In order to perform a Bioterrorism security risk assessment, each individual who requires access to select agents and toxins, the entity’s Responsible Official (RO), the entity’s Alternate Responsible Official (ARO) and any individual who owns or controls the entity must submit a completed FBI Form FD-961 and two legible fingerprint cards, printed by a local law enforcement agency, to the FBI. The FD-961 Form can be obtained by accessing the Criminal Justice Information Services Division web page at www.fbi.gov/hq/cjisd/cjis.htm. Click on the Bioterrorism link located at the bottom of the page. The fingerprint card packages consists of two fingerprint cards, general instructions, fingerprint instructions, and a pre-addressed return envelope. These packages can be obtained via faxing a request to the FBI at 304-625-3984. The faxed request should include the following: the entity name, point of contact or RO, the correct mailing address, contact telephone number and how many fingerprint card packets are requested. In order for the security risk assessment to be processed in a timely manner, the FD-961 Form and two legible fingerprint cards must be returned to the FBI as one package. The FBI will not conduct a security risk assessment for an individual unless it has received a completed FD-961 Form and two legible fingerprint cards.
COMPLETION OF THE FD-961 FORM:
The term entity is defined as any government agency (Federal, State, or local), university, corporation, company, partnership, association, firm, sole proprietorship, or other legal entity, including an individual acting on his or her own.
For the RO, ARO and For Individuals Who Require Access to Select Agents or Toxins: Each individual who requires access to select agents or toxins must complete Sections I, II, and III of the FD-961 Form.
For Individuals Who Own or Control the Entity/Corporate Officers: Each individual who owns or controls a private entity (academic, non-profit, commercial, or other) must complete Sections I, II, and III of the FD-961 Form. The individual must indicate whether they are a corporate officer, board of director, and/or stock holder.
An individual will be deemed to own or control an entity under the following conditions: (1) For a private accredited academic institution, an individual will be deemed to own or control the entity if the individual is an officer, trustee, member of a board, or owner of the academic institution, and is in a managerial or executive capacity with regard to the select agents or toxins possessed, used, or transferred by the entity. (2) For entities other than accredited academic institutions (public or private), an individual will be deemed to own or control an entity if the individual is a partner, officer, director, holder, or owner of 50 percent or more of its voting stock and is in a managerial or executive capacity with regard to the select agents or toxins possessed, used, or transferred by the entity.
An entity will be considered to be an accredited academic institution if it is a postsecondary, language, or vocational school that is accredited by an accrediting agency recognized by the U.S. Department of Education. Proof that a school has been determined to be eligible under Title IV of the Higher Education Act of 1965 is sufficient to establish that a school is properly accredited. The specific requirements for Title IV eligibility are specified in 34 CFR part 600. Federal, state, or local governmental agencies, including public accredited academic institutions, are exempt from the security risk assessments for the entity and the individual who owns or controls such entity.
GENERAL GUIDANCE ON COMPLETING THE FD-961 FORM:
Section I, Block 3: The type of the entity should be identical to that indicated on the CDC or APHIS registration application form (CDC Form APHIS/CDC Form 1).
Section II:
1.
Block 4: Include full name (last, first, middle, and
suffix, e.g. Jr. or III) . The name
provided in block 4 should be identical to that indicated on Table 4B of CDC
Form APHIS/CDC Form 1.
2.
Block 4a: Include any Aliases/Maiden names.
3.
Block 11: Ensure the unique identifying number
supplied by APHIS or CDC for the individual is provided. CDC or APHIS will provide to the RO a unique
identifying number for each individual listed on Table 4B of CDC Form APHIS/CDC Form 1. Information about how to obtain a unique
identifying number is available on the Internet at http://www.aphis.usda.gov/programs/ag_selectagent/index.html
or http://www.cdc.gov/od/sap.
4.
Block 12a - 12h: Answer
all questions located in blocks 12 a-h with a "yes" or "no" in the boxes provided.
5.
Questions concerning
completion of the FD-961 Form can be directed to the Bioterrorism Help Line at
304-625-4900.
BIOTERRORISM PREPAREDNESS ACT: ENTITY / INDIVIDUAL INFORMATION - FD-961 (pdf)
COMPLETION OF FINGERPRINT CARDS:
Each individual will be provided with two fingerprint cards
to have printed by a local law enforcement agency. Individuals or entities must arrange for this service. In most instances the law enforcement
offices will charge a fee for this service.
