New Member Packet
(Revised 01-08)

DUPLICATE

1. Division 4 New Member Check Off Sheet   Send original, retain copy.
   IT IS IMPERATIVE THAT ALL INSTRUCTIONS ON THIS CHECK-OFF SHEET BE FOLLOWED.
For in-depth instructions, download D4/17:
Enrollment Applications Instructions: 

2. Enrollment Application: ANSC Form a7001f. It is recommend that form be fill out in black ink, signed in BLUE ink.
SUBMIT IN DUPLICATE. BOTH SETS MUST HAVE ORIGINAL SIGNATURES. 
This form now includes:
  a.  Prospective Member Interview Record
  b.  Verification of U.S. Citizenship
  c.  Prior/Current Clear Information
  d.  Applicant Interview Record
  e.  Special Agreement Check
  f.  Release of Information
  g. Patriot Readiness Input Information
  h. ID card information

USE OF OBSOLETE ENROLLMENT FORMS WILL RESULT IN PACKAGE BEING REJECTED.

3. New Member Test Answer Sheet: CG-4886a ANSC Form 7010.  Send original, retain copy. One Copy only.

4.  Photo on CD or Disk or Passport type. Must have appropriate red background color.  Recommend using uniform shirt with "member" insignia. Retain Copy.

5. Two (2) FBI Applicant Fingerprint Cards: Form FD-258. Must use appropriate USCG/DHS cards with correct URI information preprinted on them. Cards must be filled out and signed in BLACK ink only. DO NOT COPY. NO BLUE INK PERMITTED ON FINGERPRINT CARDS PER FBI.

6. Proof of US Citizenship. Original Document Required for Viewing. Attach Copy.
 (See Verification of US Citizenship form for approved types of  documentation). This document must be returned to applicant/member). DO NOT SUBMIT ORIGINAL.

7. Copy of US Citizenship Documentation
 (Copy of above item 6 is submitted with security package. This is a mandatory attachment.

8.. Verification of US Citizenship by Authorized Officer
(Fingerprint Technician; Flotilla Commander; DDSL; DEA-S or FSO-PS.

9. Enrollment packages are forwarded to the DDSL. 

Direct Operations (DO) Packet

DUPLICATE\

THIS FORM HAS BEEN REVISED.
The current form revision date is July 2008.
All others are obsolete. Use eof an obsolete form will result in it being rejected.

1.  D-4 Direct Operations Check-Off Sheet
Send original, retain copy.

2.  Two (2) FBI Applicant Fingerprint Cards: Form FD-258.  Previously was three cards.
Must use appropriate USCG/DHS cards with correct URI information preprinted on them. Cards must be filled out and signed in BLACK ink only.
    a.  Print all requested information except your OCA #, FBI #, and miscellaneous information unless they apply.
    b.  Your armed forces number (MNU) should be your member (ID) number.
    c.  Race codes are:
         A: Asian or Pacific Islander
         B: Black
         I: American Indian or Alaskan Native
         W: White
         U: Unknown
Note; H is not used. Hispanic is not a rce, but an ethnic indicator per the FBI.
For Black Hispanics, enter B.
For White Hispanics: enter W.

     
3.  Fair Credit Reporting Act Form: Form DHS 11000-0 (Replaces DOT 1631)
Disclosure and Authorization Pertaining to Consumer Reports Pursuant to the Fair Credit Reporting Act. This form replaces the original form issued by the DOT. Submit in duplicate.

4. Questionnaire for National Security Positions: Form SF-86.
a: PDF Version
b. MS Word Version

Two (2) copies required, filled out in BLACK INK. Sign with original signatures in BLUE INK on all copies.
It is strongly recommended that a blank copy of the SF-86 be printed out as a work copy.

An SF-86 must be submitted regardless of current security clearance status.  A current security clearance, as indicated in the SF-86, simply relieves the SECCEN of not having to do a duplicate investigation. The form is still required to verify current status.

Note: Unless you have a program that allows saving PDF documents, the PDF  version cannot be saved online. All data will be lost after leaving the government  website. The alternative is to use the MS Word version.
The MS version can also be sent in an encrypted state to the DDSL for review via e-mail. When encrypting (saved with a password), be sure to use an alternative file name, not the original file name. That way in the event something goes wrong with the encryption process, you will still have the original document. This process is only for review. The actual application, and related forms, must be sent to the DDSL for review and processing.
Under no circumstances is an unencrypted SF-86 to be sent in open e-mail.

