Atf Form 5400.28 - Employee Possessor Questionnaire - U.s. Department Of Justice, Bureau Of Alcohol, Tobacco, Firearms And Explosives Page 2
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1
2Under Indictment or Information or Convicted in Any Court. An
1.
Instructions
indictment, information, or conviction in any Federal, State, or local court.
Who must fill out and complete this form? EACH employee possessor, as
1.
defined below, MUST personally complete this questionnaire form and certify
Employee Ppossessor. An employee possessor is an individual who has actual
2.
that the answers are true, correct, and complete. This form is not required to
or constructive possession of explosive materials during the course of his
be completed by Employee Possessors whose sole responsibility is transporting
employment. Actual possession exists when a person is in immediate
explosives in commerce.
possession or control of explosive materials (e.g., an employee who physically
handles explosive materials as part of the production process; or an employee,
To whom do I submit this form? You must complete and submit this form to
2.
such as a blaster, who actually uses explosive materials). Constructive
your employer (applicant for license/permit). The employer will submit this
possession exists when an employee lacks direct physical control over explosive
form, along with the application, to ATF. If this form is being submitted
materials, but exercises dominion and control over the explosive materials,
AFTER a license or permit has been issued in order to ADD you as an employee
either directly or indirectly through others (e.g., an employee at a construction
possessor, then the form must be accompanied by a signed letter from the licensee
site who keeps keys for magazines in which explosive materials are stored, or
or permittee requesting that you be added as an employee possessor. If this
who directs the use of explosive materials by other employees; or an employee
form is being submitted for at least a second time, in relation to the same license/
transporting explosive materials from a licensee to a purchaser).
permit renewal, the employee possessor may follow instructions 3 below and the
3.
form should be sent to: ATF, Federal Explosives Licensing Center, 244 Needy
Alien. An alien in the United States means any person who is not a citizen or
Road, Martinsburg, WV 25405.
national of the United States.
Exceptions
3.
Resubmission of form upon 3-year renewal of license/permit. The person
completing the form may choose to resubmit a photocopy of their original ATF
1.
A person who has been convicted of a felony, or any other crime, for which the
Form 5400.28 provided the information has not changed. You must certify that
judge could have imprisoned the person for more than one year, is not
all the answers are still true, accurate and complete by signing and dating
prohibited from shipping, transporting, possessing, or receiving explosives if:
the form.
(1) the conviction was properly invalidated by a court on the basis that the
conviction was unconstitutional; (2) in the case of a Federal conviction, the
4.
Why is this form required? 18 U.S.C., Chapter 40, was amended by the Safe
person received a Presidential pardon; or (3) ATF granted relief from Federal
Explosives Act of 2002 (the Act). The Act made it unlawful for certain
explosives disabilities under
persons to ship, transport, receive, or possess explosive materials. The Act also
18 U.S.C. § 845(b), 27 CFR 555.142.
made it unlawful to distribute explosive materials to certain persons. Informa-
tion you provide on this form will allow ATF to determine whether you, an
2. Purposes of this form, aliens can be employee possessors if they are lawful
employee possessor in the explosives business or operations, are prohibited
permanent residents. 18 U.S.C. § 842(d)(7); (i)(5).
from shipping, transporting, receiving, or possessing explosive materials.
Privacy Act Information
18 U.S.C. § 842(d), (i).
The following information is provided pursuant to Section 3 of the Privacy Act of
5.
Should documentation be attached to clarify a response to a question
1974, 5 U.S.C. § 552a(e)(3):
or item? Providing additional documentation to clarify a response to a specific
question or item on the front of this form could help prevent a delay in
1. Authority. Solicitation of this information is made pursuant to 18 U.S.C.
processing your Employer Possessor Questionnaire. Please ensure that your
§§ 842, 843. Disclosure of this information by the employee possessor is
name is on any attached documents(s). In addition, if your employer is
mandatory if the employee possessor wishes to possess explosives.
renewing a Federal explosives license or permit, ensure that the employer's
2. Purpose. To determine the eligibility of the employee possessor to possess
current license or permit number is on any attached documents.
explosive materials.
6.
How do I obtain additional forms? The form can be downloaded from ATF's
3. Routine Uses. The information will be used by ATF to make determinations
website in Adobe PDF format at The form can
set forth in paragraph 2. In addition, information may be disclosed to other
be ordered using ATF's Online Distribution Center Order Form at
Federal, State, foreign, and local law enforcement and regulatory agency
The form can also be ordered by calling ATF's
personnel to verify information on the employee possessor questionnaire and
Distribution Center at (301) 583-4696.
to aid in the performance of their duties with respect to the regulation of
explosives unless such disclosure is prohibited by law. Finally, the information
7.
What do I do if I am prohibited from possessing explosives as indicated
may be disclosed to members of the public in order to verify the information
above? If you are prohibited from possessing explosives, you may request
on the questionnaire when such disclosure is not prohibited by law.
relief from your Federal explosives disability by filing an ATF Form 5400.29,
Application for Restoration of Explosives Privileges. This form can be down-
4. Effects of not supplying the requested information. Failure to supply
loaded from ATF's website at or may be
complete information will delay processing and may cause denial of the
obtained by calling (202) 648-7110. Please be advised that you cannot
application.
possess explosives until such time that relief from Federal explosive disabilities
5. Disclosure of social security number. Disclosure of the individual's social
may be granted. For example, if you are a nonimmigrant alien, you should
security number is voluntary. Under 18 U.S.C. §§ 842(f), 843, and Executive
answer "yes" to question 25, and you are prohibited from possessing
Order 9397, November 22, 1943, ATF has the authority to solicit an
explosives. You may file a relief application, but you cannot possess
individual's social security number. The number may be used to verify the
explosives until such time that ATF may grant you relief.
individual's identity.
8.
Need assistance in completing the form? Please review information online
concerning this form at , contact the National Licensing Center at
Paperwork Reduction Act Notice
(404) 417-2750, or contact your local ATF office.
This request is in accordance with the Paperwork Reduction Act of 1995. The
purpose of this information collection is to determine the eligibility
ATF Form 5400.28 is used to determine the eligibility of the employee possessor
of the employee possessor to engage in certain operations. The information
to possess explosives materials. Under Federal explosives laws it is unlawful for
requested is required to obtain or retain a benefit and is mandatory by statute
certain prohibited persons to possess explosives. See 18 U.S.C. § 842(d) and (i).
18 U.S.C. 843.
18 U.S.C. § 845 (a)(1) provides that these prohibitions do not apply to any
"aspects of transportation of explosive materials via railroad, water, highway, or air
The estimated average burden associated with this collection is 20 minutes per
that pertain to safety, including security, and are regulated by the United States
respondent, depending on individual circumstances. Comments concerning the
Department of Transportation or the Department of Homeland Security." The
accuracy of this burden estimate and suggestions for reducing this burden should be
Department of Transportation and the Transportation Security Administration have
addressed to Reports Management Officer, Document Services Branch, Bureau of
exercised their regulatory authority concerning employee qualifications to
Alcohol, Tobacco, Firearms and Explosives, Washington, DC 20226.
transport explosive materials. Accordingly, ATF does not have to determine the
eligibility to possess explosives of Employee Possessors who fall within this
An agency may not conduct or sponsor, and a person is not required to respond to, a
exception.
collection of information unless it displays a currently valid OMB control number.
ATF Form 5400.28
Definitions
Revised January 2010
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