OCCUPATIONAL SAFETY AND HEALTH OSHRC OA 101 REVIEW COMMISSION October 27, 2005
Personal Identity Verification of
Occupational Safety and Health Review
Commission
Employees and Contractors
I. PURPOSE
This directive provides policies and
procedures to be followed by the Occupational Safety and Health Review
Commission (Review Commission or OSHRC) to meet requirements established
through Homeland Security Presidential Directive (HSPD)-12 and Government-wide
standards and requirements. Specifically,
it addresses Part I - Common Identification, Security and Privacy
Requirements, which is the minimum requirement for a Federal personal
identity verification (PIV) system that meets the control and security
objectives of HSPD-12. It includes the
personal identity proofing, registration, and issuance process for employees
and contractors.[1]
II. AUTHORITY
·
Homeland
Security Presidential Directive HSPD-12, Policy for a Common Identification
Standard for Federal Employees and Contractors, dated
August
27, 2004.
·
U.S.
Department of Commerce, National Institute of Standards and Technology (NIST),
Federal Information Processing Standard Publication 201 (FIPS 201), Personal
Identity Verification (PIV) of Federal Employees and Contractors, dated
February
25, 2005.
·
OMB
Memorandum M-05-24, Implementation of Homeland Security Presidential
Directive (HSPD)-12 Policy for a Common Identification Standard for Federal
Employees and Contractors, dated
August 5, 2005.
III. BACKGROUND
HSPD-12 requires that all government
agencies develop specific and consistent standards for both physical and
logical identification systems. NIST's
FIPS 201 establishes detailed standards on implementing processes and systems
to fulfill the requirements of HSPD-12.
FIPS 201 specifies a PIV system within
which common identification credentials can be created, and later used to
verify a claimed identity. It also
defines a reliable, government-wide PIV system for use in applications such as
access to federally controlled facilities and information systems. FIPS 201 outlines two phases to implementing
an HSPD-12 program. Phase I (PIV I)
describes the registration, identity proofing, and issuance procedures, and
Phase II (PIV II) describes the technical and interoperability requirements of
an HSPD-12 compliant system. PIV II
includes card elements, systems interfaces, and security controls required to
securely store and retrieve data from the card.
IV. APPLICABILITY
The FIPS 201 standard applies to
individuals employed by, detailed to, or assigned to the Review Commission and
all individuals under long-term (six months or longer) contract to the Review
Commission. The standard is applicable
to credentials that the Review Commission issues to its employees and
contractors for gaining physical access to federally controlled facilities and
logical access to federally controlled information systems.
PIV I requires the implementation of
registration, identity proofing, and issuance procedures in line with the
requirements of FIPS 201. PIV I does not
require the implementation of any new systems or technology. It applies to new long-term (six
months or longer) employees and contractors who begin work at the Review
Commission on or after October 27, 2005. These individuals will have to follow
the procedures outlined in section IX (B) below to apply for and receive their
credentials. The Review Commission will continue to issue existing credentials
under PIV I, but the process for application and issuance will be different.
It is not required that temporary
employees and “occasional visitors” to the Review Commission facilities be
subject to PIV requirements. Therefore,
temporary employees and contractors (less than six months), will not be subject
to PIV requirements under FIPS 201; however they may be required to undergo a
limited reference check, following an agency risk-based assessment of the need
for such.[2]
V. SCHEDULES AND
DEADLINES
The agency must create and implement a PIV
I compliant process no later than
October 27,
2005. The agency will apply the PIV I credential
process to all new Review Commission employees and contractors who begin
working for the Review Commission on or after October 27, 2005.
All current Review Commission
employees and contractors should be identity proofed no later than October 27,
2007 and all employees will be issued a FIPS 201
compliant card as their sole identification card for the Review Commission by
October 27, 2007.
By October 27, 2007, the agency will
verify and/or complete background investigations for all current employees,
contractors and other applicable individuals.
The agency must create and implement a PIV
II compliant system no later than
October 27, 2006.
