DS-7783 Overseas One Badge Application

OMB CONTROL NO. 1405-XXXX
EXPIRATION DATE: XX-XX-20XX
ESTIMATED BURDEN: 5 Minutes

RSO Official Use

UNITED STATES DEPARTMENT OF STATE
A. Security Access Level:

Overseas ONE BADGE Application

TS

B. RSO Vetting Certification:

(DOS Foreign Service Officers and Specialists
should use the Automated Badge Request
(online) form or complete DS-1838)

Yes

-

S
-

No

-

SBU
-

-

NA

NA

C. Date granted: _________________________
D. Verified by: _______________________________________

PLEASE TYPE or CLEARLY PRINT ALL ENTRIES

E. Post three digit numeric code: _____________________________

1. Applicant Name (Last, First, Middle, Suffix)

2. Date of Birth (mm-dd-yyyy)

3. Social Security or National ID Number or NA

4. Citizenship (if other, specify country):
U.S.

6. Applicant Home Address

5. Gender:

Other

Male

Female

8. State/Province

7. City

9. Postal Code

Sections 10 through 16 - (Applies only to those employed at the mission)
10. Employer Name

11. Employer Phone Number

12. Employer E-mail Address or FAX Number

13. Employer Address

14. City

15. State/Province

16. Postal Code

17. Mission Affiliation (Select one)
Non-DOS USG Employee (Specify Agency)

18. Hours of Access:
Standard Business Hrs

LES

EFM

Contractor

Other (Specify)

19. Type of Access (both may apply):
24Hr/7

Facility

Other

20. Escort Authority:

OpenNet/DOS E-mail

Yes

No

Sections 21-22 - (Applies only to contractors)
21. Contract Number (if contract applicable)

22. Contract Expiration Date

23. Applicant’s Sponsor (Last, First, MI, Suffix)

24. Sponsor’s Office Phone Number

25. Sponsor Type:

26. Sponsor’s Mission Section

HRO

Office Supervisor

Other (Specify)

27. Sponsor’s Certification

Date (mm-dd-yyyy)

28. Sponsor’s DOS Badge Number

Date (mm-dd-yyyy)

30. RSO's DOS PIV Number

By checking this box, I, _______________________ , certify that I am the individual submitting this document.
29. RSO/PSO Approver's Certification (Please complete RSO Official Use Box before certifying)
By checking this box, I, _______________________ , certify that I am the individual submitting this document.

ENROLLMENT OFFICE USE ONLY
B. Enroller:_______________________

A. Applicant Unique Identifier: If Line item 3 above is not available, enroller must create an individual’s
unique identification number (Post Facility Code + Date + Time – See instructions).

Date:_______________________

ISSUANCE USE ONLY
B. Card Returned Badge Number:
A. Card Issued Badge Number: _______________________________

C. Issuance Type:
New

Re-issuance (Expired, Lost, Stolen, Damaged)

PIN Changed

D. Badge Type:
FLAC

______________________________________
E. Issuer:_______________________

FAC

Date:_______________________

Privacy Act Statement
Authority: The information is sought pursuant to Homeland Security Presidential Directive 12 (HSPD-12), Executive Order 10450, 44 U.S.C. § 552a(e)(3).
Purpose: The information solicited on this will be used to conduct appropriate national agency checks prior to issuing a Department of State Personal Identification Card. The Social Security
Number is mandatory. Additionally the social security number and date of birth will be used to generate a State Global Identification (SGID) number within the DS Identity Management System
(IDMS) that replaces the SSN in all other systems and applications.
Routine Uses: The information on this form may be shared with federal, state, and local law enforcement agencies in the performance of conducting an applicant's employment background
investigation. The information may also be made available to agencies having statutory intelligence responsibilities, and agencies having oversight or review authority with regard to criminal
investigations. More information on the Routine Uses for the information can be found in the System of Records Notice (SORN) State-36, Security Records.
Disclosure: Providing this information, including applicant's social security number, is mandatory. Failure to provide the information requested on this form may result in an individual not being
issued a Department of State Personal Identification Card.

