DD254_-_Distance_Learning_Support_service.pdf

DEPARTMENT OF DEFENSE

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

(The requirements of the DoD Industrial Security Manual apply to all security aspects of this effort.)

1. AND SAFEGUARDING

a. CLEARANCE REQUIRED

b. LEVEL OF SAFEGUARDING REQUIRED

2. IS FOR: (X and complete as applicable)

a. CONTRACT NUMBER

b. SUBCONTRACT NUMBER

c. DUE DATE (YYYYMMDD)

3. IS: (X and complete as applicable)

a. (Complete date in all cases)

REVISION NO.

c. (Complete Item 5 in all cases)

DATE (YYYYMMDD)

b. REVISED (Supersedes all previous specs)

DATE (YYYYMMDD)

DATE (YYYYMMDD)

4. THIS A FOLLOW-ON CONTRACT? YES NO. Yes, complete the following:

Classified material received or generated under (Preceding Contract Number) is transferred to this follow-on contract.

5. THIS A FINAL DD FORM 254? YES NO. Yes, complete the following:

In response to the contractor's request dated , retention of the classified material is authorized for the period of

6. (Include Commercial and Government Entity (CAGE) Code)

a. ADDRESS, AND ZIP CODE b. CAGE CODE c. SECURITY OFFICE (Name, Address, and Zip Code)

7.

a. ADDRESS, AND ZIP CODE b. CAGE CODE c. SECURITY OFFICE (Name, Address, and Zip Code)

8. PERFORMANCE

a. b. CAGE CODE c. SECURITY OFFICE (Name, Address, and Zip Code)

9. IDENTIFICATION OF THIS PROCUREMENT

10. CONTRACTOR WILL REQUIRE ACCESS TO: 11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL:YES NO YES NO

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION

b. RESTRICTