Narrative of Changes

Narrative of Changes

1652-0027-Security Threat Assessment of Individuals Applying for a Hazardous Materials Endorsement for a Commercial Drivers License

Removed fields (that were on previous application)

• Military Service (Yes/No)

• Branch

• Discharge Date

• Type of Discharge

• Current Employer Name

  • Current Employer Phone

  • Current Employer Address

    • City

    • State

    • Zip

New fields (that were not on the previous application)

• HME Type (H or X)

• Type of Application (Renewal/Transfer/New)

• If transferring:

• CDL Number

• CDL State

• Home Phone

• Work Phone

• Cell Phone

• Email Address

• Are you a U.S. citizen? (Yes/No)

• State Department Form Number (if born abroad)

• U.S. Passport Number

• Legal Status Document and Number

• Have you undergone or are you undergoing a DHS (including TSA) security threat assessment? (Yes/No)

  • If yes, Name of program

• Have you had or do you have a DHS/TSA credential? (Yes/No)

  • If yes,   Type of credential

  • Credential reference number

Legal Status Document and number

If you possess any of the following documents or cards, please fill out the form number of the document/card you possess and the number on the document/card:

I-94, Arrival/Departure Record	I-873, Northern Mariana Card
I-327, Re-entry Permit	I-571, Refugee Travel Card
I-151 or I-551, Permanent Resident Card	DSP-150, Border Crossing Card
I-197 or I-179, U.S. Citizenship ID Card	N-550 or N-570, Certificate of Naturalization
I-872, American Indian Card	N-560 or N-561, Certificate of U.S. Citizenship
	I-6888, Temporary Resident Card
	I-688A or I-766, Employment Authorization Card
	I-688B, Employment Authorization Document

Were on previous form and re-worded on new application (to make more concise for applicants)

• Five Questions at bottom of form

• Legal Status Document and number section

• Privacy Act and Paperwork Reduction Act Notices

• Listing of Disqualifying Criminal Offenses

• Listing of Permissible Legal Status