VI. DEFINITIONS
Access control - the process of granting or denying
requests to access physical facilities or areas, or logical systems (i.e.,
computer networks or software applications). See also "logical access
control system" and "physical access control system."
Authentication - the process of establishing an
individual's identity and determining whether individual Federal employees or
contractors are who they say they are.
Authorization - process of giving individuals access to
specific areas or systems based on their authentication.
Biometric - a measurable physical characteristic
used to recognize the identity of an individual. Examples include fingerprints
and facial images. A biometric system
uses biometric data for authentication purposes.
Contractor - an individual under contract to a
department or agency requiring routine access to federally controlled
facilities and/or federally controlled information systems to whom Federal
agency identity credentials would be issued, consistent with the agency’s
securities policies.
e-OIP Tracking Number - number assigned by the Electronic
Questionnaire for Investigations Processing (e-QIP) to each SF-85 application.
This tracking number
must be written on the fingerprint card
when it is submitted to OMB in order to bind the fingerprint card to the proper
applicant.
FBI Fingerprint Check - fingerprint check of the FBI
fingerprint files. This check is an integral part of the NACI, and is the
minimum requirement for provisional card issuance.
FD-258 - fingerprint chart to accompany the NACI request when the individual
to be investigated is a contractor (neither a Federal employee nor an applicant
for Federal employment), or when agreed to by the Office of Personnel
Management (OPM) Federal Investigations Processing Center (FIPC).
Identity Proofing - the process of providing sufficient
information (e.g., driver's license, proof of current address, etc.) to a
registration authority, or the process of verifying an individual's information
that he or she is that individual and no other.
Logical Access Control System (LACS) - protection mechanisms that limit users'
access to information and restrict access on the system to only what is
appropriate for them. These systems may be built into an operating system,
application, or an added system.
National Agency Check (NAC) - is part of the National Agency Check
with Written Inquiries. Standard NACs
consist of searches of the Security/Suitability/Investigations Index (SSI),
Defense Clearance and Investigation Index (DCII), FBI Name Check, and FBI
National Criminal History Fingerprint Check.
National Agency Check with Written
Inquiries (NACI) -
the basic and minimum investigation required for all new Federal employees and
contractors consisting of searches of the OPM Security/Suitability
Investigations Index (SII), the Defense Clearance and Investigations Index
(DCII), the Federal Bureau of lnvestigation (FBI) Identification Division's
name, fingerprint files, and other files or indices when necessary. A NACI also includes written inquiries and
searches of records covering specific areas of an individual's background
during the past five years (inquiries sent to current and past employers,
schools attended, references, and local law enforcement authorities). Coverage includes: employment (five years);
education (five years and highest degree verified); residence (three years);
references; law enforcement (five years); and NACs.
Physical Access Control System (PACS) - protection mechanisms that limit users'
access to physical facilities or areas to only what is appropriate for
them. These systems typically involve a
combination of hardware and software (e.g., a card reader), and may involve
human control (e.g., a security guard).
PIV II Credential - a government-issued credit card-sized
identification that contains a contact and contactless chip. The holder's facial image will be printed on
the card along with other identifying information and security features. The contact chip will store a PKI
certificate, the CHIUD, and a fingerprint biometric, both of which can be used
to authenticate the user for physical access to federally controlled facilities
and logical access to federally controlled information systems.
Public Key Infrastructure (PKI) - A service that provides cryptographic
keys needed to perform digital signature-based identity verification, and to
protect communications and storage of sensitive data.
SF-87 - fingerprint chart to accompany the NACI request when the
individual to be investigated is a Federal employee or applicant for Federal
employment.
Submitting Office Number (SON) - number assigned by OPM to identify the
office that submitted the NACI request.
