+--------------------------------------+-------------------------------+
| ##                                   | Instructions: Complete ALL of |
|                                      | the information below and     |
| ## REQ                               | attach it to the appropriate  |
| UEST FOR PERSONNEL SECURITY SERVICES | paperwork.                    |
|                                      |                               |
| #### U.S. DEPARTMENT OF AGRICULTURE  |                               |
+--------------------------------------+-------------------------------+

+-----------------------------------------------------------------------+
| **[The following action is requested on the individual named          |
| below:]{.underline}**                                                 |
|                                                                       |
| INITIAL INVESTIGATION                                                 |
|                                                                       |
| REINVESTIGATION                                                       |
|                                                                       |
| INTERIM SECURITY CLEARANCE                                            |
|                                                                       |
| UPGRADE SECURITY CLEARANCE                                            |
|                                                                       |
| INTERNAL TRANSFER OF SUITABILITY/SECURITY DETERMINATION (CHANGE IN    |
| USDA DEPT)                                                            |
|                                                                       |
| RECIPROCITY: TRANSFER INVESTIGATION CONDUCTED BY ANOTHER AGENCY       |
+-----------------------------------------------------------------------+

EMPLOYEE INFORMATION

+---------------------------------+------------------------------------+
| 1\. **NAME:      **             | 2\. **JOB STATUS:** EMPLOYEE       |
|                                 | CONTRACTOR                         |
|                                 |                                    |
|                                 | APPLICANT OTHER/VOLUNTEER          |
+---------------------------------+------------------------------------+
| 3\. **POSITION TITLE:      **   | 4\. **DOB/POB:      **             |
+---------------------------------+------------------------------------+

JOB INFORMATION

  ------------------------------------ ----------------------------------
  5\. **USDA AGENCY:      **           6\. **DUTY LOCATION:**      

  ------------------------------------ ----------------------------------

+------------------------------------+---------------+-----------------+
| > 9\. **TYPE OF INVESTIGATION**    |               |                 |
+------------------------------------+---------------+-----------------+
| ##### TYPE OF INVESTIGATION        | **Priority**  | **Standard**    |
|                                    |               |                 |
| (PICK ONE)                         | **(A)**       | **(C)**         |
+------------------------------------+---------------+-----------------+
| SSBI                               |               |                 |
+------------------------------------+---------------+-----------------+
| BI                                 |               |                 |
+------------------------------------+---------------+-----------------+
| LBI                                |               |                 |
+------------------------------------+---------------+-----------------+
| MBI                                |               |                 |
+------------------------------------+---------------+-----------------+
| ANACI                              |               |                 |
+------------------------------------+---------------+-----------------+
| NACLC                              |               |                 |
+------------------------------------+---------------+-----------------+
| SGI (SBI upgrade)                  |               |                 |
+------------------------------------+---------------+-----------------+
| SAC                                |               |                 |
+------------------------------------+---------------+-----------------+
| SSBI-PR                            |               |                 |
+------------------------------------+---------------+-----------------+
| PRI                                |               |                 |
+------------------------------------+---------------+-----------------+
| BGI (BI upgrade)                   |               |                 |
|                                    |               |                 |
| PPR                                |               |                 |
|                                    |               |                 |
| PTSBI                              |               |                 |
+------------------------------------+---------------+-----------------+

+-----------------------------------------------------------------------+
| 10\. **REQUIRED ACCOUNTING INFORMATION**                              |
|                                                                       |
| OPAC-ALC:                                                             |
|                                                                       |
| MISCELLANEOUS OBLIGATION NUMBER:                                      |
|                                                                       |
|                                                                       |
|                                                                       |
| AGENCY DATA: **     **                                                |
+-----------------------------------------------------------------------+

*POSITION DESIGNATION INFORMATION*

+-----------------------------------------------------------------------+
| 7.  **NATIONAL SECURITY POSITION (SF-86):** YES NO, GO TO QUESTION #8 |
|                                                                       |
| > **POSITION SENSITIVITY LEVEL:** SPECIAL-SENS(4) CRITICAL-SENS(3)    |
| > NON-CRITICAL SENS(2)                                                |
|                                                                       |
| **LEVEL OF CLEARANCE**: TS/SCI(4) TOP SECRET(3) SECRET(2)             |
| CONFIDENTIAL(1) NONE(0)                                               |
|                                                                       |
| > \*\*\*IF YOU ARE REQUESTING A SECURITY CLEARANCE, THE               |
| > ***'JUSTIFICATION FOR REQUESTED SECURITY CLEARANCE'*** FORM         |
| > (AD-1188) MUST BE ATTACHED UNLESS YOU ARE REQUESTING A              |
| > REINVESTIGATION FOR THE SAME POSITION/LEVEL OF CLEARANCE.           |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| 8.  **PUBLIC TRUST POSITION (SF-85P):** YES NO                        |
|                                                                       |
| > **POSITION SENSITIVITY LEVEL:** HIGH RISK MODERATE RISK             |
+-----------------------------------------------------------------------+

+-------------------------------+---------+----------------------------+
| 12. **REQUESTED BY:**         | 13\.    | 14\. **POINT OF CONTACT:** |
|                               | *       |                            |
| \_\_\_\_\_\_\_\_              | *DATE** | NAME:                      |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |         |                            |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | > **    | PHONE:                     |
|                               |      ** |                            |
| AUTHORIZING SIGNATURE         |         |                            |
+-------------------------------+---------+----------------------------+

  -----------------------------------------------------------------------
  11\. **REMARKS/NOTES:**      

  -----------------------------------------------------------------------