DEPARTMENT OF VETERANS AFFAIRS Veterans Benefits Administration Washington, D.C

Similar documents
RULES OF TENNESSEE BUREAU OF INVESTIGATION CHAPTER DIVISION OF TENNESSEE INSTANT CHECK SYSTEM PROGRAM TABLE OF CONTENTS

PART 25 DEPARTMENT OF JUSTICE INFORMATION SYSTEMS. Subpart A The National Instant Criminal Background Check System

SENATE STAFF ANALYSIS AND ECONOMIC IMPACT STATEMENT

GAO GUN CONTROL AND TERRORISM. FBI Could Better Manage Firearm- Related Background Checks Involving Terrorist Watch List Records

DEPARTMENT OF HEALTH AND HUMAN SERVICES. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and the

Gun Control, Mental Incompetency, and Social Security Administration Final Rule

DEPARTMENT OF VETERANS AFFAIRS Veterans Benefits Administration Washington, D.C

Reducing Gun Violence in America

An Overview of the Background Check System

Your Morning Jolt: Background Checks. Mike Menkus Life Member GeorgiaCarry.Org Annual Convention August, 2015

Disclosure of Intent to Obtain Consumer Report and/or Investigative Consumer Report for Employment Purposes

Overview of the Fully Developed Claims (FDC) Program and Provisional Decisions NVLSP

EMPLOYMENT BACKGROUND CONSENT AUTHORIZATION FORM

LIMITED-SCOPE PERFORMANCE AUDIT REPORT

RIGHTS OF MASSACHUSETTS INDIVIDUALS WITH A REPRESENTATIVE PAYEE. Prepared by the Mental Health Legal Advisors Committee August 2017

Rights and Responsibilities

TEXAS REGIONAL BANK APPLICATION FOR EMPLOYMENT

Rights and Responsibilities

Covered California 3/5/2019. Title 10. Investment. Chapter 12. California Health Benefit Exchange. Article 11. Certified Application Counselor Program

UNIVERSITY OF WYOMING STUDENT HEALTH SERVICE NOTICE OF PRIVACY PRACTICES

Federal Firearms Laws

2. Current Residence Address (U.S. Postal abbreviations are acceptable. Cannot be a post office box.) Number and Street Address City County. (Lbs.

(c) "Subject" means the commercial enterprise about which a commercial credit report has been compiled.

Medicare Claims Appeals Developments and Proposals for Expansion

Fixing the Background Check System to Prevent Violence Against Women. February 2013

APPLICATION SCREENING COVER NOTICE

If you wish to apply for a distribution at this time, please follow the instructions below:

Recent Trends in Firearm Legislation and Case Law Update

YOUR RIGHTS AND RESPONSIBILITIES YOU HAVE THE FOLLOWING RIGHTS

BACKGROUND CHECK DISCLOSURE

TECHNICAL ADVISORY. TA 218 January 3, 2003

APPLICATION FOR EMPLOYMENT

Short Term Disability and Long Term Disability Insurance Plans

STATE QUESTION NO. 1. Amendment to Title 15 of the Nevada Revised Statutes. Yes EXPLANATION & DIGEST

SECTION 5. SMALL CASE PROCEDURE FOR REQUESTING COMPETENT AUTHORITY ASSISTANCE.01 General.02 Small Case Standards.03 Small Case Filing Procedure

CALEX EXPRESS, INC 58 Pittston Avenue Pittston, PA

INVESTIGATIVE CONSUMER REPORT NOTICE

1. INTRODUCTION AND PURPOSE OF THIS DOCUMENT:

Applications must be submitted in person or by mail to 2681 Driscoll Road, Attn: Manager s Office, Fremont, CA

Employment Application CDL Holder Federal Rd, Suite B Houston, TX

Volunteer / Intern Application

material modifications

Airport Drayage NE 112 th Ave Portland, OR 97220

DISCLOSURE CONCERNING REQUEST FOR BACKGROUND CHECK REPORT

BlueRibbon. Authorization for Background Check, State Law Notices and Combined Summaries of Rights Disclosure

