Request for private sector organization screening form

A completed Request for private sector organization screening form is required for any private sector organization needing access to Protected and Classified information, assets or work sites within the next twelve months. Only an approved source may complete this form.

An approved source may include:

Wish to learn more? Explore the screening process.

Submitting the form

Email:
SSIINSCRIPTION.ISSREGISTRATION@tpsgc-pwgsc.gc.ca
Fax:
613-948-1762
Mail:
Contract Security Program
Public Services and Procurement Canada
Registration Division
2745 Iris St
c/o PSPC Central Mail Room
Portage III, 0B3
11 Laurier St
Gatineau QC K1A 0S5

Other format available for download:
Request for private sector organization screening form—PDF version (189KB)
Alternative formats and plug-ins

A—Type of application (required)

If this is the organization’s first request for a private sector organization screening, select “New.” If the organization is applying for a higher level of screening under the same or another contract or project, select “Upgrade.”

B—Information on the proposed organization

Provide a number that isn’t likely to change.

For a designated organization screening (Protected level requirement), provide the full name (surname, given name) of a contact person within the organization who is aware of the request for a private sector organization screening.

For a facility security clearance (Classified level requirement), provide the full name (surname, given name) of the organization’s president or highest-ranking official in Canada.

11. Preferred language of correspondence (required)
C—Information on the registered or head office in Canada (if different from section B)
D—Reason(s) for the private sector organization screening request (select those that apply, at least one is required)

If selecting this option, you must also attach a completed Treasury Board of Canada Secretariat security requirements checklist.

E—Information on security requirements

To gain access to Protected or Classified information, assets and work sites, personnel must have the respective reliability screening or security clearance.

A reliability status screening is required to access Protected A, B and C, and foreign Restricted information, assets and work sites.

A security clearance at the level of information, assets and work sites to be accessed is required to access Confidential, Secret and Top Secret. In the case of North Atlantic Treaty Organization (NATO), a NATO security clearance at the level of the Classified information, assets or work sites to be accessed is required prior to access. A security clearance also entitles a person to access Protected information and assets on a need-to-know basis.

Learn more about reliability status and personnel security clearances in the Industrial Security Manual.

1. Indicate level(s) of personnel security screening required (select those that apply, at least one is required)
2. Will the proposed organization be required to store Protected or Classified information or assets? (required)
a) If yes, indicate security level(s) of information or assets to be stored (select those that apply, at least one is required)

The level(s) you select may not be higher than the level(s) you identified above in question 1 of section E.

Also, provide address(es) where information or assets will be stored in b) and c) below. If completing this section, please attach a completed Treasury Board of Canada Secretariat security requirements checklist.

3. Will the proposed organization be required to store Protected or Classified communications security (COMSEC) information or assets? (required)
a) If yes, indicate the security level(s) of Protected or Classified COMSEC information or assets to be stored (select those that apply, at least one is required)

The level(s) you select may not be higher than the level(s) you identified above in question 1 of section E.

Provide any additional information that you feel is important or would assist in processing this form.

F—Information on the procurement officer or project manager requesting private sector organization screening (if different from section G)

To be completed by the procurement officer or project manager. If this is the same individual as the approved source, leave this section blank and skip to section G.

G—Information on the approved source requesting the private sector organization screening

The approved source must complete this section of the form.

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