BPA F 5632.11e BPA Visitor(s) Access Request

BPA F 5632.11e

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

Number:1910-5188
Expiration date: 08/31/2022

(09/09/2019)

BPA VISITOR(S) ACCESS REQUEST

INSTRUCTIONS: All Requests should be submitted at least 24 hours in advance.

1. Control Center Access: ALL visitor(s) without unescorted physical access please fill out Section I. Send the completed form via e-mail to the
appropriate mailbox: Ross Access Request or Munro Access Request.

2. For all visitors (non-BPA personnel) attending a meeting or visiting BPA Headquarters, Ross Complex or Munro Complex please fill out Section I
and refer to Section II. Send the completed form via e-mail (as an attachment) to the appropriate mailbox: HQ Access Request, Ross Access
Request, , Munro Access Request, or Celilo Post for Access Request

3. Foreign Visitors (Non U.S. Citizens) should fill out form BPA F 5632.08e…“Unclassified Visits and Assignments - Foreign Nationals Registration
(Short Form)”.

*Do not submit visitor access requests for Foreign Nationals to HQ Access Request, Ross Access Request or Munro Access
Request until the Foreign National Visits and Assignments (FV&A) request has been approved by the FV&A Office.

I. VISITOR INFORMATION (If the visitor is not a U.S. citizen review item 3 above.) For Wireless Access Accounts, please contact the BPA Help Desk.
Check if
U.S. Citizen

Name

Yes
Yes
Yes
Yes
Yes

Visit Date(s)

Company Name / Relationship to BPA Host

Check for Escorted
Control Center

Control Center(s)

Dittmer
Dittmer
Dittmer
Dittmer
Dittmer
Meeting / Event Location(s). (Include room numbers)

No
No
No
No
No

Visit Time(s)

Munro
Munro
Munro
Munro
Munro

Reason for the visit or meeting.
Provide a BPA Host (point of contact (POC)) or an Escort that can be reached when the visitor(s) arrive.
Name of BPA Host (POC)
Work Phone number Name of Escort (if different than POC)

Work Phone number

Submitted by (Name)

Date

Work Phone number

Routing

VALID SIGNATURES: Per OMB A-130, Digital Signature (web link to instructions) or Electronic Signature (handwritten signature scanned into
electronic format) are recognized as a valid signatures. Use of “/s/” is NOT a valid signature.

II. Access Authorization

General Access (Physical Security)
Approved
Disapproved

Signature

Date Processed

For Control Center approvals, forward Dittmer requests to “Control Cntr Privileges” and Munro requests to “Munro Control Cntr Privileges”.
Control Center Access (Security Privilege Coordinator) Signature
Date Processed
Approved
Disapproved
FOR PHYSICAL SECURITY OFFICE USE ONLY

Daily Access Book (For security filing purposes only.)
Section Number

Sub Section

File Code: SS-18-11(d) Retention: See BPA Record Manual

Pull Date (Day, Month, Year)

Request processed for filing by (Initials)

OMB Control Number: 1910-5188
Expiration Date: 08/31/2022

BPA F 5632.11e
(09-19)

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

BPA VISITOR(S) ACCESS REQUEST (continuation page)

VISITOR INFORMATION continued…For Wireless Access Accounts, please contact the BPA Help Desk.
Name

Check if
U.S. Citizen

Company Name / Relationship to BPA Host

Check for Escorted
Control Center

Control Center(s)

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

Yes

No

Dittmer

Munro

BPA F 5632.11e
(09/09/2019)

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

OMB Control Number:1910-5188
Expiration date: 08/31/2022

BPA VISITOR(S) ACCESS REQUEST

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to ensure the security and safety of BPA employees, contractors, and facilities. The data you supply will be used by security
personnel for all visitors attending or visiting BPA facilities. Public reporting burden for this collection of information is estimated to average .16 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.