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

Brainerd Housing and Redevelopment Authority 324 East River Road Brainerd, MN PHONE: (218) FAX: (218)

APPLICANT Full Name (Last) (First) (Ml) Date of Birth Home Phone Number ( ) Cell Phone Number ( ) Work Phone Number ( ) Area Code

Chapter 13 Section 6. Provider Exclusions, Suspensions, And Terminations

Application for Employment

Cigarettes, roll-your-own tobacco, and smokeless tobacco are covered. Cigars are excluded.

Dear Applicant, Sincerely, John W. Bluford, III President, CEO Truman Medical Centers

CONSUMER AUTHORIZATION Fax Completed Documents to GIS at (866)

APPLICATION FOR APARTMENTS. NAME: Last First Middle. ADDRESS: Street City State Zip Code TELEPHONE #: HOME WORK MESSAGE. * Social Security #

SERVICE OFFICER CODE OF PROCEDURE

Circuit Court for Baltimore City Case No UNREPORTED IN THE COURT OF SPECIAL APPEALS OF MARYLAND. No September Term, 2017

Notice of Privacy Practices

Justifacts Guide to Understanding the FCRA

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Bureau of Alcohol, Tobacco, Firearms, and Explosives

For Office Use Only STREET ADDRESS: APT/UNIT #: ARE YOU ON PROBATION OR PAROLE? OWN TRANSPORTATION TO WORK?

THE INTEGRITY CENTER objective risk management information A Unit of Integrity Centers Corporation

CITY OF SHAVANO PARK EMPLOYMENT APPLICATION An Equal Opportunity Employer

Claims and Appeals Procedures

Retiree Concealed Firearms

NOTICE OF PRIVACY PRACTICES 1. PLEASE REVIEW IT CAREFULLY.

THE JAPAN COMMERCIAL ARBITRATION ASSOCIATION COMMERCIAL ARBITRATION RULES. CHAPTER General Provisions

Kenneth Henry Court 6475 Foothill Blvd. Oakland, CA (510)

CLEAR, ACCURATE AND CONSPICUOUS DISCLOSURE pursuant to the Federal Credit Reporting Act 15 U.S.C. Section 604 (b)(2)(a)(i):

Saint Louis University Notice of Privacy Practices Effective Date: April 14, 2003 Amended: September 22, 2013

UNITED TECHNOLOGIES CORPORATION HEALTH AND BENEFITS PLAN NOTICE OF HIPAA PRIVACY PRACTICES

CLAIM FORM FOR LIFE INSURANCE PROCEEDS

IN THE COURT OF CRIMINAL APPEALS OF TENNESSEE AT KNOXVILLE MAY SESSION, 1996

Disability Benefits Continuance Claim

1. Provide a copy of any document which Appellant has submitted since his removal from the Agency in search of employment.

The Balancing Act of Gun Control

Housing Choice Voucher Program: Waiting List Information

Sun Life Assurance Company of Canada

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) NOTICE OF PRIVACY PRACTICES

TEXAS EAR, NOSE AND THROAT SPECIALISTS, L.L.P. NOTICE OF PRIVACY PRACTICES

AN INTRODUCTION TO GUN TRUSTS UNDER THE NATIONAL FIREARMS ACT Presented By: Paul J. Kellogg, Esq. Phillips Law Firm, Inc.

