Attach_2_(DD254).pdf

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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PREVIOUS EDITION IS OBSOLETE.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:

October 31, 2020 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 List of Attachments (All Files Must be Attached Prior to Signing, i.e., for any digital signature on the form)

Blk 12:

Information requiring AF or DoD-level review will be forwarded by the entry-level public affairs office thru the MAJCOM/DRU Public Affairs Office to the Secretary of the Air Force, Office of Public Affairs, Security and Review Division (SAF/PAX), 1690 Air Force Pentagon, Wash DC 20330-1690.

711 HPW/RHXM, 2450 D Street, Wright-Patterson Air Force Base, OH 45433 for non-SAR related material. Transmission of public release request via e-mail is not authorized.

Ref Blk 10e(1): Public release of Sensitive Compartmented Information (SCI) is NOT authorized.

Blk 13:

Ref Blk 10e(1): Contractor requires access to SCI materials; SCI security requirements apply, (see 21 IS/INS, SSO WPAFB, SCI addendum, for details).

Ref Blk 10e(2): Contractor will require access to intelligence information and must comply with directions provided by the Program Manager (PM). 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 PM will identify what intelligence information is required for the contractor to satisfy the contract and will submit that information to the AFRL servicing Senior Intelligence Officer (SIO) for approval prior to granting access.

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

Ref Blk 10g: Access to JWICS is authorized. Users shall be briefed to NATO Secret IAW the NISPOM, Para 10-706, prior to access.

Ref Blk 10j: See DoDM 5200.01, Volume 4, DoD Information Security Program: Controlled Unclassified Information (CUI), for requirements.

Ref Blk 11c: Any classified information generated in the performance of this contract shall require the contractor to apply derivative classification and markings consistent with the source material or be governed by the current version of the Air Force Distributed Common Ground System (AF DCGS) Security Classification Guide, June 2006, revised 31 December 2011, ISRG-HBK-SEC-6000 Rev – 31 December 2011. . SCDG will be provided under separate cover. Partial performance as a receive & generate visitor in support of RQKHA will occur in Warner Robins Air Logistics Center (WR-ALC) Air Force Distributed Common Ground System C2ISR Division (WR-ALC/GRC), Robins Air Force Base, GA. Any classified information generated in the performance of this contract shall require the contractor to apply derivative classification and markings consistent with the source material.

Program Manager: Anne Cybenko, 711HPW/RHXM, 937-713-1763, anne.cybenko.1@us.af.mil

Security Manager: Tina L. Henry, 711 HPW/OMS, 2245 Monahan Way, WPAFB, OH 45433-7008, tina.henry@us.af.mil.

IT Level I duties require a favorably completed Single Scope Background Investigation (SSBI) and a periodic reinvestigation every 5 years. (Tier 5)

Ref Blk 18f (Distribution):

711 HPW/OMS, 2245 Monahan Way, WPAFB, OH 45433-7008, 711hpw.oms.sec@us.af.mil.

AFRL Senior Intelligence Office: HQ AFRL/XP2, 1864 4th Street, B015, WPAFB, OH 45433, ellen.noble.1@us.af.mil. 711 HPW Senior Intelligence Office: 711 HPW/RHAS, 2620 Q Street, Bldg 852, WPAFB, OH 45433, brandon.black.1@us.af.mil.

WPAFB Special Security Office (SSO): 21 IS/INS, SSO WPAFB, 2450 D Street, Bldg 20, Area B, WPAFB OH 45433-7629, WPAFBSpecialSecurityOffice.Mailbox@us.af.mil.

Program Manager: Anne Cybenko, 711HPW/RHXM, 937-713-1763, anne.cybenko.1@us.af.mil

GCA: Joseph Mizzi, 937-713-9925, joseph.mizzi@us.af.mil

SSO, Industrial Security Manager

Ref Blk 10e(1): SCI security requirements apply, see SCI addendum for details.

Ref Blk 11i: Emanations security (aka TEMPEST) requirements apply to the SCIF execution location. See Defense Federal Acquisition Regulation Supplement (DFARS) Clause 252.239-7000, Protection Against Compromising Emanations, dated 25 June 2004, revised 10 January 2008; Intelligence Community (IC) Tech Spec-for ICD/ICS 705, Technical Specifications For Construction and Management of Sensitive Compartmented Information Facilities, version 1.4, dated 28 September 2017; Committee on National Security Systems Advisory Memorandum (CNSSAM) TEMPEST/01-13, Red/Black Installation Guidance, dated 17 January 2014.

Ref Blk 11j: OPSEC requirements apply. See Statement of Work (SOW) for requirements.

Wright-Patterson AFB, OH 45433