Security Clearance Status Clarification Request Form
Request clarification regarding your security clearance status. Please provide complete information to help us review and respond to your inquiry.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Department
*
Current Clearance Level
*
Please Select
Confidential
Secret
Top Secret
Other
Type of Clearance in Question
*
Please Select
Initial Application
Renewal
Upgrade
Downgrade
Other
Reason for Clarification Request
*
Describe the Issue or Question
*
Preferred Contact Method
Email
Phone
No Preference
Attach Supporting Documentation (if any)
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Date of Request
*
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Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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