Form FBIQ "Financial Background Investigation Questionnaire" - New York City

What Is Form FBIQ?

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 FBIQ 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 FBIQ "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
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 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
_________________
FBIQ (June 2018)
1
The City of New York
Department of Investigation
th
80 Maiden Lane, 17
Floor
New York, NY 10038
(212) 825-5911
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 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
_________________
FBIQ (June 2018)
1
DEPARTMENT OF INVESTIGATION
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 26
(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
Check here if additional information is provided in the addendum.
2
ASSETS
Bank, Brokerage, and Investment Accounts
4.
List all U.S. bank, brokerage, and investment accounts (including but not limited to
savings, checking, money market, mutual funds, cryptocurrency, certificates of
deposit, and credit union accounts).
N/A
Include all accounts on which you or your spouse or domestic partner is named
as a primary, secondary, or joint account holder, or for which either of you is
an authorized signatory. If you have more than one account with an institution,
list each account separately.
Name of Financial
Approximate
Name(s) of Account Holder(s)
Account Type
Institution
Current Balance
Check here if additional information is provided in the addendum.
3
.
Retirement Accounts and Annuities
5.
List all U.S. retirement accounts (including but not limited to IRAs, deferred
compensation, Keoghs, pension, and 401(k) accounts), as well as annuities, owned
N/A
by you or your spouse or domestic partner.
Approximate
Name of Institution
Name(s) of Account Holder(s)
Account Type
Current Value
Bonds, Notes, and Bills
6.
Provide the total market value of all U.S. government-issued bonds, notes, and bills
(e.g., savings bonds, municipal bonds, treasury notes) held by you or your spouse or
N/A
domestic partner.
Total Approximate Market Value of Holdings:
Check here if additional information is provided in the addendum.
4
Stocks and Other Bonds
7.
List all U.S. stocks that are not held in a brokerage account, and all bonds that are
N/A
not government-issued, held by you or your spouse or domestic partner.
Number of
Dividend or
Approximate
Name of
Name(s) of Account
Shares or
Interest Income
Current
Institution/Issuer
Holder(s)
Face Value
Earned Prior
Market Value
of Bonds
Calendar Year
Foreign Financial Interests
8.
Provide details below if you or your spouse or domestic partner has direct control or
ownership of foreign financial businesses, foreign bank accounts, or other foreign
financial interests (including but not limited to stocks, annuities, retirement accounts,
N/A
government-issued bonds, notes, and bills, investments, or ownership of corporate
entities). Exclude U.S.-based funds or accounts managed through an employer.
Type of Foreign Financial Interest
Name(s) of Account Holder(s)
Value (U.S. Dollars)
Check here if additional information is provided in the addendum.
5