INSTRUCTIONS

In order to perform a Bioterrorism security risk assessment, each individual who requires access to select biological 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 can be obtained via www.fbi.gov and fingerprints 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. If the FBI does not receive a completed FD-961 and two legible fingerprint cards, the security risk assessment will not be completed.

RO and ARO: To complete the registration of your entity, please provide the name (s) of any individual (s) who own or control the entity to the Animal and Plant Health Inspection Service (APHIS) or the Centers for Disease Control (CDC) on Table 4B of CDC Form 0.1319/APHIS Form 2044. This information will be sent to the sponsor (APHIS or CDC) where the application for registration for select biological agents or toxins was submitted. APHIS or CDC will assign a unique identifying number to each individual and report that number to the RO or ARO. The RO or ARO will distribute the unique identifier to each individual so it can be entered in block 17 of the FD-961 form. FD-961s will not be processed if the unique identifying number from APHIS or CDC is not provided.

FD-961 Form: The RO and/or ARO of each entity must complete Section I and II of the FD-961 and return it to the FBI.

Definition of Entity: An entity, for purposes of this collection means 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.

Section I, block 3: The type of the entity should be as indicated on the CDC or USDA registration form.

Section II: Commercial, Private, Academic or Other Entities must complete Section II.

Definition of Commercial, Private, Academic or Other Entity: Entities that checked Commercial, Private, Academic or Private, or Other in Section I, Type of Entity block, of the Application Laboratory Registration for Possession, Use, and Transfer of Select Biological Agents and Toxins must complete Section II.

Section III:

• Each individual who requires access to select biological agents and toxins, the entity's RO, the entity's ARO and any individual who owns or controls the entity must individually complete Section III.
• Block 8: Include full name (last, first and middle suffix, e.g. Jr. or III) in block 8.
• Block 8a: Include any Aliases/Maiden names in block 8a.
• Block 18a - 18h: Ascertain that all questions located in blocks 18 a-h are answered "yes" or "no" in the boxes provided.
• Block 17: Ensure the unique identifying number supplied by the sponsor is provided.
• Block 15a: Provide alien registration numbers (9-11 digits) in block 15a. Alien registration numbers are issued by the Bureau of Immigration and Customs Enforcement for individuals who are granted permanent legal resident or a naturalized citizen status in the U.S. Other situations that individuals would have an alien registration number include the following: Employment Authorization cards, Temporary Resident cards, Border Crossing cards, I-94 or Visa numbers.
• Questions concerning completion of the FD-961 Form can be directed to the Bioterrorism Help Line at 304-625-4900.

Section IV: Each individual who requires access to select biological agents and toxins, the entity's RO, the entity's ARO and any individual who owns or controls the entity must individually complete Section IV.

BIOTERRORISM PREPAREDNESS ACT: ENTITY / INDIVIDUAL INFORMATION -  FD-961 (pdf)

Completion of the Fingerprint Card: 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 completed Receipt for Fingerprint Form and two fingerprint cards must be submitted to the FBI in the provided envelope in order to process the security risk assessment. The FBI will 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, the Receipt for Fingerprint Form, 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.

PRIVACY ACT STATEMENT

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 biological agents and toxins, individuals who own or control an entity, individuals authorized to have access to select biological 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 biological 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 biological 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 biological 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 biological agent or toxin because of an incomplete application or an unapproved security risk assessment.

PAPERWORK REDUCTION ACT NOTICE

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 30 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, Records/Information Dissemination Section, 935 Pennsylvania Ave., N.W., Washington, DC 90535.

If you have difficulty accessing material associated with this page, please contact us at 202-324-3626 and we will work with you to make the information available.

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