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Guidelines for Completing & Signing
DOE Form 5631.20
(for outgoing classified visits)

DOE Form 5631.20 (formerly DOE Form DP 277) is confusing to fill out and not all the information needed for approval is obvious, based on what the form requests. The table below should prove extremely helpful, if followed, in expediting Group requests for LANL visits to other classified facilities. Items in White must be supplied or form cannot be processed and will be returned to requesting Group. Items in Navy are completed by the Badge Office.

Name of Box

Who Enters

Comments

To Group Enter the name of the facility to be visited
From Badge Office  
Date Group Enter date form is prepared and submitted
Prepared by Group Enter name of Group's Point of Contact
Symbol Group Optional; may be used to designate a memorandum number, Group abbreviation
Telephone No. Group Group Point of Contact's telephone number
Last Name, First, Middle Initial and Social Security Number Group Name and SSN of each traveler for the visit. Use continuation sheet for additional names. NOTE: If visit is to a non-U.S. facility, the following must also be included in this box: Place of Birth (City, State, Country), Home Address, Job Title. If the visit is to a United Kingdom facility, it is absolutely critical to include traveler(s)' Passport Number and Expiration Date, plus the VISAM number.
Check (Citizenship) Group  
Date of Birth Group  
Organization Group Enter "LANL" plus the Group designation
Type Clearance Badge Office  
Clearance No. Badge Office  
Date of Clearance Badge Office  
Name of Facility(ies) to be Visited Group List facility to be visited under this request. Only list one facility on a single request.
For Inclusive Dates Group Maximum of one year. NOTE: If the end date is the same as the start date, but one year later, this is considered one year + one day; make sure the end date is one day less than the start date but one year later.
DOE Security Official Verifying DOE Clearance Badge Office Badge Office Security Officer with approval authority signs if clearance is in order..
For the Purpose of Group Enter the purpose of the visit to the extent known
To Confer with the Following Person(s) Group List the host(s) at the facility being visited; it is extremely helpful to include fax and telephone number of each host, if unforeseen problems need to be quickly resolved.
Specific Information to Which Access is Requested Group The classification level and category of the information to which the traveler needs access including, if appropriate, nuclear weapon information categories (Sigma) LANL only or CNDWI
Access Requested to Group Check the appropriate boxes. If "NO" is checked for both choices, the request for access to classified information will be denied.
Prior arrangements have/have not been made as follows Group Describe any advance arrangements that have been made.
Certification for Personnel Having DOD Clearance Not Applicable Leave blank. NOTE: If a LANL traveler has a DoD clearance and intends to have that clearance extended to the DoD facility to be visited, arrangements need to be made directly with the visiting facility's Security Office. Do NOT submit the form to the Badge Office.
Certification for Personnel Having a DOE Clearance Group The Group Leader or Deputy Group Leader signs and fills in title. The traveler may not sign his/her own request - a higher level of management must sign. NOTE: If the visit is to be to the LLNL Weapons Vault or the SNL/NM Weapons Vault, the Laboratory Director or designee must sign here and is the only person who can sign.
Part "B" Not Applicable Do NOT sign in this section. Leave blank.

 

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