Contractor Background Investigation Request Form REV 02-04-2025.pdf

This is a Contractor Background Investigation Request form issued by the VA Personnel Security Adjudication Center (PSAC) for use by the Department of Veterans Affairs. The form is a template used to initiate background investigations for contractor personnel working on VA contracts or task orders.

The form requires completion of three primary sections: Individual Information, Company Information, and CO/COR Information. The Individual Information section collects personal identification data including Social Security Number, name, date and place of birth, citizenship, contact information, marital status, and position title. The Investigation field requires selection of investigation level, with additional options available after selection. Foreign nationals must also complete a Foreign National Check Form. The Company Information section requires contractor company name, task order number, point of contact details, and company address. The CO/COR Information section requires identification of the Contracting Officer or Contracting Officer's Representative, including name, email address, and signature. All fields are mandatory for form completion. The signed request must be uploaded to the PSAC Resource Site. The form version is dated February 4, 2025.