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UNITED STATES AIR FORCE REPAIR CONTRACT

APPENDIX B COORDINATION RECORD FOR CAV AF CONTRACTS

INSTRUCTIONS: As a minimum, coordination will be obtained from the organizations listed below. It is the responsibility of the Production Management Specialists to include additional organizations if required. To conserve time in the coordination process, duplicates of this record and the Appendix B may be sent simultaneously to organizations having a responsible interest. However, all coordination’s will be presented at the time of final review to 559 CBSS/GBLC. Respective CDM organization or 559 CBSS/GBLC will establish the Abbreviated Procurement Instrument Identification Number (PIIN). Coordination sheet will be attached to the Appendix B and forwarded to Procurement. Upon contract award, the Procurement Contracting Officer (PCO)/Production Management Specialist (PMS) will provide contract number, contractor name, address, Department of Defense Activity Address Code (DODAAC) EZ number and RIC to 559 CBSS/GBLC (GFM) or respective CDM (CFM) organization depending on type of contract (GFM or CFM).

Purchase Request Number FD2030-08-01432 Date 29 FEB 2008 Contract Number_______________________________________ Date__________________

PIIN____________CAVAF_______________________________ Date___________________ PMS Code NKY DODAAC EZ__________________________________________

Contractor Routing Identifier Code (RIC)________________________________________________

COORDINATIONS

ORG
COORDINATION
DATE
EXT

PRODUCTION MANAGEMENT SPECIALIST (PMS)

Suppa-Velten, Terri A Civ 552 CBSS/GBMB
29 FEB 08
736-5162

TECHNICAL (ES or ENG)

Echevarria, Stephen Civ 552 CBSS/GBMB
29 FEB 08
736-7171

TRANSPORTATION

559 CBSS/GBLAB

Bealer, Terri D Civ 559 CBSS/GBLAB
29 FEB 08
739-5828

PACKAGING

559 CBSS/GBLAA

Padilla, Silvia Civ 559 CBSS/GBLAA
29 FEB 08
739-7184

LOAN PROPERTY & ST/STE

559 CBSS/GBMAC

CONTRACT REPAIR

559 CBSS/GBLC

848 CBSG /OMX
Lynnice Hamlin
6 March 2008
736-3720

NOTE: The PMS will contact respective CDM/CDMAG organization to obtain the Abbreviated PIIN during the PR process with the necessary documentation (signed coordination sheet, appendix B, copy of PR, CRT minutes.

HEADQUARTERS

OKLAHOMA CITY AIR LOGISTICS CENTER

TINKER AIR FORCE BASE

APPENDIX B

GOVERNMENT PROPERTY MANAGEMENT

1 February 2008

Contract #: _____________________________
PMS: Terri A.Suppa-Velten (NKY)
PR #: FD2030-08-01432
Ph #: (405)736-5162

Abbr Contr#: _(H7)______________________ To obtain abbreviated PIIN numbers call:

848th CBSG contracts call 736-3720

448th CBSG contracts call 736-3177

748th CBSG contracts call 736-3959 Fax #: (405) 736-4510 Date: 29 February 2008

Type Work:

Overhaul Workload Type: Overhaul of Rate of flow Transmitter 5 year Req Type Contract 15 Ea. Per Year

Contract Designation is: CFM

TABLE OF CONTENTS

Section Page

1.
Terms Explained………………………………………………………………………….
2
2.
Contract Designation of CFM…...………………………………………………………
5
3.
Government-Furnished Property ……..………………………………………………….
5
4.
Contractor Property Control Records…………………………………………………….
6
5.
Production Problems……………………………………………………………………...
7
6.
Disposition of Government Property……………………………………………………..
7
7.
Discrepancies Incident to Shipment………………………………………………………
7
8.
Disposition of Condemned Government Property………………………………………..
8
9.
Contractor Reporting……………………………………………………………………...
8
10.
Visits……………………………………………………………………………………...
9
11.
Other………………………………………………………………………………………
9
12.
References………………………………………………………………………………..
9

LIST OF ATTACHMENTS

Attachment

Page

1
Contractor Communications Network (CCN)……………………………………………
11

PURPOSE STATEMENT

This Appendix B is part of the contract and provides detailed instructions pertaining to the management and control of government-owned property and instructions/guidance on how the property is obtained, maintained, protected, controlled, accounted for, and disposed of. These instructions expound the general guidance given in the Federal Acquisition Regulation (FAR), which is incorporated by reference and made part of this contract. If the provisions of this appendix conflict with existing FAR or other government directives, the contractor will contact the contracting officer at OC-ALC for guidance.

