DD 254.pdf

CLASSIFICATION (When filled in): Unclassified

FA8601-21-Q-0032

PREVIOUS EDITION IS OBSOLETE. Page 1 of 4 AEM LiveCycle Designer

DD FORM 254, APR 2018

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:

May 31, 2022

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

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

(See Instructions)

Top Secret

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

None (See instructions)

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)

a. PRIME CONTRACT NUMBER (See instructions.)

For Solicitation, Not valid for contract award

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

FA8601-21-Q-0032

DUE DATE (YYYYMMDD)

3. THIS SPECIFICATION IS: (X and complete as applicable.)

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20201123

b. REVISED (Supersedes all previous specifications.)

REVISION NO. DATE (YYYYMMDD)

c. FINAL (Complete Item 5 in all cases.) DATE (YYYYMMDD)

4. IS THIS A FOLLOW-ON CONTRACT? No Yes If yes, complete the following:

Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract.

5. IS THIS A FINAL DD FORM 254? No Yes If yes, complete the following:

In response to the contractor's request dated , retention of the classified material is authorized for the period of:

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code)

a. NAME, ADDRESS, AND ZIP CODE

TBD

b. CAGE CODE

N/A

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

TBD

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) Add Row Remove last Row Delete All Rows

a. NAME, ADDRESS, AND ZIP CODE N/A

b. CAGE CODE

N/A

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional) N/A

8. ACTUAL PERFORMANCE (Click button to add more locations.) Add Row Remove last Row Delete All Rows

a. LOCATION(S) (For actual performance, see instructions.)

N/A

b. CAGE CODE

(If applicable, see Instructions.)

N/A

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional) N/A

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

Contractor will provide American Sign Language (ALS) interpreter services to requesting hearing impaired employees in accordance to American with Disability Act of 1990

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10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

b. RESTRICTED DATA g. NORTH ATLANTIC TREATY ORGANIZATION

(NATO) INFORMATION

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.) h. FOREIGN GOVERMENT INFORMATION

d. FORMERLY RESTRICTED DATA i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI) (See instructions.)

k. OTHER (Specify) (See instructions.)

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.)

a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT

ANOTHER CONTRACTOR'S FACILITY OR A GOVERNMENT

ACTIVITY

(Applicable only if there is no access or storage required at contractor facility.

See instructions.)

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE, STORE, AND GENERATE CLASSIFIED

INFORMATION OR MATERIAL

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

e. PERFORM SERVICES ONLY

f. HAVE ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE

THE U.S.,PUERTO RICO, U.S. POSSESSIONS AND TRUST

TERRITORIES

g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE

TECHNICAL INFORMATION CENTER (DTIC) OR OTHER

SECONDARY DISTRIBUTION CENTER

h. REQUIRE A COMSEC ACCOUNT

i. HAVE A TEMPEST REQUIREMENT

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED

INFORMATION (CUI).

(DoD Components: refer to DoDM 5200.01, Volume 4 only for specific CUI protection requirements. Non-DoD Components: see instructions.)

m. OTHER (Specify) (See 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)

DIRECT THROUGH (Specify below)

See Item 13

Public Release Authority:

See Item 13.

13. SECURITY GUIDANCE Add Signature Remove last Signature Delete All Signatures

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.)

Item 12 Cont'd:

Ref Item 12: Contractor is to submit requests through the Contracting Officer for OPSEC Program Manager review and public release authorization. The Contracting Officer will provide contractor with written approval/disapproval. Information requiring AF or DoD–level review will be reviewed by the unit’s OPSEC Program Manager or Coordinator who will in-turn forward to the entry-level public affairs office through the AFIMSC Public Affairs Office to the Secretary of the Air Force, Office of Public Affairs, Security and Review Division (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690. Transmission of public release request via e-mail is not authorized.

