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Request for Report on Loyalty Data Standard Form 84A, August 4, 1947
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REQUEST FOR REPORT ON LOYALITY DATA

This form was apparently used by U.S. government agencies to request "loyalty" information from other government agencies.

The text of the standard request is as follows:

The following information is furnished for identification purposes on the person named below. Kindly furnish a report on any derogatory loyalty information contained in your files. (The fingerprints of this person are attached.)

The flipside of the form has a blank space under the text heading "REPORT OF DEROGATORY INFORMATION DEVELOPED" with a line at the bottom for the name of the "Reporting Agency" to be filled in.

The form template is dated August 4, 1947, a few months after the distinguished junior Senator from Wisconsin, Joseph McCarthy, took office. Probably just a coincidence.
REQUEST FOR REPORT ON LOYALITY DATA
Standard Form 84A
Promulgated August 4, 1947
By Civil Service Commission
U.S Government Printing Office
16-52840-1

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