Form 5400.13A/5400.16 Part B - Explosives Responsible Person Questionnaire

OMB No. 1140-0074 (09/30/2028)

U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms, and Explosives

Part B - Explosives Responsible Person Questionnaire

Part B - Responsible Person Questionnaire
Each responsible person must complete and sign a separate Part B– Explosives Responsible Person Questionnaire, ATF Form
5400.13A/5400.16. In the future, if you need to add a responsible person (RP) to your federal explosives license/permit (FEL/P), the RP being added
must complete this Part B-Responsible Person Questionnaire and include a signed request from an existing RP on the FEL/P giving permission to add
the new responsible person.
Issuance of your license or permit, or addition as a RP will be delayed if Part B is incomplete or otherwise improperly prepared.
All new RPs must submit a properly prepared FD-258 (fingerprint card) with this questionnaire. The fingerprints must be clear and must be rolled at a
facility using approved technology and equipment. The FD-258 must include “WVATF0900 ATF-FELC, Martinsburg, WV” in the Originating Agency
Identifier (ORI) block to facilitate processing of fingerprints.
List all given, married, and maiden names in Item #4 (e.g., “Mary Alice (Smith) Jones,” not “Mrs. John Jones”) (If additional space is needed, attach a
separate sheet)
1. Federal explosives licensee or permittee or license or applicant name
3. Name of responsible person (last, first, middle)
6. Social Security Number (voluntary)

2. Federal explosives license or permit number (If being added to an existing FEL/P)

4. Aliases (include given, married, maiden names)

7. Date of birth (MM/DD/YYYY)

5. Position/title

8. Place of birth (city & state or foreign country)

9. Current full residential address

11. Personal telephone number (10-digit)
12. E-mail address

10. Mailing address (if different from resident address)

13. Driver’s license or State ID number (include state of issuance)
14. Previous address(es) - (Please provide residential
history and dates for the past five years. Use
additional sheet(s) if necessary.)

15. Sex

16. Height

17. Weight 18. Eye color

Male

Feet

Female

Inches

20. Ethnicity
Hispanic or Latino

Yes

No

21. Race (please check one or more boxes)
American Indian or Alaska Native
Black or African American
Native Hawaiian or other Pacific Islander
Asian

(lbs)

19. Hair color

Black
Blue
Brown
Gray
Green
Hazel
Multiple
Pink
Other

Bald
Black
Blond
Brown
Gray
Red
Sandy
White
Other

White

Yes

For the following questions give full details on a separate sheet for all “Yes” answers as necessary.
22. Have you ever held a federal explosives license or permit? (If known, please include FEL/P name and/or number)

No

23. Have you ever been a responsible person on a federal explosives license or permit? (If known, please include FEL/P name and/or
number)
24. Have you ever been an employee of a federal explosives licensee or permittee?
25. Have you ever been issued a letter of denial for your clearance to possess explosive by ATF?
26. Have you ever been granted explosives relief from disability? (please attach copy of relief letter)
27. Are you under indictment or information in any court for a felony, or any other crime, for which the judge could imprison you for
more than one year; Or are you a current member of the military who has been charged with violation(s) of the Uniform Code of
Military Justice, and whose charge(s) have been referred to a general court-martial? (see definitions)
28. Have you ever been convicted in any court, including a military court, for a felony, or any other crime, for which the judge could
have imprisoned you for more than one year, even if you received a shorter sentence including probation? (see definitions)
29. Are you a fugitive from justice? (see definitions)
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ATF Form 5400.13A/5400.16
Revised September 2025

Yes

No

Yes

No

30. Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?
Warning: The use or possession of marijuana remains unlawful under federal law regardless of whether it has been legalized
or decriminalized for medicinal or recreational purposes by state law.
31. Have you ever been adjudicated as a mental defective or have you ever been committed to a mental institution?
(see definitions)
32. Have you been discharged from the Armed Forces under dishonorable conditions?
33. Country of citizenship: (check/List more than one, if applicable) (nationals of the United States may check U.S.A.)
United States of America

Other country/countries (specify):

34. Have you ever renounced your United States citizenship? (18 U.S.C. § 842 (i)(7))
35. Are you an alien who has been admitted to United States for permanent residence? (18 U.S.C. § 842 (i)(5)(A))
36. Are you an alien who has been admitted to the United States under a nonimmigrant visa? (18 U.S.C. § 842 (i)(5)(B))
37. If you are an alien, record your U.S.-issued alien or admission number (AR#, USCIS#, or I-94#):
(Please note that an employment authorization card is insufficient to serve an RP) Attach supporting documentation to this questionnaire
38. Under the penalties imposed by 18 U.S.C. §§ 842 and 1001, I declare that I have reviewed the answers on this form and examined any related
documents submitted in regard to this questionnaire Part B-ATF Form 5400.13A/5400.16 and to the best of my knowledge and belief, they are true,
correct and complete. This signature, when presented by a duly authorized representative of the U.S. Department of Justice, will constitute consent
and authority for the appropriate U.S. Department of Justice representative to examine and obtain copies and abstracts of records and to receive
statements and information regarding my background. Specifically, I hereby authorize the release of the following data or records to ATF: Military
information/records pursuant to 18 U.S.C. § 842 (i)(6), medical information/records pursuant to 18 U.S.C. § 842(i)(4), police and/or criminal records.

