PRIVACY ACT STATEMENT

AUTHORITY:

The E-Government Act of 2002 (Pub. L. No. 107-347); the Federal Information Security Modernization Act of 2014 (Pub. L. No. 113-283) (44 U.S.C. 3551-3559); 10 U.S.C. 113, Secretary of Defense; 50 U.S.C. 3038, Responsibilities of Secretary of Defense Pertaining to National Intelligence Program; E.O. 12333, United States Intelligence Activities, as amended; E.O. 13402, Strengthening Federal Efforts to Protect Against Identity Theft, as amended; E.O. 13526, Classified National Security Information; White House Memorandum dated September 20, 2006, Subject: Recommendations for Identity Theft Related Data Breach Notification; and E.O. 9397 (SSN), as amended.

PURPOSE:

To provide breach notification and facilitate the provision of breach mitigation services to individuals affected by the breach of information in the Office of Personnel Management (OPM) background investigation databases. DoD will also use the data to respond to breach verification inquiries received from individuals using the link on OPM's website that redirects individuals to a DoD website where they can enter their information to find out if they have been affected by this breach. These records may also be used for tracking, reporting, measuring, and improving the Department's effectiveness in implementing this data breach notification.

ROUTINE USE:

In addition to disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, these records may specifically be disclosed outside the DoD as follows:

To commercial entities, under contract with DoD, for the sole purpose of verifying addresses of affected individuals in order to provide notification to such individuals.

The DoD applicable Blanket Routine Use(s) are: Law Enforcement Routine Use, Disclosure of Information to the National Archives and Records Administration Routine Use, Disclosure to the Office of Personnel Management Routine Use, Counterintelligence Purpose Routine Use and Data Breach Remediation Purposes Routine Use. The applicable DoD Blanket Routine Uses can be found Online at:http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx

DISCLOSURE:

Voluntary. However, failure to provide requested information may prevent or delay DoD's ability to provide breach notification to and facilitate the provision of mitigation services to individuals affected by the breach of information in OPM background investigation databases.

OMB Control Number:

0704-0545

Expiration Date:

7/31/2019

OPT IN:

I authorize the collection, use, maintenance, and dissemination of data that I have provided for the purposes of breach notification and to facilitate the provision of mitigation services regarding the breach of information in OPM background investigation databases. I also authorize the collection, use, maintenance, and dissemination of information about me needed to notify me in writing at the address provided as to whether or not I am impacted by the breach.

I agree

The Federal Government has set up this site to assist individuals who are impacted, or believe they may have been impacted, by the theft of background investigation information from the Office of Personnel Management. Individuals who believe they may have been impacted and have not received a letter, or those who have lost their PIN code and would like a duplicate copy of their letter can submit their information using this site. Upon submission, the Government will investigate the situation and provide a response via a letter in approximately 2-4 weeks through the U.S. Postal Service. More information is available at https://www.opm.gov/cybersecurity.

Enter Information

Please do not use special characters unless specified otherwise.

Fill in all required fields indicated by an * symbol

First Name: *

First name is required

First name must consist of Alphabetic, ', and - characters only.

Middle Name:

Middle name must consist of Alphabetic, ', and - characters only.

Last Name: *

Last name is required

Last name must consist of Alphabetic, ', and - characters only.

Date of Birth: *

Date of birth is required

Date of birth must consist of Numeric and / characters. Format: MM/DD/YYYY.

SSN (no dashes): *

Social Security Number is required

Social Security Number must consist of 9 numeric characters.

Social Security Number too short, must be 9 numeric characters.

E-mail:

E-mail must have proper email format: name@example.com.

Check if your address outside of the U.S. Postal Service System:

Yes my address is outside of the U.S. Postal System

Country: *

Country is required

Address Line 1: *

Address is required

Address must consist of Alpha-Numeric characters only.

Address Line 2:

Address must consist of Alpha-Numeric characters only.

City: *

City is required

City must consist of Alphabetic characters only.

State: *

State is required

Region / Province:

Region / Province must consist of Alphabetic, ', and - characters only.

Zip Code: *

Zip code is required

Zip code must consist of 5 numeric characters.

Zip code is too short, must be 5 numeric characters.

Postal Code:

Postal code must consist of Alpha-Numeric characters.

Zip Code Extension:

Zip code extension must consist of 4 numeric characters.

Zip code extension is too short, must be 4 numeric characters.

Reason: *

Reason is required

Enter the PIN that you received in the letter: *

All five PIN fields are required.

All five PIN fields must be numberic only.

PIN field is too short, must be five numbers long.

Consent:

I am lawfully submitting this information for the purpose of determining matching against records known to be affected by the OPM breach. I understand that the government will do its best to match the information I have provided and that this may take several days to get an answer.

I agree

You must fill out all required fields before continuing

Your request for verification has been successfully submitted. You will receive a response via mail in the next couple of weeks. Thank you for your patience.

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