Fillable Privacy Act Request (Page 2 of 2) in pdf

PRIVACY ACT REQUEST FOR

Form Approved

OMB No. 3206-0266

COMPLETED STANDARD FORM SF85/SF85P/SF86

Privacy Routine Use and Disclosure Information

Privacy Act Statement. Information provided by a requester will be used to locate and provide the requester responsive records pursuant to the Freedom of

Information Act (5 U.S.C. § 552), and/or the Privacy Act of 1974 (5 U.S.C. § 552a). Authority to collect this information is contained in 5 U.S.C. § 552, 5 U.S.C. § 552a,

5 C.F.R. § 297.201(b). The purpose of the collection is to enable the United States Office of Personnel Management (OPM) Federal Investigative Services to locate

applicable records and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974. Failure to provide the required information

may result in no action being taken on the request.

Routine Uses. The information collected on this form will primarily be used to comply with requests for information under Title 5 U.S. Code 552 and 552a. Routine

uses of the records include:

To disclose information to the Office of Management and Budget at any stage in the legislative coordination and clearance process in connection with private

relief legislation as set forth in OMB Circular No. A-19.

To disclose information to an agency, subject to law, rule, or regulation enforced by OPM having been found in violation of such law, rule, or regulation, in

order to achieve compliance with OPM instructions.

To disclose information to Federal agencies in order to obtain advice and recommendations concerning matters on which the agency has specialized

experience or particular competence, for use by OPM in making required determinations under the Freedom of Information Act or the Privacy Act of 1974.

To disclose information to any source from which additional information is requested (to the extent necessary to identify the individual, inform the source of

the purpose of the request, and to identify the type of information requested), where necessary to obtain information relevant to an OPM decision concerning

a Privacy or Freedom of Information Act request.

To disclose to the Federal agency involved, an OPM decision on an appeal from an initial denial of a request involving OPM-controlled records.

To disclose pertinent information to the appropriate Federal, State, or local agency responsible for investigating, prosecuting, enforcing, or implementing a

statute, rule, regulation, or order, where OPM becomes aware of an indication of a violation or potential violation of civil or criminal law or regulation.

To provide information to a congressional office from the record of an individual in response to an inquiry from that congressional office made at the request

of that individual.

To disclose information to another Federal agency, to a court, or a party in litigation before a court or in an administrative proceeding being conducted by a

Federal agency, when the Government is a party to the judicial or administrative proceeding. In those cases where the Government is not a party to the

proceeding, records may be disclosed if a subpoena has been signed by a judge.

To disclose information to the National Archives and Records Administration for use in records management inspections.

By OPM in the production of summary descriptive statistics and analytical studies in support of the function for which the records are collected and

maintained, or for related workforce studies. While published studies do not contain individual identifiers, in some instances the selection of elements of data

included in the study may be structured in such a way as to make the data individually identifiable by inference.

To disclose information to the Department of Justice, or in a proceeding before a court, adjudicative body, or other administrative body before which OPM is

authorized to appear, when: (1) OPM, or any component thereof; or (2) Any employee of OPM in his or her official capacity; or (3) Any employee of OPM in his

or her individual capacity where the Department of Justice or OPM has agreed to represent the employee; or (4) The United States, when OPM determines

that litigation is likely to affect OPM or any of its components; is a party to litigation or has an interest in such litigation, and the use of such records by the

Department of Justice or OPM is deemed by OPM to be relevant and necessary to the litigation provided, however, that the disclosure is compatible with the

purpose for which records were collected.

To disclose information to officials of the Merit Systems Protection Board or the Office of the Special Counsel, when requested in connection with appeals,

special studies of the civil service and other merit systems, review of OPM rules and regulations, investigations of alleged or possible prohibited personnel

practices, and such other functions, e.g., as promulgated in 5 U.S.C. 1205 and 1206, or as may be authorized by law.

To disclose information to the Equal Employment Opportunity Commission when requested in connection with investigations into alleged or possible

discrimination practices in the Federal sector, compliance by Federal agencies with the Uniform Guidelines on Employee Selection Procedures or other

functions vested in the Commission and to otherwise ensure compliance with the provisions of 5 U.S.C. 7201.

To disclose information to the Federal Labor Relations Authority or its General Counsel when requested in connection with investigations of allegations of

unfair labor practices or matters before the Federal Service Impasses Panel.

Information Regarding Disclosure of your Social Security Number (SSN) under Public Law 93-579, Section 7 (b). Solicitation of SSNs by OPM is authorized

under the provisions of Executive Order 9397, dated November 22, 1943. Providing your social security number is voluntary. You are asked to provide your social

security number only to facilitate the identification of records relating to you. Without your social security number, OPM may be unable to locate records pertaining

to you. The use of SSNs is necessary because of the large number of Federal employees, contractors, civilians and military personnel who have identical names and/

or birth date and whose identities can only be distinguished by their SSNs.

Public Burden Statement. Public burden reporting for this collection of information is estimated to vary from 5 to 15 minutes with an average of 5 minutes per

response, including time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the collection of

information. Send comments regarding the accuracy of this burden estimation and any suggestions for reducing the burden to: U.S. Office of Personnel

Management, Federal Investigative Services, Attn: OBM Number (3206-xxxxx), 1900 E. Street NW, Washington, DC 20415-7900.

U.S. Office of Personnel Management

Page 2 of 2

INV 100A

Federal Investigative Services

Sept 2015