Attachment 5-DHS Form 11055 FN Screening.pdf

This is DHS Form 11055, a Foreign National Screening Request Form used to screen foreign nationals being considered for access to DHS information, personnel, systems, and facilities. The form requires detailed information about the foreign national, including personal details (name, citizenship, residence), identification documents (passport and visa information), employment information, and visit/event details.

The form contains three main sections: Foreign National Information, Sponsor Information (for internal use), and Visit or Event Information (for internal use). The form must be completed by requestors and forwarded to the foreign national(s) being considered for screening. Multiple individuals can be included on one form for the same visit or event using the Add Individual button. All fields are mandatory, and incomplete submissions may result in processing delays. The form is authorized under 6 U.S.C. § 341 (2010) and is used by DHS Security personnel and contractor employees to evaluate foreign nationals requesting access. The form version shown is dated 06/17.