1. TERMS EXPLAINED: Terms and definitions are included in the regulations referenced as cited in this appendix and are supplemented for clarification and guidance as they apply to this contract as follows:

1.1. Abbreviated Contract Number: An eight position alpha-numeric designator that represents the contract number and is used in tracking contractor transactions and requisitions. The first position is for the ALC and the remaining seven positions are the control number.

1.2. Administrative Contracting Officer (ACO): A contracting officer assigned the responsibility for the post award functions related to the administration of a government contract in the field. The ACO is normally located in the Defense Contract Management Agency (DCMA) office. The ACO is responsible for ensuring the contractor performs in accordance with the terms of the contract.

1.3. Agency-Peculiar Property (APP): Government-owned property for military operations. It includes end items and integral components of military weapons systems along with related support equipment that are not readily available as commercial items. It does not include normal government material, special test equipment, special tooling, or facilities; also referred to as military property.

1.4. Bench Stock: Low cost, high usage, and non-sensitive consumable, material located in work areas for contract performance. Quantities of such stock shall not exceed that amount normally consumed in a 30 day period, or as established in the contractors approved property control system (normally used for broken units of issue).

1.5. Consumable Item: An item that may or may not be subject to repair that is consumed during the repair process. This includes stock listed and non-stock listed items which have an expendability, recoverability, and reparability category (ERRC) of P (XF3) or N (XB3). May also be referred to as expense or stock funded items. Consumable material will be provided as contractor furnished material in support of depot maintenance repair.

1.6. Commercial Asset Visibility AF (CAV AF): is a web-based Government off the shelf (GOTS) application developed by Navy Supply Information Systems Activity (NAVSISA). CAV AF allows commercial contract repair facilities to report Repair and GFM transactions on a daily basis. CAV AF will be the management control authority (MCA) for contract repair end items and GFM located at contractor facilities. The connection between CAV AF and commercial facilities will be via the internet.

1.7. Contractor Furnished Equipment (CFE): Equipment furnished by the contractor, title to which remains with the contractor.

1.8. Contractor Furnished Material (CFM): Material provided by the contractor, as a part of the maintenance service provided. All material with an expendability, recoverability, and reparability category (ERRC) code; N or P (also known as consumables) will be CFM, regardless of the source of supply (SOS), i.e; Defense Logistics Agency (DLA), General Support Division (GSD) and AF managed items. This material is incorporated into or attached to an end item to be delivered under the contract or may be consumed in the performance of a contract.

1.9. Contractor Furnished Property (CFP): Property other than government-furnished property (GFP) or government-furnished material (GFM).

1.10. Expendability, Recoverability, and Reparability Category (ERRC) Code: The code assigned to an Air Force item which designates the extent of repair for the item.

1.11. Facilities: Industrial property (other than material, tooling, agency-peculiar property, and test equipment) for production, maintenance research, development, or test, including real property and rights therein; buildings, structures, improvements and plant equipment.

1.12. Government-Furnished Equipment (GFE): An all-inclusive term to define all types of equipment defined in the FAR. It includes facilities, plant equipment, agency peculiar property, special tooling, and special test equipment. For the purpose of annually reporting dollar values on Department of Defense (DoD) property in the custody of contractors (DD Form 1662, DOD Property in the Custody of Contractors), items must be categorized according to the specific FAR property definitions.

1.13. Government-Furnished Material (GFM): Government property supplied to the contractor, for incorporation into an end item to be delivered under the contract or which may be consumed in the performance of the contract. It includes, but is not limited to, raw and processed material, parts, components, and assemblies. GFM is also referred to as materials and direct materials under the terms of the contract.

1.14. Government-Furnished Property (GFP): All property acquired using government funds and/or in the possession of the government which is subsequently delivered or otherwise made available to the contractor. GFP also includes GFE and GFM.

1.15. Hazardous Material: Any used or unused property, including scrap and waste, that is ignitable, corrosive, reactive, or toxic because of its quality, concentration, physical, chemical, or infectious characteristics. The property can be in a solid, liquid, semi-liquid, or contained gas form and may cause or significantly contribute to an increase in serious illness or mortality or pose a substantial threat or potential hazard to the environment when improperly treated, stored, transported, disposed of, or otherwise managed.

