ML20206E739
ML20206E739 | |
Person / Time | |
---|---|
Issue date: | 06/17/1988 |
From: | Mcdonald W NRC OFFICE OF ADMINISTRATION & RESOURCES MANAGEMENT (ARM) |
To: | Stello V NRC OFFICE OF THE EXECUTIVE DIRECTOR FOR OPERATIONS (EDO) |
Shared Package | |
ML20206E703 | List: |
References | |
FRN-53FR30829, RULE-PR-11, RULE-PR-25 AC90-2-5, NUDOCS 8811180181 | |
Download: ML20206E739 (24) | |
Text
__ __ _ _ __ _______ _ __ _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ - _ _ _ _ _ _ _ _
a .
juN 1 ?-1988
, 0G AM. J f ." F ; lic ct itelio, Jr. /M. 7C d E4ecative D ret.tve ter C;entles
,P b R FRCM: William G. Mcdonald, Director Office of Administration and Resources ManageMnt
SUBJECT:
RECCMPENDATION FCR PRCMULGAT:NG RULE: :PFLEMENTA~:CN OF ~HE USE OF SF.86, "CUf571fNNA:RE FOR SENS:':VE R05;T!CNS' JA;T3
'.1 AND 25' FCR PL5LICA~:CF lN THE CE;E?AL REG:STEF In resrense to the February D,1984, memorandum "Control of NRC Rulecakings by Offices Reporting to the EDO," ! have enclosed pertinent information which supports my recommendation for the initiation of a rule amendment.
As of September 16, 1988, the Office of Personnel Management (OPM) will accept only the Standard Form (SF) 86, which will serve'as the basis for the investi.
gation of all individuals who require an NRC personnel security clearance and/or special ruclear material access authorization. The exception to the use of the SF.86 held by NRC (for the use of the NRC Fonn.1, "Personnel Security Question-nalre") is being discontinued because the SF-86 enables OPM to computerize the investigative process. Licensee personnel, licensee contractors, and other persons who requ!re access to classified information must be granted an NRC personnt. : security clearance; and those requiring access to or control over special nuclear material must be granted a material access authorization by NRC. Therefore, the current regulations,10 CFR Part 11. "Criteria and Procedures for Determining Eligibility for Access to or Control Over Special Nuclear Material," and 10 CFR brt 25, "Access Authorization for Licensee Personnel," must be amended to reflect changes in form requirements. Otherwise, the adverse impact on industry would be significant as the necessary background investigation conducted by OPM cannot be performed and the industry would be unable to obtain future NRC personnel security clearances / material access authorizations, if you have any questions, or necd further information, please contact Raymond J. Brady, Director, Division of Security on 49 24100.
Original Signed By W:mam G. McCodd 8811180181 881115 William G. Mcdonald, Cirector Office of Administration and
{R 3 pg Rescurces Managecent
Enclosures:
- See previous concurrences t
- 1. Regulato.y Agenda Entry
- 2. Results of Preliminary Office Reviews of Rulemaking l
- 3. Pr liminary Regulatory Analysis GFC :F5056* :750$E' :PER5EC* :00/5EC* :D/SEC* :0GC* :RP5*
NAME :CGHarbaugh :0GKidd :JJNnleavy :RACopp :RJBrady :"JVoegele :Clyeyer DATE :6/13 /88 :6/13 /88 :6/14 /88 :6/ /88 :6/15 /88 :6/15 /88 ,
.....:............:............:............:............ has been the word "initiation" L NAME :AWShepard :PGNorry :EBMason :'aGMcDonald in the 1st paragraph.
O_ ATE :6/16 /88 :6/16 /88 :6/ /88 ': 6/ 17 /88 : .
NRC OFFICIAL RECORD COPY
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'MEM0iAhCUM FOR: Victor Stello, Jr.
Etecutive Direct.ur for Cpeir.ior.s FROM: William G. Mcdonald, Director 3f fice of Adr.iinistration and Pesources Management
SUBJECT:
RECCFFENDAT!0N FOR PROMULGATING RULE: IMPLE.MENTA'!ON OF T.HE USE OF SF-86, "GUESTIONNA!RE FOR SENS:TIVE POSITIONS" (PARTS 11 AND 25) FOR PUBLICATION IN THE FEDERAL REG: STER In response to the February 13, 1984, memorandum "Control of NRC Rulemakings by Offices Reporting to the EDO," I have enclosed pertinent information d ich supports iny recommendation for the initiative of a rule amendsnent. -
As of September 16, 1988, the Office of Personne,1 Management (OPM)'will accept only the Standard Form (SF) 86, which will serve as the basis for the investi-gation of all individuals who require an NRC personnel securt'ty clearance and/or special nuclear material access authorfaation. The exception to the use of the SF-86 held by NRC (for the use of the NRC Form-1, "Perse'nnel Security Question.
naire") is being discontinued because the SF.86 enabMs OPM to computerize the investigative process. Licensee personnel, li..ases contractors, and other persons who require access to classified informatIon must be granted an NRC personnel security clearance; and those requir/ng access to or control over special nuclear material must b eanted a otterial access authorization by NRC. Therefore,thecurrentre.;Iations,40CFRPart11."Criteriaand Procedures for Determining Elli,.bility hr Access to or Control Over Special Nuclear Material," and 10 CFR Part 25,'"Access Authorization for Licensee Personnel," oust be rnended to ref1p6t changes in form requirements. Otherwise, the adverse impact on industry wculd be significant as the necessary background investigation conducted by 0FM_ cannot be performed and the industry would be unable to obtain future NRC personnel security clearances / material access authorizations. ,
If you have any questio[s, or need further i. formation, please contact Paymond J. Brady, Director, Disiston of Security on 49 24100.
William G. Mcdonald, Director Office of Administration and Resources Management
Enclosures:
- 1. Regulatory Agenda Entry
- 2. Resuits of Preliminary Of /. Reviews of Rulemaking
- 3. Preliminary Regulatory ..a ly s i s J. s , w -<.
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NUCLE AR REGUL ATORY COMYlSSION
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- ,..a JUN 171988 F.EPCRANCl,M FOR: Victor Stello, Jr.
Executive Director"for Operaticns FRCM: William G. Mcdonald, Ofrector Office of Administration and Resources Managerrent
SUBJECT:
RECOMMENDATION FOR PROMULGATING PULE: IMPLEMENTATION OF THE USE OF SF-86, "QUES 110hNAIRE FOR SENSITIVE POSITIONS" (PARTS 11 AND 25) FOR PUBLICATION IN THE FEDERAL REGISTER In response to the February 13, 1984, memorandum "Control of NRC Rulemakings by Offices Repcrting to the E00," I have enclosed pertinent infortration which supports my recomendation for the initiation of a rule amendment.
As of September 16, 1988, the Of fice of Personnel Management (OPM) will accept oilly the Standard Form (SF) 86, which will serve as the basis for the investi-gation of all individuals who require an NRC personnel security clearance and/or special nuclear material access authorization. The exception to the use of the SF-86 held by NRC (for the use of the NRC Form-1, "Personnel Security Question-naire") is being discontinued because the SF-86 enables OPM to computerize the investigative process. Licensee personnel, licensee contractors, and other persons who require access to classified information must be granted an NRC personnel security clearance; and those requiring access to or control over special nuclear material must be granted a material access authorization by NRC. Therefore, the current regulations,10 CFR Part 11. "Criteria and Procedures for Determining Eligibility for Access to or Control Over Special Nuclear Material," and 10 CFR Part 25, "Access Authorization for Licensee Personnel," must be amended to reflect changes in form requirements. Otherwise ,
the adverse impact on industry would be significant as the necessary background investigation conducted by OPM cannot be performed and the industry would be unable to obtain future NRC personnel security clearances / material access authorizations.
If you have any questions, or need further information, please contact Rapend J. Brady, Director, Division of Security en 49-241C0,
!.b :d._ ' N -c.< < -c William G. Mcdonald, Director Office of Administration and Resources Managecent
Enclosures:
- 1. Regulatory Agenca Entry
- 2. Results of Preliminary Office Reviews of Rulerroing
- 3. Preliminary Regulatory Analysis 1
(
e Enclosure 1 REGULATORY AGENDA ENTRY
Title:
Implementation of the Use of SF-86, "Questionnaire for Sensitive Positions" CFR Citation:
10 CFR 11; 10 CFR 25 Abstract:
The final rule would change the forms required to request an NRC personnel security clearance and/or material access authorization, for NRC licenstes and others,whenanOfficeofPersonnelManagement(OPM)backgroundinvestigation is necessary. .
The final amendments are necessary because as of September 16, 1988, OPM will accept only the Standard Form (SF) 86, "Questionnaire for Sensitive Positions" as the basis for their background investigations. The exception to the use of SF-86 held by NRC (for use of the NRC Form-1, "Personnel Security Questionnaire") is being discontinued. Therefore, there is no reasonable alternative to rulemaking. This rule will have a negligible effect on the general public. NRC resources required for processing this rule through final publication are estima',ed to be 120 staff hours.
Timetable:
Final Rule to be published in the Federal Register by August 1988 Legal Authority:
4? USC 2165; 42 USC 2201; 42 USC 5841; 42 USC 2273; E.O.10865; E.O.12356 Effects on Small Business and Other Entities:
None Agency
Contact:
Cynthia G. Harbaugh V. S. Nuclear Regulatory Comission Office of Administration and Resources Management Washington, D. C. 20555 (301)492-4128
e
, , t encI osure 2 Results of Preliminary Office Review of Rulemaking Entitled "Implerentation of the use of SF-86, "Questionnaire for Sensitive Positions" ssue to be Accressed The Office of Administration and Resources Management (AFP) seeks approval to amerd 10 CFR Part 11 "Criteria and Procedures for Determning Eligibility for Access to or Control Over Special Nuclear Material," anc 10 CFR Part 25, "Access Authorization for Licensee Personnel," to implement a change in the forms required to request NRC personnel security clearances and/or material access authorizations, for NRC licensee personnel and others, when an Office of Personnel Management (0PM) background investigation is necessary.
Need for Addressing the Issue As of September 16, 1988, the Office of Personnel Management (OPM) will accept only the Standard Form (SF) 86, which will serve as the basis for investi-gation of all individuals who require an NRC personnel security clearance and/or material access authorization. The exception to the use of the SF-86 held by NRC (for the use of the NRC Form-1, "Personnel Security Questionnaire")
is being discontinued because the SF-86 enables OPM to computerize the investi-gative process. Licensee personnel, licensee contractors, and other persons who require access to classified information must be granted an NRC personnel security clearance; and those requiring access to or control over special nuclear material must be granted a material access authorization by NRC.
Therefore, the current regulations,10 CFR Part 11, "Criteria and Procedures for Determining Eligibility for Access to or Control Over Special Nuclear Material," and 10 CFR Part 25, "Access Authorization for Licensee Personnel,"
must be amended to reflect changes in form requirements. Otherwise, the adverse impact on industry would be significant as they would be unable to otdain future NRC personnel security clearances / material access authorizations.
Alternatives to Rulemaking ARM sees no alternative to amending these rules that would be more effective and use fewer NRC resources.
How Issues Will be Addressed by Rulemaking This final rule will amend 10 CFR Parts 11 and 25 to incicate char.ges in form requirements needed to request an NRC personnel security clearance and/or material access authorization.
How the Public, Industry, and NRC Will Be Affected A negligible af fect is predicted for the general public since this ruleraking activity applies only to those licensees and others who need to use, process, sture, transport, or deliver to a carrier for transport formula quantities of special nuclear material (as defined in 10 CFR Part 73) cr generate, receive, safeguard, and store National Security Information or Restricted Data (as defined in 10 CFR Part 25). Approximately 14 NRC licensees and other interests will be affected. ARM views these amendments as a necessity.
Enclosure 2 s cent'c; NRC Resources and Scheduling Needed for the Rulemaking NRC staff resources shoule total approximately 120 hours0.00139 days <br />0.0333 hours <br />1.984127e-4 weeks <br />4.566e-5 months <br />. ADI plans to publish tnese amendments as a final rule in the Federal Register by August 1988.
( 8 Enclosure 3 9
PRELIMINARY REGULATORY ANALYSIS
- 1. Statement of Problem As of Septerter 16,1986, the .0ffice of Personnel Management (0PM) will accept only the Standard Form (SF) 86, unich will serve as the basis for tbc investigation of all Indivicuals who require an NRC personnel security arance and/or raterial access authorization. The exception to the use of the SF-86 held by NRC (for the use of the NRC Form-1, "Personnel Security Questionnaire") is being discontinued because the SF-86 enables OPM to computerize the investigative process. Licensee personnel, licensee contractors, and other persons who require access to classified information must be granted an NRC personnel security clearance; and those requiring access to or control over special nuclear material must be granted an material access authorization by NRC. Therefore, the current regulations, 10 CFR Parts 11 and 25 must be amended to reflect changes in form requirements.
- 2. Objective The objective of this regulatory initiative is to inform licensees and other nongovernment bodies of changes in the forms required to request NRC personnel security clearances and/or material access authorizations.
NRC's intended regulatory initiative specifically adopts these new requirements and promulgates this revised national policy to those ifcensees and others requiring a background investigation.
- 3. Alternatives There is no reasonable alternative to revision of these regulations that would achieve the desired result.
4 Consequence There are approximately 14 affected entities licensed by NRC. NRC personnel security clearances, which permit access to classified information and/or material access authorizations, which permit access to or control over special nuclear material, must be granted to certain
' licensee and licensee contractor personnel and others in order for them i
to conduct business. Unless the SF 86 is used to request personnel security clearances and/or material access authorizations from NRC, the necessary background investigations conducted by OPM can not be preformed.
l
- 5. Decision Rationale The only available method of imposing this legitimate requirement on selected licensees is to revise 10 CFR Parts 11 and 25.
Other avenues would lack the reouisite forr.ality and legality necessary to require all affected NRC licensees to adhere to the changes in forms required for background investigations relating to those licensee personnel applying for NRC personnel security clearances and/or material access authorizations.
. Ecclosure 3
- 6. Implementation The Division of Security intends to publish a final rule amending 10 CFR Parts 11 ano 25 by August 1988.
4
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(~ g cjo x Offica of PJrtonni! Managtment FPM Bulletin 736-16 f Federal Personnel Manual System 7DR FPM BuNetin Hulichn No 736-16 hhint:fon. D f 204M
$USIECT: Revised Standard Fotm 86, Questionnaire for Sensitive Positions ,
Heads 01 Departrnents and indepencie nt (stablishrnents
- 1. We have revised and retitled Sta.idard Form 86, Cuestionnaire for Sensitive Positions, and have issued a new form, Standard Form 86A, Continuation She '.
, for Questionnaire for Sensitive Positions. The revision of the SF 86 (revised October 1987) enhances the f orm to better meet the Government's personnel security, suitability, and background investigations requirements and to meet automated data processing requirements. .
- 2. Instructions for use of the revised forms are contained in FPM Supplement 296-33, The Guide to Processing"Personnel Actions, and a new pamphlet, "Request-ing OPM Federal Investigations, 0 FI- 15.
- 3. Please take steps to insure that a11' personnel and security office managers receive and use the revised SF 86 and the new SF 86A. Shipment of the forms to GSA Supply Centers will begin March 15, 1988. The following schedule has been established for use of the new forms to request OPM investigations for sen-sitive positions April 1, 1988 - Begin use of the new forms.
( September 16, 1988 - Only the new forms will be accepted.
The previous edition of the SF 86 should be discarded when the October 1987 edition of the SF 86 is received.
- 4. The revised forms can be obtained through the MILSTRIP/FEDSTRIP ordering sys-tem from the Federal Supply Service, General Services Administration. The Na-tional Stock Number for the SF 86 is 7540-00-634-4036. The National Stock Nu m-ber for the SF 86A is 7540-01-268-4828.
h Constance 51 ener I Director i
Atracheents inquities: Training and Investigations Group, Office of Federal Investigations, (202) 632-6152 Code: 736, Investigations Distributmn. '4asic FPW Bulletin f spirev Aort 20, 1989
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. I Attachment . to FPM Btn, 736-16 (1)
StandardForm OS e.- .
beed Otteer t ae7 on a se mosam u s omos et Pweanrad unnagement ,7,,lL 8
FPW Chapter 738 w, Questionnaire for Sensitive Positions Read this information carefully. Follow the instru:tions fully or we cannot process your form.
Why do we need the information you will give Many investigations include an interview with you as a us and how will we una It? normal part of the invesdgative process. This Personal Interview is the Ant step in the investigation, and is The U.S. Government has conducted background investigations for over 50 years. It does this to .:* Nid.
conducted undu oas M ahon. k p@s p the
- PP """N d PI 'h "" ***
pletely m Y '* " P on ** y#N' '",d that people who want to be employed by the Gove'n-
- ormation ur rm which often helps to mers are suitable for the job and that they, along *ith mmpkte pr innsdgadon fastu. If pr innsdgadon people who will work for the Government useler , ,
requires a Personal Interview, you will be contacted in contract, are eligible for any required security clearance, advance h tekM w md m anange a h aM We use the information from this form primarily as the basis for an investigation that will be used to determine locadon fw iwrview. k s imponam sat se interview be conducted as soon as possible after you your qualifications and suitability for a panicularjob or han been contacted Postponemnts wG May the eligibility for a clearance, pocessing of your investigation. Dec!ining an interview Asking you for this information is in cornpliance with may result in your inveadgation being canceled.
the Privacy Act of 1974. The information you gin us is for Omelal Use Only; we will protect it froen un- You will be asked to bring identincation with your <
authorized disclosure. We may share some information picture on it, such as a valid State dnver's license, to the with Federal and other sources to get additional informa. Personal Interview,1here are other dccuments you may tion about you. We may also give some of the informa- be asked to bring to verify your identity as well. These tion to Federal, State, and local agencies checking on include: documernation of any legal name change; ,
law violations or for other lawfut purioses. Social Security card; anNor birth certificate.
(
Giving us the information we ask for is voluntary. ggy ,jg, g;, , ,,g flowever, wt may not be able to complete your in- g gg g g vestigau,on, or complete it in a timely manner, if yw tion; naturalization certificate; originals or certified don t give us each item of information we request. This copies of college tran+:nys or degrees; high school may affect your employment or clearance prospects.
dipW phim Nvnse(s) or certificate (s);
% hat authority do we have to ask you for the n hary discharge anWate(s) @D Fonn 214);
information requested on this form? mamage unincatew, pan papen; tax mum; passpon; anNor business hcense(s).
The U.S. Government is authorized to ask for this inform tion under sections 1303,1304, and 3301 of title You'also may be asked to bring documents that pertain
$ of the U.S. Code; secema 2165 of dtle 42, U.S. Code; to information provided in your answers to questions on Executive Order 10450; ard parts 5,731,732, and 736 the form or other matters requiring speific attention.
of title 5, Code of Federal Regulations. We ask for your lhese matters include: termination or discharge frorn Social Security number to keep our records accurate, employment; delinquent loans or tases, bankruptcy,
, because other people may have the same name and judgments, tiens, or other financial obligations; agree-binhdate. Execuuse Order 9397 also asks Federal ments involving child custody or support, alimony, or agencies to use this number to help idernify irdMduals proprty settlemeres; and arrests, convictions, probation in agency records. anfor parele.
Mhat le the insestigathe process?
ho makes a final determination?
The information you provide on thP iorm is confirmed by insestiganon. 1he type of investigation done Final determination on your suitability for employment depends on the level of sensitivity of the posioon you anNor your being granted a clear:,nce is the respn.
are seeking or now hold. The mformanon obtained in an sabihty of the OPM or tre Feders) agency that requested invesugation ecmes from records and peope. Sensieve your investiganon. You may be provided the opportu.
psirbns require an invest ganon that relies more on are nity to penonally enplain. refute, or mitigate any insestigaar interviewing pople who know you. informanon before a final decision is made.
- (
Attachment 1 t) FPM Btn) . J ti- 16 W)
C llow is this forr a organized? view with a Federal official you aill have adequate opporturury to esplain any infonranon you give us on This form has .wo parts. Part I asks for background the form and make your commenta part of the record.
information, includirig where you have lised, gone to school, and worked. Part 2 asks about your activities and such matten as firings from a job, a police record, llow is this form Alled out?
and questions about your association m'ith certain organizations. In answering Part 2, you should keep in 1. Follow the instructions of the pnon who gave you mind that your answen tc, any of the questions alone the form. Find out how man / copies of the form yOJ are may not disqualify you from a sensitive posi: ion. to turn in. You must sign and date,in ink, the origi.
nal and each copy you submit.
What are the penalties for inaccurate or false 2. Before you leave the office, look the form over and .
Information? ask for continuation sheets (SF 36A) if you think you'll need them. If you had more than 5 residences or 5 The U.S. Cr6.La*! Code provides that knowingly employmenu/self employrnents/unemployments la the falsifying or concealing a material fact is a felony which past 15 yean, or you have anended more than 2 schools, may resuh in fines of up to $10,000, or 5 years im. you will need a continuation sheet (s). The spaces pisonrnent, or both. In addition, Federal agencies prosided on pages 6 and 9 are to be used to continue generally fire or disqualify individuals who have your answers to other questions. If additional space is materially and deliberately falsined these forms, and needed, use a blank piece of paper. Each blank pece of this remains a part of our permanent record for future peper you use must contain your name and Social placements. Because the position for which you are Security number at the top of the page, being considered is a sensitive one, your trustwonhiness is a very isnportant consideration in deciding your 3. Type or legibly print your answers. We cannot suitability or eligibility for security clearance. Your acces your form ifit is not legible.
pospects of employment are becer if you answtr all .
questions truthfully and completely than if you falsify or omit any of the information. In the coune of an inter,
- 4. You must use the State codes (abbreviatioar) listed in the box below w hen you fill out your form.
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Asabama AL Hawed HI Wassactuees WA Neo unmco NW Saue Dakota 30 A:aska AX Idaho 10 Mcfogen he New Yort NY Tenresase TN AMona A2 ISnoe IL 64nnesota 494 Norm Carcana NC Tomas TX AAsnaas AR Incsana IN bles,ss# hts Nort Dakoes NO LAmh UT Castorrua CA loea LA Lessourt M0 CNo OH Vermont VT Colorse CO Karsas KS bbreana WT Cocahorna OK VIryrsa VA Connedxut CT Kanady KY Netraska NE Oregon CA Washegton Wa Deiseare DE Lou 6siana LA Nevada NV Peresy4 van,a PA West Wgiria WV Flottsa FL Mene ME NewHae W ure, NH Areds islW Al Wisconsen W1 Georgia GA MarYW b0 Nee Jersey NJ Scum Caroena SC Wyomeg #f 1
Aredcan Samoa AS Det of coksntne DC Guam 00 Noreem Mamas CW Puerio Rico P4 Trust forery TT VVge is:ar'ds VI e
5.1he 5-digit postal ZIP codes are needed to steed the space to write the month; and for the same reason, for proccuing of your investigation. The office that year you may show the last two numbers in the year.
I povided you with the form will amst you in completing For example, June 8,1967. could be shown as 6167,or l
the ZIP codes. January 1984 could be shown as 1/84.
l l 6. Whenever "City (Coa.arryr is shown in an address if you have any questions, call the office that gave you l block, also provide in that block the name of the country the form. Be sure to sign and date the certJfication when the address is outside the Uruted States. staternent on page 9 and compete the release on page
- 10. Any forms that are not completed according to these
- 7. When provid4ng dates, you may use numten 1 12 to instructions will be retumed. ThJs *111 delay the mdicate months if you don't beliese you have enough pocessing of your eaw.
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9 wusae vou iavi tivio Your Addrese. In the column geve the informaton roovested for People Who Knew You. Use the cobmn on8y lor those rm.
overy place you have lived for the past 15 years. Bege wth weere donces you show on the left that you occup.ed dunng the test 3 you We now aM work backwarde. For any Mdcasa ethan the poet years. Across from each such residence. grve the name and 3 yeere that conssted of "General Detrvery*, a Rural Route. or Star address of someone who knew you in that neigPterhood, prefer.
Rou'e, efth no desgna'od stree; addrees, don't gwe that as your ably someone who sta Ives there.
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from each such school, give the name GM addresa Cd Someoet wards. Use the totwing codes to indeste the type of seteos you (een as estrucer or erudent) .+c knew you at the school. 3 attended:
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b Attachd a to ITN Brn 736-16 (5) 0 11 va.m emomuneevoer ra mrow emc*ceal vd ee,v e ry enn e u ere < ead
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Attactrent "I to TTN Btn. 736-16( ;
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( Att[ ant 1 to ITN Btn. 736-16 (7)
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CON DNUA DON SPACE: Us. e. conwwa.on en mts) (5/ 86AJ tot mMacom are rs to questore 9.10. and 1I. Us. m space te to coetm. armem e an oe. ians a mor. c. . n $.e re ear anowmo te. ,e e e e. e a.or, e w r. w.re r t mee.,or e. son S
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( Attac[ t to rTu stn. 736-16 (9)
M *j* , QUESTIONNAIRE FOR ,'- ,g, vso' aced'-=<=' e SENSITIVE POSITIONS <- w =
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- Devil know* or "Don 1 receir. e he *0ther Ageney* headbg. besos If yeer roepeee ls "He'. cr you dcm1 e'r ces et can1 recall 8 yew were bvestigated and ciewed. che:A te "Me* bot Codes tor mestgathe Agorcy Coon tor Securey Cneararre Recewd 1 0+4 erne Depetwat 4 . F 81 0.NotAequeed 8 7op Secret 6. O Noneermee t . Staw Dspeitnant 8. treasury Dooare.nt 1. Corertal 4. Sensee Correetwted Lnformatoi 7.t 3.Cwn ee of Pe<soaret Managemert 6. Otef (Scoot) 3. Secet 8 . O Sers*w 4 . Oter Dese Averwy Cherence Dese Agens, caserere.
(stenfb Yearf Code Code (SAerW4 Teed Code Code 1
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At t a chrnc(i. 1 to FPM Btn. 736-16 (11) l p beast W eareemStie.et' vee ese i 30a wa rou ever seea a e.me.r. anc.r or e s*,ee e e. commurai *=+,' ZZ l 30 b yw.,-a.sc.
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l l read and wndestood tra estrecas eisa sq tre overcse of the 'orm aad P Feeval Go ernme ,t apor fy 'or soq tre o,estom I read eah oves'ca ash ed of me aN wMe<s*ced eoch owes'on I wMe*staN tP af f I dd not tel tre truth on tr4s torm or dd act Lat eI re'ersat or mater.al f ac*s or eve 1s. t*e Federal GovernreeM +sy '<e me, may avat hee me. may de7 or ree.a e my cseat ance or may prosecJe me I wMrstand that presecJon m ey resst e my t. N ' red wo io 110 000. wsoaed up to 5 yea >s. or botn wee (sve aisw co.
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Attachment 1 to FPM Btn,k 6-16 (12)
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UNITED STATES OF AMERICA Carefully read this authorintion to retease information about you, then sign a'd date it in ink.
AUTHORITY FOR RELEASE OF INFORMATION I Authorize any duly accredited representative of the Federal Government, including those from the U.S. Office of -
Personnel Management, the Federal Bureau of Investigation, and the Department of Defense, to obtain any informa-tion relating to my activities from schools, residential management agents, employers, criminal justice agencies, fmancial or lending institutions, credit bureaus, consumer reporting igencies, retail business establishments, medi-cal in titutions, hospitals or other repositories of medical records, or individuals. His information may include, but is not limited to, my academic, residential, achievement, performance, attendance, personal history, disciplinary, criminal history record, anest, conviction, medical, psychiatric / psychological, and financial and credit information.
I Further Authorize the U.S. Office of Personnel Management, the Federal Bureau of Investigation, the Depart-ment of Defense, and any other authorized agency, to request criminal history record information about me from criminal justice agencies for the purpose of determining my eligibility for access to classified information, or assignment to, or retention in, sensitive national security duties, in accordance with 5 U.S.C. 9101.
I Direct You To Release such information upon request of the duly accredited representative of any authorized (.
agency regardless of any agreement I may have made with you previously to the contrary.
I Understand that the information you release is for official use by the Federal Government, and that these users may redisclose the information you release as authorized by law.
I Release any individual, including records custodians, from all liability for damages that may result to me on account of compliance or any attempts to comply with this authorization. His release is binding, now and in the future, on my heirs, assigns, associates, and personal representative (s) of any nature. Copies of this authorization that show my signature are as valid as the original release signed by me.
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