Post-Enrollment Providing of Biometrics

Service Location: Nashville TN (8023)
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MI

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Kirk

James

T

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Post-Enrollment Biometrics

9:00am

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Clever

Joe

D

Pre

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9:15am

03/22/1931

Grey

Steven

R

TWIC

Enroll

9:30am

*Biometric

Thompson

Joanne

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TWIC

Activate Card

10:15am

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James

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Pre

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10:30am

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George

S

Pre

Enroll

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Williams

Amy

A

TWIC

Post-Enroll

10:45am

Hartwell

Paul

R

TWIC

Enroll

11:00am

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Steve

H

TWIC

Reset Card PIN

11:30am

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Robert

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Pre

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12:00pm

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John

D

Pre

Enroll

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Keith

W

TWIC

Reset Card PIN

12:30pm

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Chris

N

Pre

Enroll

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Hoover

Richard

K

TWIC

Post-Enrollment Biometrics

12:45pm
1:00pm

Service Outage

Lester

David

D

TWIC

Activate Card

1:30pm

Training Module Due

Freeman

Steven

S

TWIC

Enroll

1:45pm

Phone

*
* Country Code

United States (+1)
*Phone

202-867-5309
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Message Center
Date

! 07/16/13
07/10/13

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EN 05/21/2014@ 8:56 AM

Service Location: Nashville TN (8023)
Search

Appointments

*Search Method

Last Name

First Name

MI

Program

Service

Appointment

Phone

Kirk

James

T

Pre

Post-Enrollment Biometrics

9:00am

*Date of Birth

03/22/1931
*Biometric

*
* Country Code

United States (+1)
*Phone

202-867-5309
Search

Clear

Message Center
Date

! 07/16/13
07/10/13

Subject

Service Outage
Training Module Due

Print Appointments

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EN 05/21/2014@ 8:56 AM

Service Location: Nashville TN (8023)
Enter Customer Information
Essential

Contact

*First Name

*Preferred Language

James
John

English

*Middle Name

*Method of Contact (At least one method is required)
Email
Verify Email

Tiberius

[email protected]
*Last Name

Kirk
*Gender

Male
*Date of Birth

03/22/1931

Suffix

Country Code

United States (+1)
Country Code

United States (+1)

[email protected]
Phone 1

202-867-5309
Phone 2

615-123-7645

*Preferred Method of Contact

Email
December 30, 1972

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EN 05/21/2014@ 8:56 AM

Universal Enrollment Services
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Post-Enrollment Biometrics

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EN 05/21/2014@ 8:56 AM

Universal Enrollment Services

TSA Pre/ ®

Privacy Act and Paperwork Reduction Act Statements
PRIVACY ACT STATEMENT:
Authority: The authority for collecting this information is 49 U.S.C. 114 and 114note.
Principal Purpose(s): This information is needed to verify your identity to render you eligible for TSA Pre/ ® expedited biometric screening. Furnishing this
information, including your SSN or alien registration number, is voluntary; however, all information provided during the enrollment process assists in the timely
processing of your biometric screening eligibility. Failure to provide it will delay and may prevent completion of your biometric screening eligibility.
Routine Uses: Principal disclosures include disclosure to the FBI to retrieve your criminal history record; to TSA contractors or other agents who are
providing services relating to the security threat assessments; and to appropriate governmental agencies for licensing, law enforcement, or security purposes, or
in the interests of national security. For additional information regarding disclosures, please see system of records notice DHS/TSA-021, TSA Pre/ ® Application
Program.
PAPERWORK REDUCTION ACT STATEMENT:
Statement of Public Burden: This is a voluntary collection of information, but failure to provide the information may result in an inability to approve your
eligibility for the requested TSA program or benefit. TSA estimates that the total average burden per response associated with this collection for enrollment is
approximately 9-12 minutes, not including travel or wait time. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The control number for this collection is OMB Control No. 1652-0059, which expires 05/31/2015.

