+------------------+--------------------------------+-----+---+-------+
| U.S. Agency for  |                                |     |   |       |
| International    |                                |     |   |       |
| Development      |                                |     |   |       |
|                  |                                |     |   |       |
| FOREIGN ACTIVITY |                                |     |   |       |
| DATA             |                                |     |   |       |
|                  |                                |     |   |       |
| *(Supplementing  |                                |     |   |       |
| Standard Form    |                                |     |   |       |
| 86)*             |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| **PRIVACY ACT    |                                |     |   |       |
| STATEMENT:** The |                                |     |   |       |
| following        |                                |     |   |       |
| statement is     |                                |     |   |       |
| required to be   |                                |     |   |       |
| attached to the  |                                |     |   |       |
| subject form by  |                                |     |   |       |
| the Privacy Act  |                                |     |   |       |
| of 1974, Public  |                                |     |   |       |
| Law 93-579; 88   |                                |     |   |       |
| Statute 1896.    |                                |     |   |       |
|                  |                                |     |   |       |
| This form is to  |                                |     |   |       |
| be completed by  |                                |     |   |       |
| any person       |                                |     |   |       |
| having had       |                                |     |   |       |
| overseas         |                                |     |   |       |
| residence within |                                |     |   |       |
| the time         |                                |     |   |       |
| limitation       |                                |     |   |       |
| specified on the |                                |     |   |       |
| form. Furnishing |                                |     |   |       |
| of the           |                                |     |   |       |
| information is   |                                |     |   |       |
| mandatory in     |                                |     |   |       |
| order to be      |                                |     |   |       |
| considered for   |                                |     |   |       |
| employment with  |                                |     |   |       |
| USAID and/or for |                                |     |   |       |
| completion of    |                                |     |   |       |
| security         |                                |     |   |       |
| clearance,       |                                |     |   |       |
| update and/or    |                                |     |   |       |
| upgrade actions. |                                |     |   |       |
|                  |                                |     |   |       |
| The Foreign      |                                |     |   |       |
| Assistance Act   |                                |     |   |       |
| of 1961, as      |                                |     |   |       |
| amended; the Act |                                |     |   |       |
| of August 26,    |                                |     |   |       |
| 1950; and        |                                |     |   |       |
| Executive Order  |                                |     |   |       |
| 10450 constitute |                                |     |   |       |
| authority for    |                                |     |   |       |
| collecting the   |                                |     |   |       |
| information.     |                                |     |   |       |
| Disclosure of    |                                |     |   |       |
| information      |                                |     |   |       |
| provided will    |                                |     |   |       |
| not be made      |                                |     |   |       |
| outside the      |                                |     |   |       |
| Agency without   |                                |     |   |       |
| the written      |                                |     |   |       |
| consent of the   |                                |     |   |       |
| employee         |                                |     |   |       |
| concerned except |                                |     |   |       |
| (a) pursuant to  |                                |     |   |       |
| any applicable   |                                |     |   |       |
| routine use      |                                |     |   |       |
| listed under     |                                |     |   |       |
| USAID's          |                                |     |   |       |
| Personnel        |                                |     |   |       |
| Security and     |                                |     |   |       |
| Suitability      |                                |     |   |       |
| Investigations   |                                |     |   |       |
| Records, USAID-8 |                                |     |   |       |
| in USAID's       |                                |     |   |       |
| Notice of        |                                |     |   |       |
| Systems of       |                                |     |   |       |
| Records for      |                                |     |   |       |
| implementing the |                                |     |   |       |
| Privacy Act as   |                                |     |   |       |
| published in the |                                |     |   |       |
| Federal Register |                                |     |   |       |
| or (b) when      |                                |     |   |       |
| disclosure       |                                |     |   |       |
| without the      |                                |     |   |       |
| employee's       |                                |     |   |       |
| consent is       |                                |     |   |       |
| authorized by    |                                |     |   |       |
| the Privacy Act  |                                |     |   |       |
| and provided for |                                |     |   |       |
| in USAID         |                                |     |   |       |
| Regulation 15.   |                                |     |   |       |
| (A copy of the   |                                |     |   |       |