1.16. Hazardous Waste: Any used or unused hazardous material that has no known use and, therefore, must be discarded. This includes hazardous material not otherwise disposed of through plant clearance that the contractor has been authorized, by the plant clearance officer, to dispose of as hazardous waste.

1.17. Julian Date: A method used by the government to track days according to a system usually covering one year and referring the days to a numerical sequence of the calendar year. Example: Julian Date 6133. Number 6 refers to the year 2006, and 133 refers to the one hundred thirty-third day of the year, the twelfth day of May, (May 13, 2006).

1.18. Local Manufacture (LM): The manufacture of items for the government using GFM and contracted labor.

1.19. Loan Control Officer (LCO): An individual at the prime stock number ALC who has the responsibility for the GFE assets loaned to a contractor, and validates the authorization and tracks the issuance and return of loaned assets.

1.20. Material Support Division (MSD) Items: Items that have an ERRC code of C (XD1) or T (XD2). These items are referred to as line replacement units (LRU) and shop replacement units (SRU) respectively.

1.21 Public Key Infrastructure (PKI): Allows for a unique and secure identification of users through the use of a certificate authority. The user identity must be unique for each certificate authority.

1.22. Plant Clearance Officer: An individual authorized to act on behalf of the ACO on all plant clearance matters concerning the screening, reutilization, redistribution, and marketing of excess government property.

1.23. Procuring Contracting Officer (PCO): The person responsible for entering into a contract on behalf of the government. The PCO will ordinarily be located at the funding ALC.

1.24. Production Management Specialist (PMS): An individual assigned by the contracting activity to act as liaison for production, supply, and transportation issues.

1.25. Property Control Procedures: A detailed written description of the contractor’s operation for the control, use, and care of property while in the contractor’s possession.

1.26. Property Administrator (PA): An individual authorized to act on behalf of the ACO on all matters concerning the management of government-owned property.

1.27. Property Records: Records that are construed to include all documents reflecting the status of government property.

1.28. Sensitive Property: Property for which the theft, loss, or misplacement could be potentially dangerous to the public safety or community security and which must be subject to exceptional physical security, control, and accountability. The following types of property should be designated as sensitive in the contractor’s property management system: weapons, ammunitions, explosives, narcotics, and dangerous drugs and, if authorized, classified material.

1.29. Special Tooling (ST): All jigs, dies, fixtures, molds, patterns, taps, gauges, other equipment, and manufacturing aids, and replacements thereof, which are of such a specialized nature that, without substantial modification or alteration, their use is limited to the development or production of particular supplies or parts thereof, or the performance of particular services. The term includes all components of such items but does not include consumable property, test equipment, or buildings, non-serviceable structures (except foundations and similar improvements necessary for the installation of special tooling), general or special machine tools, or similar capital items.

1.30. Special Test Equipment (STE): Electrical, electronic, hydraulic, pneumatic, mechanical, or other items or assemblies of equipment which are of such a specialized nature that, without modification or alteration, the use of such items (if they are to be used separately) or assemblies is limited to testing in the development or production of particular supplies or parts thereof, or in the performance of particular services. The term special test equipment includes all components of any assemblies of such equipment but does not include consumable property, special tooling, or buildings, non-serviceable structures, except foundations and similar improvements necessary for the installation of special test equipment), general or special machine tools, or similar capital items.

2. CONTRACT DESIGNATION: CFM

2.1. Current AF direction is to pursue performance based contracts using a CFM concept. This requires the contractor to provide all needed material as part of the cost of repair. This material is defined as material which is incorporated into an end item to be delivered under the contract or which maybe consumed in the performance of the contract. Includes, but is not limited to, raw and processed material, parts, components, and assemblies.

2.2. This contract has been designated as a CFM contract as indicated on the cover of this appendix and as detailed in the basic contract. Under the terms of CFM, no material defined as GFM is to be provided to the contractor except line items on the contract which are subject to repair.

3. GOVERNMENT-FURNISHED PROPERTY:

3.1. Contractor requisition/procurement of GFM is not authorized. However, in the rare event GFM is required, requisitioning/procurement shall be limited to only the NSN/Part Number and quantities listed and authorized on attachment(s) to this Appendix B.

