CCURE 9000 Application

				OMB Control Number:	0703-CURE
				OMB Expiration Date:	##-##-####
SOFTWARE HOUSE CCURE APPLICATION QUESTIONNAIRE
AGENCY DISCLOSURE NOTICE The public reporting burden for this collection of information, 0703-CURE, is estimated to average 7 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.							NOTE: This spreadsheet is NOT used to collect information. Privacy and PRA notices are provided and information is collected verbally. This document is intended to combine the Agency Disclosure Notice, Privacy Act Statement, and collected information onto one document to more clearly show what is being collected.
PRIVACY ACT STATEMENT AUTHORITY: 10 U.S.C. 5013, Secretary of the Navy; 10 U.S.C. 5041, Headquarters, Marine Corps and Marine Corps Order P5530.14, Marine Corps Physical Security Program Manual; and E.O. 9397 (SSN), as amended. PRINCIPLE PURPOSE: To readily identify all personnel who are allowed to access Naval Air Station Jacksonville and the Fleet Readiness Center Southeast (FRCSE) in the furtherance of the Center's Mission; and to comply, verify and update the Center authorized visitor list in support of administrative and security measures. ROUTINE USES: Data / information collected and entered into the CCURE application as part of the process for issuing access badges to FRCSE's command facilities. DISCLOSURE: Furnishing personal information on this form is totally voluntary, but failure to do so may result in disapproval of NAS Jacksonville and entry to the FRCSE's command spaces.
Personnel Type:
First Name:
Last Name:
Middle Name:
Name:
Email Address:
Text 1:			*Supplemental field built in program generated that is not used by FRCSE Badging Office
Int 1:			*Supplemental field built in program generated that is not used by FRCSE Badging Office
Checked In:			* Date Contractor Reported to the Command
Can Host:			*Supplemental field program generated that is not used by FRCSE Badging Office however it is an internal slot not asked to the customer but created for badging office employees to annotate if the person can sponsor an invididual
Can Approve Requests:			**Supplemental field program generated that is not used by FRCSE Badging Office however it is an internal block and is not asked to the customer but created for badging office employees to annotate if the person can approve other badging requests
Can Submit Requests:			*Supplemental field program generated that is not used by FRCSE Badging Office however it is an internal block that is not asked to the customer but created for badging office employees to annotate if the person can submit requests for other invididuals.
Template:			*Supplemental field built in program generated that is not used by FRCSE Badging Office
Access Code:			*Supplemental field built in program generated that is grayed out and not used by FRCSE Badging Office.
FRCSE Decal #2:			*Supplemental field used by badging if customer receives addition vehicle decal
FRCSE Decal #3:			*Supplemental field used by badging if customer receives addition vehicle decal
Co Name:			* Name of Contracting Company
Emergency Contact:			Supervisor's Phone:
Work Phone:			Emergency Contact:
Emgency Contact Person:			Supervisor's Name:
Emergency #:			Basic Clearance:				*Supplemental field built in program is a redundant field that is not used by FRCSE Badging Office however the drop down menu for this box displays the times and days authorized.
Comments:							*Supplemental field built in program generated that is not used by FRCSE Badging Office
CAC:			HID Card:				*Supplemental field built in program is redundant to record badge number however, this field is not used by FRCSE Badging Office