FEMA Form FF-900-F Facility Access Request

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency
FACILITY ACCESS REQUEST

OMB Control Number: 1660-0151
Expiration: September 30, 2024

UNCLASSIFIED - FOUO
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average .17 hours per response. The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting the form. This
collection of information is required to obtain or retain benefits. You are not required to submit to this collection of information unless it displays
a valid OMB control number. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to:
Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency (FEMA), 500 C Street
SW, Washington, DC 20472, and Paperwork Reduction Project (1660-0151). NOTE: Do not send your completed form to this address.
PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why DHS is requesting the information on this form.
AUTHORITY: FEMA is authorized to collect the information requested on this form pursuant to 40 U.S.C § 13159 to protect the buildings,
grounds, and property owned, occupied, or secured by the Federal Government, and the persons on the property.
PURPOSE: FEMA is requesting this information to collect and maintain records related to the Department's facility and perimeter access
control, including access to DHS information technology and access to facilities, as well as visitor security and management. FEMA will use
this information to support the Department's efforts related to protecting DHS facilities and operating the visitor management program.
ROUTINE USES: The information requested on this form may be shared externally as a “routine use” to FBI to assist the Department of
Homeland Security in screening FEMA employees requesting access to high security areas and visitors that are not employed by the U.S.
Government. A complete list of the routine uses can be found in the system of records notice associated with this form, “Department of
Homeland Security FEMA. DHS/ALL-024 Facility and Perimeter Access Control and Visitor Management System of Records, DHS/ALL-023
Personnel Security Management System of Records, DHS/ALL-025 Law Enforcement Authority in Support of the Protection of Property
Owned, Occupied, or Secured by the Department of Homeland Security System of Records and DHS/ALL-026 Personal Identity Verification
Management System of Records The Department's full list of system of records notices can be found on the Department's website at http://
www.dhs.gov/system-records-notices-sorns.
CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Providing this information to is voluntary. However, failure to provide this
information may result in a denial of access to FEMA facilities.

INSTRUCTIONS FOR ACCESS TO MOUNT WEATHER EMERGENCY OPERATIONS CENTER (MWEOC) AREA B
1.
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3.
4.
5.
6.

7.
8.

Special care must be taken when filling out this form as information provided on this form may be or become classified
through compilation.
Pursuant to CFR 44 Part 15, the FEMA Administrator or MWEOC Executive Administrator must approve all persons and vehicles
entering MWEOC.
Approved MW Sponsor: Complete Parts I, II, and III. (TYPE or PRINT-Applicant Signature is not required)
Agency's Security Officer: Complete Part IV.
Agency's Continuity Coordinator, Agency's Chief of Staff or higher level official must sign Part V - AUTHORIZATION
The approved MWEOC sponsor must forward the completed form to the MWEOC Area B Access Control Office via:
Unclassified fax: 540-542-2067
Unclassified email: [email protected]
Secure fax: 540-542-2232
Secure email: [email protected].
After Access has been granted all applicants must view the AREA B Security Briefing video prior to admittance to MWEOC Area B.
For questions regarding this form, please call the Area B MWEOC Access Control office at (540) 542-2081 or contact the MW Mission
Partner Liaison at FEMA-MW-PARTNER [email protected]. (All blocks contained on this form, unless marked
OPTIONAL, must be filled out in order for this form to be processed through the MWEOC Access office.)

Derived By:
Derived From:
Declassify On:

FEMA Form FF-900-FY-21-101 (formerly 121-3-1-3B)
(09/21)

UNCLASSIFIED - FOUO

Page 1 of 3

UNCLASSIFIED - FOUO
Note: Signing this form signifies that I understand that this is a Release of Information (ROI). I understand that any false statement
on any part of my application may be grounds for denying me access into Federal Emergency Management Agency Controlled
facilities, and/or grounds for prosecution under Title 18 USC 1001.
***Please ensure to use a cover sheet and password protect or use other approved methods for the protection of the applicant's PII
when submitting this form***
PART I - APPLICANT INFORMATION FOR ACCESS TO MWEOC AREA B
***Signing this form is a release of Information (ROI)***
FULL NAME OF APPLICANT (Last, First, Middle, and Maiden if applicable)

DATE OF BIRTH (MM/DD/YYYY)

PLACE OF BIRTH (CITY, STATE, COUNTRY)

DO YOU HOLD A U.S. CITIZENSHIP STATUS?
YES

SOCIAL SECURITY NUMBER

EMPLOYER AGENCY/COMPANY

SEX
MALE
FEMALE

ARE YOU A NATURALIZED CITIZEN?