VII. PRlVACY POLICY
HSPD-12 explicitly states that
"protect[ing] personal privacy" is a requirement of the PIV
system. As such, the Review Commission
shall implement the PIV system in accordance with the spirit and letter of all
privacy controls specified in FIPS 201, as well as those specified in Federal
privacy laws and policies. This
includes, but is not limited to, the E-Government Act of 2002; the Privacy Act
of 1974; OMB Memorandum M-03-22, OMB
Guidance for Implementing the Privacy Provisions of the E-Government Act of
2002, dated September 26, 2003; and OMB Memorandum M-05-24, Implementation of Homeland Security
Presidential Directive (HSDP) 12 - Policy for a Common Identification Standard
for Federal Employees and Contractors, dated August 5, 2005.
Background investigation records are
subject to the Privacy Act. The Review
Commission must ensure those records are:
·
Secured
against unauthorized access;
·
Accessed
by only those whose official duties require such access; and
·
Stored
in a locked metal file cabinet or secure room.
The Review
Commission will also:
·
Establish
procedures to allow employees or their designated representatives access to
their records, while ensuring that the records remain subject to agency control
at all times;
·
Ensure
that those authorized to access personnel records subject to the Privacy Act
understand how to apply the Act's restrictions on disclosing information from a
system of records;
·
Oversee
privacy-related matters associated with implementing the agency’s HSPD-12
program, and submit to OMB and make publicly available a comprehensive privacy
impact assessment (PIA) of the program, including an analysis of any information
technology systems used to implement this directive;
·
Review
and update the PIA periodically; and
·
Complete
the actions required in OMB guidance.[3]
VIII.
NACI/OPM/NS BI REQUIREMENTS
A NACI is the minimal background
investigation that must be performed for all individuals to whom this directive
applies, except when the position requires a higher-level OPM/NS BI. In such cases, the OPM/NS BI shall be
scheduled in lieu of the NACI.
These requirements may also be satisfied
by locating and referencing a completed and successfully adjudicated NACI or
other higher level OPM/NS BI. To locate
and reference an already completed and successfully adjudicated NACI, contact
the Human Resource Specialist. If the
Applicant indicates that he/she has already been awarded a specified level of
security clearance based on a NACI/Other BI from previous employment, the
previous employer's human resources or personnel security office should be
contacted to obtain a copy of the certificate or the original. The certificate from the previous employer
must be current from the date of inquiry. OPM may also be contacted to verify
the level of security.
The Office of Administration, in
consultation with the Office of General Counsel, is responsible for determining
the position sensitivity designation for all positions and for ensuring that
employees have the appropriate investigation that corresponds to that
determination. It must also ensure that
periodic reinvestigations are scheduled as required. The Human Resource
Specialist or the Executive Officer will submit the NACI SF-85, Questionnaire
for Non-Sensitive Positions directly to OPM.
Before issuing a credential, the agency
should receive notification of the results of the National Agency Check. If the agency has not received the results
within five days, the identity credential can be issued based on the FBI
National Criminal History Fingerprint Check (FBI fingerprint check). The Registrar may issue a credential approval
after the successful completion of a fingerprint check; however, the completion
and successful adjudication of a full NACI is still required for all
Applicants. Refer to section IX (b)
below and Appendix B for specific instructions on completing and adjudicating
the NACI.
IX. REGISTRATION,
IDENTITY PROOFING AND CREDENTIAL ISSUANCE
The
agency will use a manual Role-Based
Model specified below to register, identity proof, and credential
applicants. This process uses inspection
of identity source documents and background checks to establish assurance of
identity. All actions taken for
approval/denial of requests by all participants in the process shall have an
auditable trail, which is a critical control component in establishing the
chain of trust for PIV issuance and management.[4]
Auditing identity proofing and registration records may take place
periodically.
A. Role Based System
The
PIV I process contains critical roles associated with the identity proofing,
registration, and issuance process. These roles are ancillary roles assigned to
agency personnel who have other primary duties. No single individual may assume
more than one of these roles in the process, with the exception of the
Adjudicator role. (An individual may
assume the role of Adjudicator and Sponsor or Adjudicator and Registrar.) The following roles shall be employed for
registering and identity proofing an Applicant, and issuing an Applicant a
credential.
1.
