Attachment21_Roster_of_Employees_Requiring_Suitability.xlsx

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Limb Loss and Preservation Registry
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NIH-NICHD-NCMRR-2018-16
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Suitability Roster

ROSTER OF EMPLOYEES REQUIRING SUITABILITY INVESTIGATIONS

CAN:Contractor:
RFP/Contract #:Contractor Contact:
Contract Title:Contractor E-mail:
Project Officer:
Contract Specialist:
TO BE FILLED OUT BY
PROJECT OFFICER and ISSO:TO BE FILLED OUT BY CONTRACTOR:
TO BE FILLED IN BY CONTRACTOR:

PROJECT OFFICER and ISSO:

Suitability LevelInvestigation TypeQuestionaire RequiredExisting Clearance or Application
Last NameFirst Namee-mailPositionNon-Disclosure

Agreement Submitted (mm/dd/yyyy) Security Awareness Training Completed

(mm/dd/yyyy)1, 5, 6NACI, NACIC, MBI, LBI, BIEstimated CostSF85 or SF85PQuestionaire Submitted
(mm/dd/yyyy)HHS Credit Release Submitted
(mm/dd/yyyy)OF 306 Submitted
(mm/dd/yyyy)Fingerprinting Completed
(mm/dd/yyyy)AgencyClearance LevelDateComment

&Z&F

Sheet2

Sheet3

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