3.2. Contractor requisition/procurement of GFE, Special Tooling (ST), and Special Test Equipment (STE) is not authorized. However, in the rare event GFE, ST, or STE is required, the PMS shall contact the ALC Loan Control Officer (LCO), 559th CBSS/GBMAC for government loan property authorization. The contractor shall comply with the GFE-related clauses in the basic contract. While the GFE is in the possession of the contractor, it is the contractor’s responsibility to provide routine maintenance and calibration of the GFE to ensure the GFE is returned to the government in the same condition as when provided, less normal wear and tear. GFE will not be requisitioned until it is actually required and will be turned in when no longer required.

4. CONTRACTOR PROPERTY CONTROL RECORDS:

4.1. The official property records are described in the FAR. The contractor shall establish a property control record for each line item. Property records shall be kept current at all times, and an audit trail shall be maintained from property acquisition to consumption in use or final disposition. Property accounting records, including debit and credit support documentation, are considered part of the official government contract records.

4.2. In addition to FAR requirements, the following data shall be maintained and provided by the contractor to the government contracting officer upon request to enable better requirements planning and stock control on future repairs:

(1) Name, description, and National Stock Number (NSN)

(2) Quantity received (or fabricated in house), issued, on hand, and on order

(3) Unit of Issue (each, feet, etc.)

(4) Unit price (from receipt document or stock list data)

(5) Contract or project number relating to contract

(6) Location

(9) Posting references (to include but not limited to support documentation such as issues, receipts, inventory recording and dates of transactions)

(10) Disposition

(11) Quantity due in (on order or being fabricated)

(12) Expendability, recoverability, reparability category (ERRC) code per NSN

(13) Stock levels and reorder points per GFM NSN

(14) Quantity per assembly (QPA) from Material Requirements Listing (MRL) or Technical Order (TO)

(15) Replacement percentage factor experienced from actual repair processes for each individual NSN

(16) Commercial and Government Entity (CAGE) code number per GFM NSN

4.3. In addition to the above, a separate record of requisition numbers shall be maintained and shall include the NSN of the item requisitioned, the unit of issue, quantity, document number, and the date the item was received by the contractor. This record shall be kept current at all times.

4.4. Other reports may be required in accordance with the FAR and the Contract Data Requirements List (CDRL), DD Form 1423.

5. PRODUCTION PROBLEMS:

5.1. The contractor shall report all potential supply support deficiencies that could cause a production slippage or work stoppage to the ACO, PCO, and PMS at the managing ALC. If problems are not resolved, the contractor shall follow up with a written request/report of potential problems and impact to the ACO, PCO and PMS.

6. DISPOSITION OF GOVERNMENT PROPERTY:

6.1. These instructions apply to all government owned property. Within 90 days prior to contract expiration, the contractor shall submit a letter to the managing ALC requesting disposition instructions in the transfer of GFP. A listing identifying GFP shall include the NSN, part number/CAGE, noun, quantity, condition code, and dollar value, and the list will be submitted through the ACO to the PMS for disposition instructions.

6.2. If a follow-on contract is being awarded or, is in the negotiation or solicitation stage, the existing GFP may be retained to the extent required to support the current contract and/or the follow-on contract.

6.3. Package and Shipment of Items:

6.3.1. Expense items in their original packaging shall be shipped as is. All remaining items to be returned shall be packaged Level A and shipped Level B in accordance with the current version of MIL-STD 2073 (Standard Practice for Military Packaging) or as specified in the AFMC Form 158. All items are to be identified with the appropriate NSN/Part Number.

6.3.2. The contractor will comply with preservation, packaging, and packing instruction as specified in the basic contract and/or on the AFMC Form 158 (Packaging Requirements). The contractor will also comply with the current version of MIL-STD 129 (Standard Practice for Military Marking).

6.3.3. The contractor should refer to the basic contract for cost of packaging and shipping.

7. DISCREPANCIES INCIDENT TO SHIPMENT:

7.1. Discrepancies incident to shipment include misidentified items, variations in quantity, non-requisitioned items, lost or damaged parcel post, and items in dubious condition. These discrepancies shall be reported and resolved using the DoD web-based application WebSDR, located at: https://www.daas.dla.mil/websdr/home.asp. This system of reporting a Supply Discrepancy Report (SDR), formerly called a Report of Discrepancy (ROD), has been developed in compliance with DoD regulations 4140.1-R and 4000.25-M Volume 2, which requires automated SDR processing. In those situations where the SDR initiator is unable to gain access to the WebSDR, continued use of manual SF 364 forms is permitted.

