![](media/image1.png){width="1.25in" height="0.7583333333333333in"}

Lawrence Berkeley National Laboratory

     

Headquarters Management Panel

c/o U.S. Department of Energy

1000 Independence Avenue, SW

Washington, DC 20585

  ----------------- ------------------------------------------------------------
  **Subject:**      Requests for Visits and Assignment of Foreign Nationals from
                    Countries Identified as State Sponsors of Terrorism

                    

  **References:**   DOE O 142.3, Unclassified Foreign Visits and Assignments
                    Program, June 18, 2004
  ----------------- ------------------------------------------------------------

**Request approval from the HQ DOE Management Panel for the following:**

  ------------------ ------------------------- ----------- ---------------------
  **FACTS Request                              **     **   Visit
  No.**                                                    

  **FACTS Visitor                              **     **   Initial Assignment
  No.**                                                    

                                               **     **   Extension of
                                                           Assignment
  ------------------ ------------------------- ----------- ---------------------

+-------------------------------------+--------------------------------+
| **1. Visitor/Assignee Name:**       | **     **                      |
+-------------------------------------+--------------------------------+
| **2****. Start and End Dates:**     |                                |
+-------------------------------------+--------------------------------+
| **3. DOE Facility to be             | Lawrence Berkeley National     |
| visited/assigned to:**              | Laboratory                     |
+-------------------------------------+--------------------------------+
| **4. Purpose of visit/assignment:** |                                |
|                                     |                                |
| > **     **                         |                                |
+-------------------------------------+--------------------------------+
| **5. Justification for access:**    |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **6. Point of contact (respond to   |                                |
| questions):**                       |                                |
|                                     |                                |
| > **Host:**                         |                                |
| >                                   |                                |
| >                                   |                                |
| >                                   |                                |
| > **General Questions:**            |                                |
| >                                   |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **7. Is an International Agreement  |                                |
| involved?**                         |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **8. Identify Agreement:**          |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **9. Visitor Information**          |                                |
+-------------------------------------+--------------------------------+
| > **a. Date of Birth**              |                                |
| > (mm/dd/yyyy):                     |                                |
+-------------------------------------+--------------------------------+
| > **b. Country of Birth:**          |                                |
+-------------------------------------+--------------------------------+
| > **c. Country of Citizenship:**    |                                |
+-------------------------------------+--------------------------------+
| **10. Date of last visit to country |                                |
| of citizenship:**                   |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **11. Country of Current            |                                |
| Residence:**                        |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **12. How long at current           |                                |
| address?**                          |                                |
|                                     |                                |
| > **Current residence:**            |                                |
| >                                   |                                |
| > **Previous residences**:          |                                |
+-------------------------------------+--------------------------------+
| **13. Status:**                     |                                |
|                                     |                                |
|                                     |                                |
+-------------------------------------+--------------------------------+
| **14. Indices Check Complete?**     |                                |
|                                     |                                |
| Yes                                 |                                |
+-------------------------------------+--------------------------------+
| **15. Date Indices Completed:**     |                                |
|                                     |                                |
|                                     |                                |
+-------------------------------------+--------------------------------+
| **1****6. Current Employer**        |                                |
| (Business name and location):       |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **17. Length of Service** (with     |                                |
| current employer):                  |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **18. DOE Host:**                   |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+
| **19. DOE Host Organization & Phone |                                |
| No.**                               |                                |
|                                     |                                |
| >                                   |                                |
+-------------------------------------+--------------------------------+

Attachments

1.  Concurrence/Approval Form

2.  Foreign Assignments Central Tracking System Long Form

3.  Unclassified Foreign National Specific Security Plan

4.  Subject Matter Expert Certification -- Cyber Security

5.  Subject Matter Expert Certification -- Security, Export Control,
    Counterintelligence

6.  Approving Authority Certification

7.  Immigration Documents

8.  Curriculum Vitae

9.  Publications

**Concurrence/Approval Form**

  -------------------------- -- -------------------------- -- ------------
  David C. McGraw, Associate                                  
  Laboratory Director, Chief                                  
  Operating Officer                                           

  Name and Title                Signature                     Date
  -------------------------- -- -------------------------- -- ------------

**Site Office:**

  -------------------------- -- -------------------------- -- ------------
  Aundra Richards, Manager,                                   
  Berkeley Site Office                                        

  Name and Title                Signature                     Date
  -------------------------- -- -------------------------- -- ------------

**DOE Headquarters:**

Lead Program Secretarial Officer (LPSO SC-31)

  -------------------------- -- -------------------------- -- ------------
                                                              

  Name: Van T. Nguyen           Title                         Date
  -------------------------- -- -------------------------- -- ------------

Officer of Foreign Visits and Assignments (SP-62)

  -------------------------- -- -------------------------- -- ------------
                                                              

  Name                          Title                         Date
  -------------------------- -- -------------------------- -- ------------

DOE Management Panel (SO & CN/CI)

  -------------------------- -- -------------------------- -- ------------
                                                              

  Name                          Title                         Date
  -------------------------- -- -------------------------- -- ------------

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**Lawrence Berkeley National Laboratory**

**Unclassified Foreign National Specific Security Plan**

  --------------------------- -------------------------------------------
  **Full Name:**              **     **

  **Citizenship:**                 

  **Birthplace:**                  

  **Employer/Affiliation:**        

  **FACTS Visitor No:**            

  **FACTS Request No:**            

  **Dates of                       
  Visit/Assignment:**         
  --------------------------- -------------------------------------------

+-----------------------------+----------------------------------------+
| **1. References**           |                                        |
|                             |                                        |
| A. LBNL Director's          |                                        |
| Memorandum, Subject:        |                                        |
| Sensitive Subjects Review   |                                        |
| dated March 31, 2003        |                                        |
|                             |                                        |
| B. DOE O 142.3,             |                                        |
| Unclassified Foreign Visits |                                        |
| and Assignments Program,    |                                        |
| June 18, 2004               |                                        |
+-----------------------------+----------------------------------------+
| **2. Immigration Status:**  |                                        |
|                             |                                        |
|                             |                                        |
+-----------------------------+----------------------------------------+
| **2a. Passport no. &        |                                        |
| expiration date:**          |                                        |
|                             |                                        |
| > Passport number:          |                                        |
| >                           |                                        |
| > Issuing country:          |                                        |
| >                           |                                        |
| > Expiration date:          |                                        |
+-----------------------------+----------------------------------------+
| **2b. Visa no., type &      |                                        |
| expiration date:**          |                                        |
|                             |                                        |
| > Visa number:              |                                        |
| >                           |                                        |
| > Visa type:                |                                        |
| >                           |                                        |
| > Expiration date:          |                                        |
+-----------------------------+----------------------------------------+
| **3. Visit/Assignment:**    |                                        |
+-----------------------------+----------------------------------------+
| > **a. Visitor title or     |                                        |
| > expertise:**              |                                        |
+-----------------------------+----------------------------------------+
| > **b. On-site              |                                        |
| > location/phone no.:**     |                                        |
+-----------------------------+----------------------------------------+
| **4. Purpose of             |                                        |
| Visit/Assignment:**         |                                        |
|                             |                                        |
|                             |                                        |
+-----------------------------+----------------------------------------+
| **5. Subjects to be         |                                        |
| discussed:**                |                                        |
|                             |                                        |
| >                           |                                        |
+-----------------------------+----------------------------------------+
| **6. Sensitive Subjects:**  |                                        |
|                             |                                        |
| > Berkeley Lab conducts     |                                        |
| > work and possesses        |                                        |
| > information that require  |                                        |
| > additional security       |                                        |
| > measures beyond that of   |                                        |
| > published fundamental     |                                        |
| > research. There are laws  |                                        |
| > and procedures in place   |                                        |
| > to protect this           |                                        |
| > information, and we are   |                                        |
| > committed to adhering to  |                                        |
| > these requirements. The   |                                        |
| > Sensitive Subjects Review |                                        |
| > Panel (SSRP) provides     |                                        |
| > ongoing oversight related |                                        |
| > to information or         |                                        |
| > activities requiring      |                                        |
| > additional controls.      |                                        |
+-----------------------------+----------------------------------------+
| **7. Initial verification   |                                        |
| and access procedures       |                                        |
| (badging):**                |                                        |
|                             |                                        |
| > The visitor/assignee will |                                        |
| > report to the LBNL Site   |                                        |
| > Access Office for         |                                        |
| > identification and access |                                        |
| > processing. In accordance |                                        |
| > with the LBNL Site        |                                        |
| > Security Plan, badges     |                                        |
| > will be issued and worn   |                                        |
| > in areas designated in    |                                        |
| > the plan. Card access     |                                        |
| > will be granted only to   |                                        |
| > those areas authorized    |                                        |
| > with the local Security   |                                        |
| > Access Manager (SAM).     |                                        |
| > Badges for foreign        |                                        |
| > nationals will have an    |                                        |
| > expiration date that is   |                                        |
| > either the end of the     |                                        |
| > appointment at LBNL or    |                                        |
| > visa expiration date,     |                                        |
| > whichever is sooner.      |                                        |
+-----------------------------+----------------------------------------+
| **8. Areas to be            |                                        |
| accessed:**                 |                                        |
|                             |                                        |
| >                           |                                        |
+-----------------------------+----------------------------------------+
| **9. Additional Security    |                                        |
| Safeguards:**               |                                        |
|                             |                                        |
| >                           |                                        |
+-----------------------------+----------------------------------------+
| **10. Briefing of Foreign   |                                        |
| National                    |                                        |
| visitor/assignee:**         |                                        |
|                             |                                        |
| > New Employee Orientation: |                                        |
| > This includes             |                                        |
| > requirements for Cyber    |                                        |
| > and Physical Security and |                                        |
| > emergency procedures.     |                                        |
+-----------------------------+----------------------------------------+
| **11. Foreign Visits and    |                                        |
| Assignment (FV&A) escorts   |                                        |
| and procedures:**           |                                        |
|                             |                                        |
| > None required             |                                        |
+-----------------------------+----------------------------------------+
| **12. Security Subject      | # List all                             |
| Matter Experts:**           |  required supporting visit/assignments |
+-----------------------------+----------------------------------------+
| > **a.                      | Steven S. Minniear                     |
| > Counterintelligence:**    |                                        |
+-----------------------------+----------------------------------------+
| > **b. Security:**          | Dan S. Lunsford                        |
+-----------------------------+----------------------------------------+
| > **c. Export Control:**    | Joseph R. Milner                       |
+-----------------------------+----------------------------------------+
| > **d. Intelligence:**      | NS                                     |
+-----------------------------+----------------------------------------+
| > **e. Cyber Protection:**  | Dwayne Ramsey                          |
+-----------------------------+----------------------------------------+
| **13. DOE Computer/Cyber    |                                        |
| Access:**                   |                                        |
|                             |                                        |
| > See attached Cyber        |                                        |
| > Security Plan             |                                        |
+-----------------------------+----------------------------------------+
| **14. Host information:**   |                                        |
+-----------------------------+----------------------------------------+
| > **a. Name:**              |                                        |
| >                           |                                        |
| >                           |                                        |
+-----------------------------+----------------------------------------+
| > **b. Telephone number:**  |                                        |
| >                           |                                        |
| >                           |                                        |
+-----------------------------+----------------------------------------+
| > **c. Address:**           |                                        |
| >                           |                                        |
| > Lawrence Berkeley         |                                        |
| > National Laboratory, One  |                                        |
| > Cyclotron Road, MS      , |                                        |
| > Berkeley, CA 94720        |                                        |
+-----------------------------+----------------------------------------+
| > **d. Security             |                                        |
| > clearance:**              |                                        |
| >                           |                                        |
| >                           |                                        |
+-----------------------------+----------------------------------------+
| **15. Host briefing and     |                                        |
| certification:**            |                                        |
|                             |                                        |
| > The host will be          |                                        |
| > knowledgeable of and      |                                        |
| > involved in the           |                                        |
| > visit/assignment and has  |                                        |
| > been provided with        |                                        |
| > briefing materials. The   |                                        |
| > host is responsible for   |                                        |
| > implementing this         |                                        |
| > security plan, associated |                                        |
| > cyber security plan, and  |                                        |
| > protecting DOE security   |                                        |
| > interests during the      |                                        |
| > assignment.               |                                        |
+-----------------------------+----------------------------------------+

  -------------------------------- -- -----------------------------------
                                      

  Sponsor Name:                       Sponsor Signature Date
  -------------------------------- -- -----------------------------------

**Visit/Assignment and Specific Security Plan:**

# Approved (circle one): YES NO

  -------------------------------- -- -----------------------------------
  Dan S. Lunsford, Manager,           
  Security and Emergency              
  Operations                          

  Approval Authority Name             Approval Authority Signature Date
  -------------------------------- -- -----------------------------------

DOE O 142.3 version 6-18-04

**Hosts for Unclassified Foreign Visitors and Assignees**

Hosts for Unclassified Foreign Visitors and Assignees are DOE Federal
representatives directly responsible for the activities associated with
the successful accomplishment of foreign visits or assignments. For a
foreign national to host another foreign national, the host must first
be a DOE employee. For laboratories or facilities that perform no
classified work, and at which no classified materials are stored,
sensitive country nationals (to exclude nationals of state sponsors of
terrorism, who may not host other foreign nationals) may host only
non-sensitive country nationals for visits and assignments that do not
involve access to sensitive subjects. For all other sites, facilities
and laboratories, sensitive country nationals (to include nationals of
state sponsors of terrorism) may not host other foreign nationals.

The host must be identified to the visitor or assignee as his/her Point
of Contact (POC) and must meet the following requirements.

1)  Ensure compliance with all requirements for access approval and
    conduct, including timely, complete, and accurate information for
    FACTS documentation; security plans; Subject Matter Expert (SME)
    reviews; environment, safety, and health reviews and requirements;
    program sponsorship (such as exchange visitor programs); and
    notification to workers regarding these requirements as appropriate.

2)  Serve as the individual responsible for the conduct and activities
    of the foreign nationals for which he/she is identified as host.

3)  Complete annual DOE security briefing/certification.

4)  Report suspicious activities in accordance with local reporting
    requirements to include the local counterintelligence office and the
    local incidents and infractions reporting office.

5)  Provide the following information to the foreign nationals for whom
    they have been identified as hosts:

    i.  The terms and conditions of access approval, including
        restrictions and requirements to notify the host of changes in
        name or status (e.g., passport, visa, or other USCIS
        information), as required.

    ii. The requirement to notify the responsible host of any civil or
        criminal problems that could affect their status and association
        with DOE.

    iii. That failure to provide appropriate documentation when required
         or providing fraudulent documentation will result in suspension
         of access approval, removal from the site/facility, and
         possible cancellation of future access.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Host Signature Date

**Unclassified Foreign National Specific Cyber Security Plan**

  -------------------------- --------------------------------------------
  **Access Requirements:**   **     ** will require access to the open,
                             unclassified LBNL network.       will
                             receive LBNL's cyber security training and
                             requirements during New Employee
                             Orientation.

  **Names of Cyber           LBNL open network
  Systems:**                 

  **Time Period of Access:**      

  **Risk Assessment:**       Classified information is not stored at
                             LBNL. Information requiring additional
                             protection as listed in Reference A is
                             protected in accordance with the terms of
                             that document. There is no trust
                             relationship between LBNL and other DOE
                             facilities involving access to classified or
                             sensitive information. There are no
                             activities on LBNL cyber systems that affect
                             national security. The risk of compromise of
                             information or disruption from foreign
                             nationals is no greater than from US
                             citizens.

  **Identification of Access Access controls are contained in the LBNL
  Controls:**                Cyber Security Program Plan and associated
                             Cyber Protection Implementation Plans. The
                             LBNL Export Control Manual specifies
                             restrictions on access to High Performance
                             Computers.
  -------------------------- --------------------------------------------

**Visit/Assignment Cyber Security Plan:**

# Approved (circle one): YES NO

  -------------------------------- -- -----------------------------------
  Dwayne Ramsey, Computer             
  Protection Program Manager          

  Approval Authority Name             Approval Authority Signature Date
  -------------------------------- -- -----------------------------------

Security Review

I certify that I have reviewed the request for access approval for
     , FACTS Visitor #     , Request #     , and considered all the
sensitivity factors associated with the requested access to DOE sites,
programs, information, and technologies. I have provided advice to the
approval authority regarding this request, he/she acknowledged receiving
my advice, and addressed any concerns to my satisfaction. My review was
consistent with reasonable standards and practices used to ensure risk
to the Government associated with access approval is appropriately
identified and evaluated.

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Dan S. Lunsford Date

Security and Emergency Operations Manager

Export Control Review

Some of the work conducted by the Laboratory falls under U.S. export
controls. Berkeley Lab complies with all relevant export control laws
and regulations. As a part of this compliance, it is each employee\'s
responsibility to understand any export-control requirements related to
his or her work and to ensure that no exports are made contrary to any
of these laws and regulations.

**The great majority of Berkeley Lab work and products are fundamental
research and not subject to export controls. Fundamental research
consists of basic and applied research in science and engineering for
which the resulting information is ordinarily published and shared
broadly within the scientific community. Basic research is distinguished
from proprietary research or industrial development.**

I certify that I have reviewed the request for access approval for
**     **, FACTS Visitor #     , Request #     , and considered all the
sensitivity factors associated with the requested access to DOE sites,
programs, information, and technologies. I have provided advice to the
approval authority regarding this request, he/she acknowledged receiving
my advice, and addressed any concerns to my satisfaction. My review was
consistent with reasonable standards and practices used to ensure risk
to the Government associated with access approval is appropriately
identified and evaluated.

**­­­­­­­­­­­­­­­­­­­­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Joseph R. Milner, Export Control Officer Date

## Counterintelligence Review

I certify that I have reviewed the request for access approval for
**     **, FACTS Visitor #     , Request #     , and considered all the
sensitivity factors associated with the requested access to DOE sites,
programs, information, and technologies. I have provided advice to the
approval authority regarding this request, he/she acknowledged receiving
my advice, and addressed any concerns to my satisfaction. My review was
consistent with reasonable standards and practices used to ensure risk
to the Government associated with access approval is appropriately
identified and evaluated.

Based upon review of the personal background information furnished and
completed search of national indices during the processing of this
approval package, no objection is posed to the assignment of
**     **relative to counterintelligence or counter terrorism concerns.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Steven S. Minniear, LBNL Counterintelligence Officer Date

**Approval Authority Certification**

I certify that I have reviewed the request for access approval for
**     **, FACTS Visitor #     , Request #     , and considered all the
sensitivity factors associated with the requested access to DOE sites,
programs, information, and technologies. I have reviewed the advice
provided by the Subject Matter Experts in Security, Export Control,
Technology Transfer, Security and Counterintelligence regarding the
request, and have addressed any concerns to the satisfaction of the
Subject Matter Expert involved. My determination is consistent with
reasonable standards and practices used to ensure risk to the Government
associated with access approval is appropriately identified and
evaluated.

Additionally, I certify that any approval certifies that, in my opinion,
the benefits to the Government are greater than the risks associated
with the presence of the foreign national and that the legal and
policy-related terms and conditions associated with the proposed Visit/
Assignment have been met. These terms and conditions include, but are
not limited to, other activities at this site, visa sponsorship
requirements, visa status conditions and requirements, right-to-work
requirements, and international agreements.

­­­­­­­­­­­­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

David C. McGraw Date

Associate Laboratory Director, Chief Operating Officer

![](media/image1.png){width="1.3319444444444444in"
height="0.8069444444444445in"} **Lawrence Berkeley National Laboratory**

TO: David C. McGraw, Associate Laboratory Director, Chief Operating
Officer

FROM:      ,      ,      

RE: Assignment Approval for      

DATE:      

I have reviewed and concur with the request for DOE approval of
     assignment to the Lawrence Berkeley National Laboratory for the
period of      .      ,       Division will serve as       host.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

      Date

     

Ernest Orlando Lawrence Berkeley National Laboratory  One Cyclotron
Road  Berkeley, California 94720