AFNWC-2023-1130-1-Limited Sources J A for FA9422-24-F-0004-wkst-signed.pdf

AFNWC PUBLIC AFFAIRS

SECURITY AND POLICY REVIEW WORKSHEET

(See page 2 for instructions.)

Note: This is an application to clear information or materials for public release. Public-release clearance is NOT required for information or materials presented in a closed meeting or will not made available to the general public, posted on the internet, or distributed to public audiences in print or electronic media.

1. DATE NEEDED (15 working days for PA) 2. SUBMITTER REFERENCE NO.

ORG/OFC SYM

3. SUBMITTER (U.S. Government member; cannot be a contractor; responsible for submission)

NAME

PHONE

EMAIL

ORG. EMAIL

4. PRIMARY AUTHOR

NAME

PHONE

ORG/OFC SYM

EMAIL

5. DOCUMENT TITLE

6. CONFERENCE/EVENT/PUBLICATION/WEBSITE/PUBLIC WEB URL 7. EVENT/PUBLICATION DATE

10. DOCUMENT TYPE

OTHER

11. BUDGET CATEGORY (Choose N/A if not applicable)

OTHER

12.a. NATIONAL SECURITY STATUTES/TECHNOLOGY ISSUES: Are any aspects of this technology included in: U.S. Munitions List; ITAR 22, CFR Part 121; CCL; Program Protection Plan or Security Classification Guide? (If YES, explain rationale for release in Block 14) YES NO

YES NO

NO

14. EXPLANATIONS (additional comments, previous related cases [include case number], additional coordination accomplished/required; instructions on page 2)

CERTIFICATION AND COORDINATION SIGNATURES

Obtain all applicable signatures before submission to PA. Signatures cannot be repeated in multiple blocks; submitter or author cannot sign Block 16; only duly appointed Security Manager and STINFO Officer can sign Blocks 17 & 18 respectively. Per regulatory guidance, contractors cannot sign Blocks 15-20. (See page 2 for instructions.)

ORG OFFICE SYMBOL

SIGNATURE

DUTY TITLE DATE

17. SECURITY MANAGER (Required; must be duly appointed by letter) I certify that the information has been reviewed and the information contains no Operational Security or foreign disclosure issues.

NAME

21. PA USE ONLY

NOTES:

PUBLIC AFFAIRS OFFICER CASE NUMBER NO OBJECTION

RETURN - NO ACTION

NOT CLEARED

CLEARED

CLEARED AS AMENDED

CLEARED w/Recommendation

OTHER (Annotate in notes) OBJECTION

AFNWC PUBLIC AFFAIRS SECURITY AND POLICY REVIEW WORKSHEET, 20220726 - All previous versions are obsolete.

*8. SPONSOR/OWNER of this conference/event/publication/website is:

Industry Professional Association Academia

ORG OFFICE SYMBOL

SIGNATURE

DUTY TITLE DATE

ORG OFFICE SYMBOL

SIGNATURE

DUTY TITLE DATE

ORG OFFICE SYMBOL

SIGNATURE

DUTY TITLE

16. TECHNICAL REVIEW AND CERTIFICATION (Required) The information contained in the attached document is technically accurate; does not disclose classified, sensitive, or militarily critical technology; does not violate proprietary rights or copyright restrictions, is not subject to export control regulations and is suitable for public release.

NAME

18. STINFO OFFICER (Required if 12.d checked above; must be duly appointed by letter) I certify that the information has been reviewed and may be released IAW the guidelines of DoDI 5230.24 and AFI 61-201.

NAME

N/A

15. DOD ORIGINATOR/PROGRAM MANAGER (Required) I certify the attached material is unclassified, technically accurate, contains no critical military technology, is not subject to export controls and is suitable for public release.

NAME

DATE

ORG OFFICE SYMBOL

SIGNATURE

DUTY TITLE DATE

19. ADDITIONAL REVIEWER (If required by the unit or requested by PA) I certify that this information is suitable for public release.

NAME

ORG OFFICE SYMBOL

SIGNATURE

DUTY TITLE DATE

20. ADDITIONAL REVIEWER (If required by the unit or requested by PA) I certify that this information is suitable for public release.

NAME

AFOSR

If contractor authored the materials, enter the contract # below; Primary Contracting Officer (PCO) or Contracting Officer Representative (COR) must sign in Block 15.

e. Is this information identified as a topic of potential elevation for SAF review in AFI 35-101?

YES NO (If YES, explain in Block 14)

f. If this material results from an international agreement, is the DoD authorized to release program information? (If NO, identify release authority organization in Block 14)

g. If a joint program, does your organization maintain primary management responsibility and authority to release all information? (If NO, provide name of lead organization/POC, e.g., DARPA, NASA, Army, Navy, etc., in Block 14) or in a

Other personal/private capacity (if personal/private, you must include a disclaimer as noted in AFI 35-101, para. 9.4.)

b. Does this information meet the criteria for Public Release and unclassified, unlimited distribution? YES NO

c. Are any references classified or subject to distribution limitations? (If YES, explain rationale for release in Block 14)

d. STINFO. Does this document contain technical information relating to research, development, engineering, testing, evaluation, production, operation or maintenance of any military/space equipment or technology?

(If YES, the STINFO officer must sign in Block 18 per AFI 61-201, para. 3.4.5)

13. CONTRACTS PIA 6.x Funded Other

YES NO

YES NO

YES

N/A

*9. THIS DOCUMENT IS WRITTEN in my official/work https://static.e-publishing.af.mil/production/1/saf_pa/publication/afi35-101/afi35-101.pdf#page=166 https://static.e-publishing.af.mil/production/1/saf_pa/publication/afi35-101/afi35-101.pdf#page=166

− Requests for rush reviews in less than 15 working days must be accompanied by a justification letter signed by the 2-letter director; however, submitting a rush request does not guarantee your material can be cleared on time due to other PA priorities and cases.

− Submissions received in less than 15 working days without a justification letter will not be reviewed and will be returned with no action taken.

− Depending on complexity, requirements for additional coordination, and PA manning, cases can take longer to process than 15 working days.

− Items already publicly presented or published, or submitted for public publication, will not be reviewed and will be returned with no action taken.

Block 2: Optional. Include your organizational reference/tracking number, if desired. Tracking numbers will not be added by PA.

Block 3: Organizational submitter information. Responsible for submission throughout review process, including responding to requests or questions from PA; lack of response to PA may result in case being returned with no action taken. Receives notification when case is accepted and completed. Notifies author when case is completed and final resolution.

Block 4: List only primary author’s name, even if multiple authors. Receives notification from submitter when is case is completed. Cannot perform technical, OPSEC or STINFO reviews.

Blocks 6 & 7: Identify date of event/name of publication where submission will be published, or web site URL where cleared material will be posted. Identify date of event or date of publication/posting to web site. If the date in Block 7 is before the date needed in Block 1, the document will not be reviewed and will be returned with no action taken.

Block 8: Identify the type of organization where information will be presented; for documents, identify the type of publication/website where it is to be presented/posted. If "Other" is selected, then you must provide an explanation in Block 14.

Block 9: If the document was created as part of your official duties/requirements, no disclaimer is needed; if it is a personal endeavor, you must include the standard disclaimer.

Block 10: Indicate the type of document or information to be reviewed from the pull-down menu, or choose "Other" and fill in that blank.

Block 11: Identify the budget category or program element code associated with the weapon system from pull-down menu, or choose "NA." If "Other" selected, you must fill in that box.

Block 12: Materials that must be or are marked For Official Use Only (FOUO), Controlled Unclassified Information (CUI), or Distribution B or higher will not be cleared for public release.

If classified references are used, annotate in Block 14 the exact references, how each reference is NOT considered CUI/FOUO/classified, implications if the reference to classified or distribution-limited information is removed from your submission, and approval to release to public from owning authority and your two-letter director. If 12.f or 12.g is marked "NO" and release authority is not identified in Block 14, the document will be returned with no action taken.

Block 13: Identify contract number if a contractor authored the materials; primary contracting officer or contracting officer representative must sign Block 15.

Block 14: Include additional comments from other blocks, list previous related cases, clearly identify coordination with agencies already accomplished, release authority if 12.f or 12.g is marked "NO." If additional coordination with other command agencies is required, provide POC information (use page 2 and additional sheets as necessary).

CERTIFICATION AND COORDINATION SIGNATURES

Note: Signatures cannot be repeated in multiple blocks. Obtain all applicable signatures before submission to PA. Per regulatory guidance, contractors may not sign Blocks 15-20.

Block 15: Mandatory signature certifies that the U.S. Government originator, program manager, or author concurs that the information is appropriate for public release based on regulations, classification guides, and any other pertinent guidance.

Block 16: Mandatory signature certifies that the information has been reviewed by a U.S. Government superior/authorized peer reviewer/subject matter expert and is appropriate for public release based on regulations, classification guides, and any other pertinent guidance. Neither submitter nor author can perform technical review or certification.

Block 17: Mandatory signature certifies that the information contains no Operational Security (OPSEC) issues. Must be signed by a U.S. Government OPSEC Officer or Security Manager who is duly appointed by letter.

Block 18: Mandatory signature if 12.d is marked "YES." Certifies that the information has been reviewed and may be released IAW the guidelines of DoDI 5230.24 and AFI 61-201. Must be signed by a STINFO Officer who is duly appointed by letter. If 12.d is marked "YES" and STINFO Officer has not signed Block 18, the document will be returned with no action taken.

Blocks 19 & 20: Use for additional reviews as necessary and to document coordination with outside agencies/program offices or if organizations have an internal process that requires an additional signature.

INSTRUCTIONS FOR COMPLETING THE SECURITY AND POLICY REVIEW WORKSHEET

NOTE: If all required information is not provided, case will be returned with no action taken and must be resubmitted.

Block 1: Allow at least 15 working days, not including day of submission, for local PA review; if a submission requires higher level reviews or additional coordination, processing time could take up to 45 working days; if date needed not specified, then standard processing times will apply.

14. Explanations (Continued)

AFNWC PUBLIC AFFAIRS SECURITY AND POLICY REVIEW WORKSHEET, 20220726 - All previous versions are obsolete.

6.