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Collects applicant identity and contact details, residence information, CBP port, date of birth, birthplace, Social Security number, and phone numbers. Includes questions on eligibility for accommodations under the American Disabilities Act and whether the applicant is a U.S. officer or employee. Contains a certification section, signature and date, and detailed Privacy Act and Paperwork Reduction Act notices describing how information will be used and potential disclosure requirements.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cbp-form-3124e-customs-broker-license-exam-application/395694/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cbp-form-3124e-customs-broker-license-exam-application/395694.png","ImageObject",300,407,{"name":92,"@type":93},"Ben ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-26",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What information does CBP Form 3124E collect from the applicant?","Question",{"text":112,"@type":113},"It collects applicant name and address, residence address, CBP port, date of birth, birthplace, Social Security number, and both home and business phone numbers, plus remarks as needed.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Does the form ask about ADA accommodations and U.S. employment status?",{"text":117,"@type":113},"Yes. It asks whether the applicant seeks accommodations under the American Disabilities Act and whether the applicant is a U.S. officer or employee, with explanations provided in Block 11.",{"name":119,"@type":110,"acceptedAnswer":120},"How is the Social Security number used according to the Privacy Act notice?",{"text":121,"@type":113},"The Privacy Act notice states the SSN is voluntary to provide, used as an identifier during the background investigation and throughout the Customs broker’s career, and failure to provide requested information may prevent the required investigation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},395694,1790650001,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81,"preview_page_count":4},2336478951081,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","DEPARTMENT OF HOMELAND SECURITY  \nSee bottom of form for Paperwork Reduction Act Notice.  \n\n| U.S.Customs and Border Protection  \u003Cbr>APPLICATION  \u003Cbr>FOR  \u003Cbr>CUSTOMS BROKER LICENSE EXAM  \u003Cbr>19 U.S.C.1641;19 CFR 111.13   | 1.APPLICANT'S NAME AND ADDRESS   |\n| --- | --- |\n| 2.RESIDENCE ADDRESS(If different from Block 1;if same,write \"SAME\")   | 3.CBP PORT   |\n| 4.DOES THE APPLICANT SEEK ACCOMODATIONS UNDER THE  \u003Cbr>AMERICAN DISABILITIES ACT?  \u003Cbr>□NO  \u003Cbr>□YES (Explain in Block 11)   | 5.IS THE APPLICANTAN OFFICER OR EMPLOYEE OF THE UNITED STATES?  \u003Cbr>□YES (Explain in Block 11)  \u003Cbr>□NO   |\n\nSECTIONI  \n\n| 6.DATE OF BIRTH   | 7.BIRTHPLACE(City &State)   | 8.SOCIAL SECURITY NO.   | 9.HOME PHONE NO.   | 10.BUSINESS PHONE NO.   |\n| --- | --- | --- | --- | --- |\n|  |  |  |  |  |\n\n11.REMARKS (In responding to questions above,include Block no.If more space is needed,continue on blank sheet of paper.)  \nSECTIONⅡ--CERTIFICATION  (WARNING:Any misstatement of pertinent facts in this application constitutes suficient grounds for denial for denial of the application.)    \nI,                      certify that the statements contained in the foregoing application and supporting attachments thereto aretrue and correct to the best of my knowledge and belief.  \n16.DATE  \n# 15.SIGNATURE\n\nPrivacy Act Notice:Pursuant to the requirements of Public Law 93-579(Privacy Act of 1974),as amended,notice is hereby given in accordance with 5 U.S.C.552a(e)(3)that the authority to collect information on CBP Form 3124E is 19 U.S.C.1641;5U.S.C.301;Reorganizatio plan no.1 of 1950;TreasuryDepartment Order No.165,Revised,as amended;19 CFR Part 11.The principal purpose for collecting the nformationis to enable the U.S.Customs andBorder Protection to conduct a background investigationon the appicant and therebydetermine whether the applicant meets the criteria established for theissuance ofa Customs broker's license.The informationcollected nd contained in the applicant's file,may e providedto those employees of the Departmentof Homeland Security,U.S.Customs and Border Protection who have a need for the records in the performace of theirduties.Theinformation may also beused,when deemed appropriate,to recommend to the Commissioner of U.S.Customs and Border Protection that discilinary action be initiated,and furtherprovide to the Department of Justice for its use in connetion with appeals fromorders resulting in the suspension or revocation of licenses.Similarly theinformation may be furnished to other government agencies which have an interest in the broker or in the situation that led to the disciplinary action.  \nDisclosure of the requested information including the Social Security number (SSN)is voluntary.The SSN will be used as an identifier in conducting abackground investigation and will be used as an identifier throughout the career of the Customs broker.Failure to provide any or all of the information requestedmay řesut in the cBP inability to conduct the backgroun invesigation as required prior to the issuance ofalicense.Pursuant to the requirements of 19CFR111.12(b)the information contained in Blocks 1,2,3,22 and 23 may be released to the public and posted by appropriate electronic means.              \nPaperwork Reduction Act Statement:An agency may not conduct or sponsor an information collection and a person is not requiredto respond to this informationunless it displays a current vaid OMB control number and an expiration date.The control number for this collection is 1651-0034.The estimated average time tocomplete this application is 1 hour.If you have any commments regarding the burden estimate you can write t U.S.Cusoms and Border Protection,Office ofRegulations and Rulings,7999th Street,NW.,Washington DC 20229.","cbCaiecO7EQRALQk","https://ap.wps.com/l/cbCaiecO7EQRALQk","pdf",194374,"English","# Applicant Information\n## Sections 1 and 2\n# Certification and Signature\n# Privacy Act Notice\n# Paperwork Reduction Act Statement","[{\"question\":\"What information does CBP Form 3124E collect from the applicant?\",\"answer\":\"It collects applicant name and address, residence address, CBP port, date of birth, birthplace, Social Security number, and both home and business phone numbers, plus remarks as needed.\"},{\"question\":\"Does the form ask about ADA accommodations and U.S. employment status?\",\"answer\":\"Yes. It asks whether the applicant seeks accommodations under the American Disabilities Act and whether the applicant is a U.S. officer or employee, with explanations provided in Block 11.\"},{\"question\":\"How is the Social Security number used according to the Privacy Act notice?\",\"answer\":\"The Privacy Act notice states the SSN is voluntary to provide, used as an identifier during the background investigation and throughout the Customs broker’s career, and failure to provide requested information may prevent the required investigation.\"}]","CBP Form 3124E - Customs Broker License Exam Application | PDF",1790422984]