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EN 05/21/2014@ 8:56 AM

Prove Identity

TSA Pre/ ®

Determine Citizenship
Note: At this time, only U.S. citizens, U.S. Nationals and lawful permanent residents (LPR) are eligible for the application.
*Country of Birth

United States
*City of Birth

*State/Province of Birth

Riverside

Iowa

*Country of Citizenship

United States

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Identity

Biographics

Iris

Fingerprints

Disclosure

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EN 05/21/2014@ 8:56 AM

Prove Identity

TSA Pre/ ®

Determine Documents
Required Identity Documents

*Document

Drivers License issued by a State, or outlying possession of the U.S.

Drivers License issued by a State, or outlying possession of the U.S.

Certify birth certificate as proof of citizenship (you are not required to have birth
certificate in your possession). $20 IdentoGO Birth Certificate Certification service
fee will be applied. This is an optional convenience service offered by the TSA Pre/ ®
service provider and not required by the TSA.
Additional Document

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Biographics

Disclosure
IrisFingerprints
Fingerprints Disclosure

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EN 05/21/2014@ 8:56 AM

Prove Identity

TSA Pre/ ®

Accepted
*Document Number:

*Driver License Class

123456789

D

*Issuance Date:

*Expiration Date:

11/25/2005

11/24/2015

November 25, 2005

November 24, 2015

*Country of Issue

United States
*State/Province of Issue

Tennessee
HME Endorsement
Comment:

Flatbed Scan

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Biographics

Disclosure
IrisFingerprints
Fingerprints Disclosure

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EN 05/21/2014@ 8:56 AM

Verify Biographics

TSA Pre/ ®

Answer Personal Questions
* 1. Have you ever used a maiden/previous name?

Yes

No

* 2. Have you ever used an alias?

Yes

No

* 3. Is your mailing address the same as your residential address?

Yes

No

* 4. Have you lived at your current residential address for more than five (5) years?

Yes

No

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Iris

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EN 05/21/2014@ 8:56 AM

Verify Biographics

TSA Pre/ ®

Enter Personal Information
First Name

Middle Name

Last Name

James

Tiberius

Kirk

Suffix

Date of Birth

Gender

03/22/1931

Male

March 22, 1931

US

Metric

* Height

6

ft

* Weight

2

in

205

lbs

* Hair Color

* Eye Color

Brown

Multi-color

Social Security Number

Social Security Number

*********

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111-08-5114

Identity
Identity

Biographics
Biographics

Disclosure
IrisFingerprints
Fingerprints Disclosure

Fee
Fee

Payment
Payment

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EN 05/21/2014@ 8:56 AM

Verify Biographics

TSA Pre/ ®

Enter Mailing Address
* Country

United States
* Address Line 1

15 Century Blvd
Address Line 2

* City

* State/Province

* Postal Code

Nashville

Tennessee

37214 - 0129

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Identity

Biographics
Biographics
Biographics

Disclosure
IrisFingerprints
Fingerprints Disclosure

Fee
Fee

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1

EN 05/21/2014@ 8:56 AM

Capture Iris

TSA Pre/ ™
Look Directly At Device

Comment:

Capture

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Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
Biographics
Iris
Fingerprints
Fee

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Payment
Disclosure

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EN 05/21/2014@ 8:56 AM

Capture Iris

TSA Pre/ ™
Accepted

Comment:

Capture

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Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
Biographics
Iris
Fingerprints
Fee

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Disclosure

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EN 05/21/2014@ 8:56 AM

Capture Iris

TSA Pre/ ™
Look Directly At Device

Comment:

Capture

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Identity
Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
Biographics
Iris
Fingerprints
Fee

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Disclosure

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1

EN 05/21/2014@ 8:56 AM

Capture Iris

TSA Pre/ ™
Accepted

Comment:

Capture

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Identity
Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
Biographics
Iris
Fingerprints
Fee

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Payment
Disclosure

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EN 05/21/2014@ 8:56 AM

Capture Disclosure

TSA Pre/ ®

Answer Questions
Note: If you answer ‘Yes’ to question 2,3, 4 or 6 you may want to reconsider applying. If you answer 'Yes' to question 5, because you are currently under
indictment or have open criminal charges, you should consider waiting to apply until these matters are resolved. Application enrollment fees are not refunded.
1. Are you a U.S. citizen or U.S. National?

Yes

No

2. Excluding juvenile cases unless convicted as an adult, have you been convicted, pled guilty including “no contest” (nolo contendere),
or found not guilty by reason of insanity, of any disqualifying felony listed in TSA Eligibility Requirements, Part A, in any jurisdiction,
military or civilian?

Yes

No

3. Excluding juvenile cases unless convicted as an adult, have you been convicted, pled guilty including “no contest” (nolo contendere),
or found not guilty by reason of insanity, of any disqualifying felony listed in TSA Eligibility Requirements, Part B, in any jurisdiction,
military or civilian, during the 7 years before the date of this application?

Yes

No

4. Have you been released from incarceration in any jurisdiction, military or civilian, for committing any disqualifying felony listed in
TSA Eligibility Requirements, Part B, during the 5 years before the date of this application?

Yes

No

5. Are you wanted or under indictment for any disqualifying crime listed in TSA Eligibility Requirements, Part A and B?

Yes

No

6. Have you ever been found by a court or other lawful authority as lacking mental capacity or involuntarily committed to a
mental institution?

Yes

No

Identity
Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
Fingerprints
Biographics
Disclosure
Iris
Fingerprints
Fee

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Disclosure

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EN 05/21/2014@ 8:56 AM

Capture Disclosure

TSA Pre/ ®

Accepted
I understand my continuing obligation to notify TSA (at TSA.gov) within 24 hours if I am convicted or found not guilty by reason of insanity of any disqualifying
crime, or adjudicated as a mental defective or committed to a mental institution, while I am enrolled in the TSA Pre/ ® Application Program.
The information I provided on this application is true, complete, and correct to the best of my knowledge and belief and is provided in good faith. I understand that
a knowing and willful false statement, or an omission of a material fact can be punished by fine or imprisonment or both (see section 1001 of Title 18 United
States Code), and may be grounds for denial of my application for the TSA Pre/ ® application program by TSA.
Applicant Signature:

James T. Kirk

Comment:

Translator used to interpret disclosure
Comment:

Scan

Identity
Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
Fingerprints
Biographics
Disclosure
Iris
Fingerprints
Fee

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Disclosure

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EN 05/21/2014@ 8:56 AM

Voluntary Customer Survey

TSA Pre/ ®

Answer Survey Questions
1. Are you satisfied with the your overall experience at the enrollment center today?
2. If you experienced an issue that required a resolution, are you satisfied with the resolution?
3. Did the enrollment center representative(s) conduct themselves in a professional and courteous manner?
4. Are you satisfied with the enrollment center appearance?
5. Are you satisfied with the enrollment center location?
If no, please select from one of the following reasons:
1 - Not convenient to work
2 - Not convenient to home
3- Not convenient to highways
4- Not convenient to public transportation
5 - Location is not in a desirable area
6. How did you hear about the TSA PreCheck Application Program?
1 - Sign/brochure at airport
2 - Family/friend
3- Co-worker/Enp
4- Media/News Article
5 - Advertisement
6 - Social Media

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Identity
Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
Fingerprints
Biographics
Disclosure
Iris
Fingerprints
Fee

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1

EN 05/21/2014@ 8:56 AM

Submit Enrollment

TSA Pre/ ®

Access Agent’s TWIC

Place Right or Left Finger on Device

*PIN

******

Access

By placing my finger on the device,
I, STEVEN JONES, certify that the
information captured for John Smith
has been reviewed and verified.

Steven Jones

Identity
Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
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Iris
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1

EN 05/21/2014@ 8:56 AM

Submit Enrollment

TSA Pre/ ®

Summary

Customer:

JAMES T. KIRK

KTN:

UNASSIGNED
U11F-193H9F

UE ID:
TSA PRE/ ® POST-ENROLLMENT BIOMETRICS

0.00

IdentoGO BC CERTIFICATION

0.00

Total Fee:

0.00

Auth Code: 3154N66515RYZB

0.00

CARD (1475):

0.00

Auth Number:

Date/Time:
07/16/2013 / 8:56 AM
Enrollment Location:
Nashville, TN (8023)
Notification Method:
[email protected]

123ABC

Customer Support:
universalenroll.dhs.gov
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Identity
Identity

Disclosure
Biographics
Fingerprints Disclosure
Fee
Fee
Biographics
PaymentIrisFingerprints
Fingerprints
Biographics
Disclosure
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Fingerprints
Fee

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EN 05/21/2014@ 8:56 AM