Request For Unclassified Foreign National Access Page 3
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7NETL F 142.1-1
U.S. DEPARTMENT OF ENERGY
Revised: 11/13/2013
Reviewed: 11/13/2013
REQUEST FOR UNCLASSIFIED
(Page 3)
FOREIGN NATIONAL ACCESS
SECTION B – ACCESS PERIOD DATA
19a. This Access Request is for (check all that apply) (
)
Actual Dates of Access (DOE Use Only)
See Section H
9/24/2014
□
30 Calendar Days or less (FN Visit)
Start:
□
Greater than 30 Calendar Days (FN Assignment)
9/25/2014
End:
□
On-Site
□
Off-Site
□
Both On-Site and Off-Site
End Date Extensions:
□
Extension of previous Access Period > 30 Calendar Days
□
RUA
□
ORISE
□
National Research Council
□
Full-time, Site-Support Contractor Employment
□
Yes
□
No
□
Day Care
□
Event Management (Conference or meeting)
□
Peer Review
□
Contact Only (Email, telephonically, call-in, etc.)
19b. □
Open to the Public Event Exemption Request
(See Section J)
20. Access Purpose
(See Section H)
Conference Attendance
21. Specific Subject Area or NETL-Sponsored Event
(See Section H)
Carbon Capture
22. Justification and Purpose of Access plus Expected Outcome
(See Section H)
The U.S. DOE Carbon Capture Simulation Initiative (CCSI) is a multi-lab collaborative project that
is developing, demonstrating and now deploying new computational tools and models to enable
industry to accelerate the develop of capture related technology.
To ensure the success of the
project, the CCSI Technical Team meets with representatives from its Industry Advisory Board (IAB)
every 6-12 months to discuss recent accomplishments, new capabilities, and plans.
(see page 4)
23. Does This Access Require Cyber Access to DOE Systems or a
24. Actual or Estimated Cost to DOE
(See Section H)
Personal Laptop On-Site?
□
Yes
□
No
If Yes, see Section H.
25a. Name of DOE Contact, Division, and Office Symbol
25b. DOE Contact Telephone Number
(See Section H)
David Miller
412-386-6555
SECTION C – HOST/ALTERNATE HOST INFORMATION
26a. Name of Host, Division, and Office Symbol
26b. Host Telephone Number
(See Section H)
David Miller
412-386-6555
26c. Is Host a DOE L or Q Badge Holder?
□ Yes
□
No
26d. Is Host a U.S. Citizen?
□
Yes
□
No
I understand my responsibilities for hosting Foreign Nationals at the National Energy Technology Laboratory to include completion of the Close-Out
Report For Foreign National (FN) Access. See Section L, page 7. I have also completed the required training as prescribed in the NETL 142.3 series of
directives. See Section I – General Host Information, page 7.
Host (or Open to the Public Event POC)
Title/Organization
CS&E Div., ORD
David Miller
(See Section J)
Signature
Date (MM/DD/YYYY)
Title/Organization
Alternate Host
Signature
Date (MM/DD/YYYY)
Alternate Host
Title/Organization
Signature
Date (MM/DD/YYYY)
Alternate Host
Title/Organization
Signature
Date (MM/DD/YYYY)
Alternate Host
Title/Organization
Signature
Date (MM/DD/YYYY)
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