ATTACHMENT N - VSC Security Package

Department of Veterans Affairs
VHA 106A WMC HROO PerSec Contractor Team

CONTRACTOR REQUEST

(Email to: [email protected])(Make sure to encrypt only or password protect)

Child Care Contract

CONTRACT INFORMATION

VA Contracting Officer Name & Email:
COR Name & Email:
Contract End Date (Including Options):
VISN & Station#:
Purchase/Task Order or Contract Number:
Contractor Position Description:
Investigation Level (SAC/Tier 1/Tier 2/Tier 4):

Select One ...

Contract Company Name (Subcontractor):
Contract Company Address:
Contractor POC Name & Phone:
Contractor POC Email:

Contracting Officer/COR Signature:
***This signature verifies that an official contract is in place prior to processing the applicants for badging***

Contractor Personal Identifiable Information
SSN

City of Birth

Last Name

State of Birth

First Name

Country of Birth

Middle Name

Country of Citizenship

Date of Birth

Dual Citizenship

Marital Status

Permanent Resident

Select One...

Foreign National

Lived in US for 3 consecutive years
Select One

Sex

YES

NO

Email Address

Additional Notes

Revised July 2025

Department of Veterans Affairs
VHA 106A WMC HROO PerSec Contractor Team
[email protected]

VHA 106A WMC HROO PerSec Contractor Team SERVICES

OVERVIEW

The VHA 106A WMC HROO PerSec Contractor Team offers comprehensive services which ensures that contractor security requirements are met in accordance with OPM and federal regulations from initiation to completion.
Communication is maintained between the team POC, the contracting officer, the contracting officer representative (COR) and the Contracting company point-of-contact at all times during the process. Due to PII concerns, personnel not listed on the Contractor Request Form will be sent statuses from the Team POC. If another entity requires this information, they must work through the CO, COR or Company POC. This service provided includes the below:
Fingerprint adjudication:
o This involves a thorough background screening and adjudication of fingerprint along with any self- declared information. The National Criminal History Check (NCHC) Form will be sent to all contacts via email once the investigation is scheduled with the Defense Counterintelligence and Security Agency (DCSA).
 Existing investigations:
o Verifying existing investigation information and collecting the required documents for reciprocity. The required documentation would include the OF306 Form and Self-Certification Form. These