Att 8 - LT-CRDS DD Form 254.pdf
PDF 71 KB Posted
- Attached to
- Long-Term Capabilities Requirements Document Development Support (LT-CRDS) Federal contract opportunity
- Solicitation number
- HT001124R0064
- Issued by
- Defense Health Agency
About this file
This document is a Department of Defense Contract Security Classification Specification (DD Form 254) outlining classified information handling requirements for solicitation number HT001124R0064, the Long-Term Capabilities Requirements Document Development Support contract opportunity issued by the Defense Health Agency. The contractor will require access to classified information up to the Secret level and will receive and store classified documents at various government sites in the National Capital Region. The contractor must follow all National Industrial Security Program Operating Manual requirements and have the appropriate facility and personnel security clearances in place prior to contract award. The contractor will also access the NIPRNET and SIPRNET systems to support contract activities.
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PREVIOUS EDITION IS OBSOLETE.
Page of
DD FORM 254, APR 2018
NEEDS DD67
DEPARTMENT OF DEFENSE
CONTRACT SECURITY CLASSIFICATION SPECIFICATION
(The requirements of the National Industrial Security Program (NISP) apply to all security aspects of this effort involving classified information.)
OMB No. 0704-0567 OMB approval expires:
June 30, 2025 The public reporting burden for this collection of information, 0704-0567, is estimated to average 70 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.
1. CLEARANCE AND SAFEGUARDING
2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)
3. THIS SPECIFICATION IS: (X and complete as applicable.)
a. ORIGINAL (Complete date in all cases.)
b. REVISED (Supersedes all previous specifications.)
4. IS THIS A FOLLOW-ON CONTRACT?
If yes, complete the following:
Classified material received or generated under
5. IS THIS A FINAL DD FORM 254?
If yes, complete the following:
6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code)
7. SUBCONTRACTOR(S) (Click button if you choose to add or list the subcontractors -- but will still require a separate DD Form 254 issued by a prime contractor to each subcontractor)
8. ACTUAL PERFORMANCE (Click button to add more locations.)
10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)
e. NATIONAL INTELLIGENCE INFORMATION:
11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: (X all that apply. See instructions. Provide details in Blocks 13 or 14 as set forth in the instructions.)
12. PUBLIC RELEASE
Any information (classified or unclassified) pertaining to this contract shall not be released for public dissemination except as provided by the National Industrial Security Program Operating Manual (NISPOM) or unless it has been approved for public release by appropriate U.S. Government authority. Proposed public releases shall be submitted for review and approval prior to release to the appropriate government approval authority identified here with at least office and phone contact information and if available, an e-mail address. (See instructions)
13. SECURITY GUIDANCE
The security classification guidance for classified information needed for this effort is identified below. If any difficulty is encountered in applying this guidance or if any other contributing factor indicates a need for changes in this guidance, the contractor is authorized and encouraged to provide recommended changes; to challenge the guidance or the classification assigned to any information or material furnished or generated under this contract; and to submit any questions for interpretation of this guidance to the official identified below. Pending final decision, the information involved shall be handled and protected at the highest level of classification assigned or recommended.
(Fill in as appropriate for the classified effort. Attach, or forward under separate correspondence, any documents/guides/extracts referenced herein. The field will expand as text is added. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted. Also allows for up to 6 internal reviewers to digitally sign. See instructions for additional guidance or use of the fillable PDF.)
List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form)
14. ADDITIONAL SECURITY REQUIREMENTS
Requirements, in addition to NISPOM requirements for classified information, are established for this contract.
If Yes, identify the pertinent contractual clauses in the contract document itself, or provide an appropriate statement which identifies the additional requirements. Provide a copy of the requirements to the CSO. The field will expand as text is added or you can also use item 13. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted. (See instructions for additional guidance or use of the fillable PDF.)
15. INSPECTIONS
Elements of this contract are outside the inspection responsibility of the CSO.
If Yes, explain and identify specific areas and government activity responsible for inspections. The field will expand as text is added or you can also use item 13. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted. (See instructions for additional guidance or use of the fillable PDF.)
16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)
17. CERTIFICATION AND SIGNATURES
Security requirements stated herein are complete and adequate for safeguarding the classified information to be released or generated under this classified effort. All questions shall be referred to the official named below. Upon digitally signing Item 17h, no changes can be made as the form will be locked.
