Exchange Form 3900 Background Check for Vendors/Contractors

OMB NO. 0702-0135
OMB approval expires
OCT 31, 2022

Background Check for Facility Access
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0702-0135, is estimated to average 30 minutes
per response, including the 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 burden reduction suggestions to the Department of Defense, Washington
Headquarters Services, at [email protected]. Respondents
should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty
for failing to comply with a collection of information if it does not display a currently valid OMB control
number.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. §7103, “Secretary of the Army”; 10 U.S.C. §9013, “Secretary of the Air
Force”; United States Presidential Executive Order (E.O.) 13526, “Classified National Security”; E.O.
10450, “Security Requirements for Government Employment”; Department of Defense Instruction
(DoDI) 5200.01, “DoD Information Security Program and Protection of Sensitive Compartmental
Information”; DoDI 5200.02, “DoD Personnel Security Program (PSP)”; Army Regulation (AR) 380-67,
“Personnel Security Program”; Air Force Instruction (AFI) 31-501, “Personnel Security Program
Management”; AFI 31-401, “Information Security Program Management”; AR 215-8/AFI 34-211(I),
“Army and Air Force Exchange Service Operations”; and E.O. 9397, (SSN), as amended.
PRINCIPAL PURPOSES: To assist in the processing of personnel security clearance actions; to record
security clearances issued or denied, and to verify for access to classified information or assignment to a
sensitive position.
ROUTINE USES: Records may be disclosed outside of DoD pursuant to Title 5 U.S.C. §552a(b)(3)
regarding DoD “Blanket Routine Uses” published at
http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx. Information may be released
to Federal agencies based on formal accreditation as specified in official directives; regulations; to
Federal, State, Local, and Foreign Law Enforcement, Intelligence, or Security agencies in connection with a
lawful investigation under their jurisdiction.
DISCLOSURE: Voluntary, however, failure to provide information may result in denial of a Common
Access Card; non-enrollment in the Defense Enrollment Eligibility Reporting System (DEERS); refusal to
grant access to DoD installations, buildings, facilities, computer systems and networks; and denial of DoD
benefits if otherwise authorized.
A copy of the Privacy Impact Assessment (PIA) for the collection of information may be located at https://
www.aafes.com/about-exchange/public-affairs/FOIA/assessments.htm
SYSTEM OF RECORD NOTICE (SORN): 1703.03, "Personnel Security Clearance Case Files"; https://
dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/Army-Article-List/
EXCHANGE FORM 3900-006

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OMB NO. 0702-0135
OMB approval expires
OCT 31, 2022

Background Check for Facility Access 
This form is used by AAFES Force Protection to facilitate the prescreening of contractors/vendors 
requiring unescorted access to DoD Component facilities.   
Please follow the instructions listed below when completing this form.   
1. Please read the Agency Disclosure Notice and Privacy Act Statement on page one prior to
completing the document.
2. Please read the Consent to Criminal History Disclosure Notice listed on the top of page two of
this form.   By providing information on this form, you are acknowledging that you are aware
that your facility access will be subject to reverification every six (6) months.
3. Section I:  No entry required.  An AAFES Resource Administrator, (i.e. Contract Official), will
complete this section.
4. Section II:  The applicant must complete this section.  Please print your personal information
clearly.
5. Section III:  The applicant must complete this section.  Please print your citizenship information
clearly.  If you are not a United States Citizen, you must indicate how many years you have lived
in the United States in the space provided.  In addition, you will need to enter either your Alien
Registration Number or an Employment of Authorization Document (EAD) Document Number in
the spaces provided.  Requests submitted for non‐US citizens for facility access without this
information will be unacceptable.
6. Section IV:  Applicant must complete this section, if applicable.  The applicant must provide all
information for a vehicle that will be parked on DoD Component grounds.  If more than one
vehicle may be frequently parked at the facility, applicant may be requested to provide
addendum with same information for any subsequent vehicle.
7. Section V:  No entry required.  An AAFES Resource Administrator, (i.e. Contract Official) will
complete this section.
8. Section VI:  Applicant must sign and date the form.  Applicant should read certification
agreement carefully prior to signing.  By signing and dating this form, you are certifying that all
information provided is true, agreeing to adhere to all rules and regulations of the DoD
Component facility, which you will have access, and acknowledging your understanding that by
federal law providing false statements or the use of false documents on this form may result in
imprisonment and/or fines.
9. Section VII:  No entry required.  This section is for AAFES Force Protection internal purposes
only.
10. Your AAFES Resource Administrator will provide you the results of your request and further
directions on when and how to obtain the required security badge for facility access.

