ATF Form 8620.65 Request for Atf Background Investigation Information

ATF Form 8620.65 or the "Request For Atf Background Investigation Information" is a form issued by the U.S. Department of Justice - Bureau of Alcohol, Tobacco, Firearms and Explosives.

Download a PDF version of the ATF Form 8620.65 down below or find it on the U.S. Department of Justice - Bureau of Alcohol, Tobacco, Firearms and Explosives Forms website.

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OMB No. 1140-0105 (02/28/2017)
U.S. Department of Justice
Request for ATF Background Investigation
Bureau of Alcohol, Tobacco, Firearms and Explosives
Information
The Bureau of Alcohol, Tobacco, Firearms and Explosive (ATF), Personnel Security Branch (PSB), has received your background investigation information inquiry. In order for
the PSB staff to process your request, the below information must be provided. Please complete this form. Once completed, scan and email it to PSBVerifications@atf.gov. If
this request is being made by a State or local agency, a copy of an authorization for release of information signed by the subject of the investigation and a copy of an official
request for the information on an agency letterhead must accompany this completed form.
Subject's Information
Last Name:
First Name:
Middle Name:
Suffix:
Last Four Digits of SSN:
Other Names Used (include maiden and former names):
Requesting Agency Information
Name of Agency Requesting Background Investigation:
Date of Request:
Reason for Requesting Background Investigation (employment, reciprocity, etc.):
Title of Position for which Subject is Applying:
Agency Point of Contact (POC) (name, telephone number and e-mail address):
Preferred Method of Receiving Copy of Background Investigation:
Overnight Delivery (FedEx, DHL, etc.)
In Person Pick-Up
*OPM Portal
*Provide the OPM account holder's name (If the POC does not have an OPM account, provide the name and email address of another agency representative who is authorized to
receive the requested information through the OPM Portal.):
Agency Address to Forward Copies of Background Investigation Information:
Requestor Certification
Federal Agency's Certification. This request for information is being made in connection with the hiring or continued employment of an employee or contractor; the
conduct of a suitability or security investigation of an employee or contractor; or the grant, renewal, suspension, or revocation of a security clearance, to the extent that
the information is relevant and necessary to the hiring agency's decision.
State and Local (including the District of Columbia) Law Enforcement or Detention Agency Certification. This request for information is being made in connection with
the hiring or continued employment of an employee or contractor, where the employee or contractor would occupy or occupies a position of public trust as a law
enforcement officer or detention officer having direct contact with the public or with prisoners or detainees, to the extent that the information is relevant and necessary to
the recipient agency's decision.
Date of Request:
Requestor's Certification (signature):
Requestor's Name (please print):
Requestor's Title:
PSB Official Use Only
Date of Response:
PSB Representative Providing the Background Investigation Information:
ATF E-Form 8620.65
Revised February 2014
OMB No. 1140-0105 (02/28/2017)
U.S. Department of Justice
Request for ATF Background Investigation
Bureau of Alcohol, Tobacco, Firearms and Explosives
Information
The Bureau of Alcohol, Tobacco, Firearms and Explosive (ATF), Personnel Security Branch (PSB), has received your background investigation information inquiry. In order for
the PSB staff to process your request, the below information must be provided. Please complete this form. Once completed, scan and email it to PSBVerifications@atf.gov. If
this request is being made by a State or local agency, a copy of an authorization for release of information signed by the subject of the investigation and a copy of an official
request for the information on an agency letterhead must accompany this completed form.
Subject's Information
Last Name:
First Name:
Middle Name:
Suffix:
Last Four Digits of SSN:
Other Names Used (include maiden and former names):
Requesting Agency Information
Name of Agency Requesting Background Investigation:
Date of Request:
Reason for Requesting Background Investigation (employment, reciprocity, etc.):
Title of Position for which Subject is Applying:
Agency Point of Contact (POC) (name, telephone number and e-mail address):
Preferred Method of Receiving Copy of Background Investigation:
Overnight Delivery (FedEx, DHL, etc.)
In Person Pick-Up
*OPM Portal
*Provide the OPM account holder's name (If the POC does not have an OPM account, provide the name and email address of another agency representative who is authorized to
receive the requested information through the OPM Portal.):
Agency Address to Forward Copies of Background Investigation Information:
Requestor Certification
Federal Agency's Certification. This request for information is being made in connection with the hiring or continued employment of an employee or contractor; the
conduct of a suitability or security investigation of an employee or contractor; or the grant, renewal, suspension, or revocation of a security clearance, to the extent that
the information is relevant and necessary to the hiring agency's decision.
State and Local (including the District of Columbia) Law Enforcement or Detention Agency Certification. This request for information is being made in connection with
the hiring or continued employment of an employee or contractor, where the employee or contractor would occupy or occupies a position of public trust as a law
enforcement officer or detention officer having direct contact with the public or with prisoners or detainees, to the extent that the information is relevant and necessary to
the recipient agency's decision.
Date of Request:
Requestor's Certification (signature):
Requestor's Name (please print):
Requestor's Title:
PSB Official Use Only
Date of Response:
PSB Representative Providing the Background Investigation Information:
ATF E-Form 8620.65
Revised February 2014
Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction Act of 1995. The information collected is used by ATF to document an official request received from another agency
for an ATF background investigation record. The appropriate ATF office (Personnel Security Branch) will maintain a copy of this form. It will be used to document the
authorized disclosure of the background investigation information.
The estimated average burden associated with this collection of information is 5 minutes per respondent, depending on individual circumstances. Comments concerning the
accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Report Management Officer, Document Services Branch, Bureau of Alcohol,
Tobacco, Firearms and Explosives, Washington, DC 20226.
An Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information that does not display a currently valid OMB control number.
ATF E-Form 8620.65
Revised February 2014

Download ATF Form 8620.65 Request for Atf Background Investigation Information

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