18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL
9.0.0.2.20120627.2.874785 DD 254, "DoD Contract Security Classification Specification"
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| Select classification from drop-down list.: |
| SerialNum: |
| a. Facility clearance level. Select one.: 2 |
| b. Level of safeguarding for classified information/material required at contractor facility. Select one.: 2 |
| Select for "original.": 0 |
| Select for "original.": 1 |
| Enter prime contract number.: |
| Select for "revised.": 0 |
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| Enter subcontract number.: |
| Select for "final.": 1 |
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| Enter solicitation or other number.: HT001124R0064 |
| Enter due date in format YYYYMMDD.: |
| Enter date in format YYYYMMDD.: 20231121 |
| Enter revision number.: |
| Enter date in format YYYYMMDD.: |
| Enter final specification.: |
| Enter date in format YYYYMMDD.: |
| Select for "no.": 1 |
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| Select for "yes.": 0 |
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| Enter preceding contract number.: |
| Enter contractor's request date in format YYYYMMDD.: |
| Enter period.: |
| Enter typed name of certifying official (last, first, middle initial).: |
| Enter CAGE code of the prime contractor.: |
| Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: |
| Select to add row to locations.: |
| Select to remove last row from locations.: |
| Select to delete all signatures.: |
| Enter location(s).: Defense Health Agency |
7700 Arlington Blvd Falls Church, VA 22042 Enter general unclassified description of this procurement.: DHA J5 Capability Management Division requires contract to support the continued development of joint capability documents. This support is a critical need considering DHA views joint requirements as a top enterprise priority and currently does not have a Joint Requirements office. The work site location and the requesting organization is Defense Health Headquarters (DHHQ) in Falls Church, VA.
| Select for "a. CONTRACTOR.": 1 |
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| Select for "f. OTHER AS NECESSARY.": 0 |
| Select for "f. OTHER AS NECESSARY.": 0 |
| Select for "f. OTHER AS NECESSARY.": 0 |
| Select for "b. SUBCONTRACTOR.": 0 |
| Select for "b. SUBCONTRACTOR.": 1 |
| Select for "b. SUBCONTRACTOR.": 0 |
| Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0 |
| Select for "g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER.": 0 |
| Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0 |
| Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 0 |
| Select for "c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR.": 1 |
| Select for "h. REQUIRE A COMSEC ACCOUNT.": 0 |
| Select for "h. REQUIRE A COMSEC ACCOUNT.": 0 |
| Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 0 |
| Select for "d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION.": 1 |
| Select for "i. HAVE A TEMPEST REQUIREMENT.": 0 |
| Select for "i. HAVE A TEMPEST REQUIREMENT.": 1 |
| Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (1) Sensitive Compartmented Information (SCI).": 0 |
| Select for "e. NATIONAL INTELLIGENCE INFORMATION: - (2) Non-SCI.": 0 |
| Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 1 |
| Select for "j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS.": 0 |
| Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0 |
| Select for "k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE.": 0 |
| Enter infomration for "other.": |
| Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 0 |
| Select for "e. ADMINISTRATIVE CONTRACTING OFFICER.": 1 |
| Select for "l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED INFORMATION (CUI). .": 0 |
| Select for "m.OTHER.": 0 |
| Select for "direct.": 0 |
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| Enter specification for "through".: Freedom of Information & Security Review Office |
1155 Defense Pentagon,Room 2C757 Washington DC 20311-1155
| Enter public release authority.: |
| Select to add signature.: |
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| text: General Comments : This contract involves access to classified data/information up to and including SECRET Contractors shall follow all |
applicable Standard Office Procedures. All contractor personnel performing under this contract shall possess a minimum of an active (Secret) clearance prior to reporting to any assignment within (DEFENSE HEALTH AGENCY, FALLS CHURCH VA). Prior approval of the GCA is required for any subcontracting. The use of cellular phones, hand-held radios, beepers, pagers, cordless phones, and cordless microphones shall be addressed in the Standard Operating Procedures of each computer facility where classified information processing is accomplished.
All contractor personnel performing under this contract shall be required to sign and execute a proprietary information non-disclosure statement. The proprietary information non-disclosure statement shall be required as part of the initial in-processing and must be executed prior to performing any work under this contract. The proprietary information non-disclosure will be maintained on file within the (DEFENSE HEALTH AGENCY FALLS CHURCH, VA) Security Office. Contractor personnel who refuse to sign the proprietary information non-disclosure statement will not be permitted to work within the offices of (DEFENSE HEALTH AGENCY FALLS CHURCH VA).
10.a. COMSEC information. (Applies if block 10.a. is marked yes) Classified COMSEC material is not releasable to contractor employees who have not received a final security clearance at the appropriate level. Cryptologic keying materials and Controlled Cryptographic Items (CCI) are controlled by Department of Defense, NISPOM, and National Security Agency (NSA) guidelines. The contractor shall be guided by NSA/CSS Policy Manual 3-16 in the control and protection of COMSEC material/information at their facilities. When access is required at Government facilities, contractor personnel will adhere to COMSEC rules and regulations as mandated by DoD 5520.22-M, EKMS 1 (series), Command policy and procedures. Written concurrence of the Technical Point of Contact (TPOC) identified in Block 16, or Contracting Officer Representative/Contracting Officer Representative (COR) for Security (as applicable) is required prior to subcontracting.
1 Applicable 0Not Applicable.
10.j. Receive, Store or Generate CUI Information. Controlled Unclassified Information under this contract shall be safeguarded as specified in DoDI 5200.48, "DoD Controlled Unclassified Information (CUI)". Contractor will have access to unclassified information requiring safeguarding and dissemination control in alignment with specific laws, regulations, or government-wide policies (Formerly identified as For Official Use Only (FOUO), Privacy Act information, Sensitive but Unclassified, or Law Enforcement Sensitive). Contractor shall follow the safeguarding requirements in DoDI 5200.48. DoDM 5400.07, DoD Freedom of Information Act Program applies.
