> INCOMPLETE FORMS WILL BE RETURNED TO ORIGINATOR

+-----------------------------------------------------------------------+
| OUO                                                                   |
|                                                                       |
| REQUEST FOR UNCLASSIFIED VISIT                                        |
+-----------------------------------------------------------------------+

+----------------------+--------------------------+--------------------+
| Return to Erica De   |                          |                    |
| Smet                 |                          |                    |
|                      |                          |                    |
| (Fax 844-4701)       |                          |                    |
+----------------------+--------------------------+--------------------+

(Form may be typed, printed legibly, or completed electronically). CHECK
BOX FOR BUILDING BADGE ONLY □

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

  SSN or Employee    b\. Visitor            c\. Company/Other     d\. DOB\
  ID                                        Affiliation           (only for
                                                                  visitors
                                                                  under 18)

  E-mail address:                                                 

  e\.                                                             
  Company/Other                                                   
  Address:                                                        

                                                                       

  SSN or Employee    b\. Visitor            c\. Company/Other     d\. DOB\
  ID                                        Affiliation           (only for
                                                                  visitors
                                                                  under 18)

  E-mail address:                                                 

  e\.                                                             
  Company/Other                                                   
  Address:                                                        

                                                                       

  11.a SSN or        b\. Visitor            c\. Company/Other     d\. DOB\
  Employee ID                               Affiliation           (only for
                                                                  visitors
                                                                  under 18)

  E-mail address:                                                 

  e\.                                                             
  Company/Other                                                   
  Address:                                                        

                                                                       

  11.a SSN or        b\. Visitor            c\. Company/Other     d\. DOB\
  Employee ID                               Affiliation           (only for
                                                                  visitors
                                                                  under 18)

  E-mail address:                                                 

  e\.                                                             
  Company/Other                                                   
  Address:                                                        
  --------------- -- ------------------- -- ------------------ -- ------------

OUO

> PRIVACY ACT INFORMATION STATEMENT
>
> Collection of the information requested is authorized by Section 145
> of the Atomic Energy Act of 1954, as amended (PL 83-703, 42 USC 2165).
> Compliance with this request is voluntary; however, if the information
> submitted is inadequate or incomplete, approval for your visit to a
> classified or unclassified DOE Facility, or your access to classified
> or unclassified information may be delayed or withheld. The
> information you furnish will be used by DOE and DOE contractors to
> control access to the various forms of classification information and
> areas.