PREPARATION OF PERSONNEL SECURITY QUESTIONNAIRE

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP90-00530R000500990008-6
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 9
• Document Creation Date: December 22, 2016
• Document Release Date: October 26, 2012
• Sequence Number: 8
• Publication Date: June 26, 1987
• Content Type: MISC

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AFR 205-32 Attachment tW Lb .tune iya r w
PREPARATION OF PERSONNEL SECURITY QUESTIONNAIRE
Section A-Instructions For Completing DD Form 398, Personnel Security Questionnaire (BI/SBI)
TABLE A3 -I
HOW TO COMPLETE DD FORM 398
L
A B
I T
o complete
N i
tem E
nter
E
1 l
a l
ast name, first name, and middle name in that order. Names should agree with military or civilian
e
mployment records; if they do not, explain on an attached sheet of plain paper. If no middle name
e
nter "NMN." If name consists of initials only, enter the initials followed by "10." Include
a
dditional designations such as Jr., Sr, 11, (3rd), etc., when applicable.
2
lb
maiden name if applicable.
3
2
any other name by which you are, or have been known. Include former names, changes in name,
nicknames, or variant spellings used. If your name has changed, explain why, when, and where on
an attached sheet of plain white paper or in item 18. List husband's first and last name only if you
are known by that name (AKA Mrs John Doe)
4
3
social security number (SSN); if none, so state.
5
4
year, month, and day of your birth, in that order. Use the last two digits of the year, a two-digit
number for the month. and a two-digit number for the day; for example, 1 August 1944 is entered
as 44-08-01.
6
5a-5d
place of birth in the following order: City, (do not abbreviate), County (do not abbreviate), State
(Use two-letter abbreviation). Country if other than United States (Do not abbreviate). If foreign
born, show city, political division (state), and country; example: Oberusal/Tanners, Hesse,
Germany. If US citizen born abroad, and State Department Form FS 240, Report of Birth Abroad
of a Citizen of the United States of America, was issued, give details on an attached sheet of plain
white paper or item 18.
7
6a-6d
a check mark in either: a. civilian, or b. military. If you are a civilian employed by the federal
government, enter your grade. If military, enter your pay grade and place an "X" opposite the
applicable service. If you are neither of the above, enter "NA" in both boxes. ANG and USAFR
are part of the military program; enter these, if applicable, in the military block. Nonappropriated
fund civilian employees enter "NAF" in the grade block.
8
7a-7f
a. "male" or "female."
b. Red (Indian), Yellow (Asian/Mongoloid), Black (Negroid/African), White (Caucasoid), Other or
Unknown.
c. height in feet and inches-for example, "5 ft 11 in."
d. Weight in pounds.
e. Self-explanatory.
f. Self-explanatory.
9
8
a check mark in either "a" if a citizen, or "b," if an alien. If you are a citizen, complete items 8c
through 8h: if you are an alien, complete items 8i through 8m.
10
8c-8h
c. a check mark in "yes" if you are native born, or in "no" if citizenship was obtained by
derivation or naturalization. d: naturalization certificate number. e: parents' naturalization
numbers, if citizens by derivation. f: data subject's naturalization or derived citizenship certificate
was issued. g: city and state where naturalization or derived citizenship is recorded. It. court where
naturalization or derived citizenship is recorded.
11
8i-8m
is alien registration number. j: country of which you are currently a citizen. k: Self-explanatory.
I: city and state where you entered the United States. m: Form 1-151 number if admitted for
permanent residence.
12
9
each period of enlistment or extended active duty. If service was with foreign military, identify the
country on an attached sheet of plain paper or item 18. Officers who have prior enlisted or warrant
service, or who have integrated into regular status, include the applicable information in this item.
Reserve or National Guard service must be entered.
13
9a
date service began.
14
9b
date service ended. (If you are on active duty, enter "Present" for the latest service and ending
dates for all other periods.)
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w AFR 205-32WAttachment 3 26 June 1987
To complete
item
branch of service (Air Force, Army, Navy, or Marines)
rank at date of discharge for each period of service.
(If you entered the US Armed Forces after January 1970, your service number is the same as your
social security number (SSN). If the period of service began before and ended after January 1970,
enter both the service number and SSN.)
Also list guardians, stepparents, foster parents, brothers, sisters, stepbrothers, stepsisters and other
relatives or friends to whom you are bound by affection or obligation only if such persons are
residing in or are citizens of any foreign country.
individual's relationship to you; name (last, first, and middle initial); and maiden name, if
applicable. List date and place of marriage to current spouse in item 18.
date of birth for all persons listed. Use same as item 4 above (year-month-day).
city and state, or country if other than United States.
current address of each person listed. If deceased, enter "deceased."
citizenship of each person listed. Alien registration data, and so forth, are not to be listed on these
persons.
(For BI and PR. List all places of residence during the last 5 years, in chronological order,
beginning with the current address_If you are under 21 years of age, list residences for the past 3
years or since your 16th birthday, whichever is the shorter period.) (For SBI: List all places of
residence for the past 15 years, in chronological order, beginning with current address. If any was overseas, if period
possible, provide in item 18, "Remarks," names and addresses of two individuals
(preferably living in the United States) who can verify the period of overseas residence through
personal knowledge. If you are under 21, list residences for the past 3 years or since your 16th
birthday, whichever is the shorter period. If unable to provide overseas verification, so state in item
18, "Remarks.")
inclusive dates for each period of residence. Refer to General Instructions on the form.
(Do not list a permanent mailing address or family residence in this item, unless you actually resided
at such address during the period listed. Furnish residence addresses in the local community, and on
bases or installations while in military service. If the residence was on a military installation, include
the complete on-base address, to include barracks or house number. List the actual place of
residence while attending school. Do not list merely the name of the school or "On Campus" as a
place of residence. If you give a metropolitan address, list the borough or residence.)
(Do not abbreviate city names.)
(Use two-letter abbreviations for the state.)
(Do not abbreviate country names.)
(For BI and PR: Beginning with present employment, list each period of employment during the last
5 years, in chronological order. Include all periods of part-time employment or unemployment. If
under 21, list each period for the past 3 years or since your 16th birthday, whichever is the shorter
period. If possible, list the name and address in item 18, "Remarks," of a person who can verify
your activities during periods of unemployment and nonattendance at school full time.) (For
SBI: Beginning with present employment, list each period of employment during the last 15 years,
in chronological order. Include all periods of part-time employment or unemployment. If any
period of employment was overseas, if possible, list in item 18, "Remarks," names and addresses of
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TABLE A3-1. Continued
HOW TO COMPLETE DD FORM 398
L
A
B
I
To complete
I`
hem
Enter -
E
two individuals (preferably currently living in the United States) who can verify the period of
overseas employment through personal knowledge. Individuals listed in item 11, to verify residences,
may also be used to verify employment. If under 21, list each period for the past 3 years or since
your 16th birthday, whichever is the shorter period. List the name and address in item 18,
"Remarks," of a person who can verify your activities during periods of unemployment and
nonattendance at school full time. If unable to provide overseas verification, so state in item 18,
"Remarks.")
33
12a
inclusive dates for each period of employment, part-time employment, and unemployment. Refer to
General Instruction on the form.
34
12b
(Military personnel should identify each unit organization and station to which assigned during the
required reporting period (last 5 years for BI and last 15 years for SBI). If self-employed, show the
name and address of the business. If employed by a temporary help supplier, list only the
temporary help supplier, even though you worked at several different client companies using the
temporary help supplier's services. If employed through a union hiring hall, list only the companies
where you worked. Do not list the union as an employer unless your wages were actually paid by
the union.
35
12c
the exact local address for each employment listed. If any employers were located in a metropolitan
area include the borough or suburb. If employed by a large corporation give the specific address of
the plant where you worked. Do not merely list the corporate address or location (for
example: General Motors, Detroit, Michigan is not an acceptable address.)
36
12d
last name, first name, and middle initial.
37,
13
(Read instructions on the form first for this item.)
39
13a
(If answer is yes, list in item 18, "Remarks," the inclusive dates of service, and name and address
of last organization. If already shown in item 12, enter "see item 12.")
39
13b
(List in item 18, "Remarks," all periods of foreign travel during the reporting period (the last 5
years for a BI; the last 15 years for a SBI). Travel prior to age 16 must be included if it falls within
the reporting period. If the answer is "no," then you need not detail travel in a foreign country
that was a result of military service or government employment. If, however, you are stationed in
one country (for example, Germany), and take leave in another or take personel travel to another
(for example, France), item 13b must be answered "yes" and detailed. Show inclusive dates of
travel for each country visited and the purpose of the travel. Entries concerning travel in cities or
countries divided into free-world and communist-oriented parts must indicate in which part travel
was performed (for example, 79-04 East Berlin, East Germany).)
40
13c
(In item 18, "Remarks," explain on an attached sheet of plain white paper the nature and extent of
any foreign interests. Identify any foreign government or firm that you work for or serve in any
capacity. Describe the nature of your employment or relationship. If a foreign employer's address is
shown under item 12, enter "see also item 12.")
41
14
(See General Instructions on the form concerning dates.)
42
14a
a check in the applicable block.
43
14b
current name of any and all former spouses if divorced. Use item 18, "Remarks," of necessary.
44
l4c
all dates of prior marriage(s) if divorced more than once. Use item 18, "Remarks," if necessary.
45
l4d
city and state where each marriage ceremony was conducted.
46
l4e
show all dates of divorce if divorced more than once. Use item 18 "Remarks," if necessary.
47
I4f
(Identify fully the court where each divorce was granted.) Use item 18 "Remarks," if necessary.
48
14g
city and state where each divorce was granted. Use item 18 "Remarks," if necessary.
49
15
(For BI and PR. Beginning with the last school attended, list in chronological order all full-time
attendance at colleges, universities, and service academies. High school need not be listed unless it
was the last school attended in the last 5 years.)
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118 W AFR 205-32 AWhment 3 26 June 1987
TABLE A3-1. Continued
HOW TO COMPLETE DD FORM 398
L
A
B
I
To complete
N
item
Enter
E
(For SBI. Beginning with the last school attended, list in chronological order all full-time attendance
at colleges, universities, and service academies. High school need not be listed unless it was the last
school attended in the last 15 years. When education occurred overseas and it was not under the
auspices of the US Government, list names and addresses of two individuals, preferably residing in
the United States, who can verify the period of foreign education through personal knowledge.
References listed in item 11, "Residences," or item 12, "Employment," may also be listed to verify
education.
50
15a
inclusive dates for each education period. Refer to General Instructions on the form.
SI
15b
complete name of the school.
52
15c
number, street, city, and state or country. If located in a large metropolitan area indicate borough
or suburb.
53
15d
Self-explanatory.
54
15e
(Use proper abbreviation, for example, B.A., B.S., etc., when applicable.)
55
16
(Disregard the first sentence of instructions within parentheses on the form. All persons complete
this item. List three individuals or firms that have extended credit to you during the past 5 years.
Do not include relatives, former employers, or persons living outside the United States. If you
cannot furnish bona fide credit references, list a school where tuition was paid, or any store,
gasoline station, auto dealer, repair shop, life insurance company, doctor, lawyer, and so forth,
where cash was paid for services or goods and who has knowledge or records of the financial
transaction. Time period also pertain to_PRs.
56
16a
Self-explanatory.
57
16b
(When listing a company, business, credit card, etc., provide an account number, when proper.)
58
16c
(When listing a mail order company, show the billing address.)
59
16d
Self-explanatory.
60
l6e
(Use two-letter abbreviations for the state.)
61
16f
Self-explanatory.
62
17
(For BI and PR. List five adult good friends, co-workers, colleagues, classmates, etc., whose total
association with you covers the last 5 years of your life or the period since your 16th birthday,
whichever is the shorter period. Each person listed must be someone who knows you well. Do not
include relatives, former employers, or persons residing outside the United States. (For SBI. List
five adult good friends, co-workers, colleagues, classmates, etc., whose total association with you
covers the last 15 years of your life or the period since your 16th birthday, whichever is the shorter
period. Each person listed must be someone who knows you well. Do not include relatives, former
employers, or persons residing outside the United States.) (Military References. Military references
may be listed if their present military grade, organization, and address are known. Do not list high
ranking military or civilian officials unless a close and continuing relationship exists and you are
reasonably sure that such officials will not object to being interviewed.)
63
17a
last name, first name, and middle initial of each reference.
64
17b-c
inclusive periods of your association by referencing years; for example, From: 77, To: 79.
65
17d
Self-explanatory.
66
17e
(Do not abbreviate.)
67
17f
(Use the correct two-letter abbreviation for the state.)
68
17g
Self-explanatory.
(Addresses. Give current complete address of each reference. If available, list both the home phone
and business address and telephone numbers for each. If any reference is located in a large
metropolitan area, indicate the borough or suburb. If you indicate a rural or Star Route address,
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HOW TO COMPLETE DD FORM 398
L
A
B
I
To complete
N
item
Enter
E
give complete instructions for locating the address from the nearest town or post office (for
example, Star Route, Jackson County, 5 miles south of Grass Lake, Michigan, on Highway 31, turn
left on Parma Road, proceed I'/z miles to third white house on right side of the road.) Use item 18,
"Remarks," if necessary.)
69
18
(Use this space to continue any item on the form where insufficient space was provided for you to
complete the form item. If item 18 is filled and you need more room, attach additional sheets as
needed, clearly identified with your name and SSN. Also indicate "See Attached Sheet(s)" at the
end of the remarks section. When you use the remarks section or attach additional sheets
always
,
identify the number being continued and follow the format you have been using for information
prescribed on the form and in the instructions. See the General Instructions.
70
19a
all organizations except those referred to in b. below, in which you held or have held membership.
If none, so state.
71
19h
a check mark in either "yes" or "no," for each question. If "yes" is checked, enter in item 18
,
"Remarks," the full name of the organization (do not use initials or abbreviations) and describe the
circumstances of your membership or association. If necessary, attach additional sheets for a full
detailed statement. Include dates, places, and offices, positions, or credentials now or formerly
held. If you are associated with individuals who are members of the described organizations, then
list the individuals and the organization with which they were or are affiliated.
72
19ai
full name of the organization (do not use initials or abbreviations.)
73
19bii
number, street, city, and state (or country if other than United States.)
74
19aiii
(Identify the type of organization (for example, social, fraternal, etc.))
75
19aiv-v
inclusive dates of membership in terms of year and month, using the last two digits of the year and
a two digit number for the month (for example, January 79 would be entered as 79-01).
76
20
a check mark in either "yes" or "no" for each question. If "yes" is checked, provide a full,
detailed description of the circumstances in item 18, "Remarks." If necessary, attach additional
sheets for a full detailed statement.
77
20a-b
(See the listing of controlled substances at figure 8-1. If you illegally used. purchased, possessed, or
sold any of these substances, your response should be "yes" and you should identify the particular
substance involved! Give a detailed description of involvement. If part of the answer is covered by
item 21 add "see item 21.")
78
20c-d
(Responses regarding medical matters must identify primary physicians, therapists, and counselors
who treated you. Also state when the treatment was completed or if it is continuing. Show any
institutions or agencies involved in your treatment, to include names, dates, and locations.
79
20e
name and location of the court, and the date the bankruptcy judgment was made.
80 I
21
a check mark in either "yes" or "no" for each question. If "yes" is checked, provide clarifying
information in items 21i through 21% (see note 2).
82
21ii
any action that resulted in placement of your name on a police on record (give docket number or
indictment number, if known). Include any action committed while a juvenile or if you were
considered a "juvenile offender." List all Article 15, UCMJ, or Captains' Mast if they resulted in
fines, restrictions, demotions, etc. If part of the answer is mentioned in item 20, state "see item
20.-
&A
21iii
name of the police agency on the top line and its location (city/country and state, or country if not
in the United States) on the second line.
84
21iy
name of the court on the top Line and its location (city/county and state, or country if not in the
United States) on the second line.
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TABLE A3-1. Continued
HOW TO COMPLETE DD FORM 398
To complete
item
amount of fine, length of sentence or probation, not guilty pleas, or any special pleas as applicable.
(All information must be current as of the date of the form and must be received by DIS within 60
calendar days of the date signed.
(Sign in blue or black ink. Each copy of the form must have an original signature.)
NOTES:
1. For classified assignments, show unit of assignment as
the controlling CBPO for that classified location and show
residence as "classified assignment." Do not put classified
information on this form.
2. When in doubt as to the necessity for revealing
information under this item, it is recommended that
incidents be listed to preclude future questions regarding
omissions. Use item 18 "Remarks," if needed.
Section B-Instructions for Completing DD Form 398-2, Personnel Security Questionnaire (National
Agency Check)
TABLE A3-2
HOW TO COMPLETE DD FORM 398-2
To complete
item
name in the following order: last name, first name and middle name. Names should agree with
military or civilian employment records; if they do not, explain on an attached sheet of plain paper.
If no middle name enter "NMN." If name consists of initials only, enter the initials followed by
"10." Include additional designations such as Jr., Sr, II, (2nd), III, (3rd) etc. when applicable.
Enter maiden name if applicable.
any other name by which you are, or have been, known. Include former names, changes in name,
nicknames, or variant spellings used. If the name has changed, explain why, when and where on an
attached sheet of plain white paper. Provide the inclusive dates any other names was used.
Social Security Number (SSN); if none, so state.
the year, month, and day of your birth in that order. Use the last two digits of the year, a two-digit
number for the month and a two-digit number for the day; for example, I August 1944 will be
entered as 44-08-01.
place of birth in the following order: City, (do not abbreviate), County (do not abbreviate), State
(Use two-letter abbreviation), Country if other than United States (do not abbreviate). If foreign
born, show city, political division (state), and country, example: Oberusal/Tanners, Hesse,
Germany. If US citizen born abroad, and State Department Form FS 240, Report of Birth Abroad
of a Citizen of the United States of America, was issued, give details on an attached sheet of plain
white paper.
a check in applicable block. If you are a civilian employed by the federal government, enter your
grade. If military, enter your pay grade and place an "X" opposite the applicable service. If you
are neither of the above, enter "NA" in both boxes. ANG and USAFR are part of the military
program; enter these, if applicable in the military block. Nonappropriated fund civilian employees
enter "NAF" in the "grade" block.
a check mark in "a" if a citizen, "b" if an alien. If you are a citizen, complete items 8c through
8h; if you are an alien complete items 8i through 8m.
c. a check mark in "yes" if you are native born, or in "no" if citizenship was obtained by
derivation or naturalization, d: your naturalization certificate number. e: parents' naturalization
numbers if citizens by derivation. f: date naturalization or derived citizenship certificate was issued.
g: city and state where naturalization or derived citizenship is recorded. h: court where
naturalization or derived citizenship is recorded.
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AFR 205-32 AttachmetW 26 June 1987 -
L
A
B
1 T
o complete
N i
tem E
nter (see note 1)
E
10 8
i-8m i
. alien registration number. j. country of which are currently a citizen. k. Self-explanatory. 1: city
a
nd state where you entered the United States. m. Form 151 number if admitted for permanent
r
esidence.
11
9
each period of enlistment or extended active duty from which a discharge certificate of service was
r
eceived, even though you may have been ordered back to active duty the next day. If service was
with foreign military, identify the country on an attached sheet of plain paper. Officers who have
had prior enlisted or warrant service, or who have integrated into regular status, include the
applicable information in this item. Reserve or National Guard service must be entered.
12
9a
date service began.
13
9b
date service ended (If you are on active duty, enter "Present" for the latest service and ending dates
for all other periods.)
14
9c
branch of service (Air Force, Army, Navy, or Marines).
15
9d
rank at date of discharge for each period of service.
6
%
(If you entered the US Armed Forces after January 1970, your service number is the same as your
social security number (SSN). If the period of service began before and ended after January 1970,
enter both the service number and SSN.)
H
9f
Self-explanatory.
10
(Read instructions on the form and list all persons described.)
19
l0a
individual's relationship to yot; name; and maiden name, if applicable. List last and first names
and middle initial.
20
l0b
date of birth for all persons listed. Use same format as item 5 above (year-month-day).
21
lOc
city and state, or country if other than the United States.
22
IOd
current address of each person listed. If deceased, enter "deceased."
23
lOe
citizenship of each person listed.
24
11
(Read instructions on the form first.)
25
I la
Give inclusive data for each period of residence.
26
I lb
(Do not list a permanent mailing address or family residence, unless you actually resided at the
address during the period covered. Furnish residence address in local community and on base while
in military service. If the residence was on a military installation, include the complete on-base
address, to include dormitory or house number. Enter the actual place of residence while attending
schools, do not merely give the name of the school, or enter "On campus" as a place of residence.
If you give a metropolitan address, enter the borough or suburb. Give rural route numbers if
applicable; do not use post office box numbers.)
(Beginning with present employment, list each period of employment during the past 5 years, in
chronological order. Include all periods of part time employment or unemployment. If under 21, list
each period for the past 3 years or since your 16th birthday, whichever is the shorter period. List
the name and address of a person who can verify your activities during period of unemployment
and nonattendance at school full time on an attached sheet of plain white paper.)
inclusive dates for each period of employment, part-time employment, and unemployment.
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TABLE A3-2
HOW TO COMPLETE DD FORM 398-2
L A
1
To complete
N
Item Enter (see no
E
38 113c
-? ?~ w~-~~~ttacnment 3 26 June 1987
(Military personnel should identify each unit or organization and base or installation to which
assigned during the past 5 years. If self-employed, show the name and address of the business. If
employed by a temporary help supplier, list only the temporary help supplier even though you
worked at several different client companies using the temporary help supplier's services. If
employed through a union hiring hall, list only the companies where you worked. Do not list the
union as an employer unless your wages were actually paid by the union.)
exact local address for each employment listed. If any employers were located in a metropolitan
area, include the borough or suburb. If employed by a large corporation, give the specific address
of the plant where you worked. Do not merely list the corporate address or location (for
example: General Motors, Detroit, Michigan, is not an acceptable address).
last name, first name, and middle initial.
(If answer is yes, list on an attached sheet of plain white paper, inclusive dates of service, and name
and address of last organization. If already shown in item 12, enter "see item 12.")
(List on a separate sheet of plain white paper all periods of foreign travel during the past 5 years.
Travel prior to age 16 must be included if it falls within the reporting period. If the answer is "no,"
then you need not detail travel in a foreign country that was a result of military service or
government employment. If, however, you are stationed in one country (Germany), and take leave
in another (France), item 13b must be answered "yes" and detailed. Show inclusive dates of travel
for each country visited and the purpose of the travel. Entries concerning travel in cities or
countries divided into free-world and communist oriented parts must indicate in which part travel
was performed (for example, 79-84 East Berlin, East Germany).)
(On an attached sheet of plain white paper, explain the nature and extern of any foreign interests.
Identify any foreign government or firm that you work for or serve in any capacity. Describe the
nature of your employment or relationship. If a foreign employer's address is shown under item 12,
enter "see also item 12.")
a check mark in "yes" or "no" for each question. If "yes" is checked, provide clarifying
information in items 14i through 14v (see note 2).
Any action that resulted in placement of your name on a police or court record (give docket number
or indictment number, if known). Include any act committed while a juvenile or if you were
considered a "juvenile offender." List all Article 15, UCMJ, or Captain's Mast if they resulted in
fines, restricts, demotions, etc.)
name of the police agency on the top line and its location (citY/county and state, or country if not
in the United States on the second line.)
name of the court on the top line and its location (city/county and state, or country it not in United
States on the second line.)
amount of fine, length of sentence or probation, not guilty pleas, or any special pleas, as
applicable.
a check mark for "yes" or "no" for each question. If "yes" is checked, provide a full detailed
description on an attached sheet of plain white paper.
- u,c usung of controlled substances figure 8-1.) If you illegally used, purchased, possessed, or
sold any of these substances, your responses should be "yes" and you should identify particular
substances involved. Give detailed description of involvement. If part of the answer is already
covered by item 14, add "see item 14.")
"` " (Responses regarding medical matters must identify the priary and
counselors who treated you and state when the treatment was completed or th ttitt is continuing.
Show any institutions or agencies involved in your treatment, to include names, dates, and
locations.
48 ISe name and location of the coup, and the date the bankruptcy judgment was made.
Release 2012/10/26: CIA-RDP90-00530R000500990008-6 mmommirrIf
 Declassified and Approved For Release 2012/10/26: CIA-RDP9O-0053OR000500990008-6 123
V V
L
A
B
To complete
N
item
Enter (see note 1)
E
49
16a
all organizations, except those referred to in b below, in which you hold or have held membership.
50
16i
full name of the organization (do not use initials or abbreviations.
51
16ii
number, street, city, state, and country, if other than United States.
52
16iii
type of organization (social, fraternal, etc.)
53
16iv-v
inclusive dates of membership in terms of year and month, using the last two digits of the year and
a two digit number for the month. (for example: October 1979 would be 79-10).
54
16b
a check mark in "yes" or "no" for each question. If "yes" is checked, enter on an attached sheet
of plain white paper, the full name of the organization (do not use initials or abbreviations) and
describe the circumstances of your membership or association. Provide a full detailed statement to
include dates, places, and offices, positions or credentials now, or formerly, held. If you are
associated with individuals who are members of described organizations, then list these individuals
and the organizations with which they are or were affiliated.
NOTES:
1. Detailed answers that require continuation on plain white
paper should be entered in the same sequence in which items
appear on the questionnaire. At the top of each continuation
sheet, type or print your name, SSN, and "continuation
sheet for DD Form 398-2." Identify each remark with the
item number to which it applies. For example:
11. Residences (Continued)
78-01 to 86-04 1221, Riverside, Chaska, Hennipin, MN
55062
2. When in doubt as to the necessity for revealing
information under this item, it is recommended that
incidents be listed to preclude future questions regarding
omissions.
Declassified and Approved For Release 2012/10/26: CIA-RDP9O-0053OR000500990008-6