How to Prepare A CD-79, Request for Security Clearance

Updated 10/23/02

Note: This form must be typed - Hand written copies are not acceptable.

1. Primary Unit: Acronym(s) of operating unit down to the office level.

2. Date: Date of request.

3. Level of Clearance Requested: Check level of clearance being requested.

4. Status: Check type of employee (e.g. Applicant, Contractor, Employee, Committee Member).

5. Name Block: Last name, first name, middle initial.

6. Position: Title of position.

7. Series: Job series.

8. Social Security Number.

9. Date of Birth.

10. Grade of position.

11. Justification Block: Include the following:

• State the level of clearance required.
• Provide duration of subject's requirement for access.
• Include duties which require access to classified information.
• State where access is likely to occur.
• State frequency of access.
• Temporary Access. Interim security clearances, now called "Temporary Access" in accordance with Executive Order 12968, are no longer granted except under special circumstances. If the manager determines that temporary access to classified information is required, the manager must provide specific justification. An EXAMPLE of a request is provided in the sample CD-79.

12. Position Sensitivity: e.g. Critical Sensitive. (A list of position sensitivities appear on the example. For specific guidelines when establishing position sensitivity, contact your Human Resources Office, extension 3438, room 7417.)

13. Requested by: Supervisor/manager must sign and date the block.

14. Name and title of supervisor/manager requesting security clearance.

15. Concurrence: Leave Blank

16. Name and title of Security Officer: Leave Blank

Submit completed form to the Office of Human Resources Management in room 7413.

For additional information, contact the Security Staff at 202-482-8355.