W9127827QA001_Attachment_2_Sample_Fingerprint_Card.pdf
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- Solicitation number
- W9127827QA001
About this file
This is the Standard Form 87 (SF 87), a fingerprint chart form issued by the U.S. Department of Defense for background investigation purposes. The form, revised February 2021, is used to collect fingerprint impressions and personal identification information for individuals undergoing security clearance determinations, military enlistment, federal employment suitability assessments, or contractor fitness evaluations.
The form requires applicants to provide biographical data including last name, first name, middle name, date of birth, sex, height, weight, eye color, hair color, place of birth, aliases, scars/marks/tattoos, social security number, position applied for, department/bureau/duty station, and race/ethnicity selection. Ten individual fingerprint impression boxes are provided—five for the right hand (thumb through little finger) and five for the left hand—with additional spaces for simultaneous four-finger impressions from both hands. The instructions specify using printer's ink, washing and drying fingers thoroughly, rolling fingers from nail to nail to avoid slipping, and ensuring impressions are recorded in correct order. Quality standards require clear classification patterns (loops, whorls, or arches with visible deltas) to enable FBI fingerprint file searches. If more than three impressions are unclassifiable, a new chart must be completed. The Defense Counterintelligence and Security Agency (DCSA) is authorized to collect this information under Public Law 115-91 and Executive Orders 8781, 9397, 13467, and 13869. Disclosure is voluntary; however, failure to provide information may delay or prevent qualification determinations. The estimated public burden is approximately five minutes per response.
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Text version
SF 87 (REV. FEBRUARY 2021)
US DEPT OF DEFENSE
E.O. 13869
LEAVE BLANK
MIDDLE NAME
FBI
LEAVE BLANK
SIGNATURE OF PERSON FINGERPRINTED O
R I
SERIAL NO. (DOD USE ONLY) OCA
RESIDENCE OF PERSON FINGERPRINTED S
O N
S O I
IPAC MISCELLANEOUS NO. MNU DATE OF BIRTH DOB
MONTH DAY YEAR
ALIASES AKA SEX HGT. WGT. EYES HAIR PLACE OF BIRTH POB
DATE SIGNATURE OF OFFICIAL TAKING FINGERPRINTS
LEAVE BLANK
CLASS
REF.
TITLE AND ADDRESS SCARS, MARKS, AND TATTOOS
POSITION TO WHICH APPOINTED FBI NO. FBI
DEPARTMENT, BUREAU, AND DUTY STATION (CITY AND STATE) SOCIAL SECURITY NO. SOC
1. R. THUMB 2. R. INDEX 3. R. MIDDLE 4. R. RING 5. R. LITTLE
6. L. THUMB 7. L. INDEX 8. L. MIDDLE 9. L. RING 10. L. LITTLE
LEFT FOUR FINGERS TAKEN SIMULTANEOUSLY L. THUMB R. THUMB RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY
RACE (SELECT ONE OR MORE)
___ AMERICAN INDIAN OR ALASKA NATIVE
___ ASIAN
___ BLACK OR AFRICAN AMERICAN
___ HISPANIC OR LATINO
___ NATIVE HAWAIIAN OR OTHER PACIFIC
I ISLANDER
___ WHITE
TYPE OR PRINT ALL INFORMATION IN BLACK
LAST NAME NAM FIRST NAME
A343 Z256 21008711
*** SAMPLE ***
K5CT9SMC
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INSTRUCTIONS FOR OBTAINING CLASSIFIABLE FINGERPRINTS ON STANDARD FORM 87, FINGERPRINT CHART
1. USE PRINTER’S INK.
2 DISTRIBUTE INK EVENLY ON INKING SLAB.
3. WASH AND DRY FINGERS THOROUGHLY.
4. ROLL FINGERS FROM NAIL TO NAIL AND AVOID ALLOWING FINGERS TO SLIP.
5. BE SURE IMPRESSIONS ARE RECORDED IN CORRECT ORDER.
6. IF AN AMPUTATION OR DEFORMITY MAKES IT IMPOSSIBLE TO PRINT A FINGER,
MAKE A NOTATION TO THAT EFFECT IN THE INDIVIDUAL FINGER BLOCK.
7. IF SOME PHYSICAL CONDITION MAKES IT IMPOSSIBLE TO OBTAIN PERFECT
IMPRESSIONS, SUBMIT THE BEST THAT CAN BE OBTAINED WITH A MEMO
STAPLED TO THE CARD EXPLAINING THE CIRCUMSTANCES.