7.2. Transportation discrepancies and item transaction discrepancies shall be coordinated with the DCMA Property Administrator and ACO immediately upon discovery for corrective action in addition to WebSDR submittal.

7.3. Contract line items received with missing components (missing on induction, MOI) the contractor shall process a SDR (SF 364) immediately upon discovery in accordance with AFJMAN 23-215 and provide a copy of submitted MOI SDR form to the ACO with in 2 days of discovery.

7.4. Misdirected shipments of GFP shall be immediately reported by telephone to the DCMA Property Administrator followed by written notification within three work days. The DCMA Property Administrator will issue appropriate disposition instructions for the misdirected items. Misdirected items received by the contractor which are not part of this contract will not be receipted into CAV AF.

7.5. Overages, shortages, and misidentified items which are part of this contract and received by the contractor shall be reported into CAV AF with the actual received quantity and with the correct NSN. An SDR shall be processed in accordance with standard procedures identified above for these overages, shortages, and misidentified items.

8. DISPOSITION OF CONDEMNED GOVERNMENT PROPERTY:

8.1. Disposition instructions for all contract line items, end items or ERRC T & C items, such as critical items, MSD and save list items that are condemned during the performance of this contract, shall be requested through the PCO from the managing ALC.

8.2. The contractor shall submit a list of condemned Special Tooling/Special Test Equipment (ERRC S & U) to the contracting ALC PCO and PMS. The listing shall identify the condemned items by NSN, PN, noun and quantity; and shall be submitted together with a letter of transmittal titled Request for Disposition of ST/STE condemned on Contract Number ________________ Attn: Loan Control Officer, LCO, 559 CBSS/GBMAC. Disposition instructions will be provided by the contract managing ALC.

9. CONTRACTOR REPORTING:

9.1. The contractor shall comply with DD Form 1423-1, Contract Data Requirements List, regarding the CAV AF Reporting (DI-MGMT-81634B) via the internet using online web access.

9.2. The contractor shall be responsible for obtaining and presenting a valid DoD PKI certificate in order to log into CAV AF.

9.3. Reporting into CAV AF is at the contract and delivery order number (17 digits). The contractor shall ensure transactional reporting is applied to the correct contract and delivery order number and CAV AF reports reflect accurate data for each delivery order.

10. VISITS:

10.1. Surveillance visits will be made by the ACO and/or the contracting ALC representatives when such visits are considered necessary, particularly in relation to contract material control and production schedules.

11. OTHER:

11.1. The contractor shall not obtain GFP through the utilization of requisition codes assigned exclusively to this contract for any other contracts.

11.2. The contractor shall not transfer GFP charged to this contract to any other contract, contractor, or activity without the advance approval of the PMS through the PCO.

11.3. The government reserves the right to withdraw any GFP in possession of the contractor to supply other urgent USAF requirements. If any item so removed by the government is still required to complete the contract, the contractor shall take appropriate action to replace the removed item.

11.4. When, during the last six months of the contract, it becomes evident that an option shall most probably be exercised, the PCO will notify the contractor through the ACO to maintain stock levels necessary to meet the option workload.

12. REFERENCES:

12.1. Federal Acquisition Regulation (FAR).

12.2. Defense Federal Acquisition Regulation Supplement (DFARS).

12.3. Commercial Asset Visibility (CAV AF), version 6.0 or higher User Manual.

12.4. AFJMAN 23-215, Reporting of Supply Discrepancies.

12.5. AFMAN 23-110, USAF Supply Manual.

12.6. FED LOG CD ROM, Fed Log is the logistics information system published by the Defense Logistics Information Service and available by subscription. The Fed Log web site is: http://www.dlis.dla.mil/Fedlog/

12.7. DLA Customer Assistance Handbook.

12.8. DODI 8520.2 PKI and Public Key (PK) Enabling.

12.9. Other DoD and military service directives; if specifically referenced in the contract, special clauses or appendices.

ATTACHMENT 1

CONTRACTOR COMMUNICATIONS NETWORK (CCN)

1. GENERAL INFORMATION:

1.1. The purpose of this attachment is to provide the specific conditions, hardware specifications, and communications interface to support contractor GFM and End Item reporting requirements and supply requisitions. Through the CCN Air Force contractors, with aircraft, engine or equipment repair contracts, have the capability to electronically process GFM and End Item transactions.

1.2. Initial CAV AF training will be provided by the contracting ALC. Any follow up training will be the responsibility of the contractor.

