Statement of investigation
The signer states they are undergoing a personal background investigation as part of qualifying for a GSA position or contract.
GSA3665
Authorization to Obtain Credit Report
- Agency
- GSA
- Revision
- Rev. 5/1998
- Fillable fields
- 7
- Pages
- 1
- Official source
- GSA form page
- Checked
- October 20, 2026
GSA Form 3665: Authorization to Obtain Credit Report
GSA Form 3665, Authorization to Obtain Credit Report, is a one-page GSA form. The footer reads GENERAL SERVICE ADMINISTRATION, GSA FORM 3665 (5-98) and Prescribed by ADM P9732.1C, and GSA hosts it in its forms library.
The signer states that, as part of qualifying for a GSA position or contract, they are undergoing a personal background investigation to receive a public trust certification or national security clearance, or a periodic renewal certification or security clearance. The form then authorizes GSA and its authorized agents to obtain the signer's credit reports from any consumer or credit reporting agency for employment purposes. It asks for the employee's printed or typed name, Social Security number, signature and date signed, followed by a Privacy Act notice.
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What's on GSA Form 3665
Authorization
Authorizes GSA and its authorized agents to obtain credit reports from any consumer or credit reporting agency for employment purposes.
Name and Social Security number
Name of employee, printed or typed: last, first, middle and Jr., II, etc., with the Social Security number.
Signature and date
Signature of employee and date signed.
Privacy Act notice
Cites the Fair Credit Reporting Act, gives the three purposes of the investigation, explains redisclosure, and says disclosure of the SSN is voluntary.
The form is one page with these blocks.
How to complete GSA Form 3665
- 1
Read the statement
The opening paragraphs describe the background investigation and the authorization given to GSA and its authorized agents.
- 2
Print or type the name
Enter the last, first and middle name, and any suffix such as Jr. or II.
- 3
Enter the Social Security number
The Privacy Act notice says disclosure of the SSN is voluntary and is used to keep records accurate, because other people may have the same name.
- 4
Sign and date
Sign on the signature of employee line and enter the date signed.
- 5
Review the Privacy Act notice
The notice explains what the authorization is used for and who may receive the information.
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Routing, purpose and privacy
Where it goes
The PDF prints no address or office. The authorization is given to GSA and its authorized agents.
What the investigation is for
The notice says GSA is requesting an investigation to determine fitness for Federal employment, clearance to perform contractual service for the Federal Government, or security clearance.
Who receives the information
The information in the authorization is given to the consumer or credit reporting agency so it will release credit history. The notice says it may be redisclosed to other Federal agencies for the three purposes and to fulfill official responsibilities, to the extent permitted by law.
Adverse action
The notice says that if a decision to take adverse action is based in whole or in part on the credit report, the consumer or credit reporting agency that provided it has played no role in the decision.
Social Security number
Disclosure is voluntary. The notice says Executive Order 9397 asks Federal agencies to use the SSN to help identify individuals in agency records.
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Who fills out GSA Form 3665?
The form is written in the signer's voice and names GSA as the party receiving the authorization.
Official sources and the blank
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Questions about Form GSA3665
Who issues GSA Form 3665?
The footer reads GENERAL SERVICE ADMINISTRATION, GSA FORM 3665 (5-98) and Prescribed by ADM P9732.1C. GSA hosts it in its forms library.
What does GSA Form 3665 authorize?
It authorizes GSA and its authorized agents to obtain the signer's credit reports from any consumer or credit reporting agency for employment purposes.
Which law does the form cite?
The Privacy Act notice cites the Fair Credit Reporting Act, as amended (15 U.S. C. § 1681, et seq.), which it says allows GSA to get one or more credit reports for employment purposes.
Is the Social Security number required?
The notice says disclosure of the SSN is voluntary, and that it is needed to keep records accurate because other people may have the same name.
Can the information go to other agencies?
The notice says it may be redisclosed to other Federal agencies for the three purposes it lists and to fulfill official responsibilities, to the extent that the disclosure is permitted by law.