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6006 Form p1 - Supervisor Initiate Request - Google Forms
ICR 202611-3095-001 · OMB 3095-0057 · Object 174862900.
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Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | 6006 Form p1 - Supervisor Initiate Request - Google Forms |
| Last Modified By | Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KH |
| File Modified | 2025-02-13 |
| File Created | 2025-02-13 |
| Conversion State | complete |
Extracted Text
NA Form 6006, Facility Access Media (FAM) Request 6006 Form Part 1 - Authorizing Official Initiate PIV/Access Request * Indicates required question 1. Email * Privacy Act Statement In compliance with the Privacy Act of 1974, the following information is provided: Solicitation of the information is authorized by 44.U.S.C. 2104. Disclosure of the information is voluntary. The information provided will be used to prepare and issue an identification card or pass. Additionally, the information may be provided to an expert, consultant, or contractor of NARA to assist NARA in the performance of its duties. If some or any of the information is not provided by the candidate, the effect will be that the Facility Access Media may not be issued, resulting in the candidate being denied access to NARA facilities and IT systems. Paperwork Reduction Act Public Burden Statement You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Public burden reporting for this collection of information is estimated to be 3 minutes per response. Send comments regarding the burden statement or any other aspect of the collection of information, including suggestions for reducing this burden to the National Archives and Records Administration (MP), 8601 Adelphi Road, College Park, MD 20740-6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. NA Form 6006 (07-23) Required by NARA 275 OMB Control No. 3095-0057, Expiration date: 01/31/2027 Request Details 2. Supervisor/Hiring Manager Phone Number Candidate Information and Request Type Authorizing officials cannot submit requests for themselves. 3. Candidate's Legal First Name * 4. Candidate's Legal Last Name * 5. Candidate's email address * 6. PIV Request Type * Please read the choices below carefully. If current PIV is lost, expiring, damaged or has an expired certificate, select Replacement PIV. If new PIV is needed for 15 days to 6 months, select PIV-I. If new PIV is needed for 6 months or more, select New PIV. Mark only one oval. Replacement PIV PIV-I New PIV Skip to question 8 Skip to question 8 Replacement Reason 7. What is the reason for the replacement? * Mark only one oval. Damaged Lost Expired Other: Employee Information 8. (Optional) When will the employee be starting with NARA? If known, add the date below. Example: January 7, 2019 9. Is the candidate a NARA employee? * Mark only one oval. Yes No Term Employee Skip to question 11 10. Is the candidate a term employee? * Mark only one oval. Yes No The candidate is a Voluntary Intern Candidate Information This section applies to all employees including contractors. 11. Candidate's NARA Office Code * Mark only one oval. A AC ACO ACO1 ACO2 ACOS ACP ACPP ACPS ACR ACR1 ACR2 ACR3 ACR4 ACRC ACRS ACT ACT1 AF AFC AFN AFN-C AFN-CO AFN-CR AFN-M AFN-MC1 AFN-MC2 AFN-MC3 Dropdown AFN-MC4 AFN-MC5 AFN-MO AFN-MR AFO AFOD AFOE-AT AFOE-BO AFOE-CH AFOE-DT AFOE-FW AFOE-KR AFOE-PA AFOE-PF AFOP AFOR AFOR-R AFOR-S AFOT AFOW AFOW-DV AFOW-KC AFOW-LS AFOW-LX AFOW-RS AFOW-SB AFOW-SE AISOO AISOO-C ANDC AOGIS B B-AC BF BFF BFS BQ BQA BQB BQC BQD BQE BQF BQK BQP BQS BQU BR BX C CA CH CM F FD FL FP H HL HS HT I IB ID IG IJ IM IO IQ IR IS IT L LA LL LO LW M MP NCON ND NEEO NGC NHPRC OIG P PE PL PL-BHO PL-DDE PL-DJT PL-FDR PL-GB PL-GRF PL-GRFM PL-GWB PL-HH PL-HST PL-JC PL-JFK PL-LBJ PL-RN PL-RR PL-WJC PW R RF RR RR1 RR1M RR1P RR1R RR2 RR2A RR2R RRE RREA RREP RRER RRET RRF RRFA RRFB RRFC RRFD RRFE RRFF RRFK RRFN RRFP RRFR RRFS RRP RRPO RRS RRSC RRSM RRSS RX RXC RXM RXS RXT RZ RZA RZT S S-A SC SE ST V VE VM VP VW X XA XB XF XT Z 12. Is the candidate's duty station their home? Mark only one oval. Yes, the candidate is remote. No, the candidate's duty location is at a facility. 