Form INV 44 INV 44 Investigative Request for Law Enforcement Data

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INV FORM 44 (Rev. 10/21)
DEFENSE COUNTERINTELLIGENCE
AND SECURITY AGENCY (EO 13467)
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INVESTIGATIVE REQUEST FOR
LAW ENFORCEMENT DATA
U.S. GOVERNMENT USE ONLY

DEFENSE COUNTERINTELLIGENCE AND SECURITY AGENCY
FEDERAL INVESTIGATIONS PROCESSING CENTER
PO BOX 618
BOYERS, PA 16018-0618

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PRIVACY ACT STATEMENT: The information you provide, including your identity, will be furnished to the agency requesting the investigation, other agencies as
warranted, and to the person investigated upon his or her specific request. AUTHORITY: Section 925 of Public Law 115-91; 5 USC 301 and 9101; Executive Order 13467, as
amended by Executive Order 13869; and 5 CFR 736. PRINCIPAL PURPOSE: To obtain background information and personal records for investigating and determining an
individual’s initial or continued: eligibility for access to classified national security information or assignment to positions with sensitive duties, suitability for enlistment or
appointment into military service, suitability for federal employment, fitness for assignment to work under contract for or on behalf of the government, or eligibility for physical
or logical access to U.S. Government systems or facilities. ROUTINE USES: The information collected may be disclosed to DCSA personnel and shared externally with
other authorized government agency personnel as a routine use when necessary and relevant to personnel vetting investigations, determinations, and adjudications; and, for
other purposes permitted under subsection (b) of the Privacy Act of 1974, as amended (5 USC §552a). Information obtained will also be released to the person being
investigated upon their request unless otherwise exempt. A complete list of the routine uses can be found in the system of records notice for the Department of Defense
Personnel Vetting Records System, “DUSDI 02-DoD” at: https://www.federalregister.gov/documents/2018/10/17/2018-22508/privacy-act-of-1974-system-of-records.
DISCLOSURE STATEMENT : Disclosure is mandatory. Title 5 U.S.C. § 9101 requires law enforcement participation. Failure to provide DCSA access to the requested
information may result in our agency's inability to conduct a thorough investigation and may prevent the government from making a determination or adjudication regarding the
qualifications, suitability, eligibility or fitness of the person being investigated.
The Defense Counterintelligence and Security Agency is authorized by Statute, Presidential Executive Order and Federal Regulations to make
this investigative inquiry.

Completion and return of this original form as soon as possible will help this person and the agency perform their duties
in a more timely and efficient manner.
CASE NUMBER:

CASE TYPE:

ITEM NUMBER:

FULL NAME (LAST, FIRST, MIDDLE)
OTHER NAMES USED

DATE OF BIRTH

SOCIAL SECURITY NUMBER

PLACE OF BIRTH
CURRENT RESIDENCE

THIS PERSON CLAIMS THE FOLLOWING CRIMINAL HISTORY RECORD AT YOUR LOCATION
DATE (MO/YR)

DATE (MO/YR)

OFFENSE:

OFFENSE:

ACTION:

ACTION:

LAW ENFORCEMENT AUTHORITY OR COURT

CLAIMED RESIDENCE AT TIME OF OFFENSE

U.S. GOVERNMENT PUBLISHING OFFICE

221435-7

EXPIRATION DATE: 10/31/24

FORM APPROVED: OMB:0705-0003
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INSTRUCTIONS: We are conducting a background investigation on the person identified below to determine this person’s
eligibility for employment or security clearance. To help make this determination, we ask that you complete all items on the back
of this form and return the form in the enclosed envelope.

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CORRECT MARK:

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MARKING
INSTRUCTIONS

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• USE A NO. 2 PENCIL OR BLUE OR BLACK INK PEN ONLY.
• DO NOT USE PENS WITH INK THAT SOAKS THROUGH THE PAPER.
• DO NOT MAKE ANY STRAY MARKS ON THIS SHEET.

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INCORRECT MARKS:

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PLEASE COMPLETE THE ITEMS SHOWN BELOW
1

MARK THE FOLLOWING AS APPLICABLE:
a

2

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» WE HAVE NO RECORD ON THIS PERSON

b

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» RECORD INFORMATION SHOWN BELOW

c

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RECORD AT ANOTHER LOCATION
(Enter address and ZIP Code in Remarks)

PLEASE PROVIDE DETAILS CONCERNING CRIMINAL HISTORY RECORD AND/OR OUTSTANDING WARRANT(S).
IF OUTSTANDING WARRANT(S) EXIST, LIST THE NATURE OF THE ORIGINAL CHARGE.
PLEASE SHOW THE EXACT NATURE OF THE CHARGE - DO NOT USE CODES OR ABBREVIATIONS.

DATE

OFFENSE

DISPOSITION AND DATE

LOCATION OF DISPOSITION (COURT & CITY)

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IF ADDITIONAL REMARKS ARE PROVIDED BELOW, YOU MUST FILL IN THIS MARK

REMARKS, ADDITIONAL INFORMATION THAT MAY HAVE A BEARING ON THIS PERSON’S
ELIGIBILITY FOR EMPLOYMENT OR SECURITY CLEARANCE.

PUBLIC BURDEN STATEMENT: The public reporting burden for this collection of information, OMB 0705-0003, is estimated to average 5 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
whs.mc-alex.esd.mbx.dd-dod-infor-mation-collections@mail.mil. 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.

PRINT NAME:

DATE

SIGNATURE:

YOUR TITLE/ORGANIZATION:

DAYTIME TELEPHONE NUMBER
(INCLUDE AREA CODE)

(

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FOR DCSA USE ONLY
ISSUES/CHARACTERIZATION

RESULTS
AC ACCEPTABLE
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AA
\ ACCEPTABLE/ATTACHED
PA CONFIDENTIAL/ACCEPTABLE
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NI NO PERTINENT INFORMATION
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NR
\ NO RECORD
NL NOT LOCATED
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UC
\ UNABLE TO CONTACT
RF REFERRED
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RR
\ RECORD

IS ISSUES
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PI CONFIDENTIAL/ISSUES
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RI
\ RECORD INCONCLUSIVE
FR FEE REQUIRED
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RL RELEASE REQUIRED
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SK
\ SUBJECT UNKNOWN
NZ NOT AVAILABLE
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DN
\ DISCREPANT

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