Exchange Form 3900 e-QIP Request Form

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

REQUEST e-QIP ACCESS
(Electronic Questionnaires for Investigations Processing)

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, 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 3900-013

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

REQUEST e‐QIP ACCESS FORM 
(Electronic Questionnaires for Investigations Processing) 

INSTRUCTIONS 
Information collected on this form is used by AAFES Force Protection to facilitate the pre‐screening 
process for contractors/vendors and/or associates requiring federal background investigations in 
accordance to the HSPD‐12 and AAFES corporate publications for associates working with sensitive data.  
Please follow the instructions 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. Section I:  This section is to be completed by an AAFES Resource Administrator (i.e. Contract
Official, Service Business Manager, or Human Resource Administrator).
3. Section II.  Please provide all personal information requested.  This section is to be completed
by the applicant.
4. Section III:  Please provide prior military history if discharged within last 24 months and/or if you
have had employment with a federal agency or contractor during the past 24 months.
5. Section IV:  No entry required in this section.  If you are an AAFES employee, your AAFES
Resource Administrator (Human Resource Administrator) will complete this section of the form.
6. Section V:  No entry required in this section.  An AAFES Resource Administrator, (i.e. Contract
Official or Service Business Manager (SBM)) will complete this section.
7. Section VI:  No entry is required in this section.  An AAFES Administrator or Human Resource
Associate will complete this section by indicating that all required documents are presented to
the AAFES Force Protection Office to start the federal background investigation process.
8. Section VII:  No entry is required in this section.  This section is for Force Protection internal
operational purposes only.
9. Once you have completed Sections II and III of this form, provide this form to your Resource
Administrator or Human Resource Office.  The Resource Administrator and Human Resource
Associate will validate required documents are included with package submitted to Force
Protection either in person or by a traceable mailing method, i.e. Federal Express to start the
federal background investigation request.
10. The Resource Administrator for contractors will provide the results of your request to you either
by phone or by e‐mail.  At which time you will be provided further instructions on how to access
the OPM e‐QIP system to enter information needed for your official Federal Background
Investigation.

EXCHANGE FORM 3900‐002  
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REQUEST e-QIP ACCESS

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

(Electronic Questionaires for Investigations Processing)
Please type or write clearly
Please read the Disclosure Notice and Privacy Act Statement on Page One of this form.

The information collected on this form will be used by AAFES Force Protection to facilitate the pre-screening selection process and electronic access into the
United States Office of Personal Management Electronic Questionnaires for investigative Processing (e-QIP).

I. TO BE COMPLETED BY RESOURCE ADMINISTRATOR*
Choose One:

Exchange

Choose All That Apply:

Date of Request:

Contractor

(ex: 25 Jul 2015)

Remote

Sensitive

Non-Sensitive

To prioritize background investigations, will the Applicant/Contractor be working in any of the following situations?

Will the applicant/contractor be working with children under the age of 18?

No

Yes

Will the applicant/contractor be working with firearms?

No

Yes

Exchange Hire Date:
(ex: 25 Jul 2015)

Will the applicant/Contract be deployed to an overseas location?

Yes
No
Are there any other job requirements that AAFES Force Protection needs to know to request a background check?

II. TO BE COMPLETED BY THE APPLICANT*
(Full Name)

Last:

Gender:

Middle:

First:

Male
Female

Date of Birth:

Place of Birth:

Social Security #: (9 digits only)

(ex: 25 Jul 2015)

(City, State) or (City, Country, overseas only)

Region:

Work Location (Military Base/HQ Department):
Phone #:

Position Title:

Email Address:

III. PRIOR FEDERAL SERVICE TO BE COMPLETED BY APPLICANT*
Have you had previous Military Experience or worked for a Federal Agency as an Employee or Contractor within the last 24 months? If so, please provide the Military Branch or Federal Agency and
dates of service.
Choose One:

No

Yes

From: (Month/Year)

To: (Month/Year)

IV. TO BE COMPLETED BY THE RESOURCE ADMINISTRATOR FOR EMPLOYEES ONLY*
Supervisor's Name:

Phone Number/Email:

(Extension #)

Human Resource Manager's Name

Phone Number/Email:

(Extension #)

V. TO BE COMPLETED BY THE RESOURCE ADMINISTRATOR FOR CONTRACTORS/VENDORS ONLY*
Exchange POC Name:

Phone #:

Facility # (8-10 Digits):

Contractor's POC Name:

Phone #:

Contract #/PO #:
Company's POC Email Address:

Contracting Company Name:

VI. REQUIRED DOCUMENTS TO BE COMPLETED BY RESOURCE ADMINISTRATOR*
Choose Type of Fingerprint Submission and include: Local Police Report and OF 306. Contractors must provide National Background Check.

Electronic Fingerprints Transmission Date:
Resume/Application

OF 306

(ex: 25 Jul 2015)

Local Police Report

Fingerprint Card
(SF87 or FD-258)

Fair Credit Reporting Disclosure and Authorization

(Declaration of Federal Employment)

National Background Check (Contractors Only)
Resource Administrator please FedEx this completed form with the hardcopy fingerprint card and police report to:
Exchange (EG-FP)
3911 S. Walton Walker Blvd.
Dallas, TX 75236-1598

VII. TO BE COMPLETED BY EXCHANGE EG-FORCE PROTECTION ONLY
Initiator/Reviewer/Approver:

Date: (dd/mmm/yyyy)

Status:

Initiator/Reviewer/Approver:

Date: (dd/mmm/yyyy)

Status:

Comments:
EXCHANGE FORM 3900-013

*(Request will not be processed without the required information and documents).
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