Contractor Vetting and PDR Request Form (BLANK).pdf

Contractor Vetting & Position Designation Record (PDR)

Request Form

PART I. Basic Information

No

Date: _________________________

Requester Name/Email: _______________________________________________ COR? Yes No

COR (if other than requester): _______________________________________________________

Contracting Officer Name/Email:_____________________________________________________

Company/Contract #:_______________________________________________________________

PART II. Contractor Information

Contractor Full Legal Name: _______________________________________________________

Email:_______________________________________ Phone #: ______________________

Position Title: ______________________________________________________________

Projected length of time contractor will perform work under this contract:

Less than 180 days More than 180 days (Specify):____________________________

Duty Location (Address):__________________________________________________________

Remote: Yes No

Supervisor Name:_____________________________________________________________

Email:_____________________________________ Phone #: _____________________

System Access Required: Y e s No Credential (PIV) Required: Yes No

PART III. Position Description

Describe the primary duties and/or include relevant passages from the Statement of Work.

Notes: For fiduciary responsibilities, include maximum dollar amounts the position can obligate, expend, collect, or control.

Annotate if the position holds administrative rights to any IT system. List if the position requires use of a firearm.

PART IV. Position Requirements, Duties, and Responsibilities

Indicate any public trust duties that pertain to this contractor position. Check all the apply:

Government operations – rulemaking, policy, and major program responsibility (includes regulation or policy making, directing, implementing, advising and audits).

Public safety and health services, regulation, enforcement, and protection (Food safety and inspection, occupational health and safety, transportation safety, environmental safety and hazard mitigation).

Law Enforcement or criminal justice duties.

Protection of government funds for non-national security operations.

Customs, Immigration, and/or Critical Infrastructure and Key Resources.

Hazardous material handling and transportation.

Physical security, controlling facility or physical access to information technology, and/or controlled access to arms, ammunitions, or explosives.

Investigation, oversight, and audits of government personnel, programs, and activities.

Adjudication of matters or claims (other than national security, suitability, fitness, or credentialing) with the potential to impact the public’s trust.

Protection of government information technology systems (supervision or control of information technology systems, authority to bypass significant technical and operational security controls for general support systems, or access to major applications – the scope of these duties exceeds that of ordinary or routine computer use).

Protection of personal, private, controlled unclassified, or proprietary information-with the potential to damage the public’s trust (includes access to or processing of personally identifiable information such as that protected by the Privacy Act (PA) of 1974, financial data, or privileged information involving the award of contracts, contractor proprietary information, etc.).

Government service delivery, including customer service or public liaison duties.

Other activities demanding a significant degree of public trust (Specify any other specific duties that are not otherwise covered):__________________________________________________________

No Public Trust Duties

PART V: Level of Supervision or Other Controls

Indicate which level of supervision best applies to this contract position:

Limited or no supervision: Ability to act independently in almost all areas almost all the time.

Periodic, ongoing review: Ability to act independently most of the time, but occasionally has work reviewed by a supervisor with relevant technical knowledge.

Close technical supervision: Ability to act independently infrequently, most of or all work is reviewed by a supervisor with relevant technical knowledge.