Exhbit 5_Region 1 Contractor Suitability Contractor Instructions 090108.pdf

NEW ENGLAND REGION

CONTRACTOR SUITABILITY CONTRACTOR INSTRUCTIONS

September 01, 2008

INTRODUCTION

Homeland Security Presidential Directive 12 (HSPD 12) establishes the Policy for a Common Identification Standard for Federal Employees and Contractors. In compliance with HSPD-12 on contractor suitability clearances, the New England Region developed instructions to assist contractors completing requirements of HSPD 12 and track the processing of those clearances.

DEFINITIONS

A. E-QIP (Electronic Questionnaires for Investigations Processing): An Office of Personnel Management (OPM) online Web-based system application that houses an electronic version of the Standard Form 85P (SF-85P).

B. Escort: A credentialed Federal employee or Long Term Contractor who has received a favorable National Agency Check with Written Inquiries (NACI) and a GSA approved identification credential and who is assigned to accompany an Escorted Temporary Contractor on or within a building.

C. Escorted Temporary Contractor: A non-federal employee or individual engaged to perform work for the federal government on or within federal facilities on a non-recurring and intermittent basis from 1 calendar day up to 15 calendar days. An Escorted Temporary Contractor requires an escort and is not required to have a suitability determination.

D. GSA Regional Credentialing Office (RCO): The GSA Office that is the liaison between GSA and DHS/FPS and has responsibility for the Regional Contractor Suitability Clearance Program.

E. GSA Requesting Official: Government employees, who have the authority through their position to request contractor suitability clearances, notify the contractors of the suitability determination, determine escorts, and notify FPS in writing of escorted contractors and perform other duties associated with the Contractor Suitability Clearance Program. Requesting Officials include, but are not limited to Contracting Officers, Contracting Officers’ Representatives (COR), Contracting Officers’ Technical Representatives, Property Managers, Project Managers, Security Guards or Customer Agency Officials.

F. Long Term Contractor- Non-U.S. Citizen residing in U.S. less than 3 consecutive years: A non-federal employee or individual engaged to perform work for the federal government, on or in a Federal Premises on a recurring basis for a duration of 181 calendar days or greater. They must meet HSPD-12 requirements and receive a favorable suitability determination..

G. Long Term Contractor- U.S. or Naturalized Citizen or Non- U.S. Citizen legally residing in U.S. for more than 3 consecutive years: A non-federal employee or individual engaged to perform work for the federal government, on or in a Federal Premises on a recurring basis for a duration of 181 calendar days or greater. They must meet HSPD-12 requirements and receive a favorable suitability determination.

H. National Agency Check (NAC): A basic background check that is an integral part of all background investigations consisting of searches of the OPM Security/Suitability Investigations Index (SII), the Federal Bureau of Investigation (FBI) Identification Division’s name and fingerprint files, and other files or indices from supporting local and state governments when necessary.

I. National Agency Check with Written Inquiries (NACI): A background check that consists of a NAC with written inquiries and searches of records covering specific areas of an individual’s background during the past five years (inquiries sent to current and past employers, schools attended, references, and local law enforcement authorities).

J. Security Forms: Forms that are required based upon the duration of the contract in order to complete a contractor suitability clearance and include the Contractor Information Worksheet, Standard Form (SF) 85P entitled Questionnaire for Public Trust Positions, 2-sets of DHS/FPS FD 258 entitled Fingerprint Cards, Form I-9 entitled Employment Eligibility Verification, DHS Contractor Information Worksheet and GSA Transmittal: Contractor Suitability Request Form.

K. Suitability determination: The process of determining whether a contractor is suitable to work in a federal facility. A suitability determination establishes a contractor’s loyalty, character, trustworthiness, and reliability, and therefore eligibility for the issuance of a GSA identification credential. Suitability determinations are either favorable or unfavorable.

L. Temporary Contractor: A non-federal employee or individual engaged to perform work for the federal government on or in a Federal Premise on a recurring, non-recurring and intermittent basis from 16 calendar days up to 180 calendar days.

M. Temporary/Long Term Contractor Requiring GSA Network Computer Access:

A non-federal employee or individual engaged to perform work for the federal government, within a Federal premise on a recurring, non-recurring and intermittent basis requiring access to the GSA computer network in support of a Service or Staff Office contract requirement. A Contractor requiring GSA Network Computer Access must meet HSPD-12 requirements. All Contractors requiring GSA network computer access, who receive a Pre-Favorable Suitability Determination may receive access to the following OCIO platforms, (Lotus Notes email, Internet Access and Microsoft Office). Once a Contractor receives a NACI, then the GSA OCIO may grant full computer network access upon Service or Staff Office request, based upon GSA Order CIO P 2181.

A Temporary Contractor : A non-federal employee or individual engaged to perform work for the federal government, in or on a Federal Premise, on a non-recurring and intermittent basis from 16 calendar days up to 180 calendar days must receive a favorable suitability determination. All Temporary Contractors will receive a NAC suitability determination. In addition, all Contractors Requiring GSA Network Computer Access on a non-recurring and intermittent basis from 1 calendar day up to 180 calendar days meet HSPD-12 requirements. All Temporary Contractors requiring GSA network computer access, who receive a Pre-Favorable Suitability Determination may receive access to the following OCIO platforms, (Lotus Notes email, Internet Access and Microsoft Office). Once a Temporary Contractor receives a NACI, then the GSA OCIO may grant full computer network access upon Service or Staff Office request, based upon GSA Order CIO P 2181. The following process must be followed:

1. Prior to the work commencing, the GSA requesting Official provides the following forms including the DHS FPS Contractor Information Worksheet (CIW) to the Temporary Contractor for completion and submittal back to the GSA Requesting Official in an unsealed envelope with the contractor’s last name, first name, middle name, last four numbers of their SSN and the company name at the top of the envelope :

• The SF-85P entitled Questionnaire for Public Trust Positions and, if required by the contractor, an SF-85P Continuation Sheet, which is located at www.gsa.gov and click on Forms Library.

• Two complete sets of DHS/FPS FD 258 (Fingerprint Cards)

• A copy of two documents that establishes “proof of identity” as listed on page 2 of the Form I-9 Employment Eligibility Verification.

• Contactor to complete all information in section 1 of the DHS

Contractor Information Worksheet (CIW) as required.

All forms must be complete and in typed format. Ha nd written forms will not be accepted.

2. Suitability Determinations may be either:

• Pre-Favorable - The prospective contractor is determined to be suitable to perform work in the building for a duration of up to 180

• Unfavorable – The prospective contractor is determined to be unsuitable to perform work in the building. This determination is frequently based upon an incongruity between the forms submitted by the contractor and the law enforcement checks. The contractor may appeal this decision within 30 days. All appeals on an Unfavorable determination are handled by HQ DHS/FPS, Washington, DC.

• Clarification – The prospective contractor needs to contact the

DHS/FPS Contractor Suitability Adjudication Section within 15 days to provide additional information in order to complete the background investigation for a suitability determination. Failure to respond within the above timeframe will result in an UNFAVORABLE determination.

• Illegible Fingerprints - The prospective contractor needs to re-submit 2 new sets of the DHS/FPS FD-258 Fingerprint Cards with a copy of the DHS/FPS illegible letter through the GSA Requesting Official to the GSA Regional Credentialing Office (RCO) within 15 days of the notification. Failure to resubmit within the above timeframe will result in an invalid application of which a complete packet will be required to be resubmitted

3. In the event the contractor receives an Unfavorable or Clarification suitability determination, the contractor is afforded an opportunity to explain and correct any inconsistencies by providing additional supporting documentation to the DHS/FPS Contractor Suitability Adjudication Section, which may or may not change the suitability determination.

B. Long Term Contractor- Non-U.S. Citizen residing in U.S. less than 3 consecutive years : A non-federal employee or individual engaged to perform work for the federal government, on or in a Federal Premises on a recurring basis for a duration of 181 calendar days or greater. They must meet HSPD-12 requirements and receive a favorable NACI suitability determination. The following process must be followed:

1. Prior to the work commencing, the GSA Requesting Official provides the following forms including the CIW to the contractor for completion and submittal back to the GSA Requesting Official. These forms should be returned in an unsealed envelope with the contractor’s last name, first name, middle name, last four numbers of their SSN and the compan y name at the top of the envelope :

• The SF-85P entitled Questionnaire for Public Trust Positions and, if required by the contractor, an SF-85P Continuation Sheet, which is located at www.gsa.gov and click on Forms Library.

• Two complete sets of DHS/FPS FD 258 (Fingerprint Cards)

• A copy of two documents that establishes “proof of identity” as listed on page 2 of the Form I-9 Employment Eligibility Verification.

