UnNumbered Voluntary Appeal File (VAF) Application

1-783 (Rev. 12-31-2022)

OMB-1110-0043
Expiration: 12/31/2025

Voluntary Appeal File (VAF) Application Form

You may apply electronically by visiting https://www.edo.cjis.gov or you may complete the following application.
The VAF is offered for those who want the FBI to maintain information about themselves to avoid extended delays or erroneous
denials with future firearm transfers. The submission of fingerprints is REQUIRED to process all VAF applications. Additionally,
if a VAF application is being submitted by an attorney on behalf of their client, an Authorization to Release form MUST accompany
the VAF application. The Authorization to Release form, a downloadable fingerprint card and/or additional VAF information can all
be found at https://www.edo.cjis.gov.
APPLICANT'S INFORMATION * Denotes Required Fields

*Last Name:
Middle Name:
*Date of Birth:

*First Name:

*Place of Birth:

Suffix:
*State of Residence:

*Country of Citizenship:

Social Security Number:

Miscellaneous Number (Driver's License, Military ID):

Alien or Admissions Number (*mandatory if Country of Citizenship is other than U.S.):
*Race (please check appropriate box):
Asian or Pacific Islander

Black

White

American Indian or Native Alaskan

*Ethnicity (please check appropriate box):
Hispanic or Latino

Unknown

*Sex (please check appropriate box):

Not Hispanic or Latino

Male

Female

Other

APPLICANT'S ADDRESS

*Address:

*City:
*Postal (Zip) Code:
Phone Number:

*State:
*Country:
E-Mail:

APPLICANT’S STATEMENT: I give the information on this Voluntary Appeal File (VAF) application, and any supporting
documentation provided therewith, voluntarily with the understanding that if my application is approved, I will be entered into the
VAF maintained by the National Instant Criminal Background Check System Section of the FBI's Criminal Justice Information
Services (CJIS) Division. I further voluntarily consent that the FBI may retain my application, any supporting documentation, and
any research information relevant to the approval of my VAF application. I further understand if, at any time, I wish to be removed
from the VAF, I can make such a request in writing to the FBI's CJIS Division, at the address below. I also understand if a
disqualifying record is discovered after my entry into the VAF, the FBI's CJIS Division may remove my information from the VAF.

*APPLICANT'S SIGNATURE _______________________________________

DATE __________________

If this form does not include your signature, your VAF application cannot be processed. You may mail the signed VAF
application, completed fingerprint card, and any supporting documentation to the following address:
National Instant Criminal Background Check System
Post Office Box 4278
Clarksburg, West Virginia 26302-9922
PRIVACY ACT STATEMENT
Authority: The collection of information on this form is authorized by 28 CFR 25.10(g).

Principal Purpose: The principal purpose of collecting the requested information is to allow the FBI to maintain information about you in the Voluntary Appeal File (VAF) for the purpose of preventing the future erroneous
denial or extended delay by the National Instant Criminal Background Check System (NICS) of a transfer of a firearm, explosive, or associated permit. You do not have to provide the requested information to the FBI;
however, failure to provide the requested information will result in the FBI’s inability to retain your information in the VAF which may, in turn, result in a future erroneous denial or extended delay of a transfer of a firearm,
explosive, or associated permit.
Social Security Account Number (SSAN): Your SSAN is requested to keep records accurate because other people may have the same name and date of birth. Your SSAN will be used to verify your identity. You are not
required to provide your SSAN and failure to provide your SSAN will not result in a denial of your VAF application. However, failure to provide your SSAN may result in an increase of time to process your VAF
application or requests for additional information to verify your identity.
Routine Uses: During the processing of your application and for as long thereafter as your information is retained in the VAF, your information may be disclosed pursuant to your consent, and may be disclosed without your
consent as permitted by 28 CFR Part 25, and applicable routine uses as set forth in the System of Records Notice for the NICS, DOJ/FBI-018, 63 FR 65223 (Nov. 25, 1998), as amended at 65 FR 78190 (Dec. 14, 2000), 66
FR 6676 (Jan. 22, 2001), 66 FR 8425 (Jan. 31, 2001), 66 FR 12959 (Mar. 1, 2001), and 82 FR 24147 (May 25, 2017). Routine uses include, but are not limited to, disclosures to local, state, tribal, and territorial criminal
justice agencies to determine whether transferring a firearm, explosive, or related permit to you is prohibited by state or federal law or whether to grant or deny an appeal from a NICS transaction; and to courts or
adjudicative bodies for the purposes of resolving litigation or anticipated litigation.

PAPERWORK REDUCTION ACT STATEMENT

According to the Paperwork Reduction Act of 1995, no persons are required to provide the information requested unless a valid OMB control number is displayed. The valid OMB control number for this information
collected is 1110-0043. The time required to complete this information collected is estimated to be 10 minutes, including time reviewing instructions, gathering, completing, reviewing and submitting the information
collection. If you have any comments concerning the accuracy of this time estimate or suggestions for reducing this burden, please send to: Department of Clearance Officer, United States Department of Justice, Justice
Management Division, Policy and Planning Staff, Washington, DC 20530.