SECNAV 5512/1: Department of the Navy Local Population ID Card/Base Access Pass Registration

Enter the Last Name (Block 1), the First Name (Block 2) and the Middle Name (Block 3). If applicable, check the box for Name Suffix (Block 4): Jr., Sr., I, II, III or IV.

Block 5: Check the applicable box for Race (Check one or more): American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or Other Pacific Islander or White.

Block 6: Check the applicable box for Gender (Check one): Male or Female.

Enter the Date of Birth (Block 7), the City of Birth (Block 8), the State of Birth (Block 9) and the Country of Birth (Block 10).

Block 11: Check the applicable box for U.S. Citizenship (Check): YES or NO.

Under Dual Citizenship, check YES or NO, then enter the Country of Citizenship if other than U.S. Block 12: If not a U.S. Citizen, enter the name of the Country of Citizenship.

Block 13: Two forms of identity source documents from the list of acceptable documents must be presented to the base registrar with this completed form.

All documents must not be expired. Must present one selection from List A or a combination of one selection from List B and one selection from List C.

Check the box for the type of Documents that will be presented for identity proofing: Social Security No., State ID/Drivers License, Passport No., Certification Number and Petition Number, Derived (Parent's Certification Number) or Alien Registration No.

If the document type is not listed, use the two rows under Other Approved Identity Source Documents to enter the type of document(s) that you will present.

Block 14: Enter the Document Number located on the Identity Proofing Source document that was checked in Block 13.

Enter the State that issued the Identity Source Document (Block 15), the Country that issued the Identity Source Document (Block 16), the Date that the Identity Source Document was issued (Block 17) and the Date that the Identity Source Document will expire (Block 18).

Enter Weight in pounds (Block 19) and Height in inches (Block 20).

Block 21: Check the applicable box for Hair Color (Check one): Blond, Brown, Black, Gray, Red, White, Silver, Auburn or Bald.

Block 22: Check the applicable box for Eye Color (Check one): Brown, Green, Blue, Hazel, Black, Gray, Violet or Unknown.

Block 23: Enter the Home Address including city, state, zip code, and the Home Telephone Number (Include Area Code).

Block 24: Enter the Name of the Registrant's Base Sponsor and the Base Sponsor's Telephone Number (Include Area Code).

Block 25: Enter the Employer Name and Address including city, state, zip code, and the Employer's Telephone Number (Include Area Code).

Block 26: Enter the Supervisor's Name and Address including city, state, zip code, and the Supervisor's Telephone Number (Include Area Code).

Block 27: Check the applicable box for Work Hours (0600-1800 or 0800-1700) or check the OTHER box and enter the work hours, then check the applicable boxes for Work Days: SN, M, T, W, TH, F or ST.

Block 28: Check the applicable box for felony conviction, YES or NO. Check the applicable answer if you have been convicted of Felony and enter initials.

Block 29: Enter initials to accept terms for returning the Local Population Identification Card: you understand that you are required to return your Local Population Identification Card to the Base Pass Office when it expires or if your employment is terminated for any reason.

Block 30: Sign and date the form to attest that the foregoing information is true and complete to the best of your knowledge.

Before signing this form, review it carefully to make sure you have answered all questions fully and correctly. You declare under penalty of perjury that the statements made by you on this form are true, complete and correct.

False statements are punishable by law and could result in fines and/or imprisonment up to five years.

You authorize the DOD/DON and other authorized Federal agencies to obtain any information required from the Federal government and/or state agencies, including but not limited to, the Federal Bureau of Investigation (FBI), the Defense Security Service (DSS), the U.S. Department of Homeland Security (DHS).

You have been notified of DON right to perform minimal vetting and fitness determination as a condition of access to DON installation/facilities.

You understand that you may request a record identifier; the source of the record and that you may obtain records from the State Law Enforcement Office as may be available to you under the law. You also understand that this information will be treated as privileged and confidential information.

You release any individual, including records custodians, any component of the U.S. Government or the individual State Criminal History Repository supplying information, from all liability for damages that may result on account of compliance, or any attempts to comply with this authorization. This release is binding, now and in the future, on your heirs, assigns, associates, and personal representative(s) of any nature. Copies of this authorization that show your signature are as valid as the original release signed by you.

The Base Commanding Officer has final authority for determination on granting physical access to DON controlled installations/facilities under his/her jurisdiction.

SECNAV 5512/1 (June 2026) is the Department of the Navy Local Population ID Card/Base Access Pass Registration. This form describes the authority and purpose to collect and share the required information; and identifies the applicant/visitor and sponsor; and authorizes the DoD to perform the minimum vetting and fitness determination criteria.

Please do not return response to whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil, the address for comments regarding the burden estimate or burden reduction suggestions. Responses should be sent to the Base Registrar.