NO

YES

IF NO, PROVIDE ALIEN REGISTRATION #

NO

IF YES, PROVIDE NATURALIZATION DATE/ALIEN #

PART II - GOVERNMENT SPONSOR INFORMATION
***Signing this form is a release of Information (ROI)***
GOVERNMENT SPONSOR(Last, First, Middle)

SPONSOR PROGRAM OFFICE

BUILDING/ROOM/SUITE ENTRY DOOR TO BE
ACCESSED BY APPLICANT (OPTIONAL)**

POC PHONE NO.

LENGTH OF ACCESS REQUIREMENT
Start Date
End Date

SPONSOR'S EMAIL

SIGNATURE OF SPONSOR

DATE

PART III - NEED TO KNOW VERIFICATION
NEED TO KNOW**
The following person has the "NEED TO KNOW" for access to Area B for the following purpose
Permanent Duty

Briefing

Contracted Business

Temporary Duty

PART IV - TO BE COMPLETED BY AGENCY'S SECURITY OFFICER
***Signing this form is a release of Information (ROI)***
SIGNATURE

SPONSOR AGENCY SECURITY OFFICER NAME

INVESTIGATION TYPE

DATE

CONTRACT NO. (IF APPLICABLE) CONTRACT EXPIRATION DATE (IF CURRENT INVESTIGATION ON FILE?
APPLICABLE)

DATE OF INVESTIGATION

INVESTIGATIVE AGENCY

CLEARANCE LEVEL (if applicable)

DATE GRANTED

UNCLASSIFIED - FOUO
FEMA Form FF-900-FY-21-101 (formerly 121-3-1-3B)
(09/21)

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UNCLASSIFIED - FOUO
PART V - AUTHORIZATION - TO BE COMPLETED BY AGENCY'S CONTINUITY COORDINATOR, AGENCY'S CHIEF OF STAFF OR
HIGHER LEVEL OFFICIAL Based upon the information verified in Parts I, II, III and IV, I certify this applicant has the appropriate
clearance and a need to know for access to Area B.
***Signing this form is a Release of Information (ROI)***
AGENCY'S CONTINUITY COORDINATOR OR CHIEF OF STAFF NAME

PHONE NO.

SIGNATURE

DATE

** Information contained within the below fields may cause this form to become classified:
Part 1: EMPLOYER AGENCY/COMPANY
Part 2: SPONSOR PROGRAM OFFICE and BUILDING/ROOM/SUITE ENTRY DOOR TO BE ACCESSED BY APPLICANT
Part 3: NEED TO KNOW
PART VI - SECURITY BRIEFING ACKNOWLEDGEMENT FOR MWEOC AREA B
***Signing this form is a release of Information (ROI)***
I, the undersigned, hereby acknowledge that I have received a security briefing and orientation concerning the nature, protection
and procedures to be followed in having access to Area B, Mount Weather Emergency Operations Center, Mount Weather, Virginia I
have been advised that discussing classified aspects related to Mount Weather Area B with anyone who does not have the proper
security clearance and a valid need-to-know constitutes a security violation. I understand that I will be held responsible if I do not
properly protect classified information, which could jeopardize my security clearance and continued access to Mount Weather. The
DHS FEMA Security Classification Guide, Mount Weather Annex, should be used as a guideline to ensure protection of information
related to Mount Weather. I acknowledge receipt of the Area B security briefing and orientation and fully understand the protection
and safeguarding procedures associated with Area B.
PRINTED NAME

BRIEFING TYPE:
DVD

SOCIAL SECURITY NUMBER

SIGNATURE

WITNESS
The Area B Briefing and Orientation has been witnessed by the undersigned:

VERBAL
PRINTED NAME

SIGNATURE

DATE

NOTE: Signing this form signifies that I understand that this is a release of information (ROI). I understand that any false statement
on any part of my form may be grounds for denying access into Federal Emergency Management Agency controlled facilities, and/
or grounds for prosecution under Title18 USC 1001.
***Please ensure to use a Privacy Act cover sheet and password protect or use other approved methods for the protection of the
applicant's PII when submitting this form***

UNCLASSIFIED - FOUO
FEMA Form FF-900-FY-21-101 (formerly 121-3-1-3B)
(09/21)

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