Attachment 2 - Draft DD Form 254.pdf

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DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.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:

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"

985 Macon Street Robins AFB GA 31098 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 11WG/IP 1330 AF Pentagon, 1E871 Washington DC 20330 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: HQ ARPC/IP 18429 E. Silver Creek Ave, MS-68 Buckley AFB, CO 80011 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 301 FW/IP 1654 Lyons Drive, Suite 144 NAS JRB Ft Worth, TX 76127 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 434 ARW/IP 7207 Grissom Ave Grissom ARB, IN 46971-5000 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 452 AW/IP 6020 8th Street, Bldg 1201 March ARB, CA 92518-1667 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 482 FW/IP 29050 Coral Sea Blvd Homestead ARB, FL 33039-1299 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 439 AW/IP 975 Patriot Ave, Box 63 Chicopee (Westover ARB), MA 01022 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 910 AW/IP 3976 King Graves Rd, Unit 01 Youngstown ARS, OH 44473-5901 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 911 AW/IP Pittsburgh IAP ARS 2475 Defense Ave Coraopolis, PA 15108-4403 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 96 TW/IP 101 West D Ave, Suite 14 Eglin AFB, FL 32543 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 142 FW/IP 6801 NE Cornfoot Rd, Bldg 145 Portland IAP, OR 97218 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 688TH CW/IP 102 Hall Blvd JBSA Lackland 78243 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 94 AW/IP 1392 Second Street, Bldg 827 Dobbins ARB, GA 30069 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 914 AW/IP 2720 Kirkbridge Drive Niagara Falls ARS, NY 14304-5001 Enter cognizant security office(s) (Name, Address, ZIP Code, Telephone required; Email Address optional).: 934 AW/IP 760 Military Highway Minneapolis-St Paul ARS, MN 55450-2100

Robins AFB, GA Enter location(s).: HQ USAF/RE Pentagon, Washington DC Enter location(s).: HQ ARPC Buckley AFB, CO Enter location(s).: 301 CS NAS JRB Ft Worth, TX Enter location(s).: 434 CS Grissom ARB, IN Enter location(s).: 452 CS March ARB, CA Enter location(s).: 482 CS Homestead ARB, FL Enter location(s).: 439 CS Westover ARB, MA Enter location(s).: 910 CS Youngstown ARS, OH Enter location(s).: 911 CS Pittsburgh ARS, PA Enter location(s).: 919 CS Duke Field ABS, FL Enter location(s).: 304 RS Portland IAP, OR Enter location(s).: 960 CW JB San Antonio, TX Enter location(s).: 94 CS Dobbins ARB, GA Enter location(s).: 914 CS Niagara Falls, NY Enter location(s).: 934 CS Minneapolis-St Paul ARS

155 Richard Ray Blvd, Bldg 210, Robins AFB GA 31098 Enter public release authority.: HQ AFRC/PA 255 Richard Ray Blvd, Bldg 220, Robins AFB GA 31098

Ref 10a: Access to COMSEC material by personnel is restricted to U.S. citizens holding final U.S. govt clearances. Such information is not releasable to personnel holding only reciprocal clearances. Contractor will comply with AFMAN 17-1302-O, Communications Security (COMSEC) Operations, 3 Feb 17 when COMSEC materials issued through an AF COMSEC account. When access to COMSEC information is required at a government facility, contractor personnel will follow the security requirements of the host government activity.

Ref. 10j/11l: The contractor shall comply with DoDI 5200.48, Controlled Unclassified Information, DoDM 5200.01V3_AFMAN 16-1404V3, Information Security Program Protection of Classified Information 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.

Ref.11j: Contractor personnel will participate in the OPSEC program locally administered by the AF activity.

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. 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.

Ref 13: Security Requirements:

1. These security requirements, promulgated by DoDM 5220.22V2_AFMAN 16-1406V2, National Industrial Security Program, Industrial Security Procedures for Government Activities, and 32 CFR Part 117, National Industrial Security Program Operating Manual (NISPOM), § 117.7(a), are issued for cleared contractors who will be entrusted to have access to classified information. This guidance is applicable for contractor performance as a visitor group (VG) under the 78th Air Base Wing Information Protection Office (IPO) security cognizance, Robins AFB GA. For performance on other installations, prior to the start of performance, the contractor shall contact the host IPO to execute an agreement and/or security requirements as mandated by the above referenced documents.

2. Storage of Classified Material/Information: The government program manager (GPM) may authorize VG to store and handle classified material required for performance on this contract. All classified information shared with the VG must be stored in an approved government-owned and controlled security container. The number of VG employees authorized access to the security container will be kept to the minimum number required for efficient contract performance. When authorized, the VG shall comply with DoDM 5200.01V1_AFMAN 16-1404V1, Information Security Program: Overview, Classification & Declassification, DoDM 5200.01V2_AFMAN 16-1404V2, Information Security Program: Marking of Classified Information, and DoDM 5200.01V3_AFMAN 16-1404V3, Information Security Program: Protection of Classified Information and the government activity’s security program operating instruction (OI). The VG is prohibited from establishing and/or maintaining a separate classified information system. All classified material/information must be returned and secured in the government security container at the end of the duty day.

3. Reproduction of Classified Material: The VG may be authorized to reproduce classified information, as required for contract performance. Authorization must be accomplished IAW DoDM 5200.01V3_AFMAN 16-1404V3 and only AF-approved and controlled equipment can be used.

4. Guard Services: The host government activity will provide guard services.

5. Security Forms: Security forms and publications are accessible at: Air Force publications: https://www.e-publishing.af.mil/ DoD publications: https://www.esd.whs.mil/DD/. Local forms will be provided by the government activity.

6. Security Inspections:

a. The VG shall participate in the host Commander’s self-inspection programs IAW DoDM 5200.01V1_AFMAN 16-1404V1. Deficient items will include a corrective action plan.

b. The security focal point (SFP) will maintain the following documentation and have available for security reviews:

(1) A signed copy of the current prime DD Forms 254, and all subcontractors DD Forms 254, if applicable.

(2) Copy of the Security Agreement for visitor groups under 78 ABW/IP security cognizance.

(3) Documentation the Security Agreement was provided to all subcontractors, if applicable.

(4) Documentation of the last program review and self-inspection.

(5) Consultant Agreements, if applicable.

(6) Current list of all employees identifying their security clearance access level, including subcontractors, if applicable.

7. Transmission of Classified Material/Information:

a. Receipt and dispatch of classified material is the responsibility of the government. The VG is not authorized to perform these activities unless they are specifically contracted for and identified in the Statement of Work or Performance Work Statement. When this service is required for contract performance, the designated VG employee shall comply with DoDM 5200.01V1_AFMAN 16-1404V1, DoDM 5200.01V2_AFMAN 16-1404V2, DoDM 5200.01V3_AFMAN 16-1404V3 and the government activity’s security program OI. The security assistant (SA) will provide VG personnel training on mail handling procedures, to include proper securing of Registered, Certified, USPS Express and FedEx Mail and/or First Class mail. However, under no circumstances will the VG be authorized to open a classified package beyond the outer wrapper to determine further distribution or sign the classified document receipt.

b. The VG is not authorized for direct receipt or dispatch of classified material at RAFB GA through US postal channels or commercial carrier.

c. Classified material transmitted via U. S. postal channels or approved commercial carrier, direct from the government activity, must be prepared IAW DoDM 5200.01V3_AFMAN 16-1404V3 and processed through the classified information control system of RAFB GA.

d. Classified material may be hand carried onto or off RAFB by an appropriately cleared and briefed VG courier, provided the employee is so designated in writing by his/her company FSO as a courier and the activity Director or designee IAW DoDM 5200.1-V3_AFMAN 16-1404V3.

8. Security Badges: The government activity will issue security badges. The contractor shall return security badges to the issuing office upon the period of performance end date, termination of the contract, or when an employee is no longer supporting the contract, whichever is sooner. Transfer of security badges to another contract is not authorized.

9. Visitor Control: The contractor shall comply with DoDM 5200.08V3_AFMAN 31-101V3, Installation Perimeter Access Control, and the host installation commander’s visitor control procedures for access to the installation and the government activity’s visitor control procedures to access facilities.

10. Security Incidents: The contractor shall report security incidents to the unit’s SA and the host IPO. The government shall conduct the preliminary inquiry for security incidents occurring on the installation IAW DoDM 5200.01V1_AFMAN 16-1404V1.

11. Security Checks: Government personnel shall conduct end-of-day security checks unless the contract specifically identifies contractors to conduct end-of-day security checks.

12. Internal Security Controls: The contractor shall comply with the government activity’s security operating instructions.

13. Emergency Procedures to Protect Classified Material: The contractor shall implement emergency procedures to protect classified material as identified in the host government activity’s operating instruction.

14. Training: The contractor shall participate in the host government activity’s initial and reoccurring information protection security awareness and training education programs.

15. Subcontract DD Form 254: Should a subcontract be issued under this effort, whereas the subcontractor will require access to classified information and be physically located on RAFB GA for a minimum of 90 days, the VG must issue a subcontract DD Form 254, IAW the NISPOM, and comply with the following:

a. Provide a signed copy of the subcontract DD Form 254 to the GPM, SA and the SFP and 78 ABW/IPD.

b. Ensure the subcontractor complies with this security agreement or enter into a separate agreement with the subcontractor. The agreement to comply must be documented and a copy of the documentation provided to GPM, SA, SFP and 78 ABW/IPD. If a separate agreement is prepared, a copy shall be provided to the GPM, SA, SFP and 78 ABW/IPD.

16. Consultants: Should a consultant be acquired who will require access to classified information and be physically located on RAFB GA, a copy of the Consulting Agreement must be provided to the GPM, SA, SFP and 78 ABW/IPD.

17. Reporting Requirements: VG employees report shall report adverse information, suspicious contacts, espionage, sabotage, and subversive activities to government activity’s SA IAW DoDM 5220.22V2_AFMAN 16-1406V2, para 4.14 (Added)(AF). The contractor shall furnish a copy of adverse information reports required by 32 CFR Part 117, National Industrial Security Program Operating Manual, § 117.8(c)(1)(i), SEAD 3 and CSA-provided guidance. Reports will be submitted to the installation commander through the 78th ABW Industrial Security Office, 78 ABW/IPD at email: 78abw.ip.indsec@us.af.mil

USAF Program Manager rep: JACQUELINE P. SHULAR, SMSGT USAF Security Manager/Assistant rep: ERICK J. HOLLOWAY, CIV, A3OI MAJCOM OPSEC Program Manager:

rep: TANJA B. STEWART, CIV, A2S MAJCOM INTEL Officer/Designee rep: ROBYN E. GALLAGHER, CIV,A6OS MAJCOM COMSEC Office rep: MELVESE HARRIS, 78 ABW/IPD Servicing Security Activity