CBP_Form_78_BIRD_Form.pdf

Section A - Federal Point of Contact (FPOC) Name (Last, First, Middle Initial)

CBP Email Address Office Phone Number

Office/Division

Section B - Subject (Completed by the Subject or by the FPOC)

Social Security Number

Name (Last, First, Middle Initial)

Email Address

Current Street Address

Current City Current State Current Postal Code

Date of Birth Place of Birth (City, State, Country)

Country of Citizenship

Mother’s Maiden Name (Last, First, Middle Initial)

Father’s Name (Last, First, Middle Initial)

Section C - Position (Completed by the FPOC) Position Type

Contractor Federal

Position Sensitivity

Critical-Sensitive High-Risk

Office of Professional Responsibility Applicant

Yes No

OPR Personnel Security Division Applicant

Yes No

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

BACKGROUND INVESTIGATION REQUIREMENTS DETERMINATION (BIRD) DOCUMENT

Office of Personal Responsibility (OPR) Personnel Security Division (PSD)

CBP Form 0078 (12/18) Page 1 of 2

Privacy Act Statement

This Privacy Act Statement serves to inform you of how U.S. Customs and Border Protection (CBP) uses the personally identifiable information on this form.

Authority: CBP is authorized to collect and maintain the information on this form pursuant to 5 Code of Regulations (C.F.R.) Part 731, Suitability; 5 C.F.R. Part 732, National Security Positions; 5 C.F.R. Part 736, Personnel Investigations; and 32 C.F.R. Part 147, Adjudicative Guidelines for Determining Eligibility for Access to Classified Information. CBP collects Social Security numbers (SSN) pursuant to Executive Order (E.O.) 9397, Numbering System for Federal Accounts Relating to Individual Persons, and as amended by E.O. 13478, Amendments to Executive Order 9397 Relating to Federal Agency Use of Social Security Numbers.

Purpose: The purpose of the Background Investigation Requirements Determination Form is to collect CBP applicant and contractor information related to previous background investigations prior to entry on duty. CBP will use this form to determine if a previous background investigation conducted on the applicant or contractor is sufficient for CBP suitability and fitness determinations.

Uses: CBP uses the information you submit on this form to assess the applicant or contractor’s reciprocity eligibility. While CBP does not regularly share this information outside of DHS, CBP may make this information available as a routine use to other government agencies if the information is relevant and necessary to a requesting agency's decision concerning the hiring or retention of an individual, or issuance of a security clearance as long as the disclosure is appropriate to the proper performance of the official duties of the person making the request. A complete list of the routine uses can be found in the system of records noticed associated with this form, DHS/All/-023-Personnel Security Management System, available at:https://www.gpo.gov/fdsys/pkg/ FR-2010-02-23/html/2010-3362.htm

Disclosure: Providing this information is voluntary. However, failure to provide this information may result in a delay in determining the background investigation requirements, and may ultimately result in rescission of your selection for a position with CBP.

Security Clearance Required

Yes No

FM

Gender

Previous employment with Intel agency

No Yes https://www.gpo.gov/fdsys/pkg/FR-2010-02-23/html/2010-3362.htm https://www.gpo.gov/fdsys/pkg/FR-2010-02-23/html/2010-3362.htm

Please note: For the purpose of this instruction, the terms “applicant,” “employee,” and “subject” apply to selectees for both federal and contractor positions

A Background Investigation Requirements Determination (BIRD) request must be submitted for applicants and/or returning employees who have been selected to occupy a position for which a background investigation is required. On the BIRD document, all fields in sections A, B, and (if applicable) C must be completed and the information that’s provided must be legible. "A “complete” request includes the BIRD document, the Fair Credit Reporting Act (FCRA) Disclosure, and all required security clearance documents as appropriate. Requests must be submitted by the Federal Point of Contact (FPOC), to the Office of Personal Responsibility (OPR) Personnel Security Division (PSD) at IAPSDAPPINTAKEBRANCH@cbp.dhs.gov. Incomplete or illegible requests will be returned to the FPOC and will not be processed until corrected.