| Regulation and   |                                |     |   |       |
| Notice of        |                                |     |   |       |
| Systems of       |                                |     |   |       |
| Records is       |                                |     |   |       |
| available from   |                                |     |   |       |
| the Information  |                                |     |   |       |
| and Records      |                                |     |   |       |
| Division on      |                                |     |   |       |
| request.)        |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| APPLICANT'S NAME |                                |     | D |       |
|                  |                                |     | A |       |
|                  |                                |     | T |       |
|                  |                                |     | E |       |
|                  |                                |     |   |       |
|                  |                                |     | * |       |
|                  |                                |     | * |       |
|                  |                                |     |   |       |
|                  |                                |     |   |       |
|                  |                                |     |   |       |
|                  |                                |     |   |       |
|                  |                                |     |   |       |
|                  |                                |     | * |       |
|                  |                                |     | * |       |
+------------------+--------------------------------+-----+---+-------+
| **PURPOSE:** The |                                |     |   |       |
| purpose of this  |                                |     |   |       |
| form is to       |                                |     |   |       |
| collect          |                                |     |   |       |
| information to   |                                |     |   |       |
| allow for the    |                                |     |   |       |
| completion of    |                                |     |   |       |
| the individual's |                                |     |   |       |
| background       |                                |     |   |       |
| investigation    |                                |     |   |       |
| minimizing the   |                                |     |   |       |
| need for         |                                |     |   |       |
| extensive        |                                |     |   |       |
| foreign          |                                |     |   |       |
| inquiries. The   |                                |     |   |       |
| intent is to     |                                |     |   |       |
| obtain the       |                                |     |   |       |
| names, locations |                                |     |   |       |
| and means to     |                                |     |   |       |
| contact          |                                |     |   |       |
| individuals in   |                                |     |   |       |
| the UNITED       |                                |     |   |       |
| STATES who can   |                                |     |   |       |
| verify foreign   |                                |     |   |       |
| activities,      |                                |     |   |       |
| i.e.,            |                                |     |   |       |
| employments or   |                                |     |   |       |
| unemployment     |                                |     |   |       |
| periods, and     |                                |     |   |       |
| residences. The  |                                |     |   |       |
| ability to       |                                |     |   |       |
| verify foreign   |                                |     |   |       |
| activities       |                                |     |   |       |
| through          |                                |     |   |       |
| references who   |                                |     |   |       |
| are in the       |                                |     |   |       |
| UNITED STATES    |                                |     |   |       |
| significantly    |                                |     |   |       |
| shortens the     |                                |     |   |       |
| timetable for an |                                |     |   |       |
| investigation.   |                                |     |   |       |
|                  |                                |     |   |       |
| *                |                                |     |   |       |
| *INSTRUCTIONS:** |                                |     |   |       |
| List below       |                                |     |   |       |
| **[FOU           |                                |     |   |       |
| R]{.underline}** |                                |     |   |       |
| persons, per     |                                |     |   |       |
| overseas         |                                |     |   |       |
| location, who    |                                |     |   |       |
| are in the       |                                |     |   |       |
| UNITED STATES at |                                |     |   |       |
| the time of      |                                |     |   |       |
| completion of    |                                |     |   |       |
| this form, who   |                                |     |   |       |
| had personal     |                                |     |   |       |
| contact with you |                                |     |   |       |
| and who have     |                                |     |   |       |
| knowledge of     |                                |     |   |       |
| your foreign     |                                |     |   |       |
| residence and    |                                |     |   |       |
| employment or    |                                |     |   |       |
| unemployment.    |                                |     |   |       |
| The individuals  |                                |     |   |       |
| listed should be |                                |     |   |       |
| **in addition**  |                                |     |   |       |
| to those         |                                |     |   |       |
| references       |                                |     |   |       |
| listed on your   |                                |     |   |       |
| SF-86. For each  |                                |     |   |       |
| overseas         |                                |     |   |       |
| location, you    |                                |     |   |       |
| should list      |                                |     |   |       |