8. EXAMINE THE COMPLETED PRINTS TO SEE IF THEY CAN BE CLASSIFIED,
BEARING IN MIND THE FOLLOWING; MOST FINGERPRINTS FALL INTO THE
PATTERNS SHOWN BELOW:
(OTHER PATTERNS OCCUR INFREQUENTLY AND ARE NOT SHOWN HERE)
(A) A DELTA (Δ) IS THE POINT AT WHICH THE LINES FORMING THE LOOP OR WHORL
PATTERN SPREAD AND BEGIN GOING IN DIFFERENT DIRECTIONS. ALL LOOP PRINTS
HAVE ONE DELTA. WHORL PRINTS HAVE TWO.
(B) LOOP PRINTS CANNOT BE CLASSIFIED UNLESS THE CENTER OF THE LOOP AND DELTA,
AND THE LINES BETWEEN THEM, ARE CLEAR.
(C) WHORL PRINTS CANNOT BE CLASSIFIED UNLESS THE TWO DELTAS, AND THE LINES
CONNECTING THE DELTAS, ARE CLEAR.
(D) ARCH FINGERPRINTS CAN BE CLASSIFIED IF A SUFFICIENTLY CLEAR IMPRESSION IS
OBTAINED TO PERMIT IDENTIFICATION OF THE PATTERN AS BEING AN ARCH.
9. IF, UPON EXAMINATION, IT APPEARS THAT ANY OF THE IMPRESSIONS CANNOT BE
CLASSIFIED, NEW PRINTS SHOULD BE MADE. IF NOT MORE THAN THREE IMPRESSIONS
ARE UNCLASSIFIABLE, NEW PRINTS OF THESE FINGERS MAY BE TAKEN AND PASTED
OVER THE DEFECTIVE ONES. IF MORE THAN THREE ARE UNCLASSIFIABLE MAKE A NEW
CHART.
1. LOOP 2. WHORL 3. ARCH
PRIVACY ACT STATEMENT
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why the DoD is requesting the information on this form.
Authority: The Defense Counterintelligence and Security Agency (DCSA) is authorized to collect the information requested on this form, including your Social Security number, pursuant to Section 925 of Public Law 115-91; Executive Orders 8781, and 9397 as amended, and Executive Order 13467 as amended by Executive Order 13869.
Purpose: DCSA is requesting this information in connection with your background investigation and will use it to search the Federal Bureau of Investigation’s fingerprint files in connection with investigating and determining your initial or continued: eligibility for access to classified national security information or assignment to positions with sensitive duties, enlistment or appointment into military service, suitability for federal employment, fitness for assignment to work under contract for or on behalf of the government, or eligibility for physical or logical access to U.S.
Government systems or facilities. This information may also be used for searches of other law enforcement agencies’ fingerprint files for the same purpose.
Routine Uses: The information on this form will be shared with the Federal Bureau of Investigation, and may be shared by DCSA as a routine use with other government agencies, and commercial entities as part of a background investigation conducted to verify your identity, for any of the purposes described in the “PURPOSE” section above; and, for other purposes permitted under subsection (b) of the Privacy Act of 1974, as amended (5 USC §552a). A complete list of the routine uses can be found in the system of records notice for the Department of Defense Personnel Vetting Records System, “DUSDI 02-DoD”, at https://www.federalregister.gov/documents/2018/10/17/2018-22508/privacy-act-of-1974-system-of-records. You may also wish to refer to the FBI’s Privacy Act Statement here: https://www.fbi.gov/services/cjis/compact-council/privacy-act-statement Consequences of Failure to Provide Information: Disclosure is voluntary. However, failure to provide the requested information may delay or prevent a determination regarding qualifications, suitability, eligibility or fitness.
PUBLIC BURDEN STATEMENT
We estimate the Public Burden for this collection of information is approximately five minutes per response. This includes time for reviewing the instructions, completing the form, and the actual fingerprinting. Send comments regarding our estimate or any other aspect of this form, including suggestions for reducing completion time, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-infor-mation-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
SF 87 (REV. FEBRUARY 2021)
NSN 7540-00-634-4037
ALL OTHER PREVIOUS EDITIONS UNUSABLE
FORM APPROVED 87-207
✩ OMB NO. 0705-0002
PRINTED ON RECYCLED PAPER
DELTA
THESE LINES RUNNING BETWEEN
DELTAS MUST BE CLEAR
CENTER
OF LOOP
DELTA
THIS SPACE FOR FBI USE
THE LINES BETWEEN CENTER OF
LOOP AND DELTA MUST SHOW ARCHES HAVE NO DELTAS
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