Roles and Responsibilities
(a)
PIV Applicant
The Applicant is the individual to whom a
PIV credential needs to be issued. The
Applicant will:
·
Complete
required forms;
·
Appear
in person during various stages of the process;
·
Provide
two forms of identity source I-9 documents (OMB No. 1115-0136 Employment
Eligibility Verification) in original form to Registrar, one of which must
be a valid State or Federal government-issued picture identification to prove
claimed identity.
(b) PIV Sponsor
The Sponsor is the individual who
substantiates the need for a PIV credential
to be issued to the Applicant and provides
sponsorship to the Applicant. The
Sponsor will:
·
Authorize
the request for a PIV credential;
·
Coordinate
initial registration activities; and
·
Serve
as intermediary between Applicant and Registrar, if necessary.
(c) PIV Registrar
The Registrar is the entity or individual
responsible for identity proofing the Applicant, coordinating NACI activities,
and ensuring the successful completion of the background checks. The PIV Registrar provides the final approval
for issuance of a PIV credential to the Applicant. The Registrar is a
role that may be performed by more than one person.
The Registrar will:
·
Compare
Applicant’s information contained in the PIV Request (e.g., full name, date of
birth, contact information) with the information provided by Applicant;
·
Retain
copies of required information in a personnel security file (e.g., a facial
image and fingerprints of Applicant, completed and signed PIV Request,
completed and signed SF-85 or equivalent form received from Applicant,
information related to the checked identity source documents, results of the
required background check, and other materials used to prove the identity of
Applicant);
·
Require
Applicant to be fingerprinted at a facility referred to Applicant (e.g., a
designated DOI facility or other secured location);
·
Initiate
a NACI on Applicant as required by Executive Order 10450 by forwarding the
information to OPM by overnight/FedEx or by certified mail, return receipt
requested;
·
Approve
or Deny Issuance of PIV card;
·
Notify
the PIV Sponsor and PIV Issuer that Applicant has been approved or denied the
issuance of PIV credential; and
·
Provide
required information to PIV Issuer through a secure process.
(d) Office of Personnel Management (OPM)
The OPM is responsible for conducting the
NACI and FBI Fingerprint Check.
(e) PIV Adjudicator
The PIV Adjudicator is responsible for determining whether or
not the Applicant is eligible to receive a PIV Card, based on
results obtained from OPM. The
Adjudicator will:
·
Confirm
fingerprint check results;
·
Adjudicate
NACI and attempt to resolve issues; and
·
Notify
Registrar of results.
(f) PIV Issuer
The PIV Issuer is an individual or entity
that performs credential personalization operations and issues the identity
credential to the Applicant after all identity proofing, fingerprint checks,
and related approvals have been completed.
The Issuer will:
·
Confirm
Applicant identification source documents;
·
Capture
photo, validate that the appearance of the individual matches the picture being
printed on the PIV credential, and store duplicate photo in the personnel
security file;
·
Issue
provisional or new PIV credential;
·
Obtain
a signature from Applicant (now PIV credential holder) attesting to Applicant’s
acceptance of the PIV credential;
·
Notify
PIV Sponsor and designated PIV Registrar of the successful or unsuccessful
personalization and issuance of the credential;
·
Maintain
records (completed and formally authorized PIV Request, approval notice from
PIV Registrar, name of PIV credential holder, credential identifier, expiration
date of the PIV credential, and signed acceptance form from PIV credential
holder); and
·
Control
PIV credential stock to ensure stock is only used to issue valid credentials.
B. Registration,
Identity Proofing, and Issuance Procedures
The following is a sequential list of steps to be followed when
applying for and issuing a credential that is compliant with the Review
Commission's PIV I identity proofing and registration process.
(1) Sponsor - Send new hire
package to Applicant with PIV registration instructions. Simultaneously notify Registrar of the
request for PIV credential. Complete
Sponsor section of Personal Identity Verification Request for OSHRC Credential
(OSHRC PIV Request Form). See Appendix A.
