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Criminal Resource Manual 710 Release Form -- Psychological Evaluation

710

Release Form—Psychological Evaluation

The Witness Security Reform Act of 1984 requires a psychological evaluation of each individual (over 18 years old) who is being considered for inclusion in the Witness Security Program.
The suitability of an individual for the Program must be determined by OEO before that person may be accepted into the Program. One of the factors that must be considered in determining the suitability of an individual for acceptance into the Program is the report of the psychological evaluation.
After an individual has been psychologically evaluated, the examining authority will prepare and submit a report to the Office of Enforcement Operations, Criminal Division, Department of Justice, so that a determination can be made as to the suitability of the witness for the Program.
The following is the release form, referred to in USAM 9-21.330, that each individual being psychologically evaluated is required to sign, prior to the evaluation:
I, _______________, certify that I have read and understand the foregoing and that I voluntarily submit to this psychological evaluation. I also understand that my acceptance or rejection for placement in the Witness Security Program is not solely dependent upon the results of this psychological evaluation.
I also certify that I have no objection if the contents of the report of my psychological evaluation are disclosed to others in connection with my consideration for the Program or other lawful use.

(Date) (Signature)

(Witness or adult family member)

[cited in USAM 9-21.330]

Updated February 19, 2015