Federal Point of Contact (FPOC): The FPOC could be (but does not have to be) one of the following: Human Resources (HR) Specialist, Contracting Officer’s Representative (COR), e-QIP Initiator, or Background Investigation (BI) Coordinator.

The FPOC is responsible for the following:

working with the subject and the program office to compile a complete request submitting the complete request to PSD receiving PSD’s determination and coordinating with the applicable parties to ensure that any required actions are taken

Office of Personal Responsibility (OPR) Personnel Security Division (PSD): The OPR/PSD is responsible for managing the personnel security and suitability program, which includes initiating and/or adjudicating background investigations used in making employment suitability and security clearance determinations.

The OPR/PSD is responsible for the following:

receiving and processing the request making a determination and returning the determination to the FPOC following up with the FPOC if a “reciprocity eligible” determination is subsequently revoked

Determinations: The chart below provides a description of the determinations, the required follow-up actions, and the party responsible for taking the action or for passing the information along to whomever is responsible for taking the action

CBP Form 0078 (12/18) Page 2 of 2

Contractor Positions Only Has subject worked on a CBP contract in the past?

Yes No

If “yes” provide employment “End Date”

Section D - PSD Determination (completed by PSD) Initiation Required Reciprocity Eligible Reactivate Reciprocity Revoked

Determination Follow up Action Responsible Party

Initiation Required A background investigation (BI) has never been conducted, or the existing BI does not meet the position requirements

Subject must be initiated in e-QIP FPOC

Reciprocity Eligible An existing BI (conducted by CBP or another agency) may meet the position requirements

Existing investigation must be requested and reviewed OPR/PSD

Reactivate (Applies to contractor) The circumstances warrant the reactivation of an existing position positions only)

An existing position is reactivated in the system OPR/PSD

Reciprocity Revoked After reviewing the existing BI, PSD has determined that it doesn’t meet the position requirements

Subject must be initiated in e-QIP FPOC mailto:IAPSDAPPINTAKEBRANCH@cbp.dhs.gov

U.S. Customs and Border Protection 11.0.0.20130303.1.892433

BACKGROUND INVESTIGATION REQUIREMENTS DETERMINATION (BIRD) DOCUMENT

CBP 0078

Section A - Federal Point of Contact (FPOC) Name (Last, First, Middle Initial) CBP Email Address Office Phone Number Office/Division Section B - Subject (Completed by the Subject or by the FPOC) Social Security Number Name (Last, First, Middle Initial) Email Address Current Street Address Current City Current State Current Postal Code Date of Birth Place of Birth (City, State, Country) Country of Citizenship Mother’s Maiden Name (Last, First, Middle Initial) Father’s Name (Last, First, Middle Initial) Section C - Position (Completed by the FPOC) Position Type Contractor Federal Position Sensitivity Critical-Sensitive High-Risk Office of Professional Responsibility Applicant Yes No OPR Personnel Security Division Applicant Yes No ..\..\Library\CBP\DHS_S_4 Half Inch.tif U.S. Department of Homeland Security Seal.

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

BACKGROUND INVESTIGATION REQUIREMENTS DETERMINATION (BIRD) DOCUMENT

Office of Personal Responsibility (OPR) Personnel Security Division (PSD) CBP Form 0078 (12/18) Privacy Act Statement This Privacy Act Statement serves to inform you of how U.S. Customs and Border Protection (CBP) uses the personally identifiable information on this form.

Authority: CBP is authorized to collect and maintain the information on this form pursuant to 5 Code of Regulations (C.F.R.) Part 731, Suitability; 5 C.F.R. Part 732, National Security Positions; 5 C.F.R. Part 736, Personnel Investigations; and 32 C.F.R. Part 147, Adjudicative Guidelines for Determining Eligibility for Access to Classified Information. CBP collects Social Security numbers (SSN) pursuant to Executive Order (E.O.) 9397, Numbering System for Federal Accounts Relating to Individual Persons, and as amended by E.O. 13478, Amendments to Executive Order 9397 Relating to Federal Agency Use of Social Security Numbers.

