GSA5004

Security Inquiry Transmittal

Agency
GSA
Revision
Rev. 10/2014
Fillable fields
43
Pages
2
Official source
GSA form page
Checked
October 20, 2026
Fill GSA5004 online
Page 1 of form GSA5004

GSA Form 5004: Security Inquiry Transmittal

GSA Form 5004, Security Inquiry Transmittal, is a General Services Administration form, printed GSA 5004 10/2014. GSA hosts it in its forms library.

The Privacy Act statement says the information is requested to process a security clearance for the position with the Federal government for which the candidate has been selected. The form lists the documents attached, the investigation type, candidate information, position and accounting information, and the names of the hiring manager, administrative point of contact and human resources specialist.

The form says that upon completion it goes by e-mail to [email protected] or by fax to 202-708-5377, and it prints a mailing address for USPS, FedEx or UPS. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of GSA Form 5004: Security Inquiry Transmittal, as printed by GSA

What's on GSA Form 5004

Privacy Act and SSN statements

A Privacy Act statement under Public Law 93-579 and a statement on disclosure of the Social Security number under Section 7(b) of that law.

Documents Attached

Checkboxes for a resume, position description, OF 306, GSA 3648 or GSA 1380, a letter of justification for Secret or Top Secret clearance, GSA 3665, SF 87 fingerprint cards, and SF 85, SF 85P or SF 86 via e-QIP.

Investigation Type

Low Risk NACI, Moderate risk MBI, High Risk BI, National Security SECRET, National Security TOP SECRET, or Intern/Volunteer/Student (6 months or less) Fingerprint Only.

Candidate Information

Name, Social Security number, e-mail address, date and place of birth, citizenship status, job status, and an explanation and length of employment for an Other job status.

Position Information

Agency sub element code, correspondence symbol, personnel office ID, position title, occupational series, pay plan and grade, duty station, region, funds manager, accounting data, TAS, date the tentative job offer was accepted and proposed entry on duty date.

Contacts and remarks

On the back: hiring manager, administrative point of contact and human resources specialist, then space for remarks and additional information.

How to complete GSA Form 5004

  1. 1

    Check the documents attached

    Mark each document sent with the form. Several are marked if applicable, such as the position description, the justification letter and SF 87 fingerprint cards, 2 sets.

  2. 2

    Select the investigation type

    Check one of the six investigation types, from Low Risk NACI to National Security TOP SECRET or Fingerprint Only.

  3. 3

    Enter the candidate's details

    Fill in the Candidate Information section. For an Other job status, the form asks for an explanation and length of employment.

  4. 4

    Enter the position and accounting data

    Fill in the Position Information section, including the funds manager, ACT number or accounting data and TAS.

  5. 5

    Add contacts and remarks

    List the hiring manager, administrative point of contact and human resources specialist on the back, and any remarks.

  6. 6

    Send it

    The form says to submit it via e-mail to [email protected] or fax to 202-708-5377 upon completion.

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Where it goes and what the form says

E-mail or fax

Upon completion, the form says to submit it via e-mail to [email protected] or fax to 202-708-5377.

Mail and courier address

For USPS, FedEx or UPS: General Services Administration, Commissions and Boards Services, Mail Code: CPW, Room 1049, 301 7th St SW, Washington DC 20407-0001.

Fingerprint appointments

Next to SF 87, the form says to schedule a fingerprint appointment by e-mailing [email protected].

Investigation questionnaires

The checklist lists SF 85, SF 85P, Questionnaire for Public Trust Positions, and SF 86, Questionnaire for National Security Positions, as applicable, via e-QIP.

Privacy

The Privacy Act statement says the information is mandatory to process the security clearance and will be used exclusively for that purpose, and that failure to provide all of it will jeopardize employment with the Federal government.

Related forms

Who is named on GSA Form 5004?

  • The selected candidate

    The Privacy Act statement addresses a person selected for a federal position whose security clearance is being processed. The Candidate Information section holds their name, SSN, birth details, citizenship and job status.

  • The hiring manager

    The Contact Information section asks for the hiring manager's name, e-mail address and telephone number.

  • Administrative and HR contacts

    The same section has rows for an administrative point of contact and a human resources specialist, each with e-mail and telephone.

  • The funds manager

    Position Information asks for the funds manager's name and telephone number, with ACT number or accounting data and the Treasury Account Symbol (TAS).

  • GSA Commissions and Boards Services

    The form is sent to [email protected], and its mailing address is General Services Administration, Commissions and Boards Services.

The form does not say who fills in each section. It names these people and offices.

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Questions about Form GSA5004

Who issues GSA Form 5004?

It is a General Services Administration form, printed GSA 5004 10/2014. GSA hosts it in its forms library.

Where does GSA Form 5004 go?

The form says to submit it via e-mail to [email protected] or fax to 202-708-5377. For USPS, FedEx or UPS, it lists General Services Administration, Commissions and Boards Services, 301 7th St SW, Washington DC 20407-0001.

Which documents does the form list?

A resume, position description if applicable, OF 306, GSA 3648 or GSA 1380, a letter of justification for Secret or Top Secret clearance if applicable, GSA 3665, SF 87 fingerprint cards if applicable, and SF 85, SF 85P or SF 86 via e-QIP.

Which investigation types are listed?

Low Risk NACI, Moderate risk MBI, High Risk BI, National Security SECRET, National Security TOP SECRET, and Intern/Volunteer/Student (6 months or less) Fingerprint Only.

Why does the form ask for a Social Security number?

The form says disclosure of the SSN is mandatory, that its solicitation by the Office of Personnel Management is authorized by Executive Order 9397, and that it is used as an identifier because many people share names and birth dates.

How is a fingerprint appointment scheduled?

Next to the SF 87 fingerprint cards item, the form says to schedule a fingerprint appointment by e-mailing [email protected].