International Union of Operating Engineers Local 4 and Its Branches Pension Plan

Tenant Data Release of Information

TESORO CORPORATION SHORT-TERM DISABILITY PLAN FOR SPECIFIED EMPLOYEES SUMMARY PLAN DESCRIPTION

Helios Corner 1531 University Avenue Berkeley, CA (510)

Applicant Name: LAST FIRST M I. Soc. Sec. # - - DOB (M/D/Y) / / Driver s License # State issued: Marital Status. Home Phone: Cell Phone:

An inpatient confinement facility includes:

The Settlement in Martinez v. Astrue

COMPLETING THIS FORM TO APPOINT A REPRESENTATIVE

Driver Employment Application

PREMIER SPINE & PAIN CENTER

TABLE OF CONTENTS. .03 Farmers cooperatives. .01 A request made during the course of an examination

Please send your completed form to: Claims Department P.O. Box Atlanta, Georgia 30342

Voluntary contributions to assist low-income residential customers Administration.

Cancer Claim Form. Claimant name Male Female Birth Date Claimant Social Security Number

Notice of Privacy Practices

IN THE COURT OF CRIMINAL APPEALS OF TENNESSEE AT NASHVILLE Assigned on Briefs April 24, 2007

APPLICATION FOR EMPLOYMENT

CONSUMER DISCLOSURE AND AUTHORIZATION FORM. Disclosure Regarding Background Investigation

SOCIAL SECURITY ADMINISTRATION. [Docket No. SSA ] Privacy Act of Proposed New Routine Uses and System of Records Alterations

Transcription:

DEPARTMENT OF VETERANS AFFAIRS Veterans Benefits Administration Washington, D.C. 20420 February 20, 2014 All VA Regional Offices and Centers Fast Letter 10-51 (Revised) ATTN: All Veterans Service Center and Pension Management Center Personnel SUBJ: Processing Requests for Relief from the Reporting Requirements of the National Instant Criminal Background Check System This letter provides new information on the National Instant Criminal Background Check System (NICS) relief program and the procedures for processing relief requests. Compensation Service is in the process of drafting the regulation to reflect this process. In the interim, please follow the guidance in this letter. This letter is revised to include a new requirement to obtain a criminal history report, to require the beneficiary to submit certain types of evidence, and to add a table to clarify the procedures for processing relief requests. All relief requests pending on or after the date of this letter must be decided using these updated procedures. Veterans Service Representatives (VSRs) must decide all requests for NICS relief in an administrative decision based upon evidence submitted by the beneficiary or maintained by VA, including a Rating Veterans Service Representative s (RVSR s) evaluation of medical evidence. Background The Brady Handgun Violence Prevention Act of 1993 (The Brady Act), codified at 18 U.S.C. 922, prohibits the sale of firearms to certain people and requires the Department of Justice (DoJ) to establish a process for assisting federally licensed gun dealers in determining whether the law prohibits a person from purchasing a firearm. As mandated by the Brady Act, DoJ created NICS. The law requires VA to report to NICS information about VA beneficiaries who cannot manage their VA benefits, have been rated incompetent, and require the appointment of a fidicuary to help manage their VA funds. The NICS Improvement Amendments Act of 2007 (NIAA), Public Law 110-180, set new reporting requirements for federal and state agencies and contains an amendment to the Brady Act that obligates VA to administer a program that allows beneficiaries the opportunity to request relief from the reporting requirements imposed by the Brady Act. When VA grants a beneficiary s relief request, VA must notify DoJ of the change in status so that DoJ can remove the beneficiary s information from NICS. NIAA also obligates VA to provide beneficiaries

Page 2 both written and oral notification of the firearms prohibitions and the penalties for violating them, and information regarding the availability of the relief program. In 2013, DoJ instituted a new requirement that a criminal history background report must be obtained for all relief request grants. NICS Relief Program The NIAA places the responsibility for administering the relief program on the agency that provided the information to NICS. Public safety is the primary consideration when deciding whether to grant or deny relief. Relief from the reporting requirements is not a benefit under title 38 of the U.S. Code, and, as such, principles common to the VA adjudication process, such as benefit of the doubt and duty to assist (as demonstrated in ordering examinations or securing private medical records), do not apply to this program. The beneficiary seeking relief from the NICS reporting requirements has the burden of proof for these relief requests, and failure to meet that burden is sufficient to deny the request. Decisions that deny relief are not subject to review by the Board of Veterans Appeals but are subject to review in federal district court under the NIAA. Accordingly, it is important that all denials contain the evidence considered and an explanation of the basis for denial. Handling Requests for Relief Requests for relief from the Brady Act reporting requirements must be clear and explicit. Do not infer or interpret a request for relief as a claim for reconsideration of incompetence or a claim of competency as a request for relief. Development When VA receives a request for relief from the NICS reporting requirements, consult the table in Enclosure 1 regarding any actions that must be taken before the request for relief is ready to be developed and subsequent steps after development, if warranted. Competency Decision If a beneficiary has a relief request pending and VA determines that the beneficiary can manage his or her own benefits (is competent for VA benefit purposes), the request for relief is moot, and VA will notify DoJ of the beneficiary s change in status. DoJ will remove the beneficiary s information from NICS. In the final competency rating, include the following statement under Reasons for Decision for the competency issue: We received your request for relief from the DoJ reporting requirements contained in the Brady Handgun Violence Prevention Act. We have determined that you can manage your VA benefits. Therefore, it is not necessary to provide you a decision on your request for relief. VA will inform DoJ of

Page 3 your changed status, and DOJ will remove your information from the National Instant Criminal Background Check System. File all documents exclusive to this relief decision on the right side of the claims folder and in Virtual VA or incorporate them into VBMS as appropriate. Deciding Relief In determining whether to grant or deny a relief request, consider not just the beneficiary s desire to own firearms and/or ammunition. The beneficiary s safety and the safety of his/her family and the community must also be considered. As VA s determinations on requests for relief have the potential to affect public safety, grant relief on the basis of clear and convincing evidence. There is clear and convincing evidence to grant relief when the record shows affirmatively, substantially, and specifically that the beneficiary is not likely to act in a manner dangerous to public safety and that granting relief will not be contrary to the public interest. In determining whether to grant relief, VSRs must consider the evidence listed below. If the beneficiary does not provide the necessary evidence, the request is not ready for a decision. A current statement from the beneficiary s primary mental-health physician assessing the beneficiary s current and past (5-year period preceding the request for relief) mental health status, specifically whether the beneficiary has ever been a danger to himself or herself or to others, and whether he or she would pose such a danger if VA granted relief from the Brady Act restrictions and the beneficiary purchased and possessed a firearm. A statement is considered current if it is based upon an assessment conducted during the 90- day period immediately preceding the relief request. The beneficiary s reputation, as provided in statements and other evidence submitted by the beneficiary. These statements must identify the person supplying the information; provide the person s complete contact information, to include a current address and telephone number; and describe the person s relationship with the beneficiary and frequency of contact. The beneficiary may get such a statement from anyone, to include church clergy, law enforcement officials, employers, friends, and family members, as long as the person providing the statement has had recent and frequent contact with the beneficiary and can attest to the beneficiary s good reputation. Specifically, the person providing such a statement must indicate whether the beneficiary has a reputation for violence and whether the beneficiary would be a danger to himself or herself or others if VA granted relief from the Brady Act restrictions and the beneficiary purchased and possessed a firearm. A criminal history report, which the NICS POC will provide to the VSR upon request. If there are any questions as to the contents of the criminal history report or how to interpret the report once received from the NICS POC, direct them via e-mail to the NICS mailbox, VAVBAWAS/CO/NICS. The NICS POC will clarify the contents of the report with the VA Inspector General or other sources, as appropriate, and respond to the VSR with the pertinent information.

Page 4 The VSR must deny a request for relief and issue the appropriate administrative decision if the VSR determines, based upon clear and convincing evidence, that the beneficiary would be a danger to himself or herself or others if VA granted relief from the Brady Act firearm restrictions. This standard is satisfied if any of the following is reflected in the record: A mental-health professional s assessment of the beneficiary s current and past mental health status indicates that the beneficiary would be a danger to himself or herself or others if VA granted relief. A diagnosis of mental disability with symptoms, including the presence of suicidal or homicidal ideations. A diagnosis of substance abuse and symptoms indicating a danger to self or others. The beneficiary has a reputation for violence, which the VSR confirms by making contact with the person who provided the reputation evidence. The beneficiary is a convicted felon. Relief is available only if the beneficiary presents evidence that, notwithstanding the felony conviction, his or her right to possess a firearm has been restored. The beneficiary has a misdemeanor conviction in the past 5 years for a violent offense, including but not limited to menacing, stalking, assault, or battery, or any conviction for an attempt to commit such an offense. The beneficiary has been charged with a violent offense, but a court, board, or commission has determined that the beneficiary does not have the mental capacity to proceed with a trial (unless competency has been restored or the beneficiary has been rehabilitated through any procedure available under the law). The beneficiary has felony or misdemeanor charges pending for a violent offense, to include charges for attempting to commit such crimes. Absent such evidence, you must grant the beneficiary s relief request and issue an appropriate administrative decision. Administrative Decision The Regional Office (RO) will handle all requests for relief by preparing an administrative decision (see M21-1MR, Part III, Subpart v, Chapter 1, Section A, Topic 2). Since medical records may be used in deciding whether to grant or deny relief, an RVSR will review the evidence and then refer a summary of the evidence reviewed, via a VA Form 21-6796 (blue sheet), to the VSR, who will then prepare an administrative decision titled NICS Relief Request. The RO Director must approve all administrative decisions after concurrence by the

Page 5 Veterans Service Center Manager or Pension Management Center Manager, or the manager s designee. Inform the beneficiary of the determination by sending the NICS relief grant or denial letter (Enclosure 3 or 4). After sending the NICS relief grant letter, notify the NICS POC within 3 days at the NICS mailbox, VAVBAWAS/CO/NICS, under the subject NICS relief grant. The notification must include the beneficiary s name, claim number, Social Security number (if different than claim number), date of birth, contact information (including address and telephone number), and the date of the grant of relief. Compensation Service will notify the FBI, which manages the NICS database for DoJ, to remove the beneficiary from the NICS database. Questions Questions concerning this letter should be e-mailed to VAVBAWAS/CO/NICS. /S/ Thomas J. Murphy Director Compensation Service /S/ David R. McLenachen Director Pension and Fiduciary Service Enclosures

Page 6 Enclosure 1 Procedural Table for NICS Relief Development STEP: ACTION: 1 Before developing or reviewing the request for relief, wait until a final decision is reached on any claims involving incompetency or reconsideration of incompetency. IF: The request for relief is received prior to the final incompetency rating, THEN: Back flap the relief request or include a note that the relief request was received in VBMS as appropriate. Flash the file to note that there is a relief request pending that must be decided after the incompetency decision is made. Wait for the incompetency rating to become final before taking any additional actions regarding the request for relief. If the beneficiary is found competent, then the relief issue is moot. Follow the instructions in the Competency Decision section of this fast letter for the appropriate statement to include in the competency decision. A claim for reconsideration of competency is received in conjunction with the request for relief, If the beneficiary is found incompetent, then move to step 2. Back flap the relief request or include a note that the relief request was received in VBMS as appropriate. Flash the file to note that there is a relief request pending that must be decided after a decision is made on the claim for reconsideration. Wait for a decision on the claim for reconsideration of competency to become final before taking any additional actions regarding the request for relief. If the beneficiary is found to be competent, then the relief issue is moot. Follow the instructions in the Competency Decision section of this fast letter for the appropriate statement to include in the competency decision. If the beneficiary continues to be found incompetent, then move to step 2.

