OMB83_c_02_08

OMB Control No. 3095-0057

Expiration date: 05/31/2010

Outline of changes to NA 6006, Identification Card Request, in January 2008:

Overall the item numbers had to be changed after item 5 because some new item numbers were added.

For item 1a., added ” Defaced Lost Expired”

For item 3, add “ No”

Heading for item 4 changed from “Information” to “Affiliation” and added “(check all that apply):”

Also on item 4, added “ Foreign National”

For item 5, deleted extra line between headings and information.

Added new item after item 5, “6. Agency:       Firm:       24 Hour Access? Yes No”

Added new items after old item 12, “15. Parking Permit: Yes No

16. Brass Keys to Room #’s      ”

On top of page 2, moved “that” from after each check box to the heading “I, the Identity Processor, certify that:”

Added, after ID Processor signature and Date:,

“I, ________________________________________ acknowledge receipt of a temporary building pass, pending completion of a background investigation.

24. _______________________________________ 25. Date: [mm/dd/yyyy]

Candidate signature”

For Section C, the new item numbered 26, deleted checkboxes “ NAC FBI Fingerprint Results” and added checkbox “ Other”

Also on Section C, added:

“29. Clearances/Access:

General SEC SEC/L TS Q SCI SI TK G HCS NATO”

For Section D, added:

36. Parking Permit #:      

Since adding additional lines forced the Privacy Act Statement and Paperwork Reduction Act Public Burden Statement to the back of the form, added to the bottom of page 2:

“See the back of this form for the Privacy Act Statement and Paperwork Reduction Act Public Burden Statement that applies to the information you are providing.”