Form SFBIQ "Supplemental Financial Background Investigation Questionnaire" - New York City

What Is Form SFBIQ?

This is a legal form that was released by the New York City Department of Investigation - a government authority operating within New York City. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the New York City Department of Investigation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFBIQ by clicking the link below or browse more documents and templates provided by the New York City Department of Investigation.

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Download Form SFBIQ "Supplemental Financial Background Investigation Questionnaire" - New York City

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The City of New York
Department of Investigation
th
80 Maiden Lane, 17
Floor
New York, NY 10038
(212) 825-5911
Supplemental Financial Background Investigation Questionnaire
You are required to complete this questionnaire (in addition to the Background Investigation Questionnaire
or Supplemental Background Investigation Questionnaire) only if your appointing entity has determined
that you meet the criteria for which it is permissible for the Department of Investigation (DOI) to review and
report your consumer credit history (pursuant to NYC Administrative Code §§ 8-102 and 8-107; 47 Rules
of the City of New York §§ 2-01 and 2-05).
Your Terms and Conditions of Appointment will not be approved unless you provide all information
requested and cooperate fully with this background investigation. If you fail to do so, you may incur
disciplinary action, including the termination of your employment or removal from your appointment.
Department of Investigation (DOI) background investigations are detailed and thorough; information you
provide will be verified during the investigation. A false statement or intentional omission made in this
questionnaire, or in connection with this background investigation, may result in the imposition of
disciplinary penalties, including but not limited to termination of employment or removal from appointment,
disqualification from future employment or appointment, and criminal prosecution.
This Supplemental Financial Background Investigation Questionnaire is not a public document and cannot
be obtained through a Freedom of Information Act request. However, this questionnaire may be provided,
upon request, for use in another government agency’s background investigation, or for the purposes of
administrative action (e.g., disciplinary proceedings) by your agency, the City’s Office of Administrative
Trials and Hearings, the Conflicts of Interest Board, or others.
DOI recommends that you keep a copy of this completed questionnaire for your personal records,
and for reference in completing any future DOI Financial Background Investigation Questionnaires.
I have read and I understand this information.
Initial and date: ___________
For DOI Use Only:
Candidate’s Name
____________________________
Phone Number
_________________
Investigator
____________________________
Interview Date
_________________
Supervisor
____________________________
Review Date
_________________
SFBIQ (June 2018)
1
The City of New York
Department of Investigation
th
80 Maiden Lane, 17
Floor
New York, NY 10038
(212) 825-5911
Supplemental Financial Background Investigation Questionnaire
You are required to complete this questionnaire (in addition to the Background Investigation Questionnaire
or Supplemental Background Investigation Questionnaire) only if your appointing entity has determined
that you meet the criteria for which it is permissible for the Department of Investigation (DOI) to review and
report your consumer credit history (pursuant to NYC Administrative Code §§ 8-102 and 8-107; 47 Rules
of the City of New York §§ 2-01 and 2-05).
Your Terms and Conditions of Appointment will not be approved unless you provide all information
requested and cooperate fully with this background investigation. If you fail to do so, you may incur
disciplinary action, including the termination of your employment or removal from your appointment.
Department of Investigation (DOI) background investigations are detailed and thorough; information you
provide will be verified during the investigation. A false statement or intentional omission made in this
questionnaire, or in connection with this background investigation, may result in the imposition of
disciplinary penalties, including but not limited to termination of employment or removal from appointment,
disqualification from future employment or appointment, and criminal prosecution.
This Supplemental Financial Background Investigation Questionnaire is not a public document and cannot
be obtained through a Freedom of Information Act request. However, this questionnaire may be provided,
upon request, for use in another government agency’s background investigation, or for the purposes of
administrative action (e.g., disciplinary proceedings) by your agency, the City’s Office of Administrative
