Ae Form 190-16a - Application For Installation Access
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APPLICATION FOR INSTALLATION ACCESS
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page
(AE Reg 190-16)
PRIVACY ACT STATEMENT (For U.S. Citizens)
Authority: 5 USC 301, Departmental Regulations; 10 USC 113, Secretary of Defense, Note at Public Law (P.L.) 106-65; 10 USC 136, Under Secretary of
2
Defense for Personnel and Readiness; 18 USC 1029, Fraud and Related Activity in Connection With Access Devices; 18 USC 1030, Fraud and Related
3
Activity in Connection With Computers; 40 USC, Information Technology Management; 50 USC, Chapter 23, Internal Security; P.L. 103-398, Government
Information Security Act; P.L. 100-235, Computer Security Act of 1987; P.L. 99-474, Computer Fraud and Abuse Act of 1986; Executive Order 9397,
Numbering System for Federal Accounts Relating to Individual Persons.
Principal purpose(s): To identify personnel authorized routine or recurring access to installations under U.S. control.
Routine use(s): Those permitted under 5 USC 522a(b) of the Privacy Act and as specifically allowed outside the DOD pursuant to 5 USC 522a(b)(3) of the
Privacy Act.
Disclosure: Voluntary; however, failure to provide any item of information will result in denial of entry onto U.S.-controlled installations.
Please refer to the instructions on page 3 to ensure that the form is correctly filled in.
1. To
2. From
3. Date (YYYYMMDD)
USAG Stuttgart
SPONSOR'S ORGANIZATION
DATE COMPLETED
6. Applicant's work address (Company,
4. Name (Last, first, MI)
5. Applicant's home address
organization, unit) and telephone no.
VISITOR'S FULL NAME
VISITOR'S HOME ADDRESS
SPONSOR'S UNIT (EX:
EUCOM)
SPONSOR'S UNIT, (EX: PATCH)
SPONSOR'S WORK DSN NUMBER
7. Person category
8. Country of citizenship
9. Personal ID number
Family Member (not in Europe)
EX:
USA
MUST BE PASSPORT NUMBER
10. Supporting document expiration date
11. Residence permit required?
12. Work permit required?
(Passport/ID card)
PASSPORT EXPIRATION DATE
Yes
No
Yes
No
13. Access requested
14. Date of birth
15. Weight
16. Height
Installation pass
(YYYYMMDD)
(Pounds)
(Inches)
17. Eye Color
18. Hair Color
Temporary installation pass
19990101
130
70
EX: BLUE
EX: BROWN
Common Access Card
19. Limitations/time/day access is required
20. Pass expiration date (YYYYMMDD)
DATE GUEST LEAVES
MUST BE DAYS OF THE WEEK & TIMES, EX: MON-FRI, 0001-2400
FPCON RESTRICTION MUST ALWAYS BE "BRAVO"
IACO registrar must validate
Bravo
21. FPCON restriction
Justification
(Refer to page 3 for justification requirements.)
22. Installations for which access is required (Provide justification.)
WHAT INSTALLATIONS WOULD YOU LIKE YOUR GUESTS TO ACCESS IN THE USAG STUTTGART AREA ONLY.
Justification
WHY DOES YOUR GUEST NEED ACCESS.
EX: FAMILY VISITING
GUESTS ARE NOT ALLOWED TO HAVE SIGN-IN PRIVILEGES.
23. Visitor-sponsor/sign-in privileges
No
Yes (Provide justification.)
Justification
AE FORM 190-16A, MAY 17
Previous editions are obsolete.
LCD Vers. 01.00
Page 1 of 3
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