OPM -USE ONLY Request for Determination or Advisory OPM Case # Credit Income To (See instructions on reverse) 1. Subject's Name (Last) (First) (Middle) 4. Other Names Used 2. SSN 3. DOB 5. POB (City, County, Country) State 6. Sex M F Address 7. Investigation Code 8. Submitting Office Number (SON) 9. Requesting Official's Signature Date Printed Name Telephone Number (include area code) Facsimile Commercial PART A: EXAMINING OFFICE AND AGENCY USE 10. All announcements and position titles for which this determination will be used 11. Passover Request b. The sensitivity level of the position is: a. SF 62 attached c. The public trust level of the position is: 12. Identification of applications and related materials, statement of issues requiring suitability determination and other information pertinent to the determination or advisory being requested. Annotate whether this is a competitive service position, and confirm that the applicant is eligible and within reach. PART B: OPM-USE 13. Passover requests a. Not sustained (see item 18) b. Eligible for further certification c. Sustained d. Suspend pending further investigation 14. Acceptability relative to known suitability matters Final Determination Issue Characterization Level A B C D 3. Ineligible for failure to reply 2. Ineligible on suitability 15. Debarment Action 1. Acceptable 4. Cancel all applications and eligibilities b. Debarred from competing in examination for, or accepting appointments to, positions in the competitive Federal service until . a. None 16. Application is 17. Applicant notification a. Attached a. Applicant has been notified of the action b. Retained in OPM's Investigative File b. Applicant has not been notified of the action 18. Other action or remarks 19. Signature of OPM Representative Title File Date (mm/dd/yyyy) INV 60 (formerly OFI 86A) September 2006 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING THIS FORM GENERAL: This form is used to make a passover request or to request a suitability determination, debarment consideration, or advisory concerning suitability matters. This form should be typed and all information appropriate to your request should be furnished in the spaces provided. Make sure that any required attachments are secured to this form. Submit original of this form and any attachments to: OPM-FIPC, Suitability Branch, P.O. Box 618, Boyers, PA 16018. Any questions concerning completion of this form should be directed to OPM-FIPC. EXAMINING OFFICES (OPM AND AGENCY): Use this form to (1) request a determination of general suitability for Federal employment and (2) send a request to pass over a preference eligible (also requires an SF-62). Submit only when an eligible applicant is currently within reach or will soon be within reach for certification. Make sure that requests meet referral guidelines. PERSONNEL, SECURITY, AND SUBMITTING OFFICES: Use this form to request an advisory on suitability matters. INSTRUCTION FOR SPECIFIC ITEMS ITEM INSTRUCTIONS The subject's full name must be given in the following order - LAST, FIRST, MIDDLE. If the subject is a "Sr.", "Jr.", "III", etc., skip one space after last name and enter appropriate designation. If the subject has initials only, enter each initial in the 1 appropriate block. If the subject has no middle name, enter NMN on the block under "MIDDLE". EXAMPLES: 2 3 4 5 NORMAL ENTRY DOE SR JOHN CARR INITIALS ONLY DOE A AL Hawaii HI Massachusetts Alaska AK Idaho ID Arizona AZ Illinois IL Arkansas AR Indiana IN California CA Iowa IA Colorado CO Kansas Connecticut CT Delaware DE Florida FL Maine Georgia GA Maryland New Mexico NM South Dakota SD Michigan MI New York NY Tennessee TN Minnesota MN North Carolina NC Texas TX Mississippi MS North Dakota ND Utah UT Missouri MO Ohio OH Vermont VT KS Montana MT Oklahoma OK Virginia VA Kentucky KY Nebraska NE Oregon OR Washington WA Louisiana LA Nevada NV Pennsylvania PA West Virginia WV ME New Hampshire NH Rhode Island RI Wisconsin WI MD New Jersey NJ South Carolina SC Wyoming WY 11 12 13 thru 19 AS District of Columbia DC Guam GU Puerto Rico 8 9 10 JOHN NMN DOE MA America Samoa 7 MIDDLE NO NAME Provide the subject's Social Security Number (SSN). Provide the month, day, and year of subject's birth in that order. EXAMPLE: Enter June 7, 1970 as 06/07/1970. Refer to the applications and other documents submitted by the agency. To the extent this information is available, show all other names the subject was known by or is now using. If the subject is female, and is or was married, include maiden name and other married names if married more than once. Place of Birth (POB: Enter full name of city/town and county (or foreign equivalent). Enter name of foreign country if born outside of the U.S.A. and its territories. Using the coding shown below, provide abbreviation for State if born in the U.S.A. or its territories. EXAMPLE: The city of Knoxville, County of Knox, State of Tennessee would be shown as KNOXVILLE KNOX TN. CODING FOR STATES, DISTRICT OF COLUMBIA, AND U.S. TERRITORIES (ITEM 5) Alabama 6 C PR Trust Territory TT Virgin Islands Northern Mariana Islands CM VI If subject is Male, put an "X" under "M". If subject is Female, put an "X" under "F". Examining Offices choose one: 40 - Applicant -OR42 - Passover Other Offices must enter: 91 - Advisory (Suitability/Security) (NOTE: Additional types of cases may be developed and assigned as needed by the OPM.) Enter the SON assigned by OPM. Complete the requested information. For examining office use. For examining office use with an agency passover request. Check box a. to confirm that an SF-62 is attached to this form. Fill in the appropriate position sensitivity and public trust levels for b and c. If the agency failed to identify the position sensitivity level and public trust level, the examining office must obtain this information from the agency before referring. For examining office, personnel, security, and submitting office use. These items are for use by the OPM. American LegalNet, Inc. www.FormsWorkFlow.com INV 60 (back) (formerly OFI 86A) September 2006