The SECNAV 5512/1 form serves as a vital document for controlling physical access to Department of Defense (DoD), Department of the Navy (DON), or U.S. Marine Corps installations, units, and facilities. It ensures the security of sensitive areas by recording personal identification, managing badge issuance, and maintaining entry and exit logs for designated individuals. For those in need of access to such facilities, it's crucial to understand the form's purpose, disclosure policies, and the information required for completion. Click the button below to learn more about how to properly fill out the SECNAV 5512/1 form.
The SECNAV 5512/1 form is a critical document designed for individuals seeking access to Department of Defense (DoD), Department of the Navy (DON), or U.S. Marine Corps installations, facilities, or areas. Detailed under the guidance of federal mandates such as 10 U.S.C. 5013, 10 U.S.C. 5041, Navy and Marine Corps security program manuals, and Executive Order 9397, this form serves multiple significant purposes. Primarily, it helps in controlling physical access to sensitive sites by verifying individuals through biometric and data processing services, thereby enhancing the protection of U.S., allied government, and national security areas. The form also plays a vital role in the issuance, replacement, and retrieval of access badges, maintenance of visitor statistics, collection of information for access adjudication, and tracking the entry and exit of personnel. Moreover, it outlines the routine use of collected information, which includes sharing with designated contractors, federal agencies, and foreign governments to facilitate Navy officials' access to various facilities. The importance of providing accurate information is underscored by the form, noting that failure to do so may result in denied access benefits or entry into DoD installations. Furthermore, the document covers identity proofing, applicant information requirements, and mandates the return of the Local Population Identification Card upon expiration or employment termination, alongside authorization and release for background checks by authorized federal agencies. It stands as a comprehensive tool for ensuring the security and proper management of access to military installations and facilities, reflecting a structured approach to safeguarding national security interests.
OMB 0703-0061 Exp. 31 Mar 2017
DEPARTMENT OF THE NAVY LOCAL POPULATION ID CARD/BASE ACCESS PASS REGISTRATION
PRIVACY ACT STATEMENT:
AUTHORITY: 10 U.S.C. 5013, Secretary of the Navy; 10 U.S.C. 5041, Headquarters, Marine Corps; OPNAVINST 5530.14E, Navy Physical Security; Marine Corps Order 5530.14A, Marine Corps Physical Security Program Manual; and E.O. 9397 (SSN), as amended, SORN NM05512-2 .
PURPOSE(S): To control physical access to Department of Defense (DoD), Department of the Navy (DON) or U.S. Marine Corps Installations/Units controlled information, installations, facilities, or areas over which DoD, DON, or U.S. Marine Corps has security responsibilities by identifying or verifying an individual through the use of biometric databases and associated data processing/information services for designated populations for purposes of protecting U.S./Coalition/allied government/national security areas of responsibility and information; to issue badges, replace lost badges, and retrieve passes upon separation; to maintain visitor statistics; collect information to adjudicate access to facility; and track the entry/exit times of personnel.
ROUTINE USE(S): To designated contractors, Federal agencies, and foreign governments for the purpose of granting Navy officials access to their facility.
DISCLOSURE: Providing registration information is voluntary. Failure to provide requested information may result in denial of access to benefits, privileges, and DoD installations, facilities and buildings.
IDENTITY PROOFING AND APPLICANT INFORMATION
1. LAST NAME:
2. FIRST NAME:
3. MIDDLE NAME:
4. NAME SUFFIX:
Jr. Sr.
I
II III IV
5.
HISPANIC OR
6. RACE
AFRICAN AMERICAN
AMERICAN INDIAN OR
NATIVE HAWAIIAN
YES
NO
WHITE
ASIAN
OR OTHER PACIFIC
LATINO (Check one):
(Check one or more):
OR BLACK
ALASKIN NATIVE
ISLANDER
7.
GENDER
MALE
FEMALE
8. DATE OF BIRTH:
9. CITY OF BIRTH:
10. STATE OF BIRTH:
11. BIRTH COUNTRY:
(Check one):
12. US CITIZEN (Check):
13.DUAL CITIZENSHIP: YES NO CITIZENSHIP IF OTHER THAN US (Country) :
U.S. Citizen Minimum Documentation Required:
By Birth - Social Security No and/or State ID/Drivers License.
Naturalized - Certification Number, Petition Number, Date, Place and Court, United States passport number, Social Security No and/or State ID/Drivers License.
Derived - Parent's certification number, Social Security No and/or State ID/Drivers License.
Alien Minimum Documentation Required:
Registration Number, Expiration date, Date of entry, Port of entry.
14. IDENTITY SOURCE
15. DOCUMENT NUMBER:
16. ISSUED BY
17. ISSUED BY
18. ISSUED:
19. EXPIRES:
DOCUMENTS PRESENTED:
STATE/COURT:
COUNTRY:
Social Security No.
UNITED STATES
State ID/Drivers License
Passport No.
Certification Number and
Petition Number
Derived - Parent's
Certification Number:
Alien Registration No.
Date of Entry:
Port of Entry:
OTHER APPROVED IDENTITY SOURCE DOCUMENTS:
20.WEIGHT
(Pounds):
21.HEIGHT
(Inches):
22. HAIR COLOR (Check one):
23. EYE COLOR (Check one):
Blond
Brown
Black
Gray
Red
Green
Blue
Hazel
White
Silver
Auburn
Bald
Violet
Unknown
24. HOME ADDRESS (Include city, state, zip code):
HOME PHONE (Include Area Code):
25. BASE SPONSOR'S NAME:
SPONSOR PHONE (Include Area Code):
EMPLOYMENT ACTIVITY INFORMATON
26.EMPLOYER NAME AND ADDRESS (Include city/state/zip code):
EMPLOYER PHONE (Include Area Code):
27.SUPERVISOR NAME AND ADDRESS (Include city/state/zip code):
SUPERVISOR PHONE (Include Area Code):
SECNAV 5512/1 (APR 2014)
FOR OFFICIAL USE ONLY WHEN FILLED - PRIVACY SENSITIVE:
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Any misuse or unauthorized disclosure of this information may result in both criminal and civil penalties.
28.Check the applicable box for WORK HOURS box or check the OTHER box and enter the work hours, then check the applicable for WORK DAYS:
WORK HOURS:
0600-1800
0800-1700
OTHER
WORK DAYS:
SN
M
T
W
TH
F
ST
PRIOR FELONY CONVICTIONS
29. Have you ever been convicted of a Felony?
_______ Initial
REQUIREMENT TO RETURN LOCAL POPULATION ID CARD
30.I understand that I am required to return my Local Population Identification Card to the Base Pass Office when it expires or if my employment is terminated for any reason. ________ (initial)
AUTHORIZATION AND RELEASE AND CERTIFICATION
31.I hereby authorize the DOD/DON and other authorized Federal agencies to obtain any information required from the Federal government and/or state agencies, including but not limited to, the Federal Bureau of Investigation (FBI), the Defense Security Service (DSS), the U.S. Department of Homeland Security (DHS).
I have been notified of DON right to perform minimal vetting and fitness determination as a condition of access to DON installation/facilities. I understand that I may request a record identifier; the source of the record and that I may obtain records from the State Law Enforcement Office as may be available to me under the law. I also understand that this information will be treated as privileged and confidential information.
I release any individual, including records custodians, any component of the U.S. Government or the individual State Criminal History Repository supplying information, from all liability for damages that may result on account of compliance, or any attempts to comply with this authorization. This release is binding, now and in the future, on my heirs, assigns, associates, and personal representative(s) of any nature. Copies of this authorization that show my signature are as valid as the original release signed by me.
FALSE STATEMENTS ARE PUNISHABLE BY LAW AND COULD RESULT IN FINES AND/OR IMPRISONMENT UP TO FIVE YEARS.
BEFORE SIGNING THIS FORM, REVIEW IT CAREFULLY TO MAKE SURE YOU HAVE ANSWERED ALL QUESTIONS FULLY AND CORRECTLY.
