SF-86C SF 86 Certification

Standard Form 86C
Revised April 2006
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736

STANDARD FORM 86 CERTIFICATION
SF 86C

Form approved:
OMB No. 3206 0005
NSN 7540-01-500-4881
86-111

Follow instructions fully or we cannot process your form. Be sure to sign and date the certification statement on page 2. If you have any questions, contact the office that gave
you this form.
The Standard Form 86 (SF 86), Questionnaire for National Security Positions, is completed by persons under consideration for or retention in national security positions as
defined in 5 CFR 732 and for positions requiring access to classified information, as defined in Executive Order 12968. Depending upon the purpose of your investigation, the
United States Government is authorized to ask for this information under Executive Orders 10450, 10865, 12333, 12356, and 12968; Sections 3301, 3302, and 9101 of title 5,
United States Code; Sections 2165 and 2201 of title 42, United States Code; chapter 23 of title 50, United States Code; and parts 2, 5, 731, 732, and 736 of title 5, Code of
Federal Regulations.
There are many situations where individuals are required to fill out a new SF 86 when the sole purpose is to determine if any information on a previously executed SF 86 has
changed. This requires extensive work by the individual even if nothing has changed. The SF 86C is a certification document that allows the reporting of changes in previously
reported information on the SF 86. This certification will be in lieu of completing a new SF 86 and will allow the individual to indicate that there have been no changes in the
data provided on the most recently filed SF 86 or it will allow the individual to easily provide new or changed information. No investigation will be initiated based solely on the
execution of this form.
Your Social Security Number (SSN) is needed to keep records accurate because other people may have the same name and birth date. Disclosure of your SSN will be used to
help identify you in agency records. Although disclosure of your SSN is not mandatory, failure to disclose your SSN may prevent or delay the processing of your background
security investigation. We may verify your SSN with the Social Security Administration. The authority for soliciting and verifying your SSN is Executive Order 9397.

PRIVACY ACT ROUTINE USES
The Office of Personnel Management (OPM) has published routine uses for disclosing background information in OPM’s systems of investigative records. OPM conducts the
majority of background investigations and serves as the lead agency for the SF 86. OPM’s routine uses follow:

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To designated officers and employees of agencies, offices, and other establishments in the
executive, legislative, and judicial branches of the Federal Government, having a need to
evaluate qualifications, suitability, and loyalty to the United States Government and/or a
security clearance access or determination.
To designated officers and employees of agencies, offices, and other establishments in the
executive, legislative, and judicial branches of the Federal Government, when such agency,
office, or establishment conducts an investigation of the individual for purposes of granting a
security clearance, or for the purpose of making a determination of qualifications, suitability, or
loyalty to the United States Government, or access to classified information or restricted
areas.
To designated officers and employees of agencies, offices, and other establishments in the
executive, judicial, or legislative branches of the Federal Government, having the
responsibility to grant clearances to make a determination regarding access to classified
information or restricted areas, or to evaluate qualifications, suitability, or loyalty to the United
States Government, in connection with performance of a service to the Federal Government
under a contract or other agreement.
To the intelligence agencies of the Department of Defense, the National Security Agency, the
Central Intelligence Agency, and the Federal Bureau of Investigation for use in intelligence
activities.

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To disclose information to contractors, grantees, experts, consultants, or volunteers performing or
working on a contract, service, or job for the Federal Government.
For Judicial/Administrative Proceedings--To disclose information to another Federal agency, to a
court, or a party in litigation before a court or in an administrative proceeding being conducted by a
Federal agency, when the Government is a party to the judicial or administrative proceeding. In
those cases where the Government is not a party to the proceeding, records may be disclosed if a
subpoena has been signed by a judge.
For National Archives and Records Administration--To disclose information to the National
Archives and Records Administration for use in records management inspections.
Within OPM for Statistical/Analytical Studies--By OPM in the production of summary descriptive
statistics and analytical studies in support of the function for which the records are collected and
maintained, or for related workforce studies. While published studies do not contain individual
identifiers, in some instances the selection of elements of data included in the study may be
structured in such a way as to make the data individually identifiable by inference.
For Litigation--To disclose information to the Department of Justice, or in a proceeding before a
court, adjudicative body, or other administrative body before which OPM is authorized to appear,
when
(1)

OPM, or any component thereof; or

To any source from which information is requested in the course of an investigation, to the
extent necessary to identify the individual, inform the source of the nature and purpose of the
investigation, and to identify the type of information requested.

(2)

Any employee of OPM in his or her official capacity; or

(3)

Any employee of OPM in his or her individual capacity where the Department of Justice or
OPM has agreed to represent the employee; or

To the appropriate Federal, State, local, tribal, foreign, or other public authority responsible for
investigating, prosecuting, enforcing, or implementing a statute, rule, regulation, or order
where OPM becomes aware of an indication of a violation or potential violation of civil or
criminal law or regulation.

(4)

The United States, when OPM determines that litigation is likely to affect OPM or any of its
components; is a party to litigation or has an interest in such litigation, and the use of such
records by the Department of Justice or OPM is deemed by OPM to be relevant and
necessary to the litigation provided, however, that the disclosure is compatible with the
purpose for which records were collected.