Signature

Printed name

Date

Each responsible person must complete and sign a separate Part B– ATF Form 5400.13A/5400.16
Attach a 2” X 2”
photograph here
1. Photo must have been taken
within the last six months.
2. Photo must have been taken in full
face view without a hat or head
covering that obscures the hair or
hairline.
3. On back of photograph print full
name, last 4 of SSN, and business
address.

If applying for a new FEL/P:
Mail application, fingerprint cards, and photographs, including a separate
questionnaire Part B-ATF Form 5400.13A/5400.16 for each responsible person, to:
Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF)
National Services Center
Federal Explosives Licensing Center (FELC)
244 Needy Road
Martinsburg, WV 25405
If only adding a RP to an existing FEL/P:
Each RP being added must complete a separate Part B-ATF Form 5400.13A/5400.16
and mail it, along with their fingerprint card and photograph, to: ATF, National
Services Center, FELC, 244 Needy Rd, Martinsburg, WV 25405. The
questionnaire(s) must be accompanied by a signed written request from a current/
existing RP on the license giving permission to add the RP(s).
Questions:
If you have any questions relating to this form, please contact the ATF Federal Explosives
Licensing Center at 1-877-283-3352, or your local ATF Industry Operations office.

Print full name

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ATF Form 5400.13A/5400.16
Revised September 2025

Instructions/definitions for Part B-ATF Form 5400.13A/5400.16
(Do not return this sheet when submitting your application)
Instructions
1.

Completing the application. Type or print with blue or black ink.
Any attached sheets should:

7.

a. Be identified at the top of each page with your name and Social
Security Number.

ATF National Services Center
Federal Explosives Licensing Center
244 Needy Road
Martinsburg, WV 25405

b. Refer to the item/question(s) being answered.
2.

3.

Release of information. This application package requires you
to authorize the release of certain information to ATF such as medical
information/records. This information is used to determine, for
example, whether the applicant has ever been adjudicated as a mental
defective or committed to any mental institution pursuant to
18 U.S.C. 842(i)(4). This information is protected by the Privacy Act of
1974.

5.

6.

Definitions
(for additional definitions, please see 27 C.F.R. § 555.11)

Fingerprint cards & photographs. The following items must
accompany this questionnaire. Failure to submit these items will
delay processing and may result in denial of the application.

1.

Responsible person. An individual who has the power to direct the
management and policies of the applicant pertaining to explosive
materials.

a. A properly prepared Form FD-258 (fingerprint card) must be
submitted for all RPs, unless they have previously submitted one as
an RP for another federal explosives license/permit (FEL/P). The
fingerprints must be clear for accurate classification and taken by
someone properly equipped to take them. To facilitate processing
of fingerprints, the FD-258 should list “WVATF0900 ATF-FELC,
Martinsburg, WV” in the Originating Agency Identification block.

2.

Crime punishable by imprisonment for a term exceeding one year.
Any offense for which the maximum penalty, whether or not
imposed, is capital punishment or imprisonment in excess of one
year. The term does not include (a) any Federal or State offenses
pertaining to antitrust violations, unfair trade practices, restraints of
trade, or (b) any State offense (other than one involving a firearm or
explosive) classified by the laws of the State as a misdemeanor and
punishable by a term of imprisonment of two years or less.

3.

Fugitive from justice. Any person who has fled from any State to
avoid prosecution for a felony or a misdemeanor, or any person who
leaves the State to avoid giving testimony in any criminal proceeding.
The term also includes any person who knows that misdemeanor or
felony charges are pending against such person and who leaves the
State of prosecution.

4.

Adjudicated as a mental defective. A determination by a court,
board, commission, or other lawful authority that a person, as a result
of marked subnormal intelligence, or mental illness, incompetency,
condition, or disease: (1) is a danger to himself or to others; or (2)
lacks the mental capacity to contract or manage his own affairs. This
term shall include: (1) a finding of insanity by a court in a criminal
case; and (2) those persons found incompetent to stand trial or found
not guilty by reason of lack of mental responsibility or pursuant to
articles 50a and 76b of the Uniform Code of Military Justice,
10 U.S.C. 850a, 876b.

5.

Committed to a mental institution. A formal commitment of a
person to a mental institution by a court, board, commission, or other
lawful authority. The term includes a commitment to a mental
institution involuntarily. The term includes commitment for mental
defectiveness or mental illness. It also includes commitments for
other reasons, such as for drug use. The term does not include a
person in a mental institution for observation or a voluntary
admission to a mental institution.

