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Clearance Request Reinvestigation Form

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Clearance Request Reinvestigation Form

Recitals

WHEREAS, Requesting Agency: (hereinafter "Requesting Agency") requires the reinvestigation of an existing security clearance to determine current eligibility and suitability for access to classified or sensitive information; and

WHEREAS, Investigation Provider: (hereinafter "Provider") represents it has the qualifications and authority to perform such reinvestigation in accordance with applicable standards and this Agreement; and

WHEREAS, the parties desire to set forth the scope, terms, confidentiality obligations, payment, and other provisions governing the reinvestigation to be performed as requested herein.

Requesting Agency Contact

Subject (Applicant) Information

Full legal name:

Date of birth:    Place of birth:

Social Security (last 4 digits):    Clearance level:

Clearance grant date:    Position/Title:

Scope of Work

Requested Investigation Type

Periodic Reinvestigation (PR)    National Security Investigation/MBI    Single-Issue Reinvestigation    Other:

Known Adjudicative Concerns

Has the subject accrued any new criminal charges since the prior investigation?    Yes    No

Any material foreign contacts or foreign influence concerns?    Yes    No

Any significant financial issues that may bear on eligibility?    Yes    No

Payment Terms

Contract amount: $    Payment schedule:

Late payment fee:    Invoicing address:

Term and Termination

Commencement date:    Estimated completion date:

Either party may terminate for convenience upon written notice of days. Termination for breach permits immediate termination if the breaching party fails to cure within days after written notice.

Confidentiality

Provider shall treat all information obtained in the course of the reinvestigation, including classified materials, personally identifiable information, investigative leads, and source identities, as confidential and shall not disclose such information except as required by law or as authorized in writing by Requesting Agency. Provider will implement and maintain administrative, technical and physical safeguards appropriate to the sensitivity of the information and will ensure that its personnel with access to such information are bound by confidentiality obligations at least as protective as those set forth in this clause.

Data Handling and Records

All investigative records generated by Provider, including interview notes, electronic records, and final reports, shall be retained for a period of years unless otherwise directed. Provider shall deliver copies of final reports to Requesting Agency and shall permit audit and inspection of records upon reasonable notice.

Governing Law

This Agreement and any disputes arising from it shall be governed by and construed in accordance with the laws of the State of without regard to conflict of laws principles.

Entire Agreement

This document, together with any attachments and exhibits expressly incorporated herein, constitutes the entire agreement between Requesting Agency and Provider concerning the subject matter hereof and supersedes all prior agreements, understandings, negotiations and discussions, whether oral or written. No amendment to this Agreement is effective unless in writing and signed by authorized representatives of both parties.

Certification and Applicant Consent

The Requesting Agency certifies that it has the legal authority to request this reinvestigation and that the information provided herein is complete and accurate to the best of its knowledge. The Requesting Agency further affirms it has obtained applicable consents from the subject or otherwise has lawful authority to request the reinvestigation.

Applicant consent obtained: Yes    No

Representations and Warranties

Each party represents and warrants that it has the full right, power and authority to enter into this Agreement and to perform its obligations hereunder. Provider warrants that investigative activities will be performed in a professional manner consistent with applicable standards and that reports will be accurate and based on reasonable inquiry.

Indemnification and Limitation of Liability

Provider shall indemnify and hold harmless Requesting Agency from third-party claims arising from Provider's gross negligence or willful misconduct in performing services. Except for breach of confidentiality and indemnification obligations, neither party shall be liable to the other for consequential, incidental, or punitive damages; aggregate liability shall be limited to direct damages not to exceed the total amount paid under this Agreement.

Requesting Agency:

By:

Date:

Investigation Provider:

By:

Date:

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What the Clearance Request Reinvestigation Form Is

The Clearance Request Reinvestigation Form documents requests for updated background information when an active security clearance requires review. Agencies and cleared employers use it to collect identity, employment, contact, and adjudicative information needed for periodic or triggered reinvestigations. The form supports consistent recordkeeping, helps adjudicators evaluate changes in status, and creates a verifiable record of consent, disclosures, and attachments required by the authorizing agency or personnel security office.

Why this form matters for clearance management

A complete reinvestigation form preserves an individual’s eligibility and supports timely adjudication by the sponsoring agency, reduces administrative follow-ups, and documents consent and disclosures required for personnel security reviews.

Why this form matters for clearance management

Who completes and receives this form

Typical participants include security offices, cleared employees or contractors, and human resources or facility security officers.

  • Agency security office: prepares form and issues reinvestigation request to the subject.
  • Cleared individual: supplies accurate personal, employment, and contact information plus signatures.
  • Facility Security Officer (FSO): reviews completeness, attaches supporting records, and forwards to adjudication.

Each party has distinct responsibilities for filling, verifying, routing, and retaining the completed form.

Key roles who sign or certify

Security Officer

FSOs or agency security officers certify submission accuracy, ensure attachments are complete, and maintain the chain of custody for sensitive records when forwarding documents for adjudication.

Cleared Individual

The employee or contractor attests to the accuracy of disclosed information, provides consent where required, and signs the form; inaccuracies can trigger additional review or corrective action.

