Background Investigation Questionnaire for Contractor Personnel and Subcontractors

• Legal Form Number: FDIC Form 1600/04
• Section: Federal Deposit Insurance Corporation

Page 1 of 6

FDIC 1600/04 (6-21)

OMB Number: 3064-0072

Expiration Date: 03/31/2025

Email Forms@fdic.gov with any questions or difficulties using this form.

Federal Deposit Insurance Corporation

BACKGROUND INVESTIGATION QUESTIONNAIRE

FOR CONTRACTOR AND SUBCONTRACTOR PERSONNEL

PRIVACY ACT STATEMENT

The FDIC is authorized to request this information from you by 12 U.S.C. §§ 1819, 1820(a), 1822(f); Executive Order

9397 as amended; and 12 C.F.R. Part 366. The purpose for collecting this information is to conduct a background

investigation to determine whether you meet the required fitness and integrity standards for employment or performance

under a contract with the FDIC. Furnishing the requested information is voluntary, but failure to provide the requested

information in whole or in part may delay or prohibit any further consideration of you for employment or performance

under a contract with the FDIC. The information you provide may be provided to appropriate Federal, state, local or

foreign law enforcement authorities; to a court, administrative tribunal, or a party in litigation; to contractors, agents and

other third parties as authorized by law; and in accordance with any of the other routine uses described in the FDIC

Personnel Records (30-64-0015) System of Records available at www.fdic.gov/about/privacy. If you have questions or

concerns about the collection or use of the information, you may contact the FDIC's Chief Privacy Officer at

Privacy@fdic.gov.

ESTIMATED REPORTING BURDEN

Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the

time for reviewing the instructions, searching existing data sources, gathering and maintaining the data needed, and

completing and reviewing the collection of information. Send comments regarding this burden estimate or any other

aspect of this collection of information, including suggestions for reducing this burden, to the Paper Reduction Act

Clearance Officer, Legal Division, Federal Deposit Insurance Corporation, Washington, D.C. 20429; and to the Office of

Management and Budget, Paperwork Reduction Project (3064-0072), Washington, D.C. 20503. An agency may not

conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently

valid OMB control number.

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