Infragard Application

UPDATED INFRAGARD APPLICATION

APPLICANT REQUIREMENTS

[REMOVE] Applicant must be employed or formerly employed in a Critical Infrastructure for at least three years.

[ADD] In accordance with the National Institute of Standards and Technology 800-63 Digital Identity Guidelines, all applicants must complete an identity proofing and verification process via the FBI’s credential service provider.

Applicant must be at least 18 years of age on the date of completion of this Application.

Applicant must be a U.S. Citizen (U.S. Citizen by birth as defined by 8 USC 1401-1409 or a U.S. Citizen by Naturalization as defined by 8 USC 1421-1459).

Applicant must complete this InfraGard Membership Application Form in its entirety.

Applicant must agree with the InfraGard Information Sharing Policy, Privacy Act Statement, Agreements to Hold Harmless and Code of Ethics.

Applicant must consent to a security risk assessment and to periodic re-confirmation of the security risk assessment. The risk assessment is a membership vetting process completed by the FBI which includes local, state, and federal criminal history and driver’s license, citizenship, and other security-related database checks. Note that successful completion of the security risk assessment does not equate to a security clearance (InfraGard members are not given security clearances by the FBI).

INFRAGARD MEMBERSHIP is for the owners, operators, and security directors and their staffs of the 16 U.S. national key asset and critical infrastructure sectors, which includes members of local, state, and federal law enforcement, as well as individuals who are involved in the security of and protected research at educational institutions. A description of the critical infrastructure sectors, and the disciplines included within each one, can be found on the main InfraGard website. The 16 critical Infrastructure sectors as set forth in Presidential Policy Directive (PPD)-21 are as follows:

Chemical

Commercial Facilities

Communications

Critical Manufacturing

Dams

Defense Industrial Base

Emergency Services

Energy

Financial Services

Food and Agriculture

Government Facilities

Healthcare and Public Health

Information Technology

Nuclear Reactors, Materials and Waste

Transportation Systems

Water and Wastewater Systems

The mission of InfraGard is to promote ongoing dialogue and timely communication between members and the FBI specifically concerning the security of vulnerabilities in, and threats to critical infrastructure entities. InfraGard members are provided with information to assist them in protecting critical infrastructure assets. In turn, they are encouraged to provide information to the FBI, thereby facilitating its responsibilities to detect, deter, and investigate acts of terrorism and other crimes. Because of the focus and purpose of InfraGard, members must be affiliated with a critical infrastructure.

Full Legal Name [ADD] (Must match identity verification documentation.)

First Middle (optional) Last

Date of Birth

Year Month Day

SSN

Citizenship Information

I am a citizen of the United States of America

I am not a citizen of the United States of America

Current Employment Status

Employed Retired

Employer/Organization Name (Mark asterisk for required)

Job Title (Mark asterisk for required)

Previous Employer/Organization Name (Mark asterisk for required)

Previous Job Title (Mark asterisk for required)

Which critical infrastructure closely aligns to your job title?

(Dropdown with 16 Critical Infrastructures)

Please describe your affiliation with the critical infrastructure selected.

(Comments text box)

Chapter

PERSONAL AND CONTACT INFORMATION

Name First Middle Last

Maiden Name (optional)

Home Address City

State Zip

Home Phone Cell Phone

Personal Email Address

Confirm Personal Email Address

Birth Details

Date of Birth

City County (Optional) State/APO/APE etc. Country of Birth

Other Birth Location (e.g., Military Base) (optional)

SSN

Driver License:

Number License State

CITIZENSHIP

Check the box that reflects your current citizenship status and provide the applicable documentation.

 I am a U.S. Citizen or national by birth in the U.S. or a U.S. territory/commonwealth.

US Passport Number (Current)

Date Issued (mm/dd/yyyy)

Passport Expired: Yes/No

 I am a US Citizen or national by birth, born outside the U.S.

Passport Documentation

US Passport Number (Current)

Date Issued (mm/dd/yyyy)

Passport Expired: Yes/No

Citizenship Documentation

Document Number from State Department Form FS240, DS 1350, or FS 545:

Date form was completed (mm/dd/yyyy):

Place of issuance:

 I am a naturalized U.S. Citizen.

Passport Documentation

US Passport Number (Current)

Date Issued (mm/dd/yyyy)

Passport Expired: Yes/No

Citizenship Documentation

Citizenship Certificate Number (if applicable):

Where was the citizenship certificate issued (City/Court/State)?

Date Issued (City/Court/State)?

Naturalization Documentation

Naturalization Certificate Number (if applicable):

Where was the Naturalization Certificate issued (City/Court/State)

Date Issued (mm/dd/yyyy)

EMPLOYMENT/ORGANIZATION

Current Employment Status

Employed Retired

Employer Name/Organization Name

Job Title

Employer Address

City State Zip

Business Phone (or Previous) (Mark asterisk for required) Ext (optional)

Business Email (or Previous) (Mark asterisk for required)

CRIMINAL HISTORY

Have you ever been arrested for, charged with, or convicted of a felony or misdemeanor?

