DD Form 254.pdf

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DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, MAY 2019

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:

20220531 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.)

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 whs.mc-alex.esd.mbx.formswebmaster@mail.mil

WHS

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

2340 Dulles Corner Blvd.

Herndon, VA 20171-3400 Main: (703) 713-4332

Chantilly 1 Field Office (IOFCCI) 13473 Park Center Road, Suite 225 Herndon, VA 20171 Main: (571 373-5205)

Atlanta Field Office (IOFSA) 1899 Powers Ferry Road, Suite 330 Atlanta, GA 30339 Main: (770) 370-3740

CSO: 78 ABW/IP

985 Macon Street Robins, AFB, GA 31098

101 Industrial Park Blvd Warner Robins, GA 31088-7499 Location: AFLCMC/WNY 235 Byron St., Ste 19A Robins AFB, GA 31098-1670

Ref 8.a and 11.c: Contract performance will occur at the contractors facility listed in block 6.a. and at the following government locations:

Robins AFB, GA, Bldg 229S, 3rd floor lab. The AN/ALR-56M Radar Warning Receiver (RWR) Security Classification Guide (SCG) dated 05 December 2006, Revisions: 04 March 2011 and 01 May 2017. Prior to declassifying or downgrading information marked with a date or event on the "declassify on" line: The Contractor will confirm the OCA has not extended the classification period by reference to the applicable Security Classification or Declassification Guide or by consulting with the Program Office with the OCA.

Ref. 10.a & 11h: The contractor is governed by NSA/CSS Policy Manual 3-16, dated 23 January 2015, in the control and protection of COMSEC Material/Information. Access to COMSEC material by personnel is restricted to U.S. citizens holding final U.S. Government clearances. Such information is not releasable to personnel holding only reciprocal clearances. For on-base performance, contractor will comply with AFMAN 17-1302-O, Communications Security (COMSEC) Operations.

Ref 10.d: Access to Formerly Restricted Data requires a final U.S. Government Clearance at the appropriate level.

Ref 10.e(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. In accordance with AFMAN 14-403, 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 (SIO) for approval prior to granting access. See attached Intelligence Security Addendum, (Non-SCI)

Ref 10.j: FOUO information provided under this contract shall be safeguarded as specified in DoDM 5200.01-V4, DoD Information Security Program: Controlled Unclassified Information.

Ref. 11.d: The contractor is required to provide adequate for classified hardware or material to the level of SECRET which because of size or quantity cannot be safeguarded in an approved storage container.

Ref 11.j: For contract performance at the contractor’s facility: The contractor will be provided critical information under separate cover, if applicable. For contract performance at a US Government Installation: Contractor personnel will participate in the OPSEC program locally administered by the AF activity.

Ref 11k. Go to https://www.ustranscom.mil/cmd/associated/dcd/ for Defense Courier Service points of contacts and guidance. Contractor is authorized to use the Defense Courier Service (DCS) in support of this contract.

Ref 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. (T-1) 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.

Contractor will reference the appropriate security classification guidance when generating or deriving classified material or hardware. All classified information received or generated will be properly stored and handled according to the markings on the material. All classified information received or generated is the property of the U.S. Government. At the termination or expiration of the contract, the U.S. Government will be contacted for proper disposition instructions. Contractor will abide by and shall apply derivative classification and markings governed by the current version of the following security classification guidance:

The Contractor will notify the Government Contracting Activity and the Government Security Manager within 48 hours of any incident involving the actual or suspected compromise/loss of classified information to enable the Government to conduct immediate assessment of potential impact pending formal inquiry/investigation. Actual or suspected compromise of Covered Defense Information will be reported IAW DFARS Clause 252.204-7012.

Ref. 18.f: Ensure certifications and signatures are completed by contracting officer and distribution is made to the following organizations:

78 ABW/IPD

985 Macon Street Robins AFB, GA 31098 ATTN: Melvese Harris

AFLCMC/INGS

235 Byron St. Ste.19A Robins AFB, GA, 31098 ATTN: Michael Long

AFLCMC/WN-IP

235 Byron St. Ste.19A Robins AFB, GA, 31098 ATTN: Brandi Ellingham

AFLCMC/WNY

235 Byron Street, Suite 19A Robins AFB, GA 31098 ATTN: Joe Harper

AFLCMC/ ESZP

2145 Monathan Way, Bldg 28 Wright-Patterson AFB, OH 45433 ATTN: Sean Crone

HQ Defense Counterintelligence and Security Agency 27130 Telegraph Rd Quantico, VA 22134

AFLCMC/WNY

Brandi Ellingham, DAF

AFLCMC/WN-IP

Melvese Harris, 78 ABW/IP Servicing Security Activity rep: Brandi Ellingham, Security Specialist

AFLCMC/WN

Servicing Security Activity

235 Byron St, Suite 19A Robins AFB, GA 31098 Address: AFLCMC/WNKD 235 Byron Street, Suite 19A Robins AFB, GA 31098