Form 611-B Intelligence Background Questionnaire

Peace Corps

Office of General Counsel

Intelligence Background Questionnaire

Your application (or your relative’s application) discloses a possible connection between your background and the Intelligence community. Peace Corps policy makes it necessary to review your eligibility for employment, as it relates to our Intelligence policy. This policy states that it is crucial that there be total separation of Peace Corps from intelligence activities, both in reality and appearance. Any semblance of a connection would seriously compromise the ability of the Peace Corps to develop and maintain trust and confidence in our host countries.

The policy applies to any applicant who has engaged in intelligence activities or related work, who has been employed by or connected with such activity, OR has an immediate family member who is or has been so employed. The results of the review may find you fully eligible for service, may bar you from service for a specific time period, or limit you service to certain parts of the world. If serious doubts exist about an applicant's association, the issue will be resolved in favor of exclusion from service.

To continue processing your application, we will need to review the following factors, and these will be considered in the final determination:

1. Describe the nature of the activity or connection;

2. What agency was involved;

3. What was the duration of the connection;

4. What was the date of the last connection with the agency or activity;

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5. Describe the location where the activity or work was performed;

6. Did the activity involve contact with foreign nationals;

7. Was the connection to an intelligence activity known by the applicant or family member at the time it occurred;

8. What training was received, if any;

9. Give the regularity of contact with the agency in question

10. What was the nature of the duties performed;

11. Was the activity or connection known by the public;

12. Did your duties include any activities or specialized training involving or related to the clandestine collection of information, or the analysis of dissemination of such information, intended for use by the United States government in formulating or implementing political or military policy in regard to other countries. Be specific if you can without violating any national security concerns.

13. If the person with the intelligence connection is a family member of the applicant, describe the relationship (sister, uncle, etc) and state when and if the family member has lived with the applicant.

14. Additional Information

Disclosure of this information may be prohibited by law, if so, it may be necessary for you to consult the Office of the General Counsel of the agency involved before responding to this letter. If your connection relates to an immediate family member who is, or was, involved in intelligence activities, that person may make the contact for you. When your situation is explained to the agency, they should advise whether or not the facts requested may be disclosed. The agency may elect to discuss these issues with the Office of the General Counsel of the Peace Corps to expedite a decision.

If disclosure is prohibited, the agency in question may suggest that you withdraw your application rather than compromise either the agency or yourself. It is important for you to take immediate action because you may not be invited for volunteer service until the issue is resolved.

A copy of the Peace Corps policy, the language of which will govern the final decision, is available upon request. If you have any questions, please call this office at (202)692-2150. If you are authorized to provide information, or if the work was of a nature that does not require authorization, please forward it to:

Bonita Porter

Executive Assistant

Office of the General Counsel

1111 20^th Street, NW, Suite 8200

Washington, DC 20526

A decision regarding your eligibility, based on the information you provide, will be made as soon as possible.

Burden Statement:

Public reporting burden for this collection of information is estimated to average 10 minutes per response. This estimate includes the time for reviewing instructions and completing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: FOIA Officer, Peace Corps, 1111 20^th Street, NW, Washington, DC 20526 ATTN: PRA (0420-####). Do not return the completed form to this address.