Purpose: The purpose of the Background Investigation Requirements Determination Form is to collect CBP applicant and contractor information related to previous background investigations prior to entry on duty. CBP will use this form to determine if a previous background investigation conducted on the applicant or contractor is sufficient for CBP suitability and fitness determinations.

Uses: CBP uses the information you submit on this form to assess the applicant or contractor’s reciprocity eligibility. While CBP does not regularly share this information outside of DHS, CBP may make this information available as a routine use to other government agencies if the information is relevant and necessary to a requesting agency's decision concerning the hiring or retention of an individual, or issuance of a security clearance as long as the disclosure is appropriate to the proper performance of the official duties of the person making the request. A complete list of the routine uses can be found in the system of records noticed associated with this form, DHS/All/-023-Personnel Security Management System, available at:https://www.gpo.gov/fdsys/pkg/FR-2010-02-23/html/2010-3362.htm Disclosure: Providing this information is voluntary. However, failure to provide this information may result in a delay in determining the background investigation requirements, and may ultimately result in rescission of your selection for a position with CBP.

Security Clearance Required Yes No F M Gender Previous employment with Intel agency No Yes Please note: For the purpose of this instruction, the terms “applicant,” “employee,” and “subject” apply to selectees for both federal and contractor positions A Background Investigation Requirements Determination (BIRD) request must be submitted for applicants and/or returning employees who have been selected to occupy a position for which a background investigation is required. On the BIRD document, all fields in sections A, B, and (if applicable) C must be completed and the information that’s provided must be legible. "A “complete” request includes the BIRD document, the Fair Credit Reporting Act (FCRA) Disclosure, and all required security clearance documents as appropriate. Requests must be submitted by the Federal Point of Contact (FPOC), to the Office of Personal Responsibility (OPR) Personnel Security Division (PSD) at IAPSDAPPINTAKEBRANCH@cbp.dhs.gov. Incomplete or illegible requests will be returned to the FPOC and will not be processed until corrected.

Federal Point of Contact (FPOC): The FPOC could be (but does not have to be) one of the following: Human Resources (HR) Specialist, Contracting Officer’s Representative (COR), e-QIP Initiator, or Background Investigation (BI) Coordinator.

The FPOC is responsible for the following:

working with the subject and the program office to compile a complete request submitting the complete request to PSD receiving PSD’s determination and coordinating with the applicable parties to ensure that any required actions are taken Office of Personal Responsibility (OPR) Personnel Security Division (PSD): The OPR/PSD is responsible for managing the personnel security and suitability program, which includes initiating and/or adjudicating background investigations used in making employment suitability and security clearance determinations.

The OPR/PSD is responsible for the following:

receiving and processing the request making a determination and returning the determination to the FPOC following up with the FPOC if a “reciprocity eligible” determination is subsequently revoked Determinations: The chart below provides a description of the determinations, the required follow-up actions, and the party responsible for taking the action or for passing the information along to whomever is responsible for taking the action CBP Form 0078 (12/18) Contractor Positions Only Has subject worked on a CBP contract in the past?

Yes No If “yes” provide employment “End Date” Section D - PSD Determination (completed by PSD) Initiation Required Reciprocity Eligible Reactivate Reciprocity Revoked Determination Follow up Action Responsible Party Initiation Required A background investigation (BI) has never been conducted, or the existing BI does not meet the position requirements Subject must be initiated in e-QIP

FPOC

Reciprocity Eligible An existing BI (conducted by CBP or another agency) may meet the position requirements Existing investigation must be requested and reviewed

OPR/PSD

Reactivate (Applies to contractor) The circumstances warrant the reactivation of an existing position positions only) An existing position is reactivated in the system

OPR/PSD

Reciprocity Revoked After reviewing the existing BI, PSD has determined that it doesn’t meet the position requirements Subject must be initiated in e-QIP

FPOC

..\..\Library\CBP\DHS_S_4 Half Inch.tif U.S. Department of Homeland Security Seal.