BPA F 5632_27 Badge Replacement Request

BPA F 5632.27e

OMB

U.S. DEPARTMENT OF ENERGY
BONNEVILLE POWER ADMINISTRATION

(08-18)

BADGE REPLACEMENT REQUEST
INSTRUCTIONS:
The Badge Replacement Request, BPA Form 5632.27e, is used to report lost, stolen, damaged, faded, or malfunctioning BPA ID Badges and Smart Cards. Email
the completed form as an attachment to: Employee Badging – NNP-B1. For lost badges Personnel Security will wait five business days from the date entered as
the Request Date (item number 1), before processing. This is done to allow time to find /recover the badge. If the badge is found /recovered, explain how, from
whom, and where it was found/recovered in an email to Employee Badging – NNP-B1.
If your badge has been stolen, in addition to this form, please fill out a Security Incident Report, BPA Form 5632.01e, and send it to Security Services via email
immediately. Indicate by checking “Yes” in item number 10 below that the Security Incident Report has been filed. If the badge is recovered, explain how, from
whom, and where it was recovered in an email to Security Services.
A. BADGE INFORMATION
1. Request Date:

2. Type of Badge:

3. Date badge was first noticed
missing:

BPA Badge

Smart Card

BPA Proximity Access Card

4. Reason for replacement (choose one):

N/A

Lost

Stolen

Broken

Faded

B. CONTACT INFORMATION
5. Name of badge-holder (Last, First):

6. Phone Number:

7. Routing:

8. If you work at HQ, would you like a call for pick-up when badge is ready?
Yes

No

C. DESCRIBE ISSUE LEADING TO NEED FOR REPLACEMENT
9. Description of Incident (For Lost/Stolen) (Include as much detail as possible: who, what, when, where, why and how):

10. Has a Security Incident Report (BPA F 5632.01) been submitted to Security Services? (For Stolen Badge)

Yes

No

11. Brief Description of Deficiencies (For Damaged/Faded/Malfunctioning):

D. FOR SECURITY PERSONNEL ONLY
12. Date Report Received:

13. Date Processed:

14. Date Filed in Records:

15. Name of Processing Official:

16. Comments:

File Code: SS 18-15 Retention: NNP = 2 Yrs

OMB

BPA F 5632.27e
(08-18)

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to ensure the security and safety of BPA employees, contractors, and facilities. The data you supply will be used by security personnel to document reports of lost/stolen
or damaged/faded/malfunctioning ID Badges. Public reporting burden for this collection of information is estimated to average .21 hours per response, including the time for
reviewing instructions, searching exiting data sources, gathering and maintaining that data needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Enterprise Policy
Development & Implementation Office, IM-22, Paperwork Reduction Project (enter OMB control number), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and
to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (enter OMB control number), Washington, DC 20503.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information
subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.
The Paperwork Reduction Act (PRA) of 1995 requires each Federal agency to seek and obtain approval from the Office of Management and Budget (OMB) before undertaking a collection of
information directed to 10 or more persons of the general public, including persons involved in or supporting the operations of Government-owned, contractor-operated facilities.