The two fingerprint cards, the receipt for fingerprinting page, and the
completed FD-961 Form must be submitted to the FBI in the provided envelope in
order to process the security risk assessment.
The FBI may request a second set of prints to process in the event that
the initial two fingerprint cards are rejected from the Integrated Automated
Fingerprint Identification System for image quality.
Once printed, the two fingerprint cards, and the completed FD-961 Form must be forwarded to the FBI. In order for the security risk assessment to be processed in a timely manner, the FD-961 Form and Fingerprint Cards must be returned to the FBI as one package. The FBI will not conduct a security risk assessment for an individual unless it has received a completed FD-961 Form and two legible fingerprint cards.
Requirements due to change of employer: Under any
case where an individual is changing employers or completing a security risk
assessment renewal, the individual must submit a completed FD-961 form to the
FBI. Two fingerprint cards are not
required if a legible set is already on file with the FBI. The FBI reserves the right to request
additional fingerprint cards in the future if necessary. A full security risk assessment must be
completed prior to an individual being granted access to select agents and
toxins at the new place of employment.
The security risk assessment granted under previous employment is NOT
transferrable.
Authority:
Collection
of this information is authorized under Public Law 107-188; 18 U.S.C. § 175b; 28
U.S.C. § 534; 28
CFR § 0.85; 7 CFR Part 331; 9 CFR Part 121; 42 CFR Part 73.
Principal
Purpose and Routine Uses
The
information collected on this form will be used for the principal purpose of
conducting security risk assessments for entities that possess, receive, use
and/or transfer select agents and toxins, individuals who own or control an
entity, individuals authorized to have access to select agents or toxins, and
responsible officers. As part of this
assessment, the collected data may also be used to assist in determining
approval, denial, revocation or renewal of a certificate of registration issued
by Department of Health and Human Services (HHS) or U.S. Department of
Agriculture (USDA) for possession, use and transfer of select agents and
toxins.
Additionally,
information provided in all or part of this completed form may be disclosed to
Department of Justice personnel who need the information in the performance of
their duties and outside the Department of Justice to HHS and/or USDA for the
purpose of making security risk assessments and other determinations relating
to individuals, entities and responsible officers that have access to or
possess, use, receive and/or transfer select agents and toxins; to federal,
state, local, joint, tribal, foreign or international entities charged with the
responsibility of investigating, prosecuting, and/or enforcing laws,
regulations, rules, orders or contracts if any part of the information
received, either on its face or in conjunction with other information,
indicates a violation or potential violation of law, regulation, rule, order,
or contract; to any law enforcement or
intelligence authority or other federal, state or local entity with relevant
jurisdiction where such information reveals a risk to human, animal and/or
plant health or national security; to
organizations or individuals, both public and private, if deemed necessary, in
the sole discretion of the U.S. Department of Justice, to elicit information or
cooperation from the recipient for use in assessing suitability to access,
possess, use, receive or transfer select agents and toxins; and pursuant to the
routine uses most recently published in the Federal Register for the FBI's
Central Records System (Justice/FBI-002) and the FBI's Blanket Routine Uses
(Justice/FBI-BRU).
Social
Security Account Number
Your
Social Security Account Number (SSAN) is requested under Public Law 107-188, 7
CFR Part 331, 9 CFR Part 121 and 42 CFR Part 73, which authorize the Attorney
General to collect names and other identifying information in the security risk
assessment process and to check criminal, immigration, national security and
other electronic databases. Because
other people may have the same name and birth date, your SSAN will be used to
facilitate accurate identification and to help eliminate the possibility of
misidentification of individuals for whom a security risk assessment or database
check is being conducted.
Effects
of Nondisclosure
Completion
of this form and provision of your SSAN is voluntary. However, failure to provide the requested information may result
in a finding that you may not have access to a select agent or toxin because of
an incomplete application or an unapproved security risk assessment.
The
information required on this form is in accordance with the Paper Work
Reduction Act of 1995. The purpose of this information is to assist
the FBI in national security risk assessments for entities and individuals
having access to selected toxins as required by the Public Health Security and
Bioterrorism Preparedness Response Act of 2002.
The
estimated average burden associated with this collection of information is 45
minutes, depending on circumstances.
Comments concerning the accuracy of this burden estimate and suggestions
for reducing this burden should be directed to Federal Bureau of Investigation,
Bioterrorism Security Risk Assessment Mod E-3, Criminal Justice Information
Services Division, 1000 Custer Hollow Road, Clarksburg, WV 26306.
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