I DECLARE UNDER PENALTY OF PERJURY THAT THE STATEMENTS MADE BY ME ON THIS FORM ARE TRUE, COMPLETE AND CORRECT
DATE _______________ SIGNATURE ________________________________________
FINAL DETERMINATION ON YOUR ACCESS: The Base Commanding Officer has final authority for determination on granting physical access to DON controlled installations/facilities under his/her jurisdiction.
BELOW COMPLETED BY BASE REGISTRAR PERSON CONDUCTING IDENTY PROOFING and NCIC CHECK
32. INFORMATION VERIFIED BY:
33. ENTERED IN C/S SYSTEM BY:
34. PASS ISSUE DATE:
35. PASS EXPIRATION DATE:
36. NCIC CHECK PERFORMED BY:
37. RESULTS OF NCIC CHECK:
NO RECORDS
RECORD IDENTIFIER
RECORD NUMBER:
38. RESULTS OF LOCAL RECORDS CHECK:
Office of Under Secretary of Defense Directive-Type Memorandum (DTM) 09-012, "Interim Policy Guidance for DoD Physical Access Control," December 8, 2009. DTM 09-012 requires that DoD installation government representatives query the National Crime Information Center (NCIC) and Terrorist Screening Database to vet the claimed identity and to determine the fitness of non-federal government and non-DoD-issued card holders (i.e. visitors) who are requesting unescorted access to a DoD installation. The minimum criteria to determine the fitness of a visitor is: 1) not on a terrorist watch list; 2) not on an DoD installation debarment list; and 3) not on a FBI National Criminal Information Center (NCIC) felony wants and warrants list. Additionally, SECNAV Memo, Policy for Sex Offender Tracking and Assignment and Access Restrictions within the Department of the Navy, of 7 Oct 08 and OPNAVINST 1752.3 established the Navy's policy on sex offenders, requiring Region Commanders (REGCOMs) and Installation Commanding Officers (COs) to prohibit sex offender access to DoN facilities and Navy owned, leased or PPV housing. This form describes the authority and purpose to collect and share the required information; and identifies the applicant/visitor and sponsor; and authorizes the DoD to perform the minimum vetting and fitness determination criteria. A favorable response on the vetting and fitness determination is required to receive access to DOD-controlled installation/facilities.
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The process of filling out the Secnav 5512/1 form is crucial for individuals seeking access to Department of Defense (DoD), Department of the Navy (DON), or U.S. Marine Corps installations, facilities, or areas. This form serves multiple purposes, including the control of physical access to secure areas, the issuance and management of access badges, and the collection of demographic information for security purposes. Completing this form accurately and thoroughly is essential for ensuring the security of sensitive areas and for facilitating a smooth access process for authorized individuals.
After completing the form, review all the information for accuracy before submitting it to the appropriate office for processing. The information provided will undergo verification, including background checks, to assess eligibility for access to the requested facilities. It is crucial to provide complete and correct information to avoid delays or denial of access. Ensure that all documentation supporting your application is readily available and submitted along with the form, as per the instructions provided by the issuing authority or office.
What is the purpose of the SECNAV 5512/1 form?
The SECNAV 5512/1 form is used by the Department of the Navy to control physical access to Department of Defense (DoD), Department of the Navy (DON), or U.S. Marine Corps installations, facilities, or areas. Its main purpose is to identify or verify individuals through biometric databases and associated data processing/information services. This is essential for protecting U.S./Coalition/allied government/national security areas. The form is also used for issuing badges, replacing lost badges, and collecting information to adjudicate access to facilities.
Who needs to fill out the SECNAV 5512/1 form?
This form must be filled out by individuals who require access to Department of Defense, Department of the Navy, or U.S. Marine Corps installations, facilities, or secure areas. This includes but is not limited to military personnel, civilian employees, contractors, and visitors who need unescorted access to these areas.
What documents are required to complete the SECNAV 5512/1 form?
Depending on your citizenship status, various documents are required. U.S. citizens need to present a minimum of their Social Security Number and/or State ID/Driver's License. For naturalized citizens, additional documents such as the Certification Number, Petition Number, and United States Passport Number are required. Non-U.S. citizens must provide their Alien Registration Number, expiration date, date of entry, and port of entry among other documents.
