Attachment A.3.2.2.a – REE NEIS PII Sheet.pdf

Fingerprint Check Only OR Background Investigation/LincPass (No LincPass required) (select only one) (HSPD-12/LincPass Required)

Minimum Background Investigation required for PIV/LincPass is Tier 1/NACI

The USDA Credential Matrix indicates that a performing non-employee requires a LincPass, or in some cases, a fingerprint check. The information collected on this Personal Identifiable Information (PII) sheet is required for both processes. This information is to be collected and transmitted in accordance with The Privacy Act of 1974.

Instructions: Enter the information below for the non-employee applicant. If the form is incomplete or if required attachments are not included, the suitability package will not be processed and will be returned to Requestor.

*Required Attachments – if not included, form will not be processed and will be returned to Requestor

OF-306

Resume Finger Print Charts (2)

*Name (Last, First, Middle): Enter applicant's complete name as it appears on their government-issued ID (e.g. driver’s license or passport). If the information doesn’t match, the applicant will encounter problems during enrollment and may have to reapply.

*Date of Birth: (mm/dd/yyyy)

*Place of Birth: City/State If outside U.S., enter City/Country

*Gender: Please indicate the gender the applicant was born as

*Social Security Number:

If applicant is a Foreign National with no SSN, provide work authorization information.

*Country of Citizenship: Provide all countries of citizenship.

*Home Address: Enter the full address as it appears on the applicant’s most recent/valid government-issued ID.

*Phone Number:

*E-mail Address (business e-mail preferred): Required for enrollment notification.

*Type of Investigation Required for Position:

*Position Title:

*Length of Appointment (NTE Date):

*Company/Organization Name/Contract Number/ Agreement# Expiration Date:

*REE Area/Location/Duty Station (of employee; city and state)

*REE POC (Action Requestor/AO/HR Specialist):

Name, Title, Address, and Telephone Number

*Sponsor Name, Email Address, and Telephone Number:

HSPD-12 Sponsor for USDA Credential (LincPass)

*Name(s) of Individual to Receive Finger Print Results (AO and/or HR Liaison): As indicated in portal request.

*Purchase Order Number/Treasury Account Symbol Number:

Used for billing investigation products with OPM.

Update *Contractor Organization Code:

Please Hand Carry (or upload to AFMCS Porta d by Personnel Security, March 2021

l) to POC/Sponsor PSS Staff Use Only Date Cleared: _________________ Recipient: _______________________

Maria.Dallara Highlight

Maria.Dallara Highlight

Maria.Dallara Highlight

Maria.Dallara Highlight

(No LincPass required) (select only one) (HSPD-12/LincPass Required)