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) under the VA Enterprise Centers, version February 4, 2025.

The form is a mandatory template for initiating background investigations on contractor personnel assigned to the Department of Veterans Affairs. It requires completion of all fields organized into three primary sections: VA Organization Information, Individual Information, and Company Information, with an additional CO/COR section. The VA Organization Information section captures the Servicing Personnel Vetting Office (SPVO), assigned VA organization (VHA), and station number (438). The Individual Information section collects comprehensive personal data including SSN, full name, date and place of birth, citizenship information, country of birth, marital status, email address, phone number, and the position title for which the investigation is requested. The form includes a dropdown menu for selecting the investigation type, with a note that additional options may appear after selection and that foreign nationals require completion of a supplementary Foreign National Check Form. The Company Information section requires contractor company name, task order number, company point of contact details, address, and phone number. The CO/COR section collects the Contracting Officer or Contracting Officer's Representative name, email address, and requires their signature. Completed forms must be uploaded as signed originals to the PSAC Resource Site.