Is providing information on the SECNAV 5512/1 form mandatory?
Providing information on the SECNAV 5512/1 form is voluntary. However, failure to provide the requested information may result in denial of access to benefits, privileges, and DoD installations, facilities, and buildings.
What are the consequences of providing false information on the form?
Providing false statements on the SECNAV 5512/1 form is punishable by law. Individuals who provide inaccurate or dishonest information may face fines and/or imprisonment for up to five years. It is crucial to review all entries carefully and ensure that all provided information is true, complete, and correct.
Who has the final say in granting access to DoN controlled installations/facilities?
The Base Commanding Officer holds the final authority in determining whether physical access to Department of the Navy controlled installations and facilities is granted. This decision is based on a thorough review of the information provided on the SECNAV 5512/1 form, as well as the results of any required background checks.
When filling out the Secnav 5512/1 form, certain mistakes are commonly made, impacting the process negatively. A frequent error is not checking the document’s expiration date, leading to submissions with outdated forms. Ensuring you're working with the most current form avoids unnecessary delays.
Another common mistake involves incorrect or incomplete personal information in sections 1 through 11. It is critical to double-check entries for accuracy, especially names, birth date, and citizenship details, as these are essential for identity verification. Providing incorrect information can lead to significant delays or denial of access.
Often, applicants fail to correctly document their citizenship status, particularly if holding dual citizenship. This detail is crucial for the adjudication process and must be accurately filled in, reflecting the applicant's current status. Misrepresentation or errors in this section can complicate or extend the vetting process.
A recurring issue also lies in the proper documentation of identity proofing and applicant information. Sections 13 through 19 require careful attention to ensure that all documents presented are valid, accurately reflected, and not expired. The failure to provide correct document numbers, issuance details, and expiration dates can significantly hinder the approval process.
Furthermore, applicants sometimes overlook the importance of correctly listing their employment activity information, including accurate employer and supervisor details in sections 26 and 27. This information aids in the verification of an applicant's purpose for access, and mistakes here can cast doubt on the application's validity.
The declaration of prior felony convictions (or lack thereof) in section 29 is often mishandled. Failing to truthfully disclose this information can lead to legal repercussions and denial of access. Honesty in this section is paramount for the integrity of the security process.
Another notable mistake is not understanding the requirement to return the Local Population ID Card as stated in section 30. Overlooking this obligation can cause administrative issues or even result in access being revoked for non-compliance.
In sections 31 and beyond, where authorization, release, and certification are necessary, applicants sometimes sign without thoroughly reviewing the document. This oversight can lead to inaccuracies on the form, potentially leading to legal troubles or the need to resubmit.
Last but not least, ensuring that the form is signed and dated correctly as per the final section before the signature is crucial. An unsigned or undated form is considered incomplete and will not be processed, delaying or even denying access.
When processing or accompanying the SECNAV 5512/1 form, which is used for Department of the Navy local population ID card/base access pass registration, several other forms and documents might also be important. These documents serve various purposes, from verifying identity to ensuring security compliance.
The compilation of these documents, alongside the SECNAV 5512/1 form, plays a crucial role in managing security and ensuring safe and regulated access to Navy and Marine Corps installations and facilities. The process protects sensitive areas and information, maintaining the integrity and security of military operations.
The SECNAV 5512/1 form bears similarity to the "DD Form 1172-2 - Application for Identification Card/DEERS Enrollment" due to its function in verifying identity and authorizing access to specific populations within the Department of Defense (DoD) framework. Like the SECNAV 5512/1, the DD Form 1172-2 collects personal identification information and documentation proof to manage access and privileges within military facilities and systems. Both forms play crucial roles in maintaining security protocols, ensuring that access is granted to eligible individuals, thus safeguarding personnel and sensitive areas from unauthorized entry.
Another document with functional likeness is the "I-9 Employment Eligibility Verification" form used within the civilian workforce to verify the identity and employment authorization of individuals hired for employment in the United States. Although the I-9 form is utilized in a different context, the core purpose aligns with the SECNAV 5512/1's objective of verifying an individual's identity and eligibility. Both documents require personal information and documentary evidence to authenticate status – in one case for employment eligibility, and in the other, for access to military installations.