Essential data elements on the form

Full Legal Name: As on government ID
Social Security Number: SSN or TIN
Date of Birth: MM/DD/YYYY
Clearance Level: Secret, Top Secret, etc.
Agency/Case Number: Assigning agency ID
Contact Information: Current address and phone

Consequences of incomplete or incorrect forms

Adjudication Delay: Processing may pause
Access Suspension: Temporary loss of privileges
Administrative Action: Discipline or remediation
Denial or Revocation: Clearance could be revoked
Increased Scrutiny: More invasive reinvestigation
Record Discrepancy: Mismatched records flagged

Common preparation problems to avoid

  • Incomplete attachments: missing employment records, reference contacts, or prior adjudication documents that lengthen review time and prompt follow-ups.
  • Name mismatches: using nicknames or inconsistent legal names that cause identity verification failures and additional documentation requests.
  • Unsigned or undated sections: omitted signatures or dates can render the submission invalid and delay adjudication until corrected.
  • Poorly scanned attachments: illegible or truncated scans require re-submission and slow processing for adjudicators and background investigators.

Step-by-step: completing the Clearance Request Reinvestigation Form

Follow a consistent sequence to reduce errors: gather documents, enter core fields, attach proof, sign, and route to the security office for review.

  • 01
    Gather documents: Collect IDs, employment history, and relevant records before you begin.
  • 02
    Complete core fields: Enter legal name, SSN, DOB, clearance level, and agency case number accurately.
  • 03
    Attach evidence: Upload supporting files as PDF or scanned images with readable text.
  • 04
    Sign and route: Sign, date, and submit to the designated security office or FSO.

Where to send the completed form

Route the form according to the sponsoring agency’s instructions: secure portal, facility security officer, or specified adjudication office.

  • Agency portal: Upload via the official secure submission site when available.
  • Facility Security Officer: Deliver or email the FSO’s secure inbox for local validation.
  • Direct mail: Use certified mail only when an electronic channel is not provided.
  • RON or Notary: If notarization is required, follow the agency’s RON acceptance rules.

Configuring an online reinvestigation workflow

When using an electronic workflow, configure authentication, required attachments, routing, and audit logging to meet agency requirements.

Field Configuration
Authentication Email + SMS code or stronger KBA
Attachments Require PDF or image uploads
Routing Auto-route to FSO then adjudicator
Audit Trail Capture IP, timestamp, and actions

Delivery channels and file formats to support

Use secure, auditable channels and common formats so adjudicators can access and verify records without reformatting.

  • Accepted formats: PDF, DOCX, JPEG
  • Integrations: Common: Microsoft 365, Google Workspace, Box
  • Authentication: Email, SMS, or KBA

Core parts of a professional reinvestigation form

A well-structured form groups identifying data, adjudicative questions, consent language, attachment slots, signature blocks, and processing instructions to guide the subject and the reviewer.

Identifying Data

Collect full legal name, SSN, date of birth, contact details, and government identification references so adjudicators can match records across systems and prior investigations.

Adjudicative Questions

Include standardized, yes/no or short-answer questions about foreign contacts, financial issues, and legal matters to support consistent adjudication and reduce follow-up investigations.

Consent and Privacy

Provide explicit consent language and privacy notices informing the subject about data use, disclosure, and retention in accordance with agency rules and applicable privacy laws.

Supporting Attachments

Designate attachment fields for pay records, court documents, or identity proofs and specify acceptable file types and naming conventions to avoid processing delays.

Signature Block

Include a dated signature block that accepts handwritten, scanned, or legally compliant electronic signatures and records signer attribution and timestamp.

Processing Instructions

Add clear routing and contact instructions for FSOs and adjudicators, including who to contact for corrections and how to handle restricted information.

Practical tips for accurate and efficient completion

Adopt consistent habits to speed processing: prepare documents, use exact formats, and verify routing details before submission.

Prepare attachments in advance
Scan or export documents as searchable PDFs, label files clearly, and confirm legibility to reduce requests for resubmission and speed review.
Use consistent legal names
Always match the legal name to government IDs and prior clearance records to avoid identity-matching errors during background checks.
Check authentication settings
Confirm the required signer authentication (email, SMS, or KBA) and ensure you can receive codes or pass identity-proofing before starting.
Keep a submission log
Record submission date, routing path, and any tracking numbers so you can confirm receipt and answer follow-up inquiries quickly.

Typical timelines and response expectations

Response windows vary by agency; always meet the deadline in the reinvestigation notice and factor in processing time for attachments and routing.

Notice Deadline:

Follow the deadline stated on the request; many notices specify 10–30 business days.

Periodic Cycle:

Periodic reinvestigation cycles are set by sponsoring authorities and will be indicated in agency policy.

Adverse Information:

Report significant changes immediately when discovered, even outside the regular cycle.

Acknowledgment:

Expect an electronic acknowledgment within 1–5 business days after receipt.

Escalation:

If no acknowledgment, contact the issuing security office using the listed points of contact.

Paper submissions vs. electronic submissions

Compare core differences so you can choose the method that satisfies agency requirements while reducing processing friction.

Criteria Paper Electronic
Notarization may be required depends on agency policy
Delivery time days to weeks hours to days
Audit trail limited comprehensive (ip, timestamp)
Record retrieval manual search indexed and searchable

Typical eSignature vendor pricing and capabilities

Pricing and feature availability vary by vendor and plan; choose a provider that meets required compliance standards and supports secure workflows for sensitive personnel records.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial No No Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions about the form

Answers to common questions about format, signatures, notarization, and secure electronic submission for reinvestigation requests.


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