49 C.F.R. § 1572.9 Applicant information required for a security threat assessment for a hazardous materials endorsement.
Title 49 - Transportation
(a) For TSA to complete a security threat assessment, an applicant must supply the information required in this section when the applicant applies to obtain or renew a hazardous materials endorsement. When applying to transfer a hazardous materials endorsement, §1572.13(g) applies. (b) The application must include the following identifying information: (1) Legal name, including first, middle, and last; any applicable suffix; and any other name used previously. (2) Current mailing address and residential address if it differs from the mailing address; and the previous residential address. (3) Date of birth. (4) Social security number. (5) Gender. (6) Height, weight, hair and eye color. (7) City, state, and country of birth. (8) Immigration status and date of naturalization if the applicant is a naturalized citizen of the United States. (9) Alien registration number. (10) State of application, CDL number, and type of endorsement held. (11) The name, telephone number, and address of the applicant's current employer(s). (c) The application must include the disqualifying criminal offenses identified in §1572.103. (d) The application must include a statement, signature, and date of signature that the applicant: (1) Was not convicted or found not guilty by reason of insanity of a disqualifying crime listed in §1572.103(b) in a civilian or military jurisdiction during the 7 years before the date of the application; (2) Was not released from incarceration in a civilian or military jurisdiction for committing a disqualifying crime listed in §1572.103(b) during the 5 years before the date of the application; (3) Is not wanted or under indictment in a civilian or military jurisdiction for a disqualifying criminal offense identified in §1572.103; (4) Was not convicted or found not guilty by reason of insanity of a disqualifying criminal offense identified in §1572.103(a) in a civilian or military jurisdiction; (5) Has not been adjudicated as lacking mental capacity or committed to a mental institution involuntarily; (6) Meets the immigration status requirements described in §1572.105; (7) Has or has not served in the military, and if so, the branch in which he or she served, the date of discharge, and the type of discharge; and (8) Has been informed that Federal regulations under §1572.11 impose a continuing obligation to disclose to the State within 24 hours if he or she is convicted or found not guilty by reason of insanity of a disqualifying crime, or adjudicated as lacking mental capacity or committed to a mental institution, while he or she holds an HME. (e) The application must include a statement reading:
Privacy Act Notice: Authority: The authority for collecting this information is 49 U.S.C. 114, 40113, and 49 U.S.C. 5103a. Purpose: This information is needed to verify your identity and to conduct a security threat assessment to evaluate your suitability for a hazardous materials endorsement for a commercial drivers license. Furnishing this information, including your SSN or alien registration number, is voluntary; however, failure to provide it will prevent the completion of your security threat assessment, without which you cannot be granted a hazardous materials endorsement. Routine Uses: Routine uses of this information include disclosure to the FBI to retrieve your criminal history record; to TSA contractors or other agents who are providing services relating to the security threat assessments; to appropriate governmental agencies for licensing, law enforcement, or security purposes, or in the interests of national security; and to foreign and international governmental authorities in accordance with law and international agreement. The information I have provided on this application is true, complete, and correct to the best of my knowledge and belief and is provided in good faith. I understand that a knowing and willful false statement, or an omission of a material fact, on this application can be punished by fine or imprisonment or both (see section 1001 of Title 18 United States Code), and may be grounds for denial of a hazardous materials endorsement.
Title 49: Transportation
PART 1572—CREDENTIALING AND BACKGROUND CHECKS FOR LAND TRANSPORTATION SECURITY
Subpart A—Requirements To Undergo Security Threat Assessments
§ 1572.9 Applicant information required for a security threat assessment for a hazardous materials endorsement.
