20240712 - EXIM 800-171 Attestation Form.pdf
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- 83310126Q13CA
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Export Import Bank of the US
About this file
This is a NIST SP-800-171 Compliance Attestation Form, a template document used by vendors to formally certify their adherence to federal security requirements for protecting controlled unclassified information (CUI) in nonfederal systems and organizations.
The form requires vendors to complete identification fields including company name, contact person, title, address, phone number, and email. The attestation statement certifies that the vendor's organization has assessed its information systems and processes against NIST SP-800-171 guidelines and confirms three key compliance elements: (1) all systems and components handling CUI are included within the scope of compliance; (2) a System Security Plan (SSP) has been developed, documented, and implemented that accurately describes the system boundary, operational environment, security requirement implementation, and connections to other systems; and (3) a Plan of Action and Milestones (POA&M) has been developed to document deficiencies and establish reasonable resolution dates for addressing any unimplemented security requirements. The authorized representative must sign and date the certification, attesting under penalty of perjury that the information provided is accurate and that the vendor maintains compliance with NIST SP-800-171 as of the signature date. This attestation serves as a required compliance document for federal contracting opportunities involving CUI handling.
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Text version
NIST SP-800-171 Compliance Attestation Form
Vendor Information
• Vendor Name: ______________________
• Contact Person: ____________________
• Title: _____________________________
• Address: ___________________________
• Phone Number: _____________________
• Email: _____________________________
Attestation Statement [Vendor Name] adheres to the security requirements set forth by NIST Special Publication 800- 171, "Protecting Controlled Unclassified Information in Nonfederal Systems and Organizations."
I confirm that our organization has assessed our information systems and processes against the NIST SP-800-171 guidelines and attest to the following:
1. Scope of Compliance:
o All systems and components where controlled unclassified information (CUI) is stored, processed, or transmitted are covered under this attestation.
2. System Security Plan (SSP):
o An SSP has been developed, documented, and implemented as required by NIST
SP-800-171.
o The SSP includes an accurate description of the system boundary, operational environment, how security requirements are implemented, and the relationships with or connections to other systems.
3. Plan of Action and Milestones (POA&M):
o A POA&M has been developed to document any deficiencies and describe how and when any unimplemented security requirements will be addressed.
o POA&Ms are not open ended and have reasonable resolution dates for closure of nonconformities.
Certification: By signing below, I certify that the information provided here is accurate and that [Vendor Name] maintains compliance with NIST SP-800-171 as of the date signed below.
Signature: ___________________________ Date: _______________________________
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