Item 13:

a. The National Industrial Security Program Operating Manual (NISPOM), February 2006, Incorporating Change 2, 18 May 16, applies.

b. Ref Item 10b: Access to RESTRICTED DATA requires a final U.S. Government clearance at the appropriate level.

c. Ref Item 10c: GCA approval is required prior to granting CNWDI access to a subcontractor. Special briefings and procedures are also

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required. Access to CNWDI requires a final U.S. Government clearance at the appropriate level

d. Ref Item 10e(2): Contractor will require access to intelligence information and must comply with directions provided by the Contracting Officer’s Representative (COR). The Program Manager has determined that disclosure does not create an unfair competitive advantage for the contractor or a conflict of interest with the contractor’s obligation to protect the information. The COR will identify what intelligence information is required for the contractor to satisfy the contract and will submit that information to the servicing Senior Intelligence Officer (21 IS) for approval prior to granting access.

e. Ref Item 10g: A formal NATO briefing is required prior to granting access to NATO Secret information. See NISPOM Chapter 10, Section 7, for details.

f. Item 10j/11l: The contractor shall comply with DoDI 5200.48, Controlled Unclassified Information, AFI 16-1404 Air Force Information Security Program, Air Force Guidance Memorandum 2020-16-01, Air Force Guidance Memorandum for CUI, 23 Jul 20, and DoDM 5400.7-Air Force Manual 33‑302, DoD Freedom of Information Act (FOIA) Program. The contractor shall monitor CUI aggregation and compilation based on the potential to generate classified information pursuant to security classification guidance addressing the accumulation of unclassified data or information.

g. Ref Item 11a: The contractor will not generate classified information.

h. Ref Item 11e: Contract is for American Sign Language interpreter services for classified and controlled unclassified information. Actual knowledge of, generation, or production of classified information is not required for performance of the contract. Cleared contractor personnel are required to perform this service. Access to classified information cannot be precluded to translate the information to hard of hearing personnel. Any classification guidance will be provided by the using activity.

i. Program Manager: George A Braid Jr., 88 FSS/FSC, 937-904-3309, george.braid.2@us.af.mil

j. Security Manager: Raymond Owens, 88 FSS/FSOT, 937-656-8680, raymond.owens.2@us.af.mil

k. Ref Item 18e: See Item 17

l. Ref Item 18f (Distribution):

- 88 ABW/IPD, 1801 10th St, WPAFB OH 45433-7625, 88ABW.IPD.Industrial.security@us.af.mil

- 88 FSS/FSC, george.braid.2@us.af.mil, kevin.simmons.1@us.af.mil

- 88 FSS/FS Raymond Owens, raymond.owens.2@us.af.mil

- AFLCMC’s servicing Senior Intelligence Office: 21 IS/INI, Bldg 20, 2450 D Street, Wright Patterson AFB, OH 45433-7629, afmc.oas.xri.workflow@us.af.mil

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form) Show Attachment Bar

88 ABW/IPD Information Protection Office Solicitation Review Wright-Patterson AFB OH

NAME & TITLE OF REVIEWING OFFICIAL

SHERYL A. BAKER, DAF, CIV,

Chief, Industrial Security

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

No Yes 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.)

Ref Item 11j: OPSEC requirements apply. See Performance Work Statement for requirements.

15. INSPECTIONS

Elements of this contract are outside the inspection responsibility of the CSO.

No Yes 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)

FA8601-21-Q-0032

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DD FORM 254, APR 2018

a. GCA NAME

AFLCMC/PZI

b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)

FA8601

c. ADDRESS (Include ZIP Code) AFLCMC/PZIBB - Base Support Section 1940 Allbrook Drive, Room 109 Wright-Patterson AFB, OH 45433-5344

d. POC NAME

Caleb Rose

e. POC TELEPHONE (Include Area Code)

+1 (937) 522-4606

f. EMAIL ADDRESS (See Instructions) caleb.rose.1@us.af.mil

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.

a. TYPED NAME OF CERTIFYING OFFICIAL (Last, First, Middle Initial) (See Instructions)

Courtney, Toxie, H.

b. TITLE

Contracting Officer

c. ADDRESS (Include ZIP Code) AFLCMC/PZIBB - Base Support Section 1940 Allbrook Drive, Room 109 Wright-Patterson AFB, OH 45433-5344

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

FA8601

e. CAGE CODE OF THE PRIME CONTRACTOR

(See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (937) 522-4567

g. EMAIL ADDRESS (See Instructions) toxie.courtney.1@us.af.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

a. CONTRACTOR

b. SUBCONTRACTOR

c. COGNIZANT SECURITY OFFICE FOR PRIME AND

SUBCONTRACTOR

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY

ADMINISTRATION

e. ADMINISTRATIVE CONTRACTING OFFICER

f. OTHER AS NECESSARY (If more room is needed, continue in Item 13 or on additional page if necessary.)