• Contactor to complete all information in section 1 of the DHS

Contractor Information Worksheet (CIW) as required.

All forms must be complete and in typed format. Ha nd written forms will not be accepted.

2. Suitability Determinations may be either:

frequently based upon an incongruity between the forms submitted by the contractor and the law enforcement checks. The contractor may provide additional information in order to complete the background new sets of the DHS/FPS FD-258 Fingerprint Cards with a copy of the DHS/FPS illegible letter through the GSA Requesting Official to the GSA Regional Credentialing Office (RCO) within 15 days of the notification. Failure to resubmit within the above timeframe will result in resubmitted.

• Favorable-5 year NACI- Upon completion of OPM investigation and final favorable Suitability Determination by DHS/FPS, the contractor will receive notification from the GSA Requesting Official of their NACI clearance.

3. In the event the contractor receives an Unfavorable or Clarification suitability any inconsistencies by providing additional supporting documentation to the

C. (E-QIP)Long Term Contractor- U.S. or Naturalize d Citizen or Non- U.S.

Citizen legally residing in U.S. for more than 3 co nsecutive years: A non-federal employee or individual engaged to perform work for the federal government, in or on Federal Premises on a recurring basis requiring a duration of 181 calendar days or greater. They must meet HSPD-12 requirements and receive a favorable NACI suitability determination. The following process must be followed:

1. The GSA Requesting Official completes CIW sections 2 through 4 and then transmits CIW to the contractor to complete. The contractor completes section 1 of the CIW and returns back to the GSA Requesting Official in a sealed envelope with the contractor’s last name, first nam e, middle name, last four numbers of their SSN and the company name.

2. DHS/FPS will initiate and invite the contractor to complete the SF-85P via E- QIP with an email to their respective address as listed in Section 1 of the CIW.

Once invited, the contractor has 14 calendar days to complete E-QIP or the system will cancel the invitation. If canceled, DHS/FPS will notify the applicant and restart the process. Failure of the Contractor to comply will result in a delay for this person to perform work on the project.

3. Upon the contractor’s completion of the online application via E-QIP, the contractor is required to perform the following:

a. Print the SF-85P and transmit the last 3 signature/release pages, with original signatures and date. Photocopies of signatures will not be accepted. It is recommended that the contractor keep a copy of their complete printed SF-85P package for their records in case of clarifications.

b. Two sets of DHS/FPS FD 258 (Fingerprint Cards)

c. A copy of two documents that establishes “proof of identity” as listed on page 2 of the Form I-9 Employment Eligibility Verification.

d. The contractor will forward the documents listed in a, b and c above to the GSA Requesting Official in a sealed en velope with the contractor’s last name, first name, middle name, last four numbers of their SSN and the company name .

4. Suitability Determinations may be either:

frequently based upon an incongruity between the forms submitted by the contractor and the law enforcement checks. The contractor may provide additional information in order to complete the background new sets of the DHS/FPS FD-258 Fingerprint Cards with a copy of the DHS/FPS illegible letter through the GSA Requesting Official to the GSA Regional Credentialing Office (RCO) within 15 days of the notification. Failure to resubmit within the above timeframe will result in resubmitted.

• Favorable-5 year NACI- Upon completion of OPM investigation and final favorable suitability determination by DHS/FPS, the contractor will receive notification from the GSA Requesting Official of their NACI clearance.

5. In the event the contractor receives an Unfavorable or Clarification suitability any inconsistencies by providing additional supporting documentation to the

6. A contractor who has received either a Pre-Favorable or Favorable 5-Year suitability determination can be employed region-wide as long as their respective NAC or NACI has not expired. A NAC is valid for 180 days based upon the date of the DHS/FPS suitability determination letter and a NACI is valid for 5 years based upon the notification date from the RCO to the GSA Requesting Official on the contractor suitability determination.

For Official Use Only

Contractor Information Worksheet

Type Contractor

PBS Non-PBS

Prefer

Online (e-QIP) Hardcopy (SF-85P)

Priority (MBI / LBI / BI only)

Routine Expedite (Extra Cost)

1. Contract Employee Information Name (Last/Family)

First (Given)

Middle

Suffix

Social Security #

Date of Birth

Place of Birth: City

State:

Country e-Mail

Phone # (Day)

Phone # (Cell)

Position (Job) Title

IT/System

Admin Position?

Prior Investigation

Yes No

Investigation Date

Sex

Male Female

U.S. Citizen

Yes No

Aliens: Port of Entry City and State

Date of Entry

Alien Registration #

Citizenship

2. Contract Information

Company Name

Company is

Prime Sub Contractor

If Sub, Name of Prime

Contract / Work Order / RWA #

Contract Start Date

End Date

Has Option Years OR End Date TBD

Company Point of Contact (POC) Name

Address

3. Project/Work Location Information (Government site where contractor is working) Building Name

GSA Building #

Building Address

4. Type of Investigation Requested for: HSPD-12 Credential

Low Risk (NACI) SF-85P

Moderate Risk - (LBI / MBI)

HIGH Risk - (BI)

National Security - (BI / SSBI)

Non-HSPD-12 Credential < 6 months

Child Care Worker

Contract Guard

5. Requesting Official (Sponsor) Information Sponsor’s Name Michael Stec

Title Regional Security Officer

Is COR / COTR

Yes

Org Code / Symbol

1A e-Mail

R1HSPD12.Security@GSA.GOV

617-565-5209

Forms Reviewed

Yes

Review date

6. DHS Federal Protective Service CSA (Staff use only) Personnel Security Investigation:

OPM PIPS Inv

Status e-QIP Invitation #

Date e-Mail Sent

Release Form

CER

Med Release

GSA 3665

FD 258

CS Case

FD 258 RAP

Just

Date Received

Review ed

Scan/TIF

Date Sent to OPM

Suitability Decision Preliminary Date

Unfavorable

Favorable

Final Date

Favorable

Unfavorable

Notify GSA e-Mail: hspd12.security@gsa.gov e-Mail: it.security@gsa.gov e-Mail: Requesting Official

Comments / Notes

SPECIFIC INSTRUCTIONS FOR

Questionnaire for Public Trust Positions

SF85P

FAILURE TO FURNISH PROPERLY COMPLETED PAPERWORK WIL L

RESULT IN THE EMPLOYEE’S INABILITY TO BE EMPLOYED U NDER THE

CONTRACT UNTIL SUCH TIME AS THE CORRECT INFORMATION IS

FURNISHED.

This form can be filled online. Go to www.gsa.gov and click on Forms Library. Select Standard Form (SF), 85P and, if ne eded the continuation sheet(s) at 86A.

This instruction guideline is meant to help the individual fill out the SF85P correctly; however, this guideline may not cover every single specific question as the form is unique to the individual. It is the responsibility of the individual (applicant) to fill this form out entirely and truthfully.

It is very important to read the first page on the SF85P form as it has specific instructions and details the purpose and process of the form. By reading the first page on the SF85P along with this document thoroughly, you will help alleviate any form rejections. If the form is not filled out entirely, or any information is not filled in correctly, or ineligible, it will be rejected.

It is the intent of GSA, to attempt to catch any form errors prior to sending it to the Department of Homeland Security/Federal Protective Service (DHS/FPS), however, note that this form can be rejected by either GSA, DHS/FPS, or OPM (Office of Personnel Management, who has the ultimately authority).

General SF85P Instructions

1). Sign and date, in black ink. You are required to list your SSN at the end of each page in the spot supplied. You must type the form, but signatures must be original.

2). Type your answers in black ink. Try not to abbreviate any of your answers;

this will help negate a rejection.

3). All questions on this form MUST be answered. If no response is necessary or applicable, indicate on the form with a “none” or N/A”. If you find you cannot report an exact date, enter approximate or estimate date with an “APPROX” or “EST”. Note: You are not required to put a N/A in every si ngle line item, only the first box of the question where applicable.

4). Any changes made on this form, you must sign it with initials and date it. This can only be done by the applicant. If white out or correction tape is used, you must sign it with initials and date it.

5). You can use State codes, such as WA for Washington, but you can not abbreviate the names of cities, foreign countries, or street names.

6). ZIP codes are required.

7). A physical address is required when the form asks for your address. If you would like to add your PO Box next to it, that is fine, so you may receive correspondence.

8). All dates provided must be in the Month/Day/Year or Month/Year format.

9). Whenever “City (Country)” is shown in an address block, also provide in that block the name of the country when the address is outside of the United States.

10). If you need additional space to list residences or employments, or education, you must use the SF86A form. If additional space is needed to answer other items, you may use a blank piece of paper. Each blank piece of paper must contain your name and SSN at the top of the page. Also note what question your answer correspondence to.

Specific Instructions for the SF85P

These instructions correspond with the actual question (number) on the form.

NOTE: Not every question/number will be listed as many are very self explanatory.

1). Name: Must provide your full legal name. If no middle initial, list NMI, if you only have an initial for a middle name, list IO.

3). Place of Birth: This line asks for City, County, State and Country if outside the U.S. Make sure you list County and don’t mistake it for Country.

4). Social Security Number : should match all points in application.

5). Other names used : You must list all names used such as aliases, and maiden names. All names used, other than your current name, must have the date and year from and to. If you do not know the exact month, use approximate date.

7). Telephone Numbers : Work number listed should match the contract company you are with. If you are filling out this application to work for the government, then you should have a work number.

8). Citizenship : You must check one of the three boxes listed. Pay close attention to which box you check, then fill in the appropriate boxes needed. For example: If you check the first box, you must then fill in items b and d. (b. is required, mother’s maiden name both first and last).

Helpful Hints (Examples):

Derived: Parents became citizens so children are citizens, or adopting a child from another country.

Naturalized: Became a US Citizen through the Courts.

State Department Form 240 needed: Example: When born on a military base outside of the United States.

If no dual citizenship, put N/A.

Alien: You must put the City and State where you entered the United States. You must have the actual date, your Alien Registration # and the Country you are legally a citizen of.

Passport Information: If you have a Passport, list it, however this does not replace the Certificate # needed.

9). Where you have lived: You must include your current address on line #1.

You must list a physical address even if you receive mail at a P.O. Box address.

You can add the P.O. Box address in addition to be able to receive correspondence from the Government if applicable. Note: You must list a Street, Avenue, Court, etc on your street address. Example: You can not list you live on 123 Government, It must be 123 Gov ernment Way, Ct, Street, SE, NE, etc.

Verifier: You must list a person to verify that you lived at the addresses you list.

OPM requires you list a different verifier for each address and preferably someone that still lives near the address you list. Verifier must include first and last name. You can use a P.O. Box for the verifier.

10). Where you went to school: Pay close attention to this section. You must list all schools that you have attended BEYOND Junior High, beginning with the most recent (#1) and working back for 7 years. If all your education is beyond 7 years, then you must list any education BEYOND High School. Example: You must list all College or University Degrees and dates they were received. If all your education is beyond 7 years and you have no education after High School, then list N/A in block #1.

11). Your Employment Activities: The first block Item #1 must be the employer that you will be working for as a Government Contractor (Use code 8 for Government Contractor). Use the appropriate codes listed to put in the Code block.

List the name of your employer, and their address. For Street Address of Job Location (if different than Employers Address), list the address where you will be working as a Government Contractor.

Always list your supervisor name, their address will be required if their address is different from the Employer address you listed.

If you are self employed, you will need to list the name of your company and list a name and address of a person that can verify this information. Please note, you will need a different verifier for each period of self employment. (Example: If you have two different time periods where you have been self-employed, you will need to this information in a separate numbered block, and list different people who can verify for you).

If you have been unemployed several times, you can list all the information in one numbered block, and use the same verifier if preferred. You can also use the Previous Periods of Activity to list all times of unemployment.

13). People Who Know You Well: P.O. Boxes are permissible in this block.

You MAY NOT use any family, spouses, or former spouses.

14). Your Marital Status: You must list both the City and State in the Place of Birth block. You must complete all the required information on your Current Spouse.

15). Your Relatives: You must make an effort to put all the information needed in this block. However, if you do not know and can not find out due to estranged relationships, etc, then you can put Unknown in birthdates and addresses of your relatives. Note: You can not abbreviate Unknown.

If your relative is deceased, you do not have to put a street address or state code.

16). Your Military History: If you were in the service, you must provide your Service/Certificate No. You can visit the websites listed below to help obtain information.

17). Your Selective Service Record: Every male must have a Registration Number or the Legal Exemption Explanation. . To help obtain this information, you can try the following:

www.archives.gov www.sss.gov 888-655-1825

20). Your Police Record: You are signing a document that you can legally be held accountable for. If you have a police record within that last seven years, you must list it. Falsifying a government document can lead to Unfavorable Adjudication (security clearance).

21). Illegal Drugs: Please do not list any legal prescription medications.

Authorization for Release of Information: You must sign and date this form.

