FD-1164 Identity History Summary Request

PERSONAL
IDENTIFICATION
IDENTITY
HISTORY
SUMMARY
IDENTITY
SEE REVERSE SIDE FOR FURTHER INSTRUCTIONS
REQUEST

TYPE OR PRINT ALL INFORMATION IN BLACK
LAST NAME

FIRST NAME

LEAVE BLANK

FBI

MIDDLE NAME

FD-1164 (Rev. 09/21/2023)
OMB Control No. 1110-0046 (Exp. 09/30/2026)

SIGNATURE OF REQUESTOR
SIGNATURE
PERSON FINGERPRINTED

FINGERPRINTS SUBMITTED BY

DC000000Z

RESIDENCE
ADDRESS OF PERSON FINGERPRINTED

DATE OF BIRTH DOB YYYY/MM/DD
Month
Day
Year

SEX

DATE FINGERPRINTED

RACE

HGT.

WGT.

EYES

HAIR

PLACE OF BIRTH

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
NAME

LEAVE BLANK

SOCIAL SECURITY NO.

ADDRESS

CLASS

MISCELLANEOUS NO.
FINGERPRINTED BY

REF.

SCARS AND MARKS

1. R. THUMB

6.L. THUMB

2. R. INDEX

7. L. INDEX

LEFT FOUR FINGERSTAKEN SIMULTANEOUSLY

3. R. MIDDLE

4. R. RING

8. L. MIDDLE

9. L. RING

L. THUMB

R. THUMB

5. R. LITTLE

10. L. LITTLE

RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY

POB

FEDERAL BUREAU OF INVESTIGATION
UNITED STATES DEPARTMENT OF JUSTICE

CRIMINAL JUSTICE INFORMATION SERVICES DIVISION, CLARKSBURG, WV 26306
___________________________________________________________________________

PERSONAL IDENTIFICATION
US
Department
of Justice Order 556-73
To obtain classifiable fingerprints:
1. Use printer’s ink.
2. Distribute ink evenly on inking slab.
3. Wash
and dry
fingers
thoroughly.
To assist
with
obtaining
legible

fingerprints:

4. Roll fingers from nail to nail, and avoid allowing fingers to slip.

1. Wash and dry fingers thoroughly.

5. Be sure impressions are recorded in correct order.

2.
Roll fingers
from nail to
nail,blocks
and ifavoid
allowing
fingers
slip. fingers for any reason.
6. Notate
in the appropriate
finger
applicant
is missing
one to
or more

If not missing, all ten impressions must

3. Be
sure impressions
aredeformities
recordednotated.
in correct sequential order.
be provided
with scars and
4.
Indicate
in thecondition
appropriate
fingerprint
blocks
if fingers
missing/amputated.
7. If
some physical
makes
it impossible
to obtain
perfect are
impressions,
submit the best that can be obtained.
8. Examine the completed prints to see if they can be classified, bearing in mind the following:
If some physical condition makes it impossible to obtain perfect impressions, submit the best that can be obtained.
5.
Most fingerprints fall into the patterns shown below. Other patterns occur infrequently and are not shown here.
6. Examine the completed prints for image quality.
FD-353 Personal Identification Privacy Act Statement

The FBI's acquisition, preservation, and exchange of fingerprints and associated information is
generally authorized under 28 U.S.C. 534. The fingerprints and associated information that you
have voluntarily provided may be used for humanitarian and identification purposes. Your
fingerprints and associated information will be retained in the FBI's Next Generation Identification
Privacy Act Statement
(NGI)associated
system
or its
successor
systems
andiswill
searched
against
civil,
criminal,
and
latent
Authority:TheThe
collection
ofpreservation,
your fingerprints
and
personal
information
authorized
by
5 U.S.C.
552a
28534.
Authority:
FBI's
acquisition,
and exchange
of
fingerprints
and associated
information
isbe
generally
authorized
under
28 and
U.S.C.
in the NGI
system.
As long
your fingerprints
associated
PASTE
Depending
on the nature
of your request, supplemental fingerprints
authorities influde
federal
statutes.
Stateas
statutes
pursuant toand
Pub.
L. 92-544,information
Presidentialare
C.F.R. 16.30-16.34.
retained in NGI, they may be disclosed pursuant to your consent and may be disclosed without
Executive Orders,
and federal
regulations. Providing your
fingerprints
and
associated
voluntary;
failure to do
so may Uses
affect for the
PHOTO
HERE
your
consent as
permitted
by information
the Privacy isAct
of 1974,however,
and all applicable
Rountine
Privacy
Act Statement:
completion
or approval
of your request.
NGI
System.
Submission
of
your
Social
Security
Account
Number
on
this
form
is
voluntary
but
Purpose: The FBI will use your information towill
search
the Next
Generation
Identification (NGI), its biometric and criminal
assist thepersonal
FBI to confirm
your isidentity.
Authority: The collection of your fingerprints and associated
information
authorized by 5 U.S.C. 552a and 28

Privacy Act Statement

(OPTIONAL)
historyC.F.R.
system,
to locate your FBI Identification record (or lack thereof).
16.30-16.34.

will use your
information
search
the Next Generation
(NGI),
its biometric
and identity in accordance with
RoutinePurpose:
Uses: The
TheFBI
information
you
providetowill
be protected
and theIdentification
FBI may only
share
this information
history system, to locate your FBI Identification record (or lack thereof).
the Privacy
Act.
Routine Uses: The information you provide will be protected and the FBI may only share this information in accordance

with theProvision
Privacy Act.
Disclosure:
of your fingerprints and associated personal information, including your Social Security number, is
voluntary; however, without the information the FBI will be unable to process your request and search the NGI system for
Disclosure: Provision of your fingerprints and associated personal information, including your Social Security number, is
your FBI
Identification record.
voluntary; however, without the information the FBI will be unable to process your request and search the NGI System for
your FBI Identification record.

Paperwork Reduction Act Statement
Paperwork Reduction Act Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to provide the information requested unless a
valid OMB control number is displayed. The valid OMB control number for this information collected is 1110-0046. The time
required to complete this imformation collected is estimated to be 10 minutes, including time reviewing instructions,
gathering, completing, reviewing and submitting the information collection. If you have any comments concerning the
accuracy of this time estimate or suggestions for reducing this burden, please send to: Department of Clearance Officer,
United States Department of Justice, Justice Management Division, Policy and Planning Staff, Washington, DC 20530.

FD-XXX
(Rev.
X-XX-20
FD-353
FD-1164(Rev.
(Rev. 5-15-17)
11-1-20)