2. WEB SITE:

2.1. CAV AF web site accessed through the internet will be used to submit all GFM and End Item transactions. Each contractor user shall be required to complete a System Security Access Request, DD Form 2875, prior to using CAV AF.

2.2. The Web address for Online CAV AF access is: https://www.cavaf.com/cavweb/

2.3. The DLA/DAASC front-end computer at Wright-Patterson AFB, Ohio will act as host for GFM requisitions and MILSTRIP Status updates processed through CAV AF as batch end-of-day/beginning-of-day transactions.

3. TECHNICAL CONSIDERATIONS:

3.1. Contractors accessing CAV AF shall present a valid DoD PKI certificate to log into CAV AF. Contractors working at DoD facilities who have a common access card (CAC), should already have a PKI certificate. Contractors working outside of DoD facilities can purchase a valid DoD PKI certificate through one of three External Certificate Authorities (ECAs). A listing of ECAs and additional information on purchasing a valid DoD PKI can be found at the following web site: http://iase.disa.mil/pki/eca/ . Each contractor employee accessing CAV AF will need an Identity Certificate only; an Encryption Certificate is not required.

3.2. CAV AF is designed to be accessible using Microsoft Internet Explorer (IE6) v6.0 or higher or Netscape 4.75 or higher on a Windows 2000 or newer platform. IE6 is suggested and contains the required 128-bit encryption capability, and DoD certification. The following hardware is suggested as a minimum to adequately support CAV AF reporting with a minimum system requirement using Windows 2000 or newer version:

IBM compatible PC (1.5 GHZ Pentium)

512 MB RAM

20 GB hard drive

56 K BPS or faster data transmission modem, or connection to WAN/LAN

Laser Printer with 300 DPI resolution, (must support true type font)

3.3. The following software is required to accomplish CAV AF Web-based reporting:

Operating System: Windows 2000 or newer version Web Browser: Internet Explorer, version 6.0 (preferred), or Netscape version 4.75

(or higher) is also compatible, but not recommended for Air Force use.

3.4. CAV AF Web-based software will reside on the AF mid-tier server. CAV AF software changes will be made at the mid-tier server and they will be available to the repair vendor upon log-on to the CAV AF system. Changes to CAV AF software by the commercial repair vendors are not authorized.

4. CONTRACTOR RESPONSIBILITY:

4.1. The contractor shall be responsible for the maintenance of the hardware and supplies (paper, ink, ribbons, extra disks, etc) to keep the PC system operational and compatible with the host computer.

4.2. The contractor shall use the CCN/CAV AF Reporting System to report all GFM and end item transactions. These transactions shall be entered into CAV AF on a real time basis or as changes generate, but not later than 24 hours from the date of occurrence.

4.3. System failures that cannot be corrected within 24 hours shall be reported to the contracting ALC by the fastest means possible.

5. SYSTEM AUTHORIZED ACCESS REQUEST (SAAR):

5.1. The SAAR, DD Form 2875, shall be completed by the contractor and submitted to the managing ALC CAV AF POC. A blank SAAR, DD Form 2875, and instructions on how to fill it out are below and can be obtained from the managing ALC CAV AF POC.

5.2. The OC-ALC CAV AF POCs are: Donetta Sholette or Brandi Winner at (405) 736-7356; Fax (405) 736-5308. Mailing address is:

559th GBSS/GBLC, Contract Repair Office

ATTN: CAV AF System Administrator

3001 Staff Dr, Suite: 1AI 87A Tinker AFB, OK 73145

5.3. CAV AF user IDs will be in a standard format for all users. The user id and initial password will normally be emailed

5.4. Users will be required to change this password following your initial entry to the system.

Form as of: 15 Aug 2007

_1248163382.doc Instructions for 2875

Input Date on Top Right block

Fill out blocks 1-6, 8-10 (Block 2 should be last 4 of SSN only)

Leave IA block blank.

Fill out blocks 11-12.

Check block 16

Block 16a – Company Name and DODAAC (EZXXXX) – we need both – if they don’t fit in this block, put them in block 27.

Fill out blocks 17-20b

In block 27, put “User” if you will be inputting to the system and “View Only” if you will only be viewing the data in the system.

Supervisor/Security Manager fills out 28-28b and 29-32 if info is available – Should be either investigation for security clearance or background investigation

Fax to our office at (405) 736-5308

_1248240401.pdf

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