·
Federal
Employee New Hire Package includes:
OF-306 (Declaration of Employment) and SF-87 (fingerprint chart) with
instructions on where to obtain fingerprints; and instructions for accessing
and completing SF-85 online and downloading it as a hard copy.
·
Contractor
New Hire Package includes: OF-306
(Declaration of Employment) and FD-258 (fingerprint chart) with instructions on
where to obtain fingerprints; and instructions for accessing SF-85 online and
downloading it as a hard copy.
(2) Registrar - Confirm the validity of the PIV request. Confirm registration requirements with
Applicant.
(3) Applicant - Complete OF-306, SF-85 form, and
fingerprint card per agency instructions in new hire package. OPM questionnaire
is located at
http://www.opm.gov/forms/pdf_fill/SF85.pdf
(4) Applicant - Appear in person in front of Registrar
with completed forms from new hire package, résumé, and two identity source
documents in original form. The identity
source documents must come from the list of acceptable documents shown on Form
1-9, OMB No. 1115-0136, Employment
Eligibility Verification. At least
one document should be a valid State or Federal government-issued picture
identification (ID) card.
(5) Registrar - Inspect and validate the identity
source documents, OF-306, résumé, and fingerprint card from Applicant. Verify
that Applicant is the individual pictured in the government-issued picture
identification. Complete Registrar section
of OSHRC PIV Request Form and record information from the identity source
documents.
(6) Registrar - Copy OF-306, résumé, and fingerprint
chart and attach to Applicant's SF-85 to send to OPM to initial a NACI on
behalf of Applicant.
(7) Registrar - Send
Applicant’s completed package and fingerprint chart by secure method to OPM.
(8) OPM - Run fingerprint check based on fingerprint card. Send results to
Adjudicator.
(9) Adjudicator -Verify that fingerprint check results
received from OPM are successfully/unsuccessfully adjudicated and notify
Registrar.
(10) Registrar - Review results of fingerprint check from
Adjudicator. If approved, complete
Registrar section of OSHRC PIV Request Form.
(Applicants may be issued a provisional credential after the FBI
Fingerprint Check portion of the NACI is successfully completed.) Send approval notification to Sponsor and
Issuer to issue provisional credential; go to step 12. If denied due to unusable fingerprints or incorrect
identity, notify Sponsor; go to step 11.
(11) Registrar - If fingerprint check was unsuccessful
(unusable fingerprints,
incorrect identity), determine whether to
proceed with another fingerprint
check or terminate the process.
(12) Registrar - Contact Applicant after approval
and inform Applicant to appear in person in front of Issuer with identification
source documents to receive credential.
(13) Applicant - Appear in person in front of Issuer and
present State or
Federal ID.
(14) Issuer - Confirm Applicant's identity in person
by verifying State or
Federal ID with source document
information on OSHRC PIV Request Form received from Registrar.
(15) Issuer - Photograph Applicant or send Applicant
to a designated location to obtain a photograph and issue credential
(provisional credential if the NACI has not been completed). Complete Issuer section of OSHRC PIV Request
Form.
(16) Applicant - Complete Applicant section of OSHRC PIV
Request Form acknowledging acceptance of credential.
(17) Issuer - Forward completed OSHRC PIV Request Form
to Registrar to maintain in the personnel security file.
(18) Registrar - Receive completed OSHRC PIV Request Form
from Issuer and update personnel security file with original completed OSHRC
PIV Request Form.
NACI completion
(19) OPM - Conduct NACI and send final results to
Adjudicator. Step 19 follows Step 8 and
can be completed concurrently with the activities in steps 9 through 18.
(20) Adjudicator - Adjudicate NACI according to the
adjudication criteria listed in Appendix B and 5 C.F.R. pt. 731. Notify Registrar and Sponsor of successful
NACI.
(21) Adjudicator - Attempt to resolve any issues directly
with Applicant.
(22) Adjudicator - If NACI adjudication is successful,
notify Registrar, complete OFI-79A, store copy of OFI-79A in the personnel
security file and Letter of Adjudication in the OPF, and forward original
OFI-79A to OPM; go to step 23. If NACI
adjudication is unsuccessful, notify Registrar and Sponsor; go to step 24.