4a. SF-86 Continuation Sheets 
Use this form to continue entries for residences, schools attended and employment. For other entries that exceed what the form provides for, simply attach a blank paper to the SF-86 with the appropriate information. Be sure to indicate what block number you are referencing.  Submit in duplicate if this form is used.

Regardless of which method is utilized, two copies must be submitted with the package.
* Each copy of the SF-86 must have an original signature on it in BLUE INK. You may fill in one copy, photo copy it, then sign both in blue ink.  A third copy should be retained for future reference. 
* This form is time sensitive. If completing now, do not sign until directed to do so by the DDSL.
* All blocks must be filled in. Use N/A where information is not applicable. If something is unknown or you cannot recall, so state. But be prepared to explain on another page, or to the SECCEN at a later date.
* Place Social Security Number on the bottom of each page, beginning with page #2. Page 1 has it on top.
* If you check yes to block #21 of the SF-86, you must submit a Release of Medical Information. 

 NOTE: It is imperative that the instructions for filling out the SF-86 be read in its entirety. This form can be intimidating and confusing if the instructions are not read thoroughly, and followed explicitly. 

5. Authorization for Release of Information: SF-86 Page 18.  
This form is included in the SF-86 packet as page 18. Submit in duplicate.

6. Verification of US Citizenship Form
 Fill out in BLACK ink, sign in BLUE ink. Choose either the Word or PDF version.

7. Proof of US Citizenship. Original Document Required. (See Verification of US Citizenship form for approved types of  documentation). This document must be returned to applicant/member). DO NOT SUBMIT.

8. Copy of US Citizenship Documentation  (Copy of above item 7 is submitted with security package.)

9. Verification of US Citizenship by Authorized Officer
(Fingerprint Technician; Flotilla Commander; DDSL; DEA-S.
Note: If fingerprints are taken by a law enforcement agency, have agency fill out Verification of US Citizenship Form. 

10. Prior Security Clearance Cover Sheet.
Only for those applicants who, within the past ten (10) years, have been subject to a United States government background investigation (federal investigation only), and/or granted a security clearance. 
If a prior (10 years) security clearance has been granted, failure to submit this form may result in a prolonged and unnecessary investigation. Fill out in BLACK ink, sign in BLUE ink. 

Retiree Instructions
If you are retired and receiving a pension and/or Social Security, please follow the above "Retiree" instructions.

 

Only Air Ops personnel, Fingerprint Technicians, Coast Guard station watchstanders, Telecom operators,  Marine Safety personnel assigned to a Coast Guard MS unit National staff and elected personnel. and when directed by local Commanding Officers or OIC's, are now required to submit a "DO" package.  Transmittal Protocols Note:  Upon completion, and when directed to do so, this package goes directly to the DDSL for review and secure mailing. No member of the Division, other than the DDSL, is permitted to review the material contained within the SF-86. This package is CONFIDENTIAL. All forms, with the exception of fingerprint cards, should be filled out in black Ink and signed in blue Ink. Fingerprint cards are filled out and signed in black ink only. For simplification, complete only one set of each required form.  DO NOT DATE OR SIGN FORMS. Upon completion, photocopy each set. After photocopying, and when ready to submit, sign and date each page requiring a signature.

Replacement ID Cards

1.  Division 4 members needing a replacement identification card, whether it be for loss or expiration, should follow this procedure:
    a. Fill out a D7 Photo ID Card Form located on the division 4 website.
    b. Take a digital passport type photo, preferably with a uniform shirt, of the member concerned.
    c. Photo must have a red background. A red background is mandatory for security reasons.
    c. Have the Flotilla Commander or designee submit via e-mail either a scanned copy of the Photo ID Card Form or the information contained on the form  along with a digital copy of the photo to DIRAUX West.  Be sure to state reason for requesting a new ID card. Contact the DDSL(4) for the Diraux West E-Mail address if unknown.
    d. If submission is for an expiring identification card, be sure to submit a request for a new card at least 30 to 45 days in advance of the date of expiration. 
    e.  Upon receiving a new ID card, the old card is to be shredded.