Social Security Number
Organization Room Number
Employee Name (Last, First, MI)
U.S. Department of State
LOCATOR SHEET
DS-7666
08 2013
EMPLOYEE INFORMATION
EMERGENCY CONTACT INFORMATION
Contact Name (Last, First, MI)
Home Address (Street, City, State, ZIP Code)
The legal authority for asking for this information comes from various 5 FAM and 12 FAM Department of State regulations. The information you furnish
will be used to allow Human Resources to identify an emergency contact in case of your sickness, accident, or death. Executive Order 9397
(November 22, 1943) authorizes the use of the Social Security Number. Furnishing the Social Security Number, as well as other data, is voluntary, but
failure to do so may delay or make it impossible for the Department to notify your emergency contact in the event of your illness, accident or death.
Date of Birth(mm-dd)
Today's Date (mm-dd-yyyy)
Office Phone Number
Home Address (Street, City, State, ZIP Code) Contact Phone Number
Contact Phone Number
PRIVACY ACT STATEMENT
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome