Representatives of a Foreign Interest (RFI)
Statement

A RFI is a citizen or national of the U.S., or an intending citizen to the U.S., who is acting as a representative of a foreign interest. If any individual having or requiring a DOE security clearance is a RFI. A RFI Statement (sample document attached) must be completed.

A Foreign Interest is any foreign government, agency of a foreign government, or representative of a foreign government; any form of business enterprise or legal entity origination, chartered or incorporated under the laws of any country, other than the U.S. or its possessions and trust territories, and any person who is no a citizen at national of the U.S.

Name of the foreign interest:

Address of the foreign interest:

The nature of business of the foreign firm and the products/services involved. Also indicate if they have any military application:

Full details of ownership or affiliation with the foreign interest

The specific relationship between the foreign interest and the U.S. organization:

Your Job titles and specific duties with the foreign interest:

Percentage of time devoted to foreign interest:

Percentage of U.S. organization's revenues and net income derived from foreign firm during the U.S. organization's most recently closed accounting year:

Name and address of all U.S. facilities where you hold or are in process for an access authorization:

The nature of business of all U.S. organizations and the product/services involved.

Summary of duties with the foreign firm Provide detailed information, as well as position title:

Have you ever registered as an Agent of a foreign government as detailed in 18 U.S.C. 219? If so, please provide details:
 

CERTIFICATION:
I recognize my special responsibility to protect classified information from disclosure to any unauthorized person, foreign, or domestic.

TYPE OR PRINTED NAME:________________________________________

FULL NAME:_______________________________ DATE:_______________

Signature____________________________________________________

SOCIAL SECURITY NUMBER:_______________ FACILITY:_______________

 

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Last Modified: February 4, 2008
Please forward all questions about this site to: Michelle Holbrook


DOE, Office of Science One of ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE's Office of Science by Brookhaven Science Associates, a limited-liability company founded by the Research Foundation for the State University of New York on behalf of Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization.

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