Trials and Hearings, the Conflicts of Interest Board, or others.
DOI recommends that you keep a copy of this completed questionnaire for your personal records,
and for reference in completing any future DOI Financial Background Investigation Questionnaires.
I have read and I understand this information.
Initial and date: ___________
For DOI Use Only:
Candidate’s Name
____________________________
Phone Number
_________________
Investigator
____________________________
Interview Date
_________________
Supervisor
____________________________
Review Date
_________________
SFBIQ (June 2018)
1
DEPARTMENT OF INVESTIGATION
SUPPLEMENTAL FINANCIAL BACKGROUND INVESTIGATION QUESTIONNAIRE
INSTRUCTIONS
This questionnaire must be typed, or completed in blue or black ink.
Every question must be answered completely and accurately.
Do not leave any question blank. If a question does not apply to you, indicate “N/A”
(not applicable).
If you need more space to answer a question, use the addendum provided on page 8
(make copies if needed). Check the box at the bottom of the page on which the
question appears, and note in the addendum the question and page number.
This questionnaire is an affidavit. Upon completion, it must be signed and sworn to
before a Notary Public or Commissioner of Deeds.
I have read and I understand these instructions.
Initial and date: ___________
PERSONAL INFORMATION
1.
Full Name
Last Name
First Name
Middle Name
Jr., II, etc.
N/A
N/A
2.
Date of Birth
3.
Place of Birth
Month
Day
Year
City
State
Country
Outstanding Judgments
4.
List all judgments entered against you or your spouse or domestic partner that are
outstanding (except tax judgments and liens, which should be disclosed in
N/A
Question 5). Include documentation with your background paperwork.
Name of Creditor and Court
Date of Judgment
Garnishment
Original
Amount
Where Judgment Was Filed
(Month/Year)
Yes/No
Amount
Outstanding
Yes
No
Yes
No
Check here if additional information is provided in the addendum.
2
Tax Judgments and Liens
5.
List all tax judgments and/or liens entered against you or your spouse or domestic
partner within the past seven years, even if they have been satisfied.
Candidates undergoing a background investigation must satisfy all
outstanding tax judgments and liens with the appropriate tax authority, either
by making full payment or by entering into a payment agreement.
N/A
Include documentation of your full payment with your background paperwork
(e.g., receipt, bank statement, canceled check, certificate of release of federal tax
lien, satisfaction of judgment), or a copy of your current installment payment
agreement and documentation of your three most recent payments.
Name of
Date of
Name of Tax
Original
Amount
Date Satisfied
Responsible
Judgment
Authority
Amount
Outstanding
(Month/Year)
Taxpayer
(Month/Year)
Not satisfied
Not satisfied
Not satisfied
Not satisfied
Not satisfied
Check here if additional information is provided in the addendum.
3
Money Owed to Tax Authorities
6.
Provide details below if you or your spouse or domestic partner owes money
(not including tax judgments or liens) to federal or state tax authorities.
N/A
Include documentation (e.g., installment payment agreement) with your
background paperwork.
Name of
Details of
Anticipated
Name of Tax
Amount
Responsible
Tax Year
Most Recent
Date of
Authority
Outstanding
Taxpayer
Payment
Satisfaction
Date
Amount
Date
Amount
Bankruptcies
7.
Provide details below if you or your spouse or domestic partner has filed a petition
under any chapter of the bankruptcy code, or has been the subject of a bankruptcy
or reorganization proceeding, within the past five years.
N/A
Provide a copy of the bankruptcy discharge documents, including a list of
creditors, with your background paperwork.
Name of filer
Bankruptcy petition type
Chapter 7
Chapter 11
Chapter 13
Name of court
Date filed (month/year)
Date discharged (month/year)
Total debt discharged
Detailed explanation of the reason for filing for bankruptcy
Check here if additional information is provided in the addendum.
4
Civil Litigation and Lawsuits
8.
If you have been involved as a plaintiff, defendant, or respondent in any civil litigation
N/A
or lawsuit commenced within the past five years, provide details below.
Title of Action
Status or Outcome
Amount You Owed
Date Paid
and Date Commenced
of Litigation
or Were Awarded
(Month/Year)
(Month/Year)
N/A
N/A
N/A
Administrative Proceedings
9.
If you have been involved as a party to, or have been the subject of, an administrative
proceeding (e.g., disciplinary proceeding, censure, Conflicts of Interest Board
enforcement action) commenced within the past five years, provide details below.
N/A
Do not include any Equal Employment Opportunity or whistleblower matters
you have reported.
Disposition
Government
Fine or Penalty
Status of Fine
(Month/Year)
Agency Involved
Imposed
or Penalty
N/A
N/A
N/A
Check here if additional information is provided in the addendum.
5
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