Request For Unclassified Foreign National Access

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NETL F 142.1-1
U.S. DEPARTMENT OF ENERGY
Revised: 11/13/2013
Reviewed: 11/13/2013
REQUEST FOR UNCLASSIFIED
(Previous Editions Obsolete)
FOREIGN NATIONAL ACCESS
COVER SHEET
FOR
NETL FORM 142.1-1
PRIVACY ACT STATEMENT – Collection of the information is authorized pursuant to Section 145 of the Atomic Energy Act of 1954, as amended
(PL 83-703, 42 USC 2165). The primary purpose of the requested information is to determine unclassified access to facilities operated by the
Department of Energy (DOE) or its contractors. Access to the information collected may be provided to appropriate Federal agencies for law
enforcement purposes. Failure to provide the information may result in denial of access to DOE or contractor facilities and their personnel.
DOCUMENT/FORM attached contains Official Use Only (OUO) information only when completed.
INSTRUCTIONS FOR A COMPLETED NETL F 142.1-1
1.
Utilize this OUO Cover Sheet when transmitting a completed page 2 of this document/form, NETL F 142.1-1.
2.
When separated from a completed page 2, the remaining pages of this document/form are not considered OUO.
3.
As a custodian, handle, transmit, and protect the completed document/form as Official Use Only (OUO) information in accordance
with NETL Procedure 471.3-00.01, Identifying and Protecting Official Use Only Information.
4.
Return the completed document/form to any NETL UFNV&A team member utilizing the provided OUO Cover Sheet.
5.
This OUO Cover Sheet is not required for an Open to the Public Event exemption request. (See Section J, page 7.).
6.
If you have any questions concerning a Request For Unclassified Foreign National Access, contact the UFNV&A Support
Specialist or the NETL UFNV&A Manager.
7.
OFFICIAL USE ONLY
May be exempt from public release under the Freedom of Information
Act (5 U.S.C. 552), exemption number and category: Exemption
Number 6, Personal Privacy.
Department of Energy review required before public release.
Name/Org: K. Witte/NETL/OIO (700)
Date: 13 November 2013
OFFICIAL USE ONLY

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