The "SF-86 Questionnaire for National Security Positions" also shares commonalities with the SECNAV 5512/1 form. The SF-86 is used to gather information for background checks for individuals seeking to engage in positions affecting national security. Much like the SECNAV 5512/1 form, it collects detailed personal information, including past residences, employment history, and citizenship status, to assess an individual’s eligibility and reliability. Both forms are essential to national security protocols, ensuring that only qualified and vetted individuals gain access to sensitive information and locations.
"FBI FD-258 Applicant Fingerprint Card" is akin to the SECNAV 5512/1 form in terms of its role in identity verification and security clearance processes. The FD-258 card is often used for background checks, capturing fingerprints for individuals applying for certain jobs, licenses, or access to secure areas. While the FD-258 specifically deals with the biometric aspect of security, when combined with the information provided in forms like the SECNAV 5512/1, a comprehensive profile of an individual’s background and eligibility for access or employment is compiled.
Lastly, the "Customs and Border Protection (CBP) Declaration Form 6059B" shares a procedural similarity with the SECNAV 5512/1 form, although it serves travelers entering the United States. This form requires individuals to declare items and provide personal identification details, similar to the identity verification aspect of the SECNAV 5512/1. Both forms are integral to security measures within their respective domains, ensuring the proper vetting of individuals as they access controlled environments, be it a military base or the national border.
When completing the SECNAV 5512/1 form, it's essential to understand the do's and don'ts to ensure the process is smooth and successful. Below are critical guidelines to follow:
When it comes to the Department of the Navy's Local Population ID Card/Base Access Pass Registration, known as the SECNAV 5512/1 form, there are several common misconceptions. Let's address seven of these misunderstandings to provide clarity:
Voluntary Disclosure: Some may think providing information on this form is compulsory without exception. However, the form clearly states that disclosure is voluntary. But, it's important to understand that not providing the requested information could lead to denial of access to facilities and services.
Use of Social Security Number: It's a widespread belief that a Social Security Number (SSN) is not crucial for this form. In reality, the form uses the SSN for identity verification purposes, aligning with E.O. 9397 (SSN), as amended. It's part of the process to ensure the security and protection of U.S. Department of Defense assets.
Access Denial: Another misconception is that denial of a base access pass is final and without recourse. Applicants should note that the SECNAV 5512/1 form includes provisions for reconsideration depending on the circumstances surrounding the denial of access.
Dual Citizenship: There's often confusion about how dual citizenship affects the application process. The form explicitly asks about dual citizenship, allowing individuals to disclose their status, which ensures thorough vetting without automatically disqualifying them from access.
Physical Characteristics: Some might think personal descriptors like height, weight, and eye color are irrelevant. These details, however, are crucial for the creation of accurate and secure identification cards and badges.
Background Checks: It's mistakenly believed that the form leads to extensive criminal background checks for all applicants. While it does allow for a criminal history check through the NCIC, this is part of the minimum vetting process aimed at ensuring the safety and security of military installations.
Automatic Renewals: Lastly, a common misconception is that the Local Population ID Card gets automatically renewed. Holders must understand that they are required to return their ID card to the Base Pass Office upon expiration or termination of employment for any reason, as stated in the form.
Addressing these misconceptions promotes a better understanding of the SECNAV 5512/1 form's purpose, requirements, and the process of obtaining a Department of the Navy Local Population ID Card/Base Access Pass. This clarity ensures individuals are well informed as they complete their application.
Filling out the SECNAV 5512/1 form is a crucial step for anyone seeking to obtain a Local Population ID Card/Base Access Pass to enter Department of Defense (DoD), Department of the Navy (DON), or U.S. Marine Corps installations. Understanding this process and the key details of the form can help ensure a smooth and successful application. Here are some important takeaways:
The SECNAV 5512/1 form functions as a comprehensive tool for ensuring the safety and security of military installations by vetting individuals before granting access, highlighting the careful balance between individual privacy and the overarching need for national security.
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