Exhibit C1_New Incoming Personnel Form and Guide.pdf

CUI (when filled in)

DEFENSE HEALTH AGENCY NEW INCOMING PESONNEL FORM

DOB:

Reason:

Name:

SSN:

Place of Birth:

Citizenship:

If not born U.S. Citizen, list date of Naturalization and form type.

Naturalization Document Type and Date:

Email: Phone:

Personnel Category:

Position Title/Series/Grade:

Org./Market/MTF/Location:

Position Sensitivity Required:

Clearance/Eligibility Required:

Childcare:

PD/Contract Number:

Task Order (if applicable):

Company Name (if applicable):

Supervisor POC:

Hiring Official POC:

Submitting POC (CHRA/COR/FSO):

Date

CUI (when filled in)

Controlled by: DHA J-1 ASD CUI Category: PRVCY

LDC: FEDCON

POC: David Monteiro, 210-870-0664DHA NIP FORM JUN 2026

Volunteers and Student Interns requiring Childcare Checks must include DD 2981.

* SF50 may be used in lieu of proof of citizenship for current federal civilians ** DD3058, DA5018-R, and SUDDC IRC must be included for childcare applicants that have any prior DOD affiliation *** Justification memo required for any DHA assigned service member requiring a new investigation or upgrade

Please submit this NIP form and corresponding documents to the appropriate mailbox below.

DHA East Region Network and Europe: dha.ncr.dha-cs-mgt.mbx.dha-nip-east@health.mil

DHA West Region Network and Indo-Pacific: dha.ncr.dha-cs-mgt.mbx.dha-nip-west@health.mil

DHA Headquarters (DHHQ) Non-MTF Locations: dha.ncr.security.mbx.personnel-security-nip@health.mil

CUI (when filled in)

CUI (when filled in)

Complete for Childcare if known

LOSS Supervisor Name:

LOSS Supervisor SSN:

Please see table below for required documents.

DHA NIP FORM JUN 2026

Defense Health Agency New Incoming Personnel (NIP) Form Job Aid

Last updated 20260603

Reason: See below Date: Date you are submitting the NIP package

-New Incoming Personnel: Will be selected for most investigation requests for new civilian and contractor hires and military personnel being assigned to DHA. Military members must have orders specifically assigning them to DHA included with the NIP package.

-Current DHA Employee – Childcare Checks Required: Select this option for current DHA employees that have been identified as needing childcare checks as a part of their existing/previous investigation.

-Current DHA Employee – New Investigation Request: Select this option for current DHA employees that have been identified as needing a new investigation request. This may be due to a previous error in the investigation process, or the individual does not have a valid investigation on file.

-Current DHA Employee – Promotion/Upgrade: Select this option for current DHA employees that are moving to a new position via promotion or require an upgrade to their current clearance due to promotion, lateral transfer, temporary assignment, school attendance, etc.

-CBC 5 Year Reverification – Select this option to initiate the 5 year reverification requirement for current DHA employees in childcare position.

Name: Full name required SSN: Full SSN is required. Only including the last 4 will not be accepted.

DOB: Click dropdown arrow to populate date of birth

Place of birth: Include full City, State or City, Country if born abroad. Must match birth documents.

Personnel Category: See below

-After selecting Volunteer or Student/Intern, two additional fields will populate:

-Select Length – select over or under 180 days based on how long the Volunteer or Student/Intern will be performing their duties within a calendar year.

-Select Access – complete selection based on the computer access required by the Volunteer or Student/Intern. NEATs cards replaced VOLACs/ALT Tokens and are generally used for computer access for those not authorized a CAC. NEATs are issued by local PKI offices at the MTF/facility.

Position Sensitivity Required: Must match what is in the Position Description or Contract/PWS.

Clearance/Eligibility Required: Must match what is in the Position Description or Contract/PWS.

Childcare: See below

-Childcare Checks Required/Not Required – must match what is in the Position Description or Contract/PWS.

-CBC 5 Year Reverification – Confirms the need for 5 year reverification

-Childcare Checks Only (Current DHA) – Confirms the need for current DHA employees with existing/previous investigations that require new childcare checks only.

LOSS Supervisor and SSN: Optional field for childcare requests. If this information is known to the requester and is included in the NIP, it will allow DHA to identify if the LOSS has valid childcare checks on file and expedite the LOSS approval process.

Common Reasons for NIP Rejections:

• Missing, incomplete, and/or unsigned required documents

• Position requirements on NIP discrepant with PD/Contract/PWS

• Insufficient proof of citizenship

• Outdated/obsolete forms

• Not submitted by approved requester

Glossary of Terms used by DHA Security

ASD – DHA Administration Security Division

AVS – DCSA Adjudication & Vetting Services (formerly DODCAF, DODCAS)

CBC – Childcare Background Check

CHRA – Civilian Human Resources Agency

CVS – Central Verification System

DISS – Defense Information System for Security

DCSA – Defense Counterintelligence and Security Agency eAPP – NBIS Electronic Application

Fieldprint – Nationwide fingerprinting service used by DHA

Final Determination – Adjudication decision made after all investigation actions are completed

Interim Determination – Determination made by DHA ASD to allow applicants to onboard before Final Determination is made based on the presence of derogatory information in preliminary security checks

ISP – Investigation Service Provider

LOSS – Line of Sight Supervision

MTF – Military Treatment Facility

NIP – New Incoming Personnel

NBIS – National Background Investigation Services

PWS – Performance Work Statement

SOW – Statement of Work