See Item 13, Ref Item 18f

DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of AEM LiveCycle Designer

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:

May 31, 2022 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

Ref Item 12: Contractor is to submit requests through the Contracting Officer for OPSEC Program Manager review and public release authorization. The Contracting Officer will provide contractor with written approval/disapproval. Information requiring AF or DoD–level review will be reviewed by the unit’s OPSEC Program Manager or Coordinator who will in-turn forward to the entry-level public affairs office through the AFIMSC Public Affairs Office to the Secretary of the Air Force, Office of Public Affairs, Security and Review Division (SAF/PAX), 1690 Air Force Pentagon, Washington DC 20330-1690. Transmission of public release request via e-mail is not authorized.

Item 13:

a. The National Industrial Security Program Operating Manual (NISPOM), February 2006, Incorporating Change 2, 18 May 16, applies.

b. Ref Item 10b: Access to RESTRICTED DATA requires a final U.S. Government clearance at the appropriate level.

c. Ref Item 10c: GCA approval is required prior to granting CNWDI access to a subcontractor. Special briefings and procedures are also required. Access to CNWDI requires a final U.S. Government clearance at the appropriate level

d. Ref Item 10e(2): Contractor will require access to intelligence information and must comply with directions provided by the Contracting Officer’s Representative (COR). The Program Manager has determined that disclosure does not create an unfair competitive advantage for the contractor or a conflict of interest with the contractor’s obligation to protect the information. The COR will identify what intelligence information is required for the contractor to satisfy the contract and will submit that information to the servicing Senior Intelligence Officer (21 IS) for approval prior to granting access.

e. Ref Item 10g: A formal NATO briefing is required prior to granting access to NATO Secret information. See NISPOM Chapter 10, Section 7, for details.

f. Item 10j/11l: The contractor shall comply with DoDI 5200.48, Controlled Unclassified Information, AFI 16-1404 Air Force Information Security Program, Air Force Guidance Memorandum 2020-16-01, Air Force Guidance Memorandum for CUI, 23 Jul 20, and DoDM 5400.7-Air Force Manual 33‑302, DoD Freedom of Information Act (FOIA) Program. The contractor shall monitor CUI aggregation and compilation based on the potential to generate classified information pursuant to security classification guidance addressing the accumulation of unclassified data or information.

g. Ref Item 11a: The contractor will not generate classified information.

h. Ref Item 11e: Contract is for American Sign Language interpreter services for classified and controlled unclassified information. Actual knowledge of, generation, or production of classified information is not required for performance of the contract. Cleared contractor personnel are required to perform this service. Access to classified information cannot be precluded to translate the information to hard of hearing personnel. Any classification guidance will be provided by the using activity.

i. Program Manager: George A Braid Jr., 88 FSS/FSC, 937-904-3309, george.braid.2@us.af.mil

j. Security Manager: Raymond Owens, 88 FSS/FSOT, 937-656-8680, raymond.owens.2@us.af.mil

k. Ref Item 18e: See Item 17

l. Ref Item 18f (Distribution):

- 88 ABW/IPD, 1801 10th St, WPAFB OH 45433-7625, 88ABW.IPD.Industrial.security@us.af.mil

- 88 FSS/FSC, george.braid.2@us.af.mil, kevin.simmons.1@us.af.mil

- 88 FSS/FS Raymond Owens, raymond.owens.2@us.af.mil

- AFLCMC’s servicing Senior Intelligence Office: 21 IS/INI, Bldg 20, 2450 D Street, Wright Patterson AFB, OH 45433-7629, afmc.oas.xri.workflow@us.af.mil text: 88 ABW/IPD Information Protection Office Solicitation Review Wright-Patterson AFB OH

Chief, Industrial Security

1940 Allbrook Drive, Room 109 Wright-Patterson AFB, OH 45433-5344 Address: AFLCMC/PZIBB - Base Support Section 1940 Allbrook Drive, Room 109 Wright-Patterson AFB, OH 45433-5344