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CAPS Release of Information for Security Clearances

When completing a security clearance application, a current or previous student may be asked to disclose information regarding mental health therapy and/or alcohol-related services. Once this information is disclosed, it is likely that the investigation process will include gathering information from the agency that provided the mental health services. If CAPS is asked to disclose information, it is necessary that a CAPS Authorization for Use, Disclosure and/or Release of Protected Health Information form be completed and the specific mental health information that you wish to be released be indicated. Generally, information asked by a security clearance investigator may include the following:
  • Name
  • Date of Birth
  • Dates of Services
  • Number of Sessions
  • Names of Providers
  • Diagnosis
  • Type(s) of Treatment (including medications prescribed)
  • Reason for Referral to CAPS (initial complaint or condition)
  • Referrals Made
  • Whether the person under investigation has a condition that could impair his or her judgment, reliability or ability to properly safeguard classified national security information

**Please note that the interview process and questions asked may vary based on the agency facilitating the security clearance; therefore, it is necessary for the current or previous client to detail the specific information to be disclosed on the CAPS authorization form.

Once the CAPS Authorization for Use, Disclosure and/or Release of Protected Health Information form is completed, the CAPS Care Manager will meet briefly with the security clearance investigator to verbally disclose the information that was consented to on the completed authorization form. No copies of the mental health record are released during this process, or actually shown to the investigator, unless previously requested by the investigator and authorized in writing by the client.

For questions regarding CAPS’ Release of Information process, please contact the Care Manager at 765-494-6695. For questions regarding the security clearance process, please contact your investigator.