DS-7783
04-2018

Paperwork Reduction Act Statement
Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time required for searching existing
data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do
not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this
burden estimate and/or recommendations for reducing it, please send them to: Department of State, 8380 Alban Road, Springfield, VA 22150,
DS/SSI/IDM, SA-18.
INSTRUCTIONS FOR COMPLETING DS-7783
This form must be completed by the U.S. Government sponsor for the requesting applicant. For U.S. citizen government employees of other
government agencies and all Eligible Family Members (EFM) on an employee's travel orders, the sponsor will be the mission Human Resource's
Officer (HRO) or a senior office supervisor of an Other Government Agency (OGA) office. For all Foreign National (FN) Locally Employed Staff (LES)
the mission HRO or his/her designated U.S. Government office supervisor employee will sponsor the applicant. This form is NOT to be used by DOS
Foreign Service Officers or Specialists or DOS US-hired contractors, they should use standard form DS-1838 or the on-line Automatic Badge Request
(ABR) form.
1. Applicant Name - Enter the applicant's complete legal name.
2. Date of Birth - Enter the applicant's date of birth. Please enter the date in the [mm dd yyyy] format.
3. Social Security Number or Employee National ID Number - Enter the applicant's Social Security number (if a US Citizen) OR employee's
National ID number (if a FN LES/EFM). If the FN LES/EFM does not have a National ID number enter NA.
4. Citizenship - Check the U.S. box if the applicant is a United States citizen. Otherwise check Other and enter the country of citizenship. For
applicants claiming/holding dual citizenship, check both the U.S. box and the Other box and specify all other countries of citizenship.
5. Gender - Check the box for Male or Female as appropriate.
6 - 9. Applicant Home Address - Enter the applicant's street address (number and street name), apartment or suite number if applicable, city and
state or province of residence and the postal code. US Direct Hires and EFMs should use the US address from driver's license or use the Home
Leave Address.
10. Employer Name - If the applicant is a FN contractor, vendor, or caterer enter the company's name and NOT the Government agency that holds
the contract, otherwise leave blank. Employed Eligible Family Members (EFM) should enter NA, unless employed at the mission.
11. Employer Phone Number - Enter the applicant's employer business telephone number if applicable. If EFM, leave blank.
12. Employer E-mail address or Fax Number - Enter the applicant's employer business e-mail address or fax number if applicable. If EFM, leave
blank.
13 - 16. Employer Address - Enter the applicant's employer business address (number and street name), suite number if applicable, city and state of
business location and the postal code. If EFM leave blank.
17. Mission Affiliation Check only one box (OGA, EFM, LES, local Contractor). If the request is for a FN Contractor, ensure line items 21 and
22 are also completed. If the OTHER box is checked, then the RSO's office must be the sponsor to validate the requirement for an ID card.
Note: EFMs employed at the mission are not LES.
18. Hours of Access - Check the appropriate box for the suggested hours of access to mission facilities. The RSO office determines actual access
times.
19. Type of Access required - Check the appropriate box for applicant's access to mission facilities and computer systems. All OGA employees,
LES', EFMs, and contractors requiring both facility and OpenNet access should check both boxes. All other applicants not requiring Opennet
access should only check the facility box.
20. Escort Authority - For employees that require escort authority to escort visitors in appropriate mission areas check "Yes".
21. Contract Number - Complete this section only if the applicant is a contractor or vendor of the mission. If not applicable, leave blank.
22. Contract Expiration Date - Enter the expiration date of the contract for the contract listed in item 21. If not applicable, leave blank.
23. Applicant's Sponsor - Insert the name of the government employee responsible for sponsoring the applicant's requirement for an ID card. For
all mission personnel, the mission HRO or a U.S. citizen government employee office supervisor's name is required. For EFMs, the sponsor can
be the spouse or parent.
24. Sponsor's Office Phone Number - Enter the telephone number of the government employee responsible for requesting the applicant's ID card.
25. Sponsor Type - Check the box for the type of sponsor for this applicant. If not shown check OTHER and specify the type.
26. Sponsor's Mission Section - Enter the sponsor's mission office symbol.
27. Sponsor's Signature/Date -Sponsor is to sign and date to authorize the request and certify that all requirements have been completed.
28. Sponsor's DOS badge number - Enter the sponsor's badge number as shown on the face of the sponsor's badge.
29. RSO/PSO Approver Signature/Date - The mission RSO or designated authority is to sign and date the applicant's form as approving the
request.
30. RSO/PSO Approver's DOS PIV Badge Number - The RSO or designated authority is to enter their badge number on the face of their PIV card.
DS-7783
05-2017

Instructions Page 1 of 2

INSTRUCTIONS FOR COMPLETING OVERSEAS ONE BADGE APPLICATION
OFFICIAL USE ONLY PORTIONS

RSO Official Use:
A. Security Access Level: Determine the Security Access level the applicant will require for accessing government information. For U.S. citizen
government employees the Bureau of Diplomatic Security's office of Personnel Security and Suitability (PSS) must verify the applicant's security
clearance status. This infromantion can be obtained from PSS via phone or e-mail.
B. RSO Vetting certification: For Locally Employed Staff (LES) and Eligible Family Members (EFM) the RSO's office must certify that the applicant
was sufficiently vetted to justify the issuance of a DOS One Badge for mission facilities and computer access.
C. Date Granted: Enter the date that the security clearance, for U.S. citizen government employees, or the certification date for a LES or EFM was
granted.
D. Verified By: Enter the name of the individual that verified the security clearance or certification status of the applicant.
E. Post three digit numeric code: Enter the three digit numeric post code; e.g., Ottawa = 629.
Enrollment Office Use Only
A. Applicant Unique Identifier: If the applicant is a Foreign National LES or EFM and does not have a National ID and item 3 on the form is blank or
NA, then the enrollment individual must create a unique identification number for the applicant in the format of - Post Facility Code (xxx) + date of
enrollment (mmddyyyy) + time of enrollment (military 24 hour, local); e.g., Ottawa on January 30, 2016 at 3:15 PM = 629013020161515. Please
ensure that this number is not duplicated by two simultaneous enrollments.
B. Enroller and Date: The enroller is to enter their name and date that the applicant was enrolled into the IDMS system.
Issuance Office Use Only
A. Card Issued Badge Number: Enter the badge number from the front of the badge of the newly printed/issued One Badge. Check the PIN change
box to indicate that the applicant has change the PIN.
B. Card Return Badge number: If this is a re-issuance and the old badge is available (not lost or stollen), enter the badge number of the old
(returned) badge.
C. Issuance Type: Indicate what type of badge this issuance is; e.g., new or re-issuance.
D. Badge Type: Indicate wheather the badge is to be a Facility and Logical (Opennet/DOS E-Mail) FLAC badge or a Facility Only FAC badge.
E. Issuer: The issuer is to enter their name and date that the applicant was issued a One Badge from the IDMS system.

DS-7783
05-2017

Instructions Page 2 of 2