10.k. Performance in Government Facilities. (Mark block 10k yes) This contract requires personnel to perform work in direct support of the (DEFENSE HEALTH AGENCY FALLS CHURCH, VA) staff and will require individuals to work within Government controlled facilities. All contractor personnel under this contract who have access to classified information must possess a U.S. clearance. The Contract Monitor will provide security classification guidance for the performance of this contract.
1 Applicable 0Not Applicable.
10.k. Common Access Cards. This contract requires personnel to obtain the Government issued Common Access Card (CAC) in order to provide identification for access government computer systems and physical access to facilities. Personnel must meet and maintain investigative and adjudicative requirements specified in DoDI 5200.46, and immediately report to the GCA any issues affecting CAC eligibility. Government issued credentials are the property of the United States Government and must be returned when no longer required for performance on this contract. Return CACs to: (DEFENSE HEALTH AGENCY SECURITY OFFICE). CACs will not be used to access information systems, facilities, or installations that are outside the performance requirements of this contract. CACs will be used only by the individual to whom it was issued and will not be used for or by any other person. The contractor will immediately notify the GCA if a CAC is lost, stolen, or otherwise missing. Replacement CACs will require the contractor employee to obtain a signed memo from the (DEFENSE HEALTH AGENCY SECURITY OFFICE), requesting a new CAC be issued.
1Applicable 0Not Applicable.
10.k. NIPRNET access required. (Mark block 10k yes) This contract requires the contractor to access and use the Unclassified government computer system known as the NIPRNET at locations identified by the government customer. All provisions of DoD Risk Management Framework (RMF) apply. This system is Unclassified only, and inappropriate or improper use of the system will result in a reportable incident to the DCSA. NIPRNET as well as other unclassified systems or equipment (e.g. printers, facsimile) will not be used to process classified information. NIPRNET systems will be used only for an official Government purpose. Inappropriate or improper use of the NIPRNET system will result in a reportable incident to the Defense Counterintelligence and Security Agency (DCSA).
1Applicable 0Not Applicable
10.k. SIPRNET access required. (Mark block 10k yes) This contract requires the contractor to access and use the Classified government computer system known as the SIPRNET at locations identified by the government customer. All provisions of DoD Risk Management Framework (RMF) apply. This system is authorized for use to but not exceeding the Secret-level only, and inappropriate or improper use of the system will result in a reportable incident to the Defense Counterintelligence and Security Agency (DCSA).
1Applicable 0Not Applicable.
11.b. Receive and Store Classified Documents. (8a and applies if 11b is marked yes) Contract performance is restricted to: Various government sites located in the National Capital Region; specified locations will be determined by the government contract monitor. (DEFENSE HEALTH AGENCY SECURITY OFFICE) will provide security classification guidance under performance of this contract. Contractor will receive classified documents only. Cleared personnel are required to perform this service because access to classified information cannot be precluded. The contractor is not authorized to release classified information to any activity or person, including sub-contractors, without the government Contracting Officer Representative's (COR) written approval. Only with the expressed permission of the government COR may the contractor reproduce any classified information/material. All requirements for control and accounting for original documentation and copies apply. All classified information must be marked in accordance with Executive Order 13526. All applicable provisions of DoD 5220.22M, National Industrial Security Program Operating Manual (NISPOM) and supplements apply.
1 Applicable 0Not Applicable.
11.l. Receive, Store or Generate CUI Information. (Applies if block 10j is marked yes) Controlled Unclassified Information under this contract shall be safeguarded as specified in DoDI 5200.48, "DoD Controlled Unclassified Information (CUI)". Contractor will have access to unclassified information requiring safeguarding and dissemination control in alignment with specific laws, regulations, or government-wide policies (Formerly identified as For Official Use Only (FOUO), Privacy Act information, Sensitive but Unclassified, or Law Enforcement Sensitive). Contractor shall follow the safeguarding requirements in DoDI 5200.48. DoDM 5400.07, DoD Freedom of Information Act Program applies.
1Applicable 0Not Applicable.
Additional Security Guidance can be found in the Performance of Work Statement (PWS) on page 9 and 10.
| Click on this button to attach a file(s).: |
| rep: PFPA Industrial Security |
| Enter signature.: |
| Explain and identify specific areas and government activity responsible for inspections.: |
| Enter GCA name.: Defense Health Agency Contracting Office |
| Enter AAC of the contracting office.: HT0070 |
| Enter address (include zip code).: 7700 Arlington Blvd |
Falls Church, VA 22042
| Enter POC name.: Vicki Whiteman |
| Enter telephone number (include area code).: 7036812067 |
| Enter email address.: vicki.l.whiteman.civ@health.mil |
| Enter title.: |
| Enter the date signed in format YYYYMMDD.: |
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