36C77619Q0108-004.docx
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36C77619Q0108 Attachment D - NCHC Screening Notification.docx
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Text version
Revised June 2011 Revised July 2011
Department of Veterans Affairs VHA Service Center 6100 Oak Tree Blvd #500 Independence, OH 44131
Fingerprint Check - National Criminal History Check completion notice
Contractor Information
| Contracting Officer/Specialist: |
Prime Contractor POC Name & Phone:
| Comments: |
| Employees are eligible for access to federal facilities based on a |
favorably adjudicated fingerprint screening. Employees will not be fully functional if they require a full PIV badge. Employees will not be issued a permanent PIV badge until their investigation is scheduled.
Contractor/Employee Fingerprint check (National Criminal History Check) Information
Employee Name (Full Legal Name)
| Closed Date |
| Screening Decision |
| Date of Decision |
| Badge Type |
Form #NCHC1 This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, for individuals completing Federal Investigative Forms.
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