[104-10217-10225.pdf — page 37]
# SECRETREQUEST FOR APPROVAL OR INVESTIGATIVE ACTION(Always handcarry i copy of this form)PLEASE COMPLETE EACH SECTION AND APPROPRIATE BLANKDATE10 March 1972TO:CI/OPERATIONAL APPROVAL AND SUPPORT DIVISIONFROM:Ann Jant LongCHIEF, INVESTIGATION AND SUPPORT DIVISION, OFFICE OF SECURITYCHIEF, PERSONNEL SECURITY DIVISION, OFFICE OF SECURITYCA/B3SUBJECT:(true name)Richard Thomas GibeonPROJECTQRPHONECRYPTONYM, PSEUDONYM, AKA, OR ALIASESCI/OA FILE NO.QRPHONE/1RI 201 FILE NO.SO FILE NO.201-3060521. TYPE ACTION REQUESTEDPROVISIONAL OPERATIONAL APPROVALPROVISIONAL PROPRIETARY APPROVALOPERATIONAL APPROVALPROPRIETARY APPROVALPROVISIONAL COVERT SECURITY APPROVALCOVERT NAME CHECKCOVERT SECURITY APPROVALSPECIAL INQUIRY (SPECIFY)CONTRACT TYPE ACONTRACT TYPE BSECURITY AND RELIABILITY DETERMINATION2. SPECIFIC AREA OF USEInternational3. FULL DETAILS OF USE See PRQ Part II, page 3, Section VI, 4 and 5.4. INVESTIGATION AND COVER|                                                                                                                            | YES | NO  || -------------------------------------------------------------------------------------------------------------------------- | --- | --- || A. U.S. GOVERNMENT INTEREST MAY BE SHOWN DURING INVESTIGATION?                                                             |     | X   || B. CIA INTEREST MAY BE SHOWN DURING INVESTIGATION?                                                                         |     | X   || C. IS SUBJECT AWARE OF U.S. GOVERNMENT INTEREST IN HIM?                                                                    | X   |     || D. IS SUBJECT AWARE OF CIA interest in him identified but subject doubtless suspects CIA                                   | X   |     || E. INDICATE ANY LIMITATIONS ON COVERAGE IN THE INVESTIGATION OF SUBJECT. info from them has been received and reviewed.    |     |     || F. SUGGEST "COVER PRETEXT" TO BE USED IN CONDUCTING PERSONAL INVESTIGATION OF SUBJECT.                                     |     |     || G. DO YOU PLAN TO MAKE SUBJECT WITTING OF AGENCY OR GOVERNMENT INTEREST? IF NO INVESTIGATION OUTSIDE OF CIA, EXPLAIN FULLY | X   |     |See Memorandum dated 15 February 1966X PRO I OR BIO DATA IN (2) COPIES ATTACHED5. PRO STATUSUpdatedX PRO 11 OR EQUIVALENT WILL BE FORWARDED PRIOR TO EXPIRATION OF POA. 1 COPYUpdated|                           | WILL FORWARD           | 6. R.I. TRACES INCLUDING COMINT        | DEROGATORY/SIGNIFICANT ATTACHED |     || ------------------------- | ---------------------- | -------------------------------------- | ------------------------------- | --- || NO RECORD                 | WILL FORWARD           | NON-DEROGATORY                         |                                 |     || NO RECORD                 | WILL FORWARD           | 7. DIVISION TRACES INCLUDING COMINT    | previously sent                 |     ||                           |                        | NON-DEROGATORY                         |                                 |     || NO RECORD                 | WILL FORWARD           | 8. FIELD TRACES NA                     | NA previously sent              |     ||                           |                        | NON-DEROGATORY                         | DEROGATORY/SIGNIFICANT ATTACHED |     || NO RECORD                 | WILL FORWARD           | 9. CRS/ISG.. NA                        | DEROGATORY/SIGNIFICANT ATTACHED |     || SPECIAL CHECK NSA INDICES | WILL FORWARD           | NON-DEROGATORY                         |                                 |     || NO RECORD                 | WILL FORWARD           | 10. FI/D.. CS REFS TO FI/D (BR. FILES) | DEROGATORY/SIGNIFICANT ATTACHED |     ||                           |                        | NON-DEROGATORY                         |                                 |     || LIST AREAS CHECKED        | *IF NOT CHECKED * WHY? | NOT APPLICABLE                         | OTHER (EXPLAIN)                 |     |Comint no additional since last check 1966SIGNATURE OF CASE OFFICERRoderick I. SweetEXTENSION1055SIGNATURE DE BRANCH CHIEFFORM 3-71 772 OBSOLETE PREVIOUSEDITIONSSECRET201-306052 (0)