VISITOR: NIH VISIT REQUEST SUBMISSION FORM

You are accessing a U.S. Government web site which contains information that must be protected under the U.S. Privacy Act or other sensitive information and is intended for Government authorized use only. Unauthorized attempts to upload information, change information, or use of this web site may result in disciplinary action, civil, and/or criminal penalties. Anyone accessing this web site expressly consents to monitoring of their actions and all communication or data transitioning or stored on or related to this web site and is advised that if such monitoring reveals possible evidence of criminal activity, NIH may provide that evidence to law enforcement officials. Any communication or data transiting or stored on this information system may be disclosed or used for any lawful Government purpose.


Please collect all necessary information prior to completing this form. You cannot partially complete the form now and submit it later. For a complete list of instructions, please click on the following link:
https://publish.smartsheetgov.com/8bb36cf4299a4fb0a3e975802639499e


This statement is provided pursuant to the Privacy Act of 1974 (5 U.S.C. § 552a). The information requested is authorized to be collected pursuant to 5 U.S.C. 101, 301, 40 U.S.C. 1315, 11331 and EO 12977. The information collected is voluntary, however, declining to provide any or all the requested information could result in an inability for the National Institutes of Health (NIH), U.S. Department of Health and Human Services (HHS) to authorize entry to NIH facilities or NIH occupied spaces. The principal purpose for which the information will be used is to verify the identity of non-US persons visiting NIH facilities and NIH occupied spaces and share with the HHS Office of National Security (ONS) in accordance with HHS policy requirements. The information you provide will be included in a Privacy Act system of records, and will be used and may be disclosed for the purposes and routine uses described and published in the following System of Records Notice (SORN): 09-90-0777 Facility & Resource Access Control Records, HHS/OS https://www.hhs.gov/foia/privacy/sorns/09900777/index.html






First Name must exactly match the name used on identification card that will be presented at time of visit.


Middle Name must exactly match the name used on identification card that will be presented at time of visit. If you do not have a legal first name enter "No First Name".


Last Name must exactly match the name used on identification card that will be presented at time of visit.



























All visitors are required to provide US Visa information unless traveling to the United States from a Visa Waiver Program.


If no Visa, select N/A


If no Visa, please enter N/A


If no Visa, enter today’s date


If no Visa, enter today’s date


















Must be an NIH email address


Please upload a copy of your visitor’s passport, data/bio page, and a photocopy of the passport page (only data/bio page upload required if from a Visa Waiver Program country).

By clicking on the Submit button below, I attest that the information provided is true and accurate to the best of my knowledge and that I consent to the use of this information in processing this visit request.

Visit requests submitted with incomplete or inaccurate information will not be accepted. The NIH Host will be informed in writing of the necessary corrections for the request.






Privacy Policy   |   Report Abuse
Your submission is being processed. Please do not close this browser window until complete.