Attachment_D_-_FD-316.pdf

FD-316

Revised (12-17-2009)

FEDERAL BUREAU OF INVESTIGATION

ACCESS TO FBI FACILITIES

260C-HQ-1188944-Sub- __________________

To: Security Division, FBIHQ Date: _____________________ Attention: Contractor Clearance Unit

From: _____________________________________________ Name of Division

Subject: ________________________________________________ Candidate's Name

General Information

Type of Request: G Escorted Access

Location of Access: G FBIHQ G Other FBI Facilities __________________________________ (Division/Field Office)

Reason for Access (Explanation of Duty): ______________________________________________

Frequency and Duration of Access (Dates): __________________________________________

Complete For Access To FBI Facilities

Point of Contact: ____________________________________________________________ (must be completed)

Division: _______________________________ Phone: ____________________ Room: ____________

Required Enclosures: ______FD-816 ______ (2) FD-258 ______ FD-484 ______ SF-85P (Physicians only)

Instructions: Mark the appropriate box for each check conducted and attach an explanation of any derogatory results.

Universal/Manual Indices State and Local Police NCIC/Wanted Triple I Check G Pos. G Neg. G Pos. G Neg. G Pos. G Neg. G Pos. G Neg.

Division Recommendation: _______________ Granted Access _______________ Denied Access (Attach Explanation)

E-mail Notification Sent __________________ (Date)