Exclude minor parking and traffic violations such as parking and non-reckless speeding tickets, but do not exclude reckless driving or other major moving violation arrests, charges, or convictions.

Yes No

Notice: If you check "no" and the criminal history reveals information to the contrary, such omission may be grounds for disqualification. You are not required to report arrests, charges, or convictions that you believe to have been expunged; however, they may still appear in your criminal history.

 Should I be approved as an InfraGard member, I agree to self-report any arrests, charges, or convictions for criminal activity while an InfraGard member to the local FBI InfraGard Private Sector Coordinator.

InfraGard Members Alliance (IMA)

[New section] One of the most valuable benefits of InfraGard membership is the opportunity to join your local InfraGard Members Alliance (IMA). 

An IMA is an independent nonprofit organization made up of InfraGard members, and with 74 IMAs nationwide, there is one available to serve you in virtually all states and regions. Each IMA is associated with one of the FBI’s 56 Field Offices. In the InfraGard program, the IMAs are the boots on the ground, providing exciting local member engagement and event opportunities.

 

By joining an IMA, you’ll receive numerous benefits, including access to member-exclusive resources and the opportunity to attend IMA meetings, special events, trainings, and webinars. Joining an IMA also gives you the chance to grow your network by connecting with other security leaders and professionals in your area. IMA membership is a unique and meaningful opportunity to get involved in the protection of your community.

From the below drop-down list, please select the geographical location closest to your primary residence or business.  (Note that this is for administrative purposes ONLY and does not mean you are joining this IMA. That option is provided in the next section.)

 

 

Joining an IMA

As explained previously, if your membership application is approved you will have the option to join an IMA. Please select one of the boxes below to indicate your preference in joining an IMA: *

I would like to become a member of the IMA selected above and have access to IMA membership benefits.

I decline to become a member of an IMA and understand I will remain unaffiliated with a local IMA within the InfraGard program.

**InfraGard membership is contingent upon approval of your application and security assessment.

CODE OF ETHICS

INFRAGARD CODE OF ETHICS [Change to: InfraGard Code of Ethics and Conduct]

• Promote the protection of the critical infrastructure of the United States of America.

• Cooperate with others in the interchange of knowledge and ideas for mutual protection, and participate in local, regional, and national InfraGard events to the best of my ability.

• Support the education of members and the general public about the importance of the security of and threats to the U.S. critical infrastructure.

• Serve the interests of InfraGard and the general public in a diligent, loyal, and honest manner, and not knowingly be a party to any illegal or improper activities that endanger the U.S. critical infrastructure.

• Maintain the confidentiality and prevent the use for competitive advantage at the expense of other members, of information obtained in the course of my involvement with InfraGard, which may include information concerning the business of a fellow member or company and information identified as proprietary, confidential, or sensitive.

• Not commercially exploit InfraGard or use it as a forum to market products or services.

• Not use my affiliation with InfraGard to elicit special privileges.

• Act in a manner consistent with the InfraGard National Members Alliance (INMA) Bylaws and the local InfraGard Members Alliance (IMA) Bylaws, understanding that the Bylaws may be amended from time to time, as well as any other duly enacted national or local requirements of InfraGard.

• Protect and respect the privacy rights, civil rights, and physical and intellectual property rights of others.

• [Add bullet] Not act in a manner that may not be specifically identified by other policies but that could reasonably be regarded as so improper or inappropriate by their nature and in their context that they are harmful to the reputation and interests of both the FBI and the InfraGard Program.

I agree to abide by the InfraGard Code of Ethics and understand that not doing so may result in the revocation of my membership in InfraGard. 

INFRAGARD INFORMATION SHARING POLICY

InfraGard members may receive information that is sensitive and not publicly available. This information may be provided by or through the FBI, the InfraGard National Members Alliance, a local InfraGard chapter, another InfraGard member, partners of InfraGard, or other sources. Note that members are not obligated as a condition of InfraGard membership to disclose any information to the FBI, the InfraGard National Members Alliance, or any InfraGard chapter, member or partner; however, the key mission of InfraGard is the effective exchange of information in order to protect the nation’s critical infrastructure and such a goal cannot be optimally achieved if InfraGard members do not choose to share information.

All members must understand and agree to the following terms regarding information received or provided through InfraGard:

• Non-Disclosure: Information obtained through InfraGard shall not be released beyond its intended scope of disclosure, as established or understood, formally or informally.

• FBI Disclaimer: The FBI provides information to InfraGard members as a service and for informational purposes only. While the FBI strives to make this information as timely and accurate as possible, it cannot provide any warranties, and expressly disclaims liability, for the accuracy of information disseminated through InfraGard. The member acknowledges that he/she must use his/her own judgment in assessing the nature and accuracy of all InfraGard-related information and agrees to assume all risk for taking, or not taking, any action(s) based on such information.

• Submission in Good Faith: Applicant agrees that he/she will submit information only to further the purpose of InfraGard and will not submit information which he/she knows to be false.

