Attch 6 Sample DD254.docx

Questionnaire for Generation of Security Guidance 2019

This questionnaire reflects the data required for DS/IS/IND to provide the appropriate security guidance and to generate a DD Form 254, as applicable.

Part One – Data needed from Program Office Part One of the questionnaire is to be completed by the Program Office.

Please use Part One of this questionnaire to identify the security requirements for contract performance based on the scope of work documented in the Statement of Work (SOW).

If access to classified information/areas/systems is required, then DS/IS/IND will provide required security language and a Contract Security Classification Specification (DD Form 254) for inclusion in the contract documents.

Part Two – Data needed from Contracting Office Part Two of the questionnaire is to be completed by the Contracting Office.

Please use Part Two of this questionnaire to provide DS/IS/IND the pertinent details necessary to supply you with the DD Form 254 and/or security guidance attachments required inclusion in the contract documentation.

Part One – Data needed from Program Office Upon completion of the SOW and Part One of this questionnaire, please forward both documents to the Contracting Office.

Who is the Requestor?

What services will be required in performance of this contract?

Contract performance location:

No

No

1801 N . Lynn Street Arlington, VA 22209

SA-20

Will any part of this contract involve any of the following: (Choose all that apply)

No

No

No

Will any part of this contract involve any of the following Special Accesses:

No

Foreign Government Information (FGI) refers to information belonging to a foreign government that has been deemed sensitive or classified by that foreign government or information produced by the US Government pursuant to or as result of a joint arrangement with a foreign government which requires that the information, the arrangement, or both, are to be held in confidence. [Note: This NOT APPLICABLE when work is performed at DOS locations and does NOT include NATO information.]

No

Sensitive Compartmented Information (SCI) is classified information concerning or derived from sensitive intelligence sources, methods, or analytical processes. [Note: Access to SCI will take place only at DOS facilities or as authorized by DS/IS/SSO. SCI access will NOT be provided at the company’s physical location.]

No

Communications Security Information (COMSEC) refers to: Accountable COMSEC material; Secure Telephone Equipment (STE) at the contractor’s facility; or Other key-able COMSEC devices at the contractor’s facility.

[Note: This NOT APPLICABLE when work is performed at DOS locations and does not include NATO information.]

No

TEMPEST requirements levied on the company by the US Government?

[Note: This NOT APPLICABLE when work is performed at DOS locations.] Yes No

Access Requirements

No

No

No

No

HUMINT Threat Post(s) Locations identified as such in the Security Environment Threat List (SETL). The SETL is only available on ClassNet.

No

Work Performed at the Contractor Company’s Physical Location

No

Connectivity refers the extension of a Department of State network to an offsite location or network (e.g., an OpenNet workstation or network at a contractor facility). This is NOT the same as having access to GO. [Note: This NOT APPLICABLE when work is performed at DOS locations.]

No

No

Use of non-US Citizen personnel

A Third Country National (TCN) is defined as a citizen of neither the U.S. nor the Host Country where work is being performed. For example, an Italian citizen working in Zimbabwe would be considered a Third Country National (TCN) for the purposes of security vetting.

No

A Local National (LN) is defined as a citizen of the Host Country where work is being performed. For example, an Italian citizen working in Italy would be considered a Local National (LN) for the purposes of security vetting. [NOTE: A Local National is a Host Country National.]

No

Part Two – Data needed from Contracting Office Contracting Officer (CO):

(Full Name, Office Symbol, Phone number)

Contracting Officer’s Representative (COR):

If COR has not been designated, provide a POC that can answer questions about the SOW. If no name is provided, the CO’s name will be used until a COR is designated and that name provided.

Alternate POC (pending COR designation):

Government Technical Monitor (GTM):

RFP / RFQ number:

If this request is for a contract award, who is the Contract Awardee?

Company Name:

Company Address:

Company DUNS Number:

Company CAGE Code:

DoS Contract number:

DoS Task Order number:

BPA/IDIQ number:

General Schedule (GS) number (if awarded under a GS schedule):

If Contract Awardee has pre-approved subcontractors, provide SubK Company Name & CAGE Code:

(if more than 5 SubKs, continue on a separate page)

Company Name / CAGE Code:

Company Name / CAGE Code:

Company Name / CAGE Code:

Company Name / CAGE Code:

Incumbent contractor & contract number:

(Is there a current contractor company performing?)

Company Name:

DoS Contract number:

Date current contract will end:

· OF 347 (award), or

· SF 1449 (solicitations).

Attach Bidders DD Form 254 (if requested/completed previously)

Upon completion of Part Two of this questionnaire, please forward the SOW, the completed questionnaire, and any other documentation as requested in Part Two of the questionnaire to DS/IND.

DS/IS/IND 5 AUG 2019 Page 5 of 6