Form CBP Form 3078 CBP Form 3078 Application for Identification Card

DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection

OMB APPROVAL NO: 1651-0008
EXPIRATION DATE: 11/30/2024

APPLICATION FOR IDENTIFICATION CARD
19 U.S.C. 66, 1551, 1555, 1565, 1624, 1641;
19 CFR 112.42, 118, 122.182, 146.6
1. Type Of Activity Requiring Identification Card
CBP
Cartman/
Broker's
Security Area
Lighterman
Employee
Identification

Warehouse Officer
or Employee

Container Station
Employee

Foreign
Trade Zone
Employee

CES
Employee

2. Date
OPR

3. Name (Last, First, MI)
5. Citizenship

4. Social Security Number

Lawful Permanent Resident

Resident Alien Number
7. Date Of Birth

6. List Any Other Names You Have Ever Been Known By (Nicknames, aliases, etc.)
8. Home Address (Number, Street, City, State, and ZIP Code)

9. Name And Address Of Present Employer

10. If you checked CBP Security Area Identification in block 1. Describe the employee's job description, responsibilities and zone requested”
11. General Comments

12. Home Phone Number

13. Mobile Phone Number

14. Email Address

15. Business Phone Number

16. Employer Email Address

17. Place Of Birth (City, County, State, and Country)

18. Height

19. Weight

20. Color Hair

21. Color Eyes

22. Visible Scars Or Marks
23. U.S. Coast Guard Port Security Card Number

24. U.S. Merchant Marine Card Number

25. Have You Ever Applied For Card In Item 23 Or Item 24?

26. Has Application For Card In Item 23 Or 24 Been Denied?

YES

(Skip Items 26 and 27)

NO

YES

(If Yes, explain in Item 27)

NO

(Skip Item 27)

27. Explanation Of Application Denial
28. List All Residences During The Last 5 Years (List in reverse order, beginning with the present address)
DATES
From

Number and Street

To

City

State

Country

PRESENT

29. Have You Ever Served In The Armed Services Of The U.S.?
YES

NO

30. Branch Of Service

(Skip Items 30-34)

31. Dates Of Service

32. Serial Number

33. Type Of Discharge

34. If Discharge Was Other Than Honorable, Explain In Full Detail
CBP Form 3078 (10/24)

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YES

35. Have You Ever Applied For An Identification Card With U.S. Customs And Border Protection?

(If Yes, explain details)

NO

36. PREVIOUS EMPLOYMENT -- (List in reverse order, beginning with the most recent employment)
DATES
From

To

EMPLOYER ADDRESS

EMPLOYER NAME AND YOUR
OCCUPATION

37. Have You Ever Been Convicted Of Any Crime Or Offense Including Customs And Immigration Violations (Other than traffic
violations, you may exclude any items which occurred before your 16th birthday) In This Country Or Elsewhere?

YES (If YES, explain
in Item 38.)

NO

38. Explanation Of All Convictions (Federal, State, Military, or Foreign)

Date

Place

Charge

Court

39. Do You Now Use Or Have You Ever Used Narcotic Drugs?

YES (If YES, explain
below.)

Final Disposition

NO 40. Attach a Copy Of Any Of The
Listed Acceptable Forms Of
Identification Here

41. CERTIFICATION
Applicant acknowledges any false statement or material misrepresentation in this application may cause their access to the Customs Security Area to be
revoked or suspended. Applicant acknowledges, under the laws of the United States, that the foregoing is true and correct, and that Applicant is the person
named above and understands that any false statements in this application may be punishable under the 18 U.S.C.1001 by a fine of not more than $10,000 or
by imprisonment of not more than five years or both.
Signature

CBP Form 3078 (10/24)

Date

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Paperwork Reduction Act Notice: The Paperwork Reduction Act says we must tell you why we are collecting this information, how we will use it, and whether you
have to give it to us. We ask for this information to carry out U.S. Customs and Border Protection laws of the United States. This form is used by licensed cartmen or
lightermen or their employees as an application to apply for a CBP identification card and is required to obtain or retain a benefit. The estimated average burden
associated with this collection of information is 17 minutes per respondent or recordkeeper depending on individual circumstances. The valid OMB Control Number for
this Information Collection is 1651-0008.

CBP Form 3078/OMB No. 1651-0008
DHS Privacy Act Statement
Pursuant to 5 U.S.C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why DHS is requesting the information
on this form.
A. AUTHORITY:
Collection of the information solicited on the CBP Form 3078/OMB No. 1651-0008, is authorized by 5 U.S.C. 301; 19 U.S.C. §
1551, 1565, 1624, 1641; and 19 CFR§ 112.42.
B. PURPOSE:
The primary purpose for soliciting this information is to enable CBP to conduct a background investigation and thereby
determine whether the applicant meets the criteria required for the issuance of an identification card. Additionally, CBP solicits
information through this form to enable CBP/Office of Personal Responsibility (OPR) to conduct a background investigation
and thereby determine whether a visitor or contractor may be cleared to enter a CBP Port of Entry (POE).
C. ROUTINE USES:
CBP may provide information collected and contained in the applicant's file to those employees of CBP who have a need for
the records in the performance of their duties. CBP may also use this information, when deemed appropriate, in a proceeding
to revoke or suspend the identification card or CBP POE.
The information solicited on the CBP Form 3078/OMB No. 1651-0008 may be shared externally as a "routine use" to other
government agencies to assist the Department of Homeland Security in investigating and assessing an applicant's eligibility for
an identification card. A complete list of the routine uses can be found in the system of records notice associated with this
form; DHS/ALL-023 Department of Homeland Security Personnel Security Management, October 13, 2020, 85 FR 64511, and
DHS/ALL-026 Department of Homeland Security Personal Identity Verification Management System, June 25, 2009, 74 FR
30301. The Department's full list of system of records notices can be found on the Department's website at http://www.dhs.
gov/system-records-notices-sorns.
D. CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION:
Providing this information is not legally required and is voluntary. However, failure to do so may result in CBP's inability to
conduct the background investigation required to issue the identification card or to grant clearance to CBP POE.

CBP Form 3078 (10/24)

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