Request For Unclassified Foreign National Access Page 6
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7NETL F 142.1-1
U.S. DEPARTMENT OF ENERGY
Revised: 11/13/2013
Reviewed: 11/13/2013
REQUEST FOR UNCLASSIFIED
(Page 6)
FOREIGN NATIONAL ACCESS
SECTION H – INSTRUCTIONS
Block 1a.
If no middle name, enter “NMN.”
Block 3.
Access by foreign nationals 17 years of age or younger who are involved in non-work-related activities, are exempt from
the NETL foreign national access request, review, and approval process.
Block 9.
A Social Security Account Number (SSAN) is required for all foreign nationals with an access period “Greater than 30
calendar days,” i.e., FN Assignment.
Block 10.
Other identification documentation may include driver’s license, student ID, Employment Authorization Document,
Form I-797C (Notice of Action), etc.
Block 17.
All foreign nationals with an F-1 Student Visa (and J-1 Visa students) must provide a list of all schools attended and the
graduation dates from each school. In addition, a letter from the host school (Responsible Officer or Designated School
Official) is required stating that the student is enrolled full-time (12 hours per week minimum) prior to access start date. A
copy (pages 1 and 2) of the USCIS Form I-20 A-B/ID (Certificate of Eligibility for Nonimmigrant (F-1) Student Status - for
Academic and Language Students), or Form DS-2019 (Certificate of Eligibility for Exchange Visitor (J-1) Status) must
also be provided by the student’s host school.
Block 19a.
Unclassified events and activities that occur outside the U.S. or its territories are exempt from the NETL foreign national
access request, review, and approval process. All foreign national contracted employment, regardless of the actual work
location, (e.g., on-site, off-site, or split), is considered an access period “Greater than 30 calendar days,” i.e., FN
Assignment.
Block 20.
Choose one of the following that best describes the access purpose:
-
Commercial/Contractor Services
-
High-Level/Protocol Visit
-
Speech or Presentation
-
Conference/Meeting/Workshop Attendance
-
Information Meeting
-
Training
-
DOE or DOE Contractor Employee
-
R&D Tour
-
Experimental
-
Research
Block 21.
List all subject areas pertaining to access, or the specific NETL-sponsored event.
Block 22.
If applicable, include the title and contract number pertaining to the foreign national access, and describe what role/effort
the foreign national will play in the contract. Explain what the foreign national will be expected to accomplish during this
access period as related to their described role/effort, and further, how his/her presence is to benefit DOE (in whole or
part) in terms relative to stated goals (contractual or otherwise).
Block 23.
If Yes, NETL Form 205.2-4 must be completed. Personal laptop use on-site will require completion of additional forms as
listed on NETL Form 205.2-4.
Block 24.
Include all actual or estimated costs associated with the access period that will be charged back to DOE, (e.g., travel
expenses, training, salary and/or benefits, etc.).
Block 25a.
The Office Symbol is the numeric code assigned to the division of the DOE Contact, (e.g., 100, 320, 610, etc.).
Block 26a.
The Office Symbol is the numeric code assigned to the division of the Host, (e.g., 100, 320, 610, etc.).
Block 31.
Indicate or estimate the total numbers of days the foreign national is expected to be on an NETL site for the full access
period, (e.g., one day per week, month, etc., or twice weekly, or 10 days per month, or 365 days per year, etc.).
Block 32.
The “Primary Location” is the place (on-site, off-site, or split) where the majority of the access will occur. For an access
period “Greater than 30 calendar days,” i.e., FN Assignment, indicate where the foreign national may be badged or have
an office location. If the “Primary Location” is off-site or split between on-site and off-site, or if different than Block 11a. or
Block 11b., also include that place, location, or address.
Block 33a.
Only indicate applicable “NETL” sites.
Block 33b.
The foreign national must be escorted by the approved host/alternate host at all times when outside any common areas,
(e.g., cafeterias, restrooms, lobbies, courtyards, etc.), and any specific, on-site work areas identified.
Block 33d.
Requirements for one-time, short-term changes to the approved site access times can be found in NETL P 470.4-10.23,
Foreign Nationals Access and Control.
NOTE:
See Section K (below) if you are requesting Section A – Personal Data information directly from the prospective foreign
national visitor or assignee.
NOTE:
New sensitive country access requests for periods “Greater than 30 calendar days,” i.e., FN Assignment, and whose
indices have not yet cleared when presented for access approval - namely those foreign nationals with no FACTS/DOE
history - may receive access approval for only normal business times/days until indices has cleared.
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