Page 7 The request for relief is received Move to step 2. following the final rating of incompetency, 2 Establish an end product (EP) 290 using NICS Relief Request claim label. 3 Send the NICS Relief Development Letter with the consent form to the beneficiary (Enclosure 2). The consent form allows VA to obtain the beneficiary s criminal history. 4 Wait 30 days after sending the NICS Relief Development Letter and consent form or until the consent form is received, then follow the procedures below based on whether a signed consent form is returned. IF: The beneficiary does not return the signed consent form within 30 days, The beneficiary returns the signed consent within 30 days, THEN: Deny the request for relief using the NICS Relief Denial Letter (Enclosure 4). Ensure an electronic copy of the signed consent form exists in VBMS or Virtual VA as appropriate. Move to step 5. 5 Verify that the beneficiary has submitted all required evidence. IF: THEN: The beneficiary has submitted both Move to step 6. of the following forms of evidence: Mental health evidence A current statement from the beneficiary s primary mental-health physician assessing the beneficiary s current and past (5-year period preceding the request for relief) mental health status. The assessment must specifically address whether the beneficiary has ever been a danger to himself or herself or to others and whether he or she would pose such a danger if VA granted relief from the Brady Act firearm restrictions and the beneficiary possessed a firearm. A current statement is based upon an assessment conducted during the 90-day period immediately preceding the relief request. Reputation evidence Statements and other evidence submitted by the beneficiary concerning any reputation for violence. These statements must identify the person

Page 8 supplying the information; provide the person s complete contact information, to include a current address and telephone number; and describe the person s relationship with the beneficiary and frequency of contact. The person providing such a statement must indicate whether the beneficiary has a reputation for violence and whether the beneficiary would be a danger to himself or herself or others if VA granted relief from the Brady Act firearm restrictions and the beneficiary possessed a firearm. Field offices must obtain all information available on beneificary criminal history: Request statements or other evidence from law enforcement officials showing that a request for relief will not be contrary to the public interest. If the beneficiary does not provide the required evidence: Deny the request for relief using the NICS Relief Denial Letter (Enclosure 4) stating a failure to submit the required evidence as the basis for the denial. 6 Make a decision on the request for relief using the following procedures: IF: THEN: A mental-health professional s assessment of the beneficiary s current and past mental health status indicates that the beneficiary would be a danger to himself or herself or others if VA granted relief; The beneficiary has a diagnosis of mental disability with symptoms including the presence of suicidal or homicidal ideations; The beneficiary has a diagnosis of substance abuse and symptoms indicating a danger to self or others; The beneficiary has a reputation for violence, which is confirmed by making contact with the person who provided the reputation Deny the request for relief using the NICS Relief Denial Letter (Enclosure 4). (See step 8.)

Page 9 evidence; The beneficiary is a convicted felon; The beneficiary has a misdemeanor conviction during the 5-year period immediately preceding the request for a violent offense, including but not limited to menacing, stalking, assault, or battery, or any conviction for an attempt to commit such an offense; The beneficiary has been charged with a violent offense but a court, board, or commission has determined that the beneficiary does not have the mental capacity to proceed with a trial; or The beneficiary has felony or misdemeanor charges pending for a violent offense, to include charges for attempting to commit such crimes. If none of the above conditions exists: If the RVSR determines that the request for relief should be granted based on the evidence, Grant the request for NICS relief using the NICS Relief Grant Letter (Enclosure 3) Forward the signed consent form to the NICS point of contact (POC) at the NICS mailbox, VAVBAWAS/CO/NICS. In the email, provide the claimant s name, file number, and date of request. In the subject line of the email, include Criminal History Needed. Move to step 7. 7 Once the criminal history report is received from the NICS POC, the RVSR must re-

Page 10 evaluate the evidence while taking into account the beneficiary s criminal history. If there are any questions as to the contents of the criminal history report, contact the NICS POC, who will clarify the contents of the report with the Federal Bureau of Investigation (FBI) or VA Office of General Counsel as appropriate. 8 Follow the procedures below according to whether the RVSR determines that the request for relief should be granted or denied based on all the evidence, including the criminal history. IF: If the RVSR determines that the request for relief should be denied based on all the evidence, including the criminal history, If the RVSR determines that the request for relief should be granted based on all the evidence, including the criminal history, THEN: The RVSR will provide this information via a VA Form 21-6789, Deferred Rating Decision (blue sheet) noting the results of the medical evidence reviewed, to the VSR, and the VSR should write up the administrative decision to reflect this evidence (following the instructions in the Administrative Decision section of this fast letter) and deny the request for relief using the NICS Relief Denial Letter (Enclosure 4). The RVSR will provide this information to the VSR via a blue sheet noting the results of the medical evidence reviewed, and the VSR should write up the administrative decision to reflect this evidence (following the instructions in the Administrative Decision section of this fast letter) and grant the request for relief using the NICS Relief Grant Letter (Enclosure 3).

Page 11 Enclosure 2 NICS Relief Development Letter VARO Heading and Address XXXXXXXXXXX XXXXXXXXXXXXX XXXXXXXXXXXX In reply, refer to: File Number: XXXXXXX IMPORTANT reply needed Dear Mr./Ms.: We received your request for relief from the Department of Justice reporting requirements contained in 18 U.S.C. 922(d)(4) and (g)(4), The Brady Handgun Violence Prevention Act of 1993 (The Brady Act), Public Law 103-159. VA must report to the National Instant Criminal Background Check System (NICS) individuals whom VA determines to be unable to manage their own financial affairs. Pursuant to 18 U.S.C. 925(c) and 101(c)(2)(A) of the NICS Improvement Amendments Act of 2007, Public Law 110-180, after receiving your request for relief, VA is obligated to decide whether you are eligible to receive relief from the reporting requirements of the Brady Act. This letter contains information about what we will do with your request and what you can do to help us decide it. We may grant relief if clear and convincing evidence shows the circumstances regarding your disability and your record and reputation are such that you are not likely to act in a manner dangerous to yourself or others and the granting of relief is not contrary to public safety and/or the public interest. In order for us to process your request, you must submit the required evidence outlined below within 30 days from the date of this letter. If we do not receive all of the required evidence, your request for relief will be denied. What Evidence Should You Provide? To support your request for relief, you must submit all of the following evidence: A statement from your primary mental-health physician assessing your mental health status over the last five years. Medical information addressing the extent of your mental health symptoms and whether or not you are likely to act in a manner dangerous to yourself or to public.

Page 12 Evidence of your reputation, through character witness statements, testimony, or other character evidence. This may include statements from clergy, law enforcement officials, and/or persons that are aware of your reputation in the community and show that the granting of relief would not be contrary to the public interest. (Statements or records from law enforcement officials may be provided by the Federal Bureau of Investigation (FBI); the Bureau of Alcohol, Tobacco, and Firearms (ATF); the Attorney General, or other local law enforcement agencies.) A signed consent form that is attached to this letter that will allow us to procure your criminal history. You may also submit documentation that a court, board, or commission has found you competent. Please put your VA file number on the first page of every document you send us. Where Should You Send Your Evidence? Please send all documents to this address: (include RO address) How Soon Should You Send Your Evidence? We strongly encourage you to send any information or evidence as soon as you can. If we do not hear from you within 30 days, we will deny your request. How Can You Contact Us? Please give us your VA file number, XXXXXXXXXX, when you do contact us. Send written correspondence to the address above. Send us an inquiry using the Internet at https://iris.custhelp.com. Call us at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the number is 1-800-829-4833. We look forward to resolving your request in a timely and fair manner. Sincerely yours, Enclosure Veterans Service Center Manager

Page 13 Consent for VA to Obtain a Criminal History for the Purpose of NICS Relief I understand that the Department of Veterans Affairs (VA) may seek to obtain my criminal background history during consideration of my request for relief from the reporting requirements contained in 18 U.S.C. 922 (d)(4), The Brady Handgun Violence Protection Act of 1993, Public Law 103-159, and National Instant Criminal Background Check System (NICS) Improvement Act Amendment Amendments of 2007, Public Law 110-180. I consent to VA seeking this information from any and all sources and give permission for the release of my criminal background history and any other associated documents to VA. I further waive my rights under the Privacy Act, 5 U.S.C. 552a(b), with regard to the release of this information to VA from any federal or state agency. Name: Claim Number: Signature of Veteran: Date:

Page 14 Enclosure 3 NICS Relief Grant Letter VARO Heading and Address XXXX XXXXXXXX XXXXX, XX XXXXX In reply, refer to: File Number: xxx xx xxxx Dear Mr./Ms. : We received your request for relief under the National Instant Criminal Background Check System (NICS) Improvement Amendments Act of 2007 (NIAA), Public Law 110-180. What We Decided We decided that you are eligible for relief from the Department of Justice reporting requirements imposed by The Brady Handgun Violence Protection Act of 1993, Public Law 103-159, codified at 18 U.S.C. 922. We reviewed the following evidence in considering your request: (enter evidence) Our review of this evidence reveals that your disability, record, and reputation are such that you are not likely to act in a manner dangerous to yourself or others. Further, the granting of relief is not contrary to public safety or the public interest. Please allow the Department of Justice up to eight weeks to update its records in accordance with our decision. If You Have Questions or Need Assistance You may find more information about the NICS Relief program in 18 U.S.C. 925(c). If you have any questions regarding this decision, you may contact us by letter, Internet, or telephone. In all communications, be sure to refer to your VA file number, XXXXXXXX. To Contact VA by Mail Internet Telephone Here is what to do. Send inquiries to the address at the top of this letter Send an inquiry via VA s website at https://iris.custhelp.com Call 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the number is 1-800-829-4833.

Page 15 We sent a copy of this letter to your representative, XXXXXX, whom you can also contact if you have questions or need assistance. Sincerely yours, Veterans Service Center Manager cc:

Page 16 Enclosure 4 NICS Relief Denial Letter VARO Heading and Address XXXX XXXXXXXX XXXXX, XX XXXXX In reply, refer to: File Number: xxx xx xxxx Dear Mr./Ms. : We received your request for relief under the National Instant Criminal Background Check System (NICS) Improvement Amendments Act of 2007 (NIAA), Public Law 110-180. What We Decided We determined you are not eligible for relief from the Department of Justice reporting requirements imposed by The Brady Handgun Violence Protection Act of 1993, Public Law 103-159, codified at 18 U.S.C. 922. We considered the following evidence: (enter evidence) Based on this review, we are unable to conclude through clear and convincing evidence regarding your disability, record, and reputation that you will not likely act in a manner dangerous to yourself or others and the granting of relief would not be contrary to the public interest. Your Right for Review NIAA relief requests are not matters which fall within the scope of title 38 of the United States Code and denial of such requests are not subject to review by the Board of Veterans Appeals. However, denials of requests for relief under the NIAA are subject to review in federal district court. See 18 U.S.C. 925(c) for more information concerning your appellate rights. If You Have Questions or Need Assistance You may find more information about the NICS Relief program in 18 U.S.C. 925(c). If you have any questions regarding this decision, you may contact us by letter, Internet, or telephone. In all cases, be sure to refer to your VA file number, XXXXXXXX.

Page 17 To Contact VA by Mail Internet Telephone Here is what to do. Send inquiries to the address at the top of this letter Send an inquiry via VA s website at https://iris.custhelp.com. Call 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the number is 1-800-829-4833. We sent a copy of this letter to your representative, XXXXXX, whom you can also contact if you have questions or need assistance. Sincerely yours, Veterans Service Center Manager cc: