NF-0037.3-SEC-VisitorBackgroundCheck (Required for Organized Site Visit).pdf

Date: NBAF Sponsor Name:

Date of Visit:

US

Citizen?

(Yes/No)

Country of Origin Company/Agency Date of Birth (mm/dd/yyyy)

*Social Security Number

FOR PC:

FOR MAC:

NF-SEC-0037.3-VisitorBackgroundCheck

Telephone Number

NBAF FORM 37 (APR 2022)

TYPE ONLY in the table below (handwritten forms will NOT be accepted)

Once completed please e-mail this document to: NBAFSecurity@usda.gov *For your personal security, please DO NOT send personally identifiable information (the information contained within this document) to any other e-mail address. You should password protect and encrypt this form when returning it to NBAF and send the password in a separate email.

Name (Last, First Middle)

To password protect this document, follow the instructions below:

Select File tab, then select Protect Using Password; select Viewing; create a Password; reenter the Password to verify, and click on Apply.

Select File tab, then select Export, and click on Encrypt; create a Password; reenter the Password to verify, then click Save.

CUI//SP-SPII

VISITOR BACKGROUND CHECK

For all Background Checks, allow 3 working days for processing prior to visitor arrival

The Privacy Act, 552a, requires that federal agencies inform individuals, at the time information is solicited from them, whether the disclosure is mandatory or voluntary, by what authority such information is solicited, and what uses will be made of the information. The collection of this information is authorized by EO 9397, 6 USC 341, 44 USC 3101, and EO 12958.

Provision of the information concerning foreign visits is mandatory under the provisions of EO 12958. Failure to provide it may impact planned visits. Use of this information is for internal purposes to facilitate visitor processing.

When filled out, this document contains sensitive information exempt from mandatory disclosure under the Freedom of Information Act, 5 U.S.C 552(b)(2). Do not release without prior approval by the USDA.

For your personal security this form will be destroyed immediately upon completion of the access request process.

For questions or concerns, please contact NBAF Security at (785) 712-3093

PRIVACY ACT STATEMENT

CONTROLLED//SP-SPII

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