Authorization for Release of Medical Information: Most GSA/PBS Contractors are not required to fill out this form (examples that do: Contract Security Officers).

Leave Blank

ALL Corrections must be initialed and dated

ALL Zip-Codes must be included (See attached three digit zipcodes)

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REQUIRED REQUIRED

Required (Check One)

REQUIRED

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----------------------------------- Required if Applicable -----------------------------------

Required to go back 7 years with gaps of no more than 2 months

------------------------------ Required for the last 5 years ------------------------------

------------------------------ Required to go back 7 years ------------------------------

------------------------------ Required to go back 3 years only ------------------------------

REQUIRED

Required to go back 7 years with gaps of no more than 2 months

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Required to go back 7 years

REQUIRED

Required to go back 7 years with gaps of no more than 2 months

-------------------- Required to go back 7 years with gaps of no more than 2 months --------------------

(List periods of unemployment of 2 months or more)

-------------------------------- Required if different than employers address --------------------------------

-------------------------------- Address is Required if Address is different from above --------------------------

---------- Required if subject was previously employed within the last 7 years ----------

REQUIRED

Need to answer “Yes” or “No”

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REQUIRED

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Required for all Relatives

Fitting the codes above

REQUIRED

Need to answer “Yes” or “No”

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_____________________________________________ Required if a Male

------------------------------ Required if a Male born in 1960 or later ------------------------------

--------------------------------------------- Required if Applicable ---------------------------------------------

--------------------------------------------- Answer if Applicable ---------------------------------------------

Need to Answer” Yes” or “No”

Need to Answer

Need to Answer “Yes” or “No”

Need to Answer “Yes” or “No”

------------------------------------------- Required if Applicable ------------------------------------------

--------------------------------------------- Answer if Applicable ---------------------------------------------

--------------------------------------------- Answer if Applicable ---------------------------------------------

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Need to Answer “Yes” or “No” in all boxes

Need to Answer “Yes” or “No”

Need to Answer “Yes” or “No”

------------------- Required -------------------- Date not older than 120 days

Required

------------------------------------------- Required -------------------------------------------

Required only if Answered “Yes” to SF 85P-S Question Number 5

------------------------------------------- Required if Applicable -------------------------------------------

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------------------------------------------- Required if Applicable -------------------------------------------

Date not older than 120 days

Need to Answer “yes” or “No”

Need to Answer “yes” or “No”

Need to Answer “Yes” or “No” in all boxes

Required

FOR DEO POSITIONS ONLY

For persons under age 18 who are unable to present a document listed above:

LISTS OF ACCEPTABLE DOCUMENTS

LIST A LIST B LIST C

2. Permanent Resident Card or Alien

Registration Receipt Card (Form

I-551)

7. Unexpired employment authorization document issued by

DHS (other than those listed under

List A)

1. Driver's license or ID card issued by a state or outlying possession of the

United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color and address

1. U.S. Social Security card issued by the Social Security Administration

(other than a card stating it is not valid for employment)

9. Driver's license issued by a Canadian government authority

1. U.S. Passport (unexpired or expired)

2. Certification of Birth Abroad issued by the Department of State

(Form FS-545 or Form DS-1350)

3. An unexpired foreign passport with a temporary I-551 stamp

4. An unexpired Employment

Authorization Document that contains a photograph

(Form I-766, I-688, I-688A, I-688B)

3. Original or certified copy of a birth certificate issued by a state, county, municipal authority or outlying possession of the United

States bearing an official seal

3. School ID card with a photograph

5. An unexpired foreign passport with an unexpired Arrival-Departure

Record, Form I-94, bearing the same name as the passport and containing an endorsement of the alien's nonimmigrant status, if that status authorizes the alien to work for the employer

6. Military dependent's ID card

4. Native American tribal document

7. U.S. Coast Guard Merchant Mariner

Card

5. U.S. Citizen ID Card (Form I-197)

8. Native American tribal document

6. ID Card for use of Resident

Citizen in the United States (Form

I-179)

10. School record or report card

11. Clinic, doctor or hospital record

12. Day-care or nursery school record

Illustrations of many of these documents appear in Part 8 of the Handbook for Employers (M-274)

2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color and address

Form I-9 (Rev. 06/05/07) N Page 2

4. Voter's registration card

5. U.S. Military card or draft record

Documents that Establish Both

Identity and Employment

Eligibility

Documents that Establish

Identity

Documents that Establish

Employment Eligibility

OR AND