DHS Form 11000-9 at a glance
What it is: DHS Form 11000-9 is the Department of Homeland Security disclosure and authorization pertaining to consumer reports pursuant to the Fair Credit Reporting Act.
Who signs: Sign on the Signature line.
This is a release for the Department of Homeland Security to obtain one or more consumer/credit reports about you in connection with your application for employment or in the course of your employment with the Department.
A filled-in DHS Form 11000-9 example: a job applicant authorizes a credit report
How to fill out DHS Form 11000-9, box by box
I and the authorization
Fill in I; the Department of Homeland Security is authorized to obtain such report(s) from any consumer/credit reporting agency for employment purposes.
One or more reports about you may be obtained for employment purposes, including evaluating your fitness for employment, promotion, reassignment, retention, or access to classified information and/or sensitive, but unclassified information.
Signature and date
Enter the Date.
Copies of this authorization that show your signature are as valid as the original signed by you.
Social Security Number and Organization Assigned
Enter your Social Security Number.
Your SSN will be used to identify you precisely when it is necessary to conduct and/or obtain a credit report on you.
Although the disclosure of your SSN is not mandatory, your failure to do so may impede the acquisition of a credit report concerning you and possibly result in the denial of your being approved for access to classified and/or sensitive, but unclassified information.
Enter the Organization Assigned.
Street Address, City, State, Zip Code and Email Address
Enter your Street Address, City, State, Zip Code and Email Address.
Sources
[1] DHS Form 11000-9 (10/08), Disclosure and Authorization Pertaining to Consumer Reports Pursuant to the Fair Credit Reporting Act, Department of Homeland Security (the Official source link on this page).