(23) Registrar - If a successful NACI is received from
Adjudicator, remove provisional status from credential and update personnel
security file.
(24) Registrar - If NACI is unsuccessful, update
personnel security file and revoke credential.
(25) Sponsor - Notify Applicant of unsuccessful NACI,
recover credential, and advise Applicant of appeal rights.
(26)
Applicant - Appeal an unsuccessful
adjudication (optional).
X. APPEAL PROCEDURES FOR
DENIAL OF CREDENTIAL
In the event of an unsuccessful
adjudication, the appeal procedures noted below will be followed.
A. Appeal
Rights for Federal Service PIV Applicants
When the PIV Adjudicator determines that a
PIV Applicant has not provided his or her true identity during the registration
process or is otherwise found unsuitable, and the determination results in a
decision by the agency to withdraw an employment offer, or remove the employee
from the federal service, the appeals rights of either 5 C.F.R. pt. 315,
subpart H (probationary employees); 5 C.F.R. pt. 731, subparts D and E
(suitability); or 5 C.F.R. pt. 752, subparts D through F (adverse actions),
will be followed, depending on the employment status of the federal service
applicant, appointee, or employee. And
to the extent required by these provisions, the procedures of 5 C.F.R. pt. 1201
(practices and procedures of Merit Systems Protections Board) will be followed.
Employees who are removed from Federal
service are entitled to dispute this action using applicable grievance, appeal,
or complaint procedures available under Federal regulations, or Review
Commission directives.
B. Appeal Rights for
Contract PlV Applicants
Notice
of Proposed Action - A
notice of proposed action will be given when the PIV Adjudicator determines
that a PIV Applicant has not provided his or her true identity or is otherwise
not suitable to be employed in the current or applied-for position, i.e., after
an unsuccessful adjudication. The PIV Adjudicator will provide the individual
reasonable notice of the determination, including the Adjudicator’s reason(s)
for determining that the individual has not provided his or her true identity
or is otherwise unsuitable. The notice
will state the specific reasons for the determination, and that the individual
has the right to answer the notice in writing. The notice will inform the
individual of the time limits for response, as well as the address to which
such response should be made.
Answer - The individual may respond to the
determination in writing and, in support of the response, furnish documentation
that addresses the validity, truthfulness, and/or completeness of the specific
reasons for the determination.
Decision - After considering the PIV Adjudicator’s
rationale and any documentation submitted by, or on behalf of, the PIV
Applicant, the Chairman or his/her designee will issue a final written decision that either affirms or reverses the PIV
Adjudicator’s decision, and informs the PIV Applicant of the reasons for the
decision.
XI.
EXPIRATION DATE REQUIREMENTS
All credentials issued by the Review
Commission will have an expiration date printed on the card. The expiration
date for all credentials must be five (5) years or less from the date of
issuance.
All existing Review Commission credentials
must be replaced with PIV II credentials by October 27, 2007.
XII. REPLACEMENT AND TEMPORARY CREDENTIALS
The PIV I process does not need to be
followed to secure replacement or temporary credentials. Replacement credentials are to be issued when
an employee’s or contractor’s credential is lost, damaged, stolen, or expired. In such cases, Sponsors are required to complete
the Sponsor section of the OSHRC PIV Request Form and check the replacement
card box. Sponsor and Applicant will
follow pre-existing credential issuance procedures for obtaining a replacement
credential.
In addition, should a long-term employee or
contractor forget his/her credential on a particular day, this individual will
be issued a temporary credential after his/her identity is confirmed.
XIII.
CONTRACTING REQUIREMENTS
All contractors must follow the identity
proofing and registration requirements outlined in Section IX (B) above. The Review Commission’s contracts must
indicate that: 1) all long-term
contractor employees must go through the identity proofing and registration
process, and 2) all incumbents must be successfully identity-proofed and have a
successfully adjudicated NACI or OPM/NS BI to serve on the contract.
XIV.