• Protection of Information from Disclosure: To the extent appropriate, reasonable, and allowed by law, the FBI agrees that proprietary information received from InfraGard members and marked as “trade secrets” or “proprietary information” shall be protected from mandatory agency disclosure under 5 USC 552(b)(4) (“Exemption 4”), the Freedom of Information Act (”FOIA”), and from publication, divulgence, or release in any other manner pursuant to 18 USC 1905, the Trade Secrets Act.

I understand and agree to the InfraGard Information Sharing Policy and understand that not following such a policy may result in the revocation of my membership in InfraGard. 

PRIVACY ACT STATEMENT

Authority: The FBI’s collection of the information is authorized under: Title 28 U.S.C. Section 534 and 28 CFR 0.85.

Principal Purpose and Routine Uses: The information collected on this form will be used for the principal purpose of conducting security risk assessments on InfraGard members and applicants. As part of this assessment, the collected data may also be used to assist in determining approval, denial, revocation, or renewal of access to the IG Network and the authorization to information through InfraGard.

Member information, including name, organization, chapter, email address, telephone number, sector, and position title, may be shared with InfraGard National Members Alliance, InfraGard local chapter leadership, and other InfraGard members, on the InfraGard directory for the purpose of networking and information sharing, providing user consents through the opt-in feature located within member’s privacy settings.

In addition, your information may be disclosed as permitted by the Privacy Act of 1974, 5 U.S.C. 552a(b), pursuant to all applicable routine uses established in the following FBI System of Records Notices: FBI-002, The FBI Central Records System, 63 Fed. Reg. 8659, 671 (Feb. 20, 1998), as amended; and the FBI’s Blanket Routine Uses, 66 Fed. Reg. 33558 (June 22, 2001), as amended.

Social Security Account Number: Your Social Security Account Number (SSAN) is requested to check criminal, immigration, national security, and other electronic databases. Because other people may have the same name and birth date, your SSAN will be used to facilitate accurate identification and to help eliminate the possibility of misidentification of individuals for whom a security risk assessment or database check is being conducted.

Effects of Nondisclosure or Falsification: Completion of this application and provision of your SSAN is voluntary. However, failure to provide the requested information may result in your application being rejected for membership in InfraGard or your membership revoked. Knowingly falsifying or concealing information requested on this form will result in your application being rejected or your membership revoked. In addition, Title 18 U.S.C. Section 1001 provides that knowingly falsifying or concealing a material fact may under certain circumstances constitute a felony resulting in fines and/or imprisonment.

I understand and agree to the Privacy Act Statement. 

AGREEMENT TO HOLD HARMLESS

Agreement to Hold Harmless the U.S.: The applicant agrees not to institute, initiate, prosecute, or in any way aid in any demand, action, suit, or other claim, legal or otherwise, against the FBI, the Department of Justice, or the United States, or the officers, employees, agents, representatives, task force members, contractors/subcontractors, consultants, or advisors thereof, on account of any damage, loss, injury, or expectation arising from, in connection with, or in any way pertaining to the reporting, non-reporting, or use of information in accordance with this agreement.

Agreement to Hold Harmless Other InfraGard Members: The applicant agrees not to institute, initiate, prosecute, or in any way aid in any demand, action, suit, or other claim, legal or otherwise, against any other InfraGard member on account of any damage, loss, injury, or expectation arising from, in connection with, or in any way pertaining to the reporting, non-reporting, or use of information in accordance with this agreement, and the member further expressly agrees to hold harmless and indemnify the same against loss from any and all claims that may hereafter be brought against the same by applicant arising out of the reporting, non-reporting, or use of information.

I understand and agree to the Agreements to Hold Harmless. 

APPEALS PROCESS

An applicant who is denied InfraGard membership will receive notification via email with reason for denial.  Should the applicant wish to request additional information and/or appeal the decision, he/she must send an appeals letter via the U.S. Postal Service within 60 days of receipt of the denial notification.  Appeal instructions are provided in the notification of denial.  All subsequent communications regarding a final membership decision will be sent via the U.S. Postal Service.  

I understand the Appeals Process. 

CONSENT

By completing an InfraGard Membership Application Form, I hereby authorize the FBI to obtain and verify any information relevant to assessing my suitability to access, possess, use, receive, or transfer information obtained through InfraGard. I further authorize the FBI to disclose information obtained in connection with my security risk assessment to appropriate national security and law enforcement partners in order to determine my suitability for membership in InfraGard. I understand that the FBI will use all information provided on this application and through the record checks completed during the security risk assessment to make a decision on my membership. I also understand that, should I be approved for membership, the FBI will utilize the information I have provided herein to conduct periodic reassessments of my suitability to remain an InfraGard member.

I understand that this is a legally binding document and false statements provided by me are violations of federal law and could lead to criminal prosecution or other legal action. To the best of my knowledge and belief, I affirm that I meet all of the requirements to apply to be an InfraGard member and that the information I have provided herein is true, complete and correct.

I understand that I may cancel my membership at any time upon written notice to the local InfraGard Coordinator or National Membership Coordinator.

I consent to the security risk assessment and to periodic reassessments. 

11/9/2023