DC 20503.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork
Reduction Act unless that collection of information displays a currently valid OMB control number.
The Paperwork Reduction Act (PRA) of 1995 requires each Federal agency to seek and obtain approval from the Office of Management and Budget (OMB) before undertaking a collection of information directed to 10 or more
persons of the general public, including persons involved in or supporting the operations of Government-owned, contractor-operated facilities. Submission of this data is required.

File Code; SR-1165 Retention; Destroy 5 years after employee or contractor relationship ends.

Official Use Only