BPA F 5632.08e Unclassified Visits and Assignments- Foreign Nationals R

BPA F 5632.08e
(05-2022)

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

OMB Control Number:1910-5188

UNCLASSIFIED VISITS AND ASSIGNMENTS-FOREIGN NATIONALS REGISTRATION

Expiration Date:08/31/2022

Privacy Notice: The information on this form is requested to determine access to facilities operated by the Bonneville Power Administration (BPA) or
its contractors. Access to the information collected will be provided to the Department of Energy, and may be provided to appropriate Federal
agencies for law enforcement purposes. Failure to provide the information may result in denial of access to BPA or contractor facilities and personnel

1.Nam e of Visitor/Assignee

First Name:

Middle:

2.Visit Determ ination Inform ation

Citizenship:

Country of Employer:

Type of Request (check one):
Gender:
Male

Last:

Visit (less than 30 days)

Assignment (30 consecutive days or more)

3.Biographical Inform ation

Have you resided in the U.S. more than 3 yrs.?
Yes
No

Female

Country of Citizenship:

Date of Birth (mm/dd/yyyy):

Extension of an Assignment

Is Visitor currently in U.S.?
Yes
No

Country of Birth:

City of Birth

Additional Biographical Information: (If known, FN will complete this section completely)
Current U.S. Address:

City

Street (1)

State

Street (2)

Zip Code:

Permanent Address:

City:

Street (1):

State:

Street (2):

Zip Code:

4. Em ployer Inform ation
Institution or Company Name:

Phone Number:

Street (1):

Fax Number:

Street (2):

Email Address:

City:

State/Providence:

Zip Code:

Country of Employer:

Title or Position and Duties:

5.Visa Inform ation

6.Passport Inform ation

Visa Number:

Passport Number:

Visa Type:

Country of Issue:

Exp. Date (mm/dd/yyyy):

Exp. Date (mm/dd/yyyy):

Please submit document via email to: [email protected].

File Code; SR-1160; Retention; Destroy when 5 years old.

BPA F 5632.08e
(05-2022)

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

UNCLASSIFIED VISITS AND ASSIGNMENTS-FOREIGN NATIONALS REGISTRATION
(SHORT FORM)
7.Place of Work (if different from Employer)

Company Name:

Phone Number: Fax

Street (1):

Number:

Street (2):

Email Address:

City:

State:

Zip Code:

Country of Employer:

Title or Position and Duties:
Interpreter Needed?

Yes

Business Type conducted by Employer:

No

Educational Background:

Field of Research:

8.Host Inform ation
Host’s First Name:

Middle:

Last:

Host’s Citizenship:

Phone:

Mobile Phone

Does the host have a clearance?

Yes

No

9.Visit Inform ation
Desired Start Date (mm/dd/yyyy):

Desired End Date (mm/dd/yyyy):

Subject(s): (Choose from the drop-down menus)

3092-Fire Safety Inspection/Maintenance 3252-Virus Detection

701-Environmental Mgmt

Description of Visit/Assignment, including specific activities or involvement:

Purpose of visit (Choose from the drop-down menu):

Car Pool

Is the assignment for intermittent access periods?

(Example: 2 days one week, 3 days the next week, 1 day on 3rd week=6 days)

Number of Days On site:

Will there be interactions with individuals
with Security Clearances? (Secret or Top
Secret clearances)
Yes
No

List individuals:
First Name:

Middle:

Last:

1.
2.
Is this Visit for Employment?

Yes

No

Are there any Export Control items related to this Foreign National? Choose one option

File Code; SR-1160; Retention; Destroy when 5 years old.

BPA F 5632.08e
(05-2022)

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

UNCLASSIFIED VISITS AND ASSIGNMENTS-FOREIGN NATIONALS REGISTRATION
(SHORT FORM)

Access Type choose one:

Physical

Logical

List Buildings and Rooms to be accessed:
Building:

Project Wise

Room:

Type:

CIL Sensitive Subjects (Critical Information List)

Export Control Items/ECCN Numbers

DOE/BPA Mission(s) that will be advanced by this Visit/Assignment:

Will Visitor/Assignee be granted computer access?

Yes

No

If granted computer access, is the access on-site or off-site?

Yes

No

List hardware and software to which access is granted:

10.Remarks/Comments (or additional information that did not fit above)

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to the security and safety of BPA employees, contractors, and facilities. The data you supply will be used by
security personnel to document all foreign nationals' purpose and dates of their intended visit/assignment. Public reporting burden for this
collection of information is estimated to average .35 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.
Official Use Only

File Code; SR-1160; Retention; Destroy when 5 years old.