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PRESIDENT’S

DNA

INITIATIVE

Advancing Justice Through DNA Technology

N A T I O N A L

M I S S I N G

P E R S O N S

P R O G R A M

Consent for Collection, Testing and CODIS Entry Form

Name of Missing Person:

________________________________________ __________________________________ __________

Last

First

Family Member

Reference Sample:________________________________________________ __________________________________ __________

Last

First

Relationship to Missing Person: ________________________________________________ NCIC No.: ________________________

I understand that the answers provided on this form are correct to the best of my knowledge. I fully understand that my

answers are critical to the process of identifying my missing family member.

I freely and voluntarily consent to provide oral swab samples for DNA analysis and entry into the Combined DNA Index

System (CODIS) database, maintained by the FBI under authority of Title 42, United States Code, Section 14132. Law enforce-

ment agencies having online access to the missing persons database may search against my DNA profile for potential matches.

I understand that the information I have provided is protected by the Privacy Act notices for the National DNA Index System

and the FBI’s Central Records System as most recently published in the Federal Register. I also understand that my sample

will be destroyed and my DNA profile will be removed from the CODIS database once my family member has been positively

identified.

I authorize the appropriate law enforcement agent listed below to collect these samples for the sole purpose of identifying

my missing family member. I have witnessed my swab samples being collected, and a barcode label with my name has been

attached to each swab handle. The swabs were then placed in the sample collection pouch and sealed.

Signature of family member

or legal guardian giving consent: ____________________________________________________ Date: ______________________

I, on _____________________ at ______ : ______ a.m./p.m. have verified the identity of the individual who is providing the

DNA sample. I then collected four swab samples from this individual, attached a label with his/her name to each swab,

placed them in a sample collection pouch and then sealed the pouch.

Law Enforcement Agent collecting DNA swab samples:

Print Name

______________________________________________

Signature ________________________________________________

I understand that I am not required or obligated to provide a DNA sample, and that my consent to have a DNA sample taken

is knowingly and voluntarily made. I further consent to the use of my DNA profile in the anonymous population database

to aid in statistical inferences. The database will not contain any of my personal information, and the DNA profile cannot be

associated with me as a donor.

Signature of family member

or legal guardian giving consent: ____________________________________________________ Date: ______________________

Missing Person And Family Reference Sample Information Form - National Missing Persons Program Page 2

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