To an agency, office, or other establishment in the executive, legislative, or judicial branches
of the Federal Government, in response to its request, in connection with the hiring or
retention of an employee, the issuance of a security clearance, the conducting of a security or
suitability investigation of an individual, the classifying of jobs, the letting of a contract, or the
issuance of a license, grant, or other benefit by the requesting agency, to the extent that the
information is relevant and necessary to the requesting agency's decision on the matter.
To provide information to a congressional office from the record of an individual in response to
an inquiry from the congressional office made at the request of that individual. However, the
investigative file, or parts thereof, will only be released to a congressional office if OPM
receives a notarized authorization or signed statement under 28 U.S.C. 1746 from the subject
of the investigation.
To the Office of Management and Budget at any stage in the legislative coordination and
clearance process in connection with private relief legislation as set forth in OMB Circular
No.A-19.

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For the Merit Systems Protection Board--To disclose information to officials of the Merit Systems
Protection Board or the Office of the Special Counsel, when requested in connection with appeals,
special studies of the civil service and other merit systems, review of OPM rules and regulations,
investigations of alleged or possible prohibited personnel practices, and such other functions, e.g.,
as promulgated in 5 U.S.C. 1205 and 1206, or as may be authorized by law.
For the Equal Employment Opportunity Commission--To disclose information to the Equal
Employment Opportunity Commission when requested in connection with investigations into
alleged or possible discrimination practices in the Federal sector, compliance by Federal agencies
with the Uniform Guidelines on Employee Selection Procedures or other functions vested in the
Commission and to otherwise ensure compliance with the provisions of 5 U.S.C. 7201.
For the Federal Labor Relations Authority--To disclose information to the Federal Labor Relations
Authority or its General Counsel when requested in connection with investigations of allegations of
unfair labor practices or matters before the Federal Service Impasses Panel.

PUBLIC BURDEN INFORMATION
Public burden reporting for this collection of information averages 15 minutes, including time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden to OPM Forms Officer, U.S. Office of Personnel Management, 1900 E Street NW, Washington, DC 20415. Do not send your
completed form to this address, send it to the office that provided you the form. The OMB clearance number, 3206-0005, is currently valid. OPM may not collect this information,
and you are not required to respond, unless this number is displayed.
I certify that I have carefully read the foregoing instructions to complete this form.

Signature

Date (mm/dd/yyyy)

Standard Form 86C
Revised April 2006
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736

STANDARD FORM 86 CERTIFICATION
SF 86C

Form approved:
OMB No. 3206 0005
NSN 7540-01-500-4881
86-111

INSTRUCTIONS: Type or legibly print your answers in ink (if this form is not legible, it will not be accepted). Complete this form referencing
information contained in your most recent SF 86 or information disclosed upon the date of your last background investigation. All questions on
this form must be answered. Any changes that you make to this form after you sign it must be initialed and dated by you. Under certain limited
circumstances, agencies may modify your response(s) consistent with your intent. The United States Criminal Code (title 18, section 1001)
provides that knowingly falsifying or concealing a material fact is a felony which may result in fines and/or up to 5 years of imprisonment.
Do not provide information you have already provided on your most recent SF 86. Any “Yes” responses under Block 2 must be explained
in Block 3. If additional space is needed, use a blank sheet of paper. Each blank sheet of paper you use must contain your name and
SSN at the top of the page. Conclude by certifying the accuracy of your answers in Block 4, Certification. If you have any questions, contact
the office that gave you the form.

Block 1 - Identification
Full name (last, first, middle, maiden)

Social Security Number (SSN)

Date of birth (mm/dd/yyyy)

Place of birth (Include City (Country) and State)

Work telephone number

Home telephone number

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E-mail

)

STOP! Check this box if you wish to consult with a government security officer before completing Blocks 2 and/or 3.
Block 2 – Questions from the SF 86
INSTRUCTIONS: The following Questions correlate with your SF 86. If you report no change to a Question, place an “X” in the No box.
If there is a change, place an “X” in the Yes box. All Yes answers must be explained under Block 3, Explanations/Remarks.

Yes

No
Question 1. Name
Question 4. Social Security Number
Question 5. Other Names Used
Question 9. Citizenship
Question 10. Citizenship Information
Question 11. Where You Have Lived
Question 12. Where You Went to School
Question 13. Employment Activities
Question 15. Military History
Question 17. Marital Status
Question 18. Relatives
Question 19. Foreign Contacts
Question 20. Foreign Activities
Question 21. Mental and Emotional Health
Question 22. Police Record
Question 23. Use of Illegal Drugs and Drug Activity
Question 24. Use of Alcohol
Question 25. Investigations Records
Question 26. Financial Record
Question 27. Use of Information Systems
Question 28. Involvement in Non-Criminal Court Actions
Question 29. Association Record

Page 1

Standard Form 86C
Revised April 2006
U.S. Office of Personnel Management
5 CFR Parts 731, 732, and 736

STANDARD FORM 86 CERTIFICATION
SF 86C

Form approved:
OMB No. 3206 0005
NSN 7540-01-500-4881
86-111

Block 3 – Explanations/Remarks
INSTRUCTIONS: Before each answer, identify the SF 86 Question number associated with your answer. For example, if you have had
a change of residence, write “Question 11” and list your new address.

Check this block if additional comments are attached. Place your name and SSN at the top of each page.
STOP! – Check this block if your SF 86 is attached.

Block 4 – Certification
I certify that the above information includes all changes to my most recent SF 86 or since my last investigation. Changes, if any, are
explained under Block 3. My statements on this form, and on any attachments to it, are true, complete, and correct to the best of my
knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on this form can be punished by
fine or imprisonment or both (18 U.S.C. 1001). I understand that intentionally withholding, misrepresenting, or falsifying information will have
a negative affect on my security clearance, employment prospects, or job status up to and including denial or revocation of my security
clearance, or my removal and debarment from Federal service.
Signature (Sign in Ink)

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Date (mm/dd/yyyy)