13. Candidate's Duty Location (Facility Name or Remote and the address of the facility or office) 14. Candidate's Duty Zip Code * 15. Candidate's Position/Title * * 16. Is the candidate a contractor? * Mark only one oval. Yes No Skip to question 22 Contractors 17. Which of these apply? * Mark only one oval. The contractor is expected to be with NARA for 15 days or less. The contractor is expected to with NARA for 15 days to six months. The contractor is expected to be with NARA for six months or more. 18. Please attach the completed OF-306 (for Contractors only) * Files submitted: 19. Is the candidate on a Classified Contract? * Mark only one oval. Yes No Skip to question 22 Classified Contract Information This section applies to CONTRACTORS ONLY. 20. NARA Classified Contract Number * 21. Clearance Level Required * Agency Role 22. Candidate agency role (check all that apply) * Check all that apply. Not applicable Building manager OIG special agent Public affairs official Safety official Security official Federal emergency response official Other: 23. Candidate access. Explain required access areas needed (e.g, offices, stacks, labs, etc.) 24. Does the candidate require 24-hour building access? This requires approval by the * facility designated official. Mark only one oval. Yes No Skip to question 26 * 24 Hour Access - Designated Official Approval 25. Please upload a PDF of the approval email from the facility designated official approving 24-hour access for this employee. * Files submitted: Candidate Affiliation 26. Candidate affiliation (check all that apply) For Voluntary (Unpaid) Intern only select Voluntary (Unpaid) Intern. * Check all that apply. Federal Employee Voluntary (Unpaid) Intern Intern (Pathways) Foreign National Contractor Volunteer Foundation Employee Employee of Another Federal Agency 27. To what agency or organization does the candidate belong? (Federal agency or, if * contractor, firm's name) PIV Sponsor Location 28. If the candidate is within 50 miles of a NARA facility, please select the facility below. Mark only one oval. Candidate is REMOTE and not within 50 miles of a NARA facility. Abilene, KS Skip to question 32 Ann Arbor, MI Skip to question 32 Atlanta, GA Skip to question 32 Austin, TX Skip to question 32 Boston, MA Skip to question 32 Broomfield, CO Skip to question 32 Centerville, OH Skip to question 32 Chicago, IL Skip to question 32 College Park, MD Skip to question 32 College Station, TX Dallas, TX Skip to question 32 Skip to question 32 Ellenwood, GA Skip to question 32 Fort Worth, TX Grand Rapids, MI Skip to question 32 Hoffman Estates, IL Hyde Park, NY Skip to question 32 Independence, MO Kansas City, MO Keyser, WV Skip to question 32 Skip to question 32 Skip to question 32 Lees Summit, MO Lenexa, KS Skip to question 32 Skip to question 32 Skip to question 32 Little Rock, AR Miamisburg, OH Skip to question 32 Skip to question 32 Moraine, OH Skip to question 32 Morrow, GA Skip to question 32 New York, NY Skip to question 32 * Perris, CA Skip to question 32 Philadelphia, PA Plano, TX Skip to question 32 Skip to question 32 San Bruno, CA Seattle, WA Skip to question 32 Skip to question 32 Simi Valley, CA Skip to question 32 Spanish Lake, MO Skip to question 32 Suitland, MD Skip to question 32 Valmeyer, IL Skip to question 32 Waltham, MA Skip to question 32 Washington, DC Skip to question 32 West Branch, IA Skip to question 32 Yorba Linda, CA Skip to question 32 If the candidate is not within 50 miles of a NARA facility (REMOTE EMPLOYEES ONLY), where will the candidate go for their id card appointment? 1. Navigate to https://fedidcard.gov in a new window. 2. Select the link to Find a credential center. 3. Change the Activity filter dropdown to Enrollment/Activation. 4. Change the State or territory dropdown to the candidate's home state and select the Filter button. 5. In the filtered list, find a facility near the candidate with a Center type of Shared. 6. Copy and paste the Agency, Address, and Special Instructions below. 29. Enrollment/Activation: Agency 30. Enrollment/Activation: Address 31. Enrollment/Activation: Special Instructions Final Submission Once you submit, this information will be accessible to the Personnel Security Office and the Physical Security Office. 32. Is there anything else we need to know to process this request? This content is neither created nor endorsed by Google. Forms