Atf E Form 5400 28 PDF Details

The ATF E 5400.28 form, issued by the U.S. Department of Justice's Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), is a critical document required for employees who must possess explosive materials as part of their responsibilities in federally licensed or permitted explosives businesses or operations. This Employee Possessor Questionnaire is mandated under the "Safe Explosives Act of 2002," aiming to prevent certain individuals from shipping, transporting, receiving, or possessing explosive materials by evaluating their eligibility through specific criteria. The form encompasses detailed personal information, including citizenship, criminal history, substance abuse, mental health status, and military discharge information, to assess the potential risks associated with granting an individual the authority to handle explosive materials. Additionally, it outlines procedural steps for submission and the potential consequences of non-compliance or providing false information under perjury penalties. The ATF uses the information collected to ensure that explosives do not fall into the hands of those who might pose a threat to public safety. As a measure to safeguard this sensitive process, the form also includes guidelines for requesting relief from Federal explosives disabilities, alongside the necessary steps for those deemed ineligible to seek restoration of their explosives privileges. This comprehensive process underscores the ATF's commitment to enforcing regulations that maintain the safety and security of explosive materials handling within the United States.

Form NameAtf E Form 5400 28
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesnonimmigrant, 2003, RDS, PDF

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U.S. Department of Justice

OMB No. 1140-0072

Bureau of Alcohol, Tobacco, Firearms and Explosives

Employee Possessor Questionnaire


Who needs to complete this form? This questionnaire MUST be completed by EACH employee possessor of a Federal explosives licensee or permittee or applicant, unless otherwise provided. (See reverse for definition of employee possessor.)

For ATF Use Only


Employee Possessor Information and Certification


Print the Requested Information in Block Letters.


Explosives Applicant Business or Operations Name








Last Name




Name and address of explosives business or operations at which you are






an employee possessor.








First Name
















Your position in the explosives business or operations.

3. Middle Name

4. Name Suffix, if any (e.g., sr., Jr., II)














Federal explosives license/permit number for explosives


Other Names Used - Including Maiden Name













What is your Country of Citizenship?


Social Security Number (Voluntary, will help prevent misidentification)










17b. If you have citizenship in additional countries, please list.





7.Place of Birth (City and State - or - City and Foreign Country)



If you indicated above you are a United States citizen, skip to question 18.



8. Date of Birth (Month/Day/Year)


17c. What is your U.S. Immigration and Naturalization Service (INS) -





issued alien number or admission number?

9.Race/Ethnicity (Check one or more boxes)




The following questions must be answered with a "YES" or "NO" in the

American Indian or




Yes No

Alaskan Native




18. Are you a fugitive from justice?











Native Hawaiian or






Other Pacific Islander

19. Are you an unlawful user of, or addicted to, marijuana or









Black or African


a depressant, stimulant, or narcotic drug, or any other





controlled substance?























10. Sex (Check one box)


20. Have you ever been convicted in any court of a felony,













or any other crime, for which the judge could have







imprisoned you for more than one year, even if you




11. Home Telephone Number (Include area code)




received a shorter sentence, including probation?













(See Definition 1, Exception 1.)














21. Are you under indictment or information in any court for a




12. Work Telephone Number (Include area code and extension)




felony, or any crime, for which the judge could imprison













you for more than one year? (An information is a formal







accusation of a crime by a prosecutor. See Definition 1.)






Home Address




















Street Address








22. Have you ever been adjudicated mentally defective (which













includes having been adjudicated incompetent to manage






your own affairs) or have you ever been committed to a





Street Address (Continuation)







mental institution?











13c. Apt. Number


23. Have you ever been discharged from the Armed Forces







under dishonorable conditions?














24. Have you ever renounced your United States citizenship?














25. Are you an alien in the United States? If "YES," attach an




13e. State or Province, Country (if outside the United States)




explanatory statement showing that you are a lawful













permanent resident. (See Definition 3, Exception 2.)







(Generally, if you are an alien [except for a lawful




13d. Zip Code / Postal Code






permanent resident alien], you cannot possess explosive














Statement Attached



















ATF E-Form 5400.28 Revised February 2003

Under the penalties imposed by 18 U.S.C. 844, I,


, certify under penalties of perjury that





the answers on this questionnaire are true, correct, and complete.

Print Your Full Name



Your Signature



1.Who must fill out and complete this form? EACH employee possessor, as defined below, MUST personally complete this questionnaire form and certify that the answers are true, correct, and complete.

2.To whom do I submit this form? You must complete and submit this form to your employer (applicant for license/permit). The employer will submit this form, along with the application, to ATF. If this form is being submitted AFTER a license or permit has been issued in order to ADD you as an employee possessor, then the form must be accompanied by a signed letter from the licensee or permittee requesting that you be added as an employee possessor. In such instance, the form should be sent to: ATF, National Licensing Center, 2600 Century Parkway NE, Suite 400, Atlanta, GA 30345.

3.Why is this form required? 18 U.S.C., Chapter 40, was amended by the 'Safe Explosives Act of 2002' (the Act). The Act made it unlawful for certain persons to ship, transport, receive, or possess explosive materials. The Act also made it unlawful to distribute explosive materials to certain persons. Information you provide on this form will allow ATF to determine whether you, an employee possessor in the explosives business or operations, are prohibited from shipping, transporting, receiving, or possessing explosive materials. 18 U.S.C. 842(d), (i).

4.Should documentation be attached to clarify a response to a question or item? Providing additional documentation to clarify a response to a specific question or item on the front of this form could help prevent a delay in processing your Employer Possessor Questionnaire. Please ensure that your name is on any attached documents(s). In addition, if your employer is renewing a Federal explosives license or permit, ensure that the employer's current license or permit number is on any attached documents.

5.How do I obtain additional forms? The form can be downloaded from ATF's website in Adobe PDF format at The form can be ordered using ATF's Online Distribution Center Order Form at The form can also be ordered by calling ATF's Distribution Center at (703) 455-7801.

6.What do I do if I am prohibited from possessing explosives as indicated above? If you are prohibited from possessing explosives, you may request relief from your Federal explosives disability by filing an ATF Form 5400.29, Application for Restoration of Explosives Privileges. This form can be downloaded from ATF's website at or may be obtained by calling (202) 927-2260/2310. Please be advised that you cannot possess explosives until such time that relief may be granted. For example, if you are a nonimmigrant alien, you should answer "yes" to question 25, and you are prohibited from possessing explosives. You may file a relief application, but you cannot possess explosives until such time that ATF may grant you relief.

7.Need assistance in completing the form? Please review information online concerning this form at, contact the National Licensing Center at (404) 417-2750, or contact your local ATF office.


1.Under Indictment or Information or Convicted in Any Court. An indictment, information, or conviction in any Federal, State, local, or foreign court.

2.Employee Possessor. An employee possessor is an individual who has actual or constructive possession of explosive materials during the course of his employment. Actual possession exists when a person is

in immediate possession or control of explosive materials (e.g., an employee who physically handles explosive materials as part of the production process; an employee who handles explosive materials in order to ship, transport, or sell them; or an employee such as a blaster, who actually uses explosive materials).

Constructive possession exists when an employee lacks direct physical control over explosive materials, but knowingly has the power and intention to exercise dominion and control over the explosive materials, either directly or indirectly through others (e.g., an employee at a construction site who keeps keys for magazines in which explosive materials are stored, or who directs the use of explosive materials by other employees; or an employee transporting explosive materials from a licensee to a purchaser).

3.Alien. An alien in the United States means any person who is not a citizen or national of the United States.


1.A person who has been convicted of a felony, or any other crime, for which the judge could have imprisoned the person for more than one year, is not prohibited from shipping, transporting, possessing, or receiving explosives if: (1) the conviction was properly invalidated by a court on the basis that the conviction was unconstitutional; (2) in the case of a Federal conviction, the person received a Presidential pardon; or (3) ATF granted relief from Federal explosives disabilities under 18 U.S.C. 845(b), 27 CFR 555.142.

2.For purposes of this form, aliens can be employee possessors if they are lawful permanent residents. 18 U.S.C. 842(d)(7); (i)(5).

Privacy Act Information

The following information is provided pursuant to Section 3 of the Privacy Act of 1974, 5 U.S.C. 552a(e)(3):

1.Authority. Solicitation of this information is made pursuant to

18 U.S.C. 842, 843. Disclosure of this information by the employee possessor is mandatory if the employee possessor wishes to possess explosives.

2.Purpose. To determine the eligibility of the employee possessor to possess explosive materials.

3.Routine Uses. The information will be used by ATF to make determinations set forth in paragraph 2. In addition, information may be disclosed to other Federal, State, foreign, and local law enforcement and regulatory agency personnel to verify information on the employee possessor questionnaire and to aid in the performance of their duties with respect to the regulation of explosives unless such disclosure is prohibited by law. Finally, the information may be disclosed to members of the public in order to verify the information on the questionnaire when such disclosure is not prohibited by law.

4.Effects of not supplying the requested information. Failure to supply complete information will delay processing and may cause denial of the application.

5.Disclosure of social security number. Disclosure of the individual's social security number is voluntary. Under 18 U.S.C. 842(f), 843, and Executive Order 9397, November 22, 1943, ATF has the authority to solicit an individual's social security number. The number may be used to verify the individual's identity.

ATF E-Form 5400.28 Revised February 2003

Paperwork Reduction Act Notice

This request is in accordance with the Paperwork Reduction Act of 1995. The purpose of this information collection is to determine the eligibility of the employee possessor to engage in certain operations. The information requested is required to obtain or retain a benefit and is mandatory by statute

18 U.S.C. 843.

The estimated average burden associated with this collection is 20 minutes per respondent, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to Reports Management Officer, Document Services Branch, Bureau of Alcohol, Tobacco, Firearms and Explosives, Washington, DC 20226.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

ATF E-Form 5400.28 Revised February 2003