Exhibit C1 New Incoming Personnel Form and Guide

CUI (when filled in)

DEFENSE HEALTH AGENCY NEW INCOMING PESONNEL FORM

Date

Reason:
Name:
SSN:

DOB:

Place of Birth:
Citizenship:
If not born U.S. Citizen, list date of Naturalization and form type.

Naturalization Document Type and Date:
Phone:

Email:

Personnel Category:
Position Title/Series/Grade:
Org./Market/MTF/Location:
Position Sensitivity Required:
Clearance/Eligibility Required:
Childcare:
PD/Contract Number:
Task Order (if applicable):
Company Name (if applicable):
Supervisor POC:
Hiring Official POC:
Submitting POC (CHRA/COR/FSO):

Controlled by: DHA J-1 ASD
CUI Category: PRVCY

LDC: FEDCON

POC: David Monteiro, 210-870-0664

DHA NIP FORM JUN 2026

CUI (when filled in)

CUI (when filled in)
Complete for Childcare if known
LOSS Supervisor Name:
LOSS Supervisor SSN:

Please see table below for required documents.

Volunteers and Student Interns requiring Childcare Checks must include DD 2981. * SF50 may be used in lieu of proof of citizenship for current federal civilians ** DD3058, DA5018-R, and SUDDC IRC must be included for childcare applicants that have any prior DOD affiliation *** Justification memo required for any DHA assigned service member requiring a new investigation or upgrade Please submit this NIP form and corresponding documents to the appropriate mailbox below. DHA East Region Network and Europe: [email protected] DHA West Region Network and Indo-Pacific: [email protected] DHA Headquarters (DHHQ) Non-MTF Locations: [email protected]

DHA NIP FORM JUN 2026

CUI (when filled in)

Defense Health Agency New Incoming Personnel (NIP) Form Job Aid Last updated 20260603

Reason: See below

Date: Date you are submitting the NIP package

-New Incoming Personnel: Will be selected for most investigation requests for new civilian and contractor hires and military personnel being assigned to DHA. Military members must have orders specifically assigning them to DHA included with the NIP package. -Current DHA Employee – Childcare Checks Required: Select this option for current DHA employees that have been identified as needing childcare checks as a part of their existing/previous investigation. -Current DHA Employee – New Investigation Request: Select this option for current DHA employees that have been identified as needing a new investigation request. This may be due to a previous error in the investigation process, or the individual does not have a valid investigation on file.