Privacy Act Statement: (Public Law 93-579, 88 Statute 1896)

The information on this form is necessary to determine whether an applicant has the appropriate employment status and clearance for access identification as specified. Executive Order 10450, issued April 27, 1952, as amended by Executive Order 10548; Executive Order 13526; and section 506(a) of the Federal Records Act of 1950, as amended, constitutes authority for requesting this information. Failure to complete this form may result in refusal to provide an applicant with access identification. Disclosure of the information provided will not be made outside the Agency without written consent except (a) pursuant to applicable routine use listed under System of Records - AID 8 Personnel Security and Suitability Investigations Records, or (b) when disclosure without the candidate's consent is authorized by the Privacy Act and provided in AID Regulation 15. (A copy of the Privacy Act and Regulation 15 is available from Information and Records Division on request.)

The use of Social Security Number for U.S. citizens is authorized by Executive Order 9397. The Social Security Number is provided voluntarily to the Agency by the individual to enable proper entry of this report into the applicant's records. Failure to provide the required information could lead to mistaken identity entailing administrative complications with possible inconvenient or adverse consequences for the applicant.

Confidentiality of Records: This form shall be subject to inspection only by those persons authorized by USAID.