US Department of Justice
Federal Bureau of Investigation
Criminal Justice Information Services Division
Authority: The FBI’s acquisition, preservation and exchange of information requested by this form is generally
authorized under 28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include
numerous Federal statutes, hundreds of State statutes pursuant to Pub. L.92-544, Presidential executive
orders, regulations and/or orders of the Attorney General of the United States, or other authorized authorities.
Examples include, but are not limited to: 5 U.S.C. 9101; Pub.L.94-29; Pub.L.101-604; and Executive Orders
10450 and 12968. Providing the requested information is voluntary; however, failure to furnish the information
may affect timely completion of approval of your application.
Social Security Account Number (SSAN). Your SSAN is needed to keep records accurate because other
people may have the same name and birth date. Pursuant to the Federal Privacy Act of 1974 (5 USC 552a),
the requesting agency is responsible for informing you whether disclosure is mandatory or voluntary, by what
statutory or other authority your SSAN is solicited, and what uses will be made of it. Executive Order 9397 also
asks Federal Agencies to use this number to help identify individuals in agency records.
Principal Purpose: Certain determinations, such as employment, security, licensing and adoption, may be
predicated on fingerprint-based checks. Your fingerprints and other information contained on (and along with)
this form may be submitted to the requesting agency, the agency conducting the application investigation,
and/or FBI for the purpose of comparing the submitted information to available records in order to identify other
information that may be pertinent to the application. During the processing of this application, and for as long
hereafter as may be relevant to the activity for which this application is being submitted, the FBI (may disclose
any potentially pertinent information to the requesting agency and/or to the agency conducting the
investigation. The FBI may also retain the submitted information in the FBI’s permanent collection of
fingerprints and related information, where it will be subject to comparisons against other submissions received
by the FBI. Depending on the nature of your application, the requesting agency and/or the agency conducting
the application investigation may also retain the fingerprints and other submitted information for other
authorized purposes of such agency(ies).
Routine Uses: The fingerprints and information reported on this form may be disclosed pursuant to your
consent, and may also be disclosed by the FBI without your consent as permitted by the Federal Privacy Act of
1974 (5 USC 552a(b)) and all applicable routine uses as many be published at any time in the Federal
Register, including the routine uses for the FBI Fingerprint Identification Records System (Justice, FBI-009)
and the FBI’s Blanket Routine Uses (Justice/FBI-BRU). Routine uses include, but are not limited to, disclosure
to: appropriate governmental authorities responsible for civil or criminal law enforcement counterintelligence,
national security or public safety matters to which the information may be relevant; to State a local
governmental agencies and nongovernmental entities for application processing as authorized by Federal and
State legislation, executive order, or regulation, including employment, security, licensing, and adoption
checks; and as otherwise authorized by law, treaty, executive order, regulation, or other lawful authority. If
other agencies are involved in processing the application, they may have additional routine uses.
Additional information: The requesting agency and/or the agency conducting the application investigation will
provide additional information to the specific circumstances of this application, which may include identification
of other authorities, purposes, uses and consequences of not providing requested information. In addition, any
such agency in the Federal Executive Branch has also published notice.