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Guidelines for Completing & Signing DOE Form 5631.20 for Classified Visits to Los Alamos National Laboratory

DOE Form 5631.20 (formerly DOE Form DP 277) is confusing to fill out and not all the information needed for approval is obvious. The table below should prove extremely helpful, if followed, in processing requests from other organizations for classified visits to Los Alamos National Laboratory (LANL). If certain key information is missing, the request will be returned to the submitting organization. This form must be signed by the visitor's Security Officer. If Weapon Data is requested, per DoD Directive 5210.2, the form must be signed by the titled authorizing DoD official on DoD's current list of certified personnel.

NOTE: DO NOT initiate a classified visit request by submitting this form to the LANL host of the visitor. Depending on the circumstances, it should be submitted to either DOE Headquarters (Fax: 301/903-3395) or the LANL Control of Classified Visits Program (Fax: 505/667-9194).

Name of Box

What to Enter / Comments
To

IF VISIT INVOLVES ACCESS TO:

Weapon Data (SRD or TSRD and Sigma 1-15 LANL only) send to: DOE/HQ/NNSA Office of Nuclear Safeguards and Security Programs (NA-55) (Fax: 301/903-3395)

Weapon Data (SRD or TSRD and Sigma 1-10 LANL only) and program is Reimbursable or Phase III (or beyond) send to: Los Alamos National Laboratory Control of Classified Visits Program (Fax: 505/667-9194)

SRD or TSRD and No Weapon Data (NWD) send to: Los Alamos National Laboratory Control of Classified Visits Program (Fax: 505/667-9194)

SNSI or below
send to: Los Alamos National Laboratory Control of Classified Visits Program (Fax: 505/667-9194)

OR

IF VISITOR:

Holds a DOE Clearance but does not work for DOE or one of its contractor sites, send to: DOE/HQ/Classified Visit Coordinator, SO-213.3 (Fax: 301/903-4816)

From Name and address of visitor's organization
Date Enter date form is prepared and submitted
Prepared by Enter name of Point of Contact for questions
Symbol Optional; may be used for internal tracking by visitor's organization
Telephone No. MANDATORY: Point of Contact's telephone number
Last Name, First, Middle Initial and Social Security Number Name and SSN of each traveler for the visit.
Check (Citizenship) Self-explanatory
Date of Birth Self-explanatory
Organization Visitor's employer or organization visitor is representing
Type Clearance DOE or DoD clearance (e.g., L, Q, S, TS). Interim DoD clearances can not be accepted.
Clearance No. Applies to and is required for a DOE clearance only
Date of Clearance Required for both DOE and DoD clearances
Name of Facility(ies) to be Visited Los Alamos National Laboratory
For Inclusive Dates 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. Also note that some visits may be approved by DOE for a shorter period than one year.
DOE Security Official Verifying DOE Clearance Applies to visits from DOE sites only
For the Purpose of Provide sufficient detail to justify the visit, including access to weapon data if being requested. The text entered here must not reveal classified information. If the visit is under a Reimbursable program, indicate the program name or contract number. If a Phase III (or beyond) program, so indicate. If the visit involves accessing the LANL "Blue Room" this must be indicated.
To Confer with the Following Person(s) List the LANL host(s) - that is, the person(s) to be visited; do not list the LANL Security Officer as the host. It is also very helpful to list the host's LANL organization and telephone number.
Specific Information to Which Access is Requested Provide the DOE classification level and category of the information to which the visitor needs access including, if appropriate, DOE weapon data categories (Sigma) LANL only- do not list CNDWI here.
Access Requested to Check the appropriate boxes. If access to weapon data is being requested, both boxes must be checked YES
Prior arrangements have/have not been made as follows Optional
Certification for Personnel Having DOD Clearance MANDATORY for visitors holding a DoD clearance. Weapon Data access varies, depending on whether visitor(s) have been CNWDI briefed or not. Failure to check the appropriate CNDWI box will be interpreted to mean the visitor has not been CNDWI briefed.

If no Weapon Data is being requested, only the name and title of an authorized security individual is required. If Weapon Data is being requested, name, title, and signature are required and must be on DoD's list of certifying DoD officials, per DoD Directive 5210.2. The titled authorized DoD official on the list may delegate signature authority to other security personnel within the organization, but if a delegated person signs, the statement "For or by direction of...(certifying official)" must appear.
Certification for Personnel Having a DOE Clearance MANDATORY for visitors holding a DOE clearance. The visitor's manager must sign and fill in title. The visitor may not sign his/her own request - a higher level of management must sign.
Part "B" Do NOT sign in this section. Leave blank.

 


  
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