EXCHANGE FORM 3900‐006  
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OMB NO. 0702-0135
OMB approval expires
OCT 31, 2022

Army & Air Force Exchange Service (The Exchange)

Background Check for Facility Access
REQUEST FOR FACILITY ACCESS
Consent to Criminal History

I hereby acknowledge that with the voluntary completion of this form, I am requesting access to a Department of Defense (DoD) facility in
accordance with HSPD-12 credentialing and the Exchange EOP 66.04. I understand that assignments exceeding 6 (six) months require reverification by Force Protection and every 6 (six) months thereafter until my service is no longer required.

I. REQUEST TYPE (Select all that apply) to be completed by Resource Administrator
System Access Required

Badge Request
Initial

Sensitive/Remote

Renewal

Badge Expiration Date (dd/mmm/yyyy)

Non-Sensitive

Not Applicable

II. PERSONAL INFORMATION (Print clearly for timely processing) to be completed by Applicant
Name (Last):

First:

Middle:

Gender:

Social Security #:

Driver License State #:

Driver License State of Issue:

Phone/Area Code:

Date of Birth: (dd/mmm/yyyy)

Place of Birth (City):

Place of Birth (State):

Color Hair:

Color Eyes:

Address (Home):

Yes

Have you ever been convicted of a felony?

Height:
No

Country of Birth:

Weight:

Country of Citizenship:

If Yes. How many years since conviction?

(Years)

III. CITIZENSHIP to be completed by Applicant
Non-U.S. Citizens must provide an Alien Registration Number or Employment Authorization Document (EAD) Number and original cards with the
request. Access to the facility will not be authorized without this information. I attest, under penalty or perjury, that I am (select one):
Citizen of the United States

Non-U.S. Citizen, indicate # of consecutive years lived in the U.S.:

(Years)

Alien Registration Number:

Lawful Permanent Resident
Alien with Employment Authorization
Document #
Document (EAD)

Date Entered the United States: (dd/mmm/yyyy)

IV. VEHICLE INFORMATION to be completed by Applicant

Veh. Make:

License Plate #:

Veh. Color:

Veh. Model:

Contact Phone # at work:

Cell #:

State of Issuance:
Email Address:

V. REASON FOR ACCESS to be completed by Resource Administrator
(Select one):

Vendor

Contractor

Delivery

Company/Contractor Phone #:

Company/Contractor Name:

Other

(Explain)

Assignment/Area of Worksite of Activity:

(Indicate Floors Required for Access)

Indicate Business Justification for Access:
Contract #:

Contract Expiration Date: (dd/mmm/yyyy)

Facility #:
Indicate Number of Hours:

(Select one):

How long will you need access?

1-3 Months

Point of Contact (POC) Name:

3-6 Months

6-12 Months

POC's Command:

Less than 40 hours

POC's Phone #:

Onboarding:

40 hours
Start Date:

End Date:

(dd/mmm/yyyy)

VI. APPLICANT CERTIFICATION
I agree to return the assigned badge to the Security Office upon completion of my assignment, termination of employment or any reason that may cancel or
alter my privilege to enter this facility. By signing this document, I certify that the above information is true and agree to adhere to the rules and regulations of
this facility. I understand that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the
completion of this form.
Date: (dd/mmm/yyyy)

Signature:

VII. APPLICATION PROCESSING (FORCE PROTECTION Only)
Approved

Date Received: (dd/mmm/yyyy)

Not Approved

Fingerprints Verification Date: (dd/mmm/yyyy)

Date Processed: (dd/mmm/yyyy)

Fingerprint Results:
No Record
Record

Force Protection Certifying Official:
EXCHANGE FORM 3900-006

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