Na Form 14136 – Fill Out and Use This PDF

REQUEST PERTAINING TO

CIVILIAN CONSERVATION CORPS (CCC) PERSONNEL RECORDS

National Archives at Saint Louis

SECTION I – INFORMATION REGARDING CCC PERSONNEL RECORDS

The CCC personnel records consist of microfilmed “Individual Records” of enrollees and paper Official Personnel Folders (OPFs) of men who were formerly employed by the federal government (e.g. Camp Leaders, Medical Officers, etc.) These records are archival as they have been transferred by the originating agency to the legal custody of the National Archives and Records Administration (NARA).

Reproductions of these records are available to the public for a fee. The NARA Reproduction Fee Schedule is available for viewing at http://www.archives.gov/research/order/fees.html. Please DO NOT send payment along with your request.

In order to request copies of CCC personnel records, please send this completed form to:

National Archives & Records Administration

ATTN: Archival Programs

P.O. Box 38757

St. Louis, MO 63138

An ‘Order for Archival Record Reproduction Services’ form will be mailed to you after a search is performed and a record is located by NARA staff. If the form, along with payment, is not received within 30 days we will assume that you no longer desire a copy of the records and your request will be automatically closed without further notice.

If you are interested in viewing archival records in person, please contact the Archival Research Room at 314-801-0850 or stlarr.archives@nara.gov. An appointment to view the records is required and must be made prior to your visit. For more information on the records available, please visit http://www.archives.gov/st-louis/archival-programs.

SECTION II – CCC EMPLOYEE INFORMATION

EMPLOYEE NAME (Last, First, Middle)			BIRTH DATE			BIRTH PLACE
SOCIAL SECURITY NUMBER (SSN)			FATHER’S NAME			MOTHER’S NAME
TITLE (Ex.: Ditch-digger, Laborer, Medical Officer)				HOMETOWN AT TIME OF EMPLOYMENT
CAMP INFORMATION					DATES OF SERVICE
Company Number	Location			From			To

SECTION III – REQUESTER IDENTITY AND CONTACT INFORMATION

REQUESTER IS:

Former Civilian Conservation Corps employee identified in Section II

Descendant of CCC employee (specify relationship)

Other (specify)

SEND INFORMATION/COPIES OF DOCUMENTS TO: REQUESTER CONTACT INFORMATION (Please print legibly or type)

Name				Daytime Phone Number	Extension
Street	Apartment Number			Alternate Phone Number	Extension
City	State	Zip Code	Email Address

See the reverse side of this form for the Privacy Act Notice that applies to the information you provide above.

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION

NA FORM 14136 (02-14)

PRIVACY ACT NOTICE

Collection of this information is authorized by 44 U.S.C. 2104. The information you provide to NARA on this form will be used to search for the records you are requesting. This information is necessary in order to track your reference request and provide a response to you. Completing this form is voluntary, including providing the SSN of the CCC employee. With an SSN, NARA will be able to conduct a more comprehensive search. Without an SSN, NARA will conduct the search based on the name and birth date provided only. In accordance with the Privacy Act, 5 U.S.C. 552a(e)(4)(D), NARA may disclose this information: to appropriate Federal, state, local, or foreign agencies when needed for civil, criminal, or regulatory investigations or prosecution; in response to a request from another Federal agency or Congress; to a NARA consultant, agent, or contractor to the extent necessary for them to assist NARA in the performance of its duties; or in accordance with any other “routine uses of records” listed in the Privacy Act System of Records Notice NARA 2, “Reference Request Files.”