Form INV Form 40 INV Form 40 General Request for Investigative Information

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GENERAL REQUEST FOR
INVESTIGATIVE INFORMATION

INV FORM 40 (Rev.10/19)
DEFENSE COUNTERINTELLIGENCE
AND SECURITY AGENCY (EO 13467)

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U.S. GOVERNMENT USE ONLY

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DEFENSE COUNTERINTELLIGENCE A ND SECURITY A GENCY
FEDERAL INVESTIGATIONS P ROCESSING CENTER
PO BOX618
BOYERS, PA 16018-0618

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INSTRUCTIONS: We are Investigating the person identlfled below. Please aean:h your records, Indicating the results by marl0nt of Defonsa Personnel Vetting Records System. ·ouso1 02-DoD" at https://www.federal reglster.gov/
documents/2018/10/17/201B-22508/privacy·act•of-1974•system-of-rncords. DISCLOSURE: OJs,:;losurn Is voluntary. However, !allure to provide OCSA accesa to then,quested Information may19SUltin our
agency 's Inability to conduct a thorough investigation and may pn,vent the government from making a determination or adjudication regarding the qualifications, suitablllty, eligibility or fitness of the person
being investigated.
CERTIACATION: The per.ion we are Investigating has given wrltten consent for this Investigative inquiry. We keep that consent on file. If a copy Is n,qulred in order lo complete this form, please indicate
this requirement In writing on the reverse.

Completion and return of this original form as soon as possible will help this person and the agency perform their duties In a more timely and efficient manner.

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CASE TYPE:

ITEM NUMBER:

FULL NAME (LAST, FIRST, MIDDLE)
OTHER NAMES USED

DATE OF BIRTH

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PLACE OF BIRTH

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SOCIAL SECURITY NUMBER

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POSITION REQUIRING INVESTIGATION

ADDITIONAL INFORMATION FOR YOUR RECORD SEARCH

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PUBLIC BURDEN STATEMENT: The publiC n,porttng burden tor thtt coZ1ec1:10n ot Information, OMS 0705-0003, Is estmattld la avenige 5 minU'les per reeportH, incSudng U1• time tor nlYiewlng lnltructM>nl. searching eJdstlng dlllll IOU'CaS, gathlrlng
UICI molntoinlng lhO d.111 -· UICI COIT'C)ll11ng UICI l'IMOWing lhe oolllctlon of I-Ion. 5end - rogording lhe - ostlmlt• 0< - rac,ue11on -- •• lhe Deportment 01 .,..,.., Withington --at whunc:-alnnd.mbx.dd-dcd•lnlor,rnallon.-.ctlon.Omaltmll. Flnpand«lts ...,.,_, be ow""' tl\al notwrth-lng ""f Olhor provlolon of Jaw, no -- be oubjecl to ""f ponalty lor toJllng to comply wtJh I colectlon of int0ffllltlon H It
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G:l> U.S. GOVERNMENT PRINTING OFFICE:2020-411-708/40814

221421-4 EXPIRATION DATE:YYYYMMDD

FORM APPROVED: OMB:0705-0003