To capture required visitor information for people entering restricted or secure agency areas containing federal tax information (FTI).
Health and Human Services (HHS) field offices, headquarters, computer facilities, and data centers complete the form to record information of visitors entering and exiting secured or restricted agency areas containing FTI.
Office Type: Enter the applicable office type
- Field office
- Computer facilities
- Consolidated data centers
Division: Enter the applicable HHS division
Mail Code: Enter the HHS mail code
Note: HHS management or designated agency security personnel reviews the program area’s FTI Authorized Access List (AAL) before the person signing the FTI Visitor Access Log.
The Internal Revenue Service (IRS) requires HHS to:
- verify the person signing the FTI Visitor Access Log is authorized to access the secured or restricted area containing FTI; and
- confirm the person’s agency, department or vendor organization point of contact information.
Entry Date: Enter date of visit
Visitor Name and Organization: Enter person’s first name, last name and organization
Form of Identification: Enter type of ID used to verify identity. (i.e.- driver’s license, state issued ID, HHSC ID, etc.)
Visit Purpose: Enter visit purpose
Name of Person Visited and Organization: Enter name of person visited and organization
Entry Time: Enter entry time
Departure Time: Enter departure time
Visitor Signature: Enter visitor’s signature