6.

Explosives. Any chemical compound, mixture, or device, the
primary or common purpose of which is to function by explosion.
The term includes, but is not limited to, dynamite and other high
explosives, black powder, pellet powder, initiating explosives,
detonators, safety fuses, squibs, detonating cord, igniter cord, and
igniters.

b. Submit one color photo, 2x2 inches for each responsible
person. The photograph should be attached to the back of their Part
B—ATF Form 5400.13A/5400.16. Ensure that each photograph is
clearly identified on the reverse with the full name of the RP to
whom the photograph applies.
4.

Where to send questionnaire. Make a copy of your completed
questionnaire for your records, then submit the ATF Form
5400.13A/5400.16 Part B, Responsible Person Questionnaire, for
each responsible person (with properly identified photo
attached), fingerprint card(s), To:

Adding additional RPs. You can use this questionnaire to add a
RP(s) to an existing FEL/P. You must include a signed
written request from a current/existing RP already on the license,
giving permission to add the new RP. We cannot process a form
to add an additional RP to an existing license without the
written consent authorizing this action from an existing RP on
the license. If you are only submitting Part B for this purpose, send
Part B, along with the responsible person’s fingerprint card and
photograph, to ATF-FELC, 244 Needy Road, Martinsburg, WV
25405.
Renewal applications. This form must be re-certified and submitted
with a Federal Explosives License/Permit Renewal Application (ATF
Form 5400.14/5400.15 Part III) for current responsible persons on an
existing FEL/P. Fingerprint cards and photograph do not need to be
resubmitted. If a current responsible person fails to submit Part BATF Form 5400.13A/5400.16 with the renewal application(ATF Form 5400.14/5400.15 Part III) he/she will be removed
from the FEL/P.
Contact us. If you have any questions relating to this application,
please contact the ATF National Services Center, Federal
Explosives Licensing Center, 244 Needy Road, Martinsburg, WV
25405, Toll free 1-877-283-3352, or your local ATF Industry
Operations office. Contact information for your local office can be
found at www.atf.gov.

ATF Form 5400.13A/5400.16
Revised September 2025

7.

Explosive materials. Explosives, blasting agents, water gels and
detonators. Explosive materials include, but are not limited to, all
items in the “List of Explosive Materials” Provided for in § 555.23.

8.

Federal Explosives License or Permit (FEL/P). A license or
permit issued under the provisions of the Safe Explosives Act (SEA)
to manufacture, import, deal, or use explosives.

Privacy Act Information
The following information is provided pursuant to Section 3 and 7(b) of the
Privacy Act of 1974 (5 U.S.C. § 552 a(e)(3)):
1.

Authority. Solicitation of this information is authorized pursuant to
18 U.S.C. §§ 842 and 843. Disclosure of this information by the
responsible person (RP) is mandatory if the responsible person wishes
to be added the license or permit and possess explosives.

2.

Purpose. The information collected on ATF Form
5400.13A/5400.16 is used to determine the eligibility of the RP
to be added to a license or permit and possess explosive
materials.

3.

Routine uses. The information collected may be disclosed as
permitted by the Privacy Act of 1974 (5 U.S.C. § 552a) and in
accordance with System of Records Notice (SORN) JUSTICA/ATF008, Regulatory Enforcement Record System. It may be shared with
federal, state, local, tribal, and foreign law enforcement and
regulatory agencies for purposes including criminal investigations,
inspections, compliance monitoring, and national security, to the
extent such disclosure is authorized by law. Finally, the information
may be disclosed to members of the public in order to verify the
information on the application where such disclosure is not
prohibited by law.

4.

9.

Employer Identification Number (EIN). An EIN is also known as
federal tax identification number and is used to identify a business
entity. Generally, businesses need an EIN. For more information on
who needs an EIN and how to apply for one, go to www.irs.gov or
refer to 27 CFR § 179.35.

Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction Act of 1995.
The information collection is used to determine the eligibility of the
applicant to engage in certain operations, to determine the location and
extent of operations, and to determine whether the operations will be in
conformity with Federal laws and regulations. The information requested
is required in order to obtain or retain a benefit and is mandatory by statute
(18 U.S.C. § 843).
The estimated average burden associated with this collection of information is 20 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden
estimate and suggestions for reducing this burden should be directed to
Reports Management Officer, Reports Management Officer, Information
Technology Coordination Staff, Bureau of Alcohol, Tobacco, Firearms,
and Explosives, 99 New York Ave, NE, Washington, DC 20226.
An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid
Office of Management and Budget control number.

Effects of not supplying information requested. Failure to supply
complete information will delay processing and may cause denial of
the application.

ATF Form 5400.13A/5400.16
Revised September 2025