TRAINING
Agency specific training will be conducted
for those processes and procedures that are unique to the Review
Commission. PIV specific training is
required for various roles that must be assumed to implement HSPD-12. The Department of Interior has developed
computer-based training to meet the requirements for HSPD-12. There are several modules that address the
standardized PIV roles and responsibilities involved in the secured
process. All sponsors, registrars,
adjudicators and issuers will receive training prior to assuming such
roles. The DOI computer-based training
can be viewed at www.vodium.com/goto/blm/hspd12.asp. The OPM USA Learning website http://www.usalearning.gov/USALearning
must be used to obtain the password to complete the required
training and receive a certificate of completion.
XV. REPORTING REQUIREMENTS
FIPS 201 and OMB guidance requires the
agency to report the number of agency-issued credentials. Therefore, a report including the following
information will be submitted to the Executive Officer within 15 days of the end
of each quarter and the fiscal year to ensure that controls are in place for
tracking all PIV credentials:
A. The number of PIV credentials issued during
the quarter or the fiscal year, and the name, card identifier, issuance date,
and expiration date associated with each issued credential.
B. The number of PIV credentials cancelled
during the quarter or the fiscal year, and the name, card identifier,
cancellation date, and reason for cancellation associated with each canceled
credential.
C.
The
number of PIV credentials replaced during the quarter or the fiscal year, and
the name, old card identifier, new card identifier, replacement date, and
reason for replacement associated with each replaced credential.
XVI. GENERAL
This newly adopted directive will be placed in the Master File of OSHRC Directives subject to annual review and will be posted under “Publications” on OSHRC’s website.
OFFICIAL SEAL:
/s/ /s/
PATRICIA A. RANDLE W. SCOTT RAILTON
EXECUTIVE OFFICER CHAIRMAN
Appendix A
PERSONAL IDENTITY VERIFICATION (PIV) REQUEST FOR
OSHRC CREDENTIAL
_____________________________________________________________________________________________
Privacy Notice: Public Law 93-579 permits collection of the data requested on this form. The information is used to determine suitability for the issuance of OSHRC credentials. The information will be used to identity proof and register applicants as part of the Personal Identity Verification process. Providing this information is voluntary; however, failure to submit this information may result in denial of a OSHRC credential.
____________________________________________________________________________________________________________________
A. PIV Request & Source Document
Confirmation (To be completed by Sponsor)
1. Replacement
Card? Yes No 1a. Reason for
Replacement:__________________________
2. B1* Application Complete? Yes
(Required for new cards only) [*“B1” is a generic reference to all
investigations for federal employment purposes.]
3.
4. Contractor
Company:___________________________Contract Number:_________________
5. Application
Information Contractor Employee
Name:
__________________________________________________________
Phone:
__________________________________________________________
Birth
date (mm/dd/yyyy): _____________/____________/_________________
Hair
Color______Eye Color_________Height_______Weight____ Gender____
Position: __________________________________________________
Organization:
__________________________________________________
Work Address: __________________________________________________
City: __________________________________________________
Zip: __________________________________________________
Email: __________________________________________________
6. Sponsor Information
Name: __________________________________________________
Organization: __________________________________________________
Phone: __________________________________________________
Email: __________________________________________________
I agree to sponsor the above application for a PIV
credential and certify that the information is accurate to the best of my
knowledge.
Sponsor Signature: ___________________________________________
Date
(mm/dd/yyyy): ______________/_______________/_____________
B. Source Document Confirmation and Issuance Approval (To be
completed by Registrar for new cards only, after Section A is completed.)
1. Identity
Source Document 1 (Attach copy)
Name: _________________________________________________
Doc.#: _________________________________________________
Doc. Title: _________________________________________________
Issuer: _________________________________________________
Doc. Expiration Date
(mm/dd/yyyy): ___________/__________/___________
2. Identity
Source Document 2 (Attach copy)
Name:
_________________________________________________
Doc.
#: _________________________________________________
Doc.
Title: _________________________________________________
Issuer: _________________________________________________
Doc.
Expiration Date: (mm/dd/yyyy): ___________/___________/__________
3. FBI Fingerprint Check Results
Date
Completed (mm/dd/yyyy): ___________/____________/___________
Successful? Yes No
Comments:
_____________________________________________________________________
_______________________________________________________________________________
4. Adjudication
Completed
Yes
No
Successful
Yes
No
5. Registrar Information
Name: ____________________________________________________________________________
Organization: _____________________________________________________________________
Phone:
____________________________________________________________________________
Email: ____________________________________________________________________________
I hereby certify that the information regarding the
above applicant
is accurate to the best of my knowledge and approve this application for
credential issuance.
Registrar Signature: _________________________________________________
Date (mm/dd/yyyy):
_____________/________________/__________________
C. Credential Details (To be completed by Issuer, after
Section A [and B, if required] is completed.)
1.
Credential Issuance
Name on Credential: ________________________________________________________
Credential
Identifier:
________________________________________________________
Credential
Expiration Date (mm/dd/yyyy): ______________/______________/_____________
Picture
Taken Yes
No
2.
Credential Information
Name:
______________________________________________________________________
Organization:
_______________________________________________________________
Phone: ______________________________________________________________________
Email:
________________________________________________________________________
I hereby acknowledge issuance of a credential to the
applicant identified above based on verification of the applicant’s identity
and verification of the above Registrar’s issuance approval.
Issuer
Signature: ____________________________________________________
Date
(mm/dd/yyyy): ________________/________________/________________
D. Applicant Acknowledgement (To be completed by Applicant,
after Section C is completed.)
I, the Applicant, confirm receipt of the PIV
credential identified above and that the information is accurate to the best of
my knowledge, and agree to abide by all rules and responsibilities associated
with the credential.
Applicant
Signature: ________________________________________________
Date
(mm/dd/yyyy)): ________________/________________/_______________
Appendix
B
Adjudication Criteria
The Adjudicator will adjudicate the
Applicant’s NACI according to the criteria listed below which are consistent
with OPM requirements:
(a) When adjudicating initial and
continued eligibility to possess a credential, the Adjudicator shall make his
or her determination based on the results of the FBI Fingerprint Check, NACI,
other OPM/NS BI, or agency inquiry into misconduct.
(b) When making a PIV determination under
(a) above, the Adjudicator must find out whether or not the identity provided
to the Sponsor and Registrar during the registration process is the Applicant's
true identity. For applicants for
employment and current Federal employees, the Adjudicator will consult with the
applicant or employee's servicing Human Resources staff before making a final determination
as to whether to deny or withdraw a credential.
(c) If the adjudication confirms the
individual's true identity, but reveals unfavorable information that involve
criteria 1 through 8 below, adjudication under 5 C.F.R. pt. 731 shall be
conducted. Part 731 criteria are:
1. Misconduct or negligence in employment;
2. Criminal or dishonest conduct;
3. Material, intentional
false statement or deception or fraud in examination or appointment;
4. Refusal to furnish testimony as required by
5 C.F.R. § 5.4;
5. Alcohol abuse of a
nature and duration, which suggests that the applicant or appointee would be
prevented from performing the duties of the position in question, or would
constitute a direct threat to the property or safety of others;
6. Illegal use of
narcotics, drugs, or other controlled substances, without evidence of
substantial rehabilitation;
7. Knowing and willful
engagement in acts or activities designed to overthrow the U.S. Government by
force; or
8. Any statutory or
regulatory bar which prevents the lawful employment of the person involved in
the position in question.
(d) When making a suitability
determination under 5 C.F.R. pt. 731, the following factors should be
considered to the extent that they are deemed pertinent to the individual case:
1. The nature of the
position for which the person is applying or in which the person is employed;
2. The nature and seriousness of the conduct;
3. The circumstances surrounding the conduct;
4. The recency of the conduct;
5. The age of the person involved at the time
of the conduct;
6. Contributing societal conditions; and
7. The absence or presence of rehabilitation or efforts toward rehabilitation.