6006 Form p2 - Candidate Step - Google Forms

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NA Form 6006, Facility Access Media
(FAM) Request - Part 2
6006 Form Part 2 - Candidate PIV/Access Request Submission
This form is required to complete your Personal Identity Verification (ID Card) request. If the
Unique Submission Identifier is blank, please see the email you received containing this link.
* Indicates required question

Privacy Act Statement
In compliance with the Privacy Act of 1974, the following information is provided: Solicitation of
the information is authorized by 44.U.S.C. 2104. Disclosure of the information is voluntary. The
information provided will be used to prepare and issue an identification card or pass. Additionally,
the information may be provided to an expert, consultant, or contractor of NARA to assist NARA
in the performance of its duties. If some or any of the information is not provided by the
candidate, the effect will be that the Facility Access Media may not be issued, resulting in the
candidate being denied access to NARA facilities and IT systems.

Fingerprint Retention Policy
As a condition of employment, all personnel must undergo a background investigation for access
to National Archives and Records Administration facilities, systems, information, and/or
classified materials before they can enter on duty. Through this process, the Federal Bureau of
Investigation (FBI) maintains Federal employee fingerprint images to report any criminal activity
by employees to their agencies, specifically any criminal activity that may occur after the
completion and adjudication of the required background investigation. Agencies are required to
provide a notification to all employees of their rights with respect to the collection and use of
fingerprints, and to the accuracy of the information obtained from this continuous vetting
process. This notification serves as that notice. You can find the FBI Privacy Act Statement at this
link.
In most cases, the NARA’s Office of Human Capital will not need anything further from you to
complete this process. If our records do not contain a classifiable fingerprint for you, NARA’s
Office of Human Capital will make arrangements with you at a later date to obtain an updated
fingerprint.

Paperwork Reduction Act Public Burden Statement
You are not required to provide the information requested on a form that is subject to the
Paperwork Reduction Act unless the form displays a valid OMB control number. Public burden
reporting for this collection of information is estimated to be 3 minutes per response. Send
comments regarding the burden statement or any other aspect of the collection of
information, including suggestions for reducing this burden to the National Archives and Records
Administration (MP), 8601 Adelphi Road, College Park, MD 20740-6001. DO NOT SEND
COMPLETED FORMS TO THIS ADDRESS.

NA Form 6006 (07-23) Required by NARA 275
OMB Control No. 3095-0057, Expiration date: 01/31/2027

1.

Your Unique Submission Identifier. The value in this space links the initial request *
to your response. Do not delete or change this value.

2.

Your last name. *

3.

Your first name. *

4.

Your middle name (enter NMN if you do not have a middle name) *

5.

Name aliases (maiden name or any other applicable)

6.

Name Suffix (Jr., Sr., III., etc)

Personal Information
This information will be submitted directly to the security office.

7.

Social Security Number *

8.

Date of Birth *

Example: January 7, 2019

9.

Place of Birth: Country *

10.

Place of Birth: City *

11.

Place of Birth: State *

12.

Height *

13.

Weight *

14.

Eye Color *

15.

Hair Color *

16.

Personal Phone *

17.

Home Address *

18.

Home Address: City *

19.

Home Address: State *
Mark only one oval.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska

Dropdown

Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

20.

Zip Code *

21.

Country of Citizenship *

22.

Add additional information you think we might need to process your PIV/Access
request.

Before submitting, please verify that the information you've entered is true and correct.
Any errors in your submission will delay the process.

23.

Please indicate your sex. *
Mark only one oval.
Male
Female

24.

Please indicate your race or national origin. *
Mark only one oval.
American/Alaskan Native
Asian or Pacific Islander
Black or African American
White
Other:

Final Submission

25.

Please type your full name below to certify your responses. *

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