| **[TW            |                                |     |   |       |
| O]{.underline}** |                                |     |   |       |
| persons for a    |                                |     |   |       |
| residence and    |                                |     |   |       |
| **[TW            |                                |     |   |       |
| O]{.underline}** |                                |     |   |       |
| different        |                                |     |   |       |
| persons for an   |                                |     |   |       |
| employment or    |                                |     |   |       |
| unemployment. If |                                |     |   |       |
| the persons      |                                |     |   |       |
| listed are       |                                |     |   |       |
| currently at     |                                |     |   |       |
| USAID,           |                                |     |   |       |
| Washington, DC,  |                                |     |   |       |
| you need only    |                                |     |   |       |
| list RRB for the |                                |     |   |       |
| Ronald Reagan    |                                |     |   |       |
| Building, the    |                                |     |   |       |
| room number and  |                                |     |   |       |
| telephone        |                                |     |   |       |
| extension. If    |                                |     |   |       |
| additional       |                                |     |   |       |
| overseas         |                                |     |   |       |
| sections are     |                                |     |   |       |
| required, use    |                                |     |   |       |
| form AID 6-85A,  |                                |     |   |       |
| annotated as     |                                |     |   |       |
| page two or      |                                |     |   |       |
| three, as        |                                |     |   |       |
| appropriate.     |                                |     |   |       |
|                  |                                |     |   |       |
| **NATURE OF      |                                |     |   |       |
| OVERSEAS         |                                |     |   |       |
| CONTACT:** List  |                                |     |   |       |
| **P              |                                |     |   |       |
| **-professional; |                                |     |   |       |
| **S**-social or  |                                |     |   |       |
| **P/             |                                |     |   |       |
| S**-professional |                                |     |   |       |
| and social to    |                                |     |   |       |
| describe the     |                                |     |   |       |
| contact.         |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| OVERSEAS         |                                |     |   |       |
| LO               |                                |     |   |       |
| CATION/TIMEFRAME |                                |     |   |       |
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| **FOREIGN        |                                |     |   |       |
| EMPLOYM          |                                |     |   |       |
| ENT/UNEMPLOYMENT |                                |     |   |       |
| CONTACTS**       |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| NAME             | ADDRESS IN UNITED STATES       | TEL |   | N     |
|                  |                                | EPH |   | ATURE |
|                  |                                | ONE |   | OF    |
|                  |                                |     |   | CO    |
|                  |                                |     |   | NTACT |
+------------------+--------------------------------+-----+---+-------+
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| **FOREIGN        |                                |     |   |       |
| RESIDENCE        |                                |     |   |       |
| VERIFIERS**      |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| NAME             | ADDRESS IN UNITED STATES       | TEL |   | N     |
|                  |                                | EPH |   | ATURE |
|                  |                                | ONE |   | OF    |
|                  |                                |     |   | CO    |
|                  |                                |     |   | NTACT |
+------------------+--------------------------------+-----+---+-------+
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| OVERSEAS         |                                |     |   |       |
| LO               |                                |     |   |       |
| CATION/TIMEFRAME |                                |     |   |       |
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| **FOREIGN        |                                |     |   |       |
| EMPLOYM          |                                |     |   |       |
| ENT/UNEMPLOYMENT |                                |     |   |       |
| CONTACTS**       |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| NAME             | ADDRESS IN UNITED STATES       | TEL |   | N     |
|                  |                                | EPH |   | ATURE |
|                  |                                | ONE |   | OF    |
|                  |                                |     |   | CO    |
|                  |                                |     |   | NTACT |
+------------------+--------------------------------+-----+---+-------+
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| **FOREIGN        |                                |     |   |       |
| RESIDENCE        |                                |     |   |       |
| VERIFIERS**      |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
| NAME             | ADDRESS IN UNITED STATES       | TEL |   | N     |
|                  |                                | EPH |   | ATURE |
|                  |                                | ONE |   | OF    |
|                  |                                |     |   | CO    |
|                  |                                |     |   | NTACT |
+------------------+--------------------------------+-----+---+-------+
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+
|                  |                                |     |   |       |
|                  |                                |     |   |       |
+------------------+--------------------------------+-----+---+-------+

**AID 6-85 (03/04) (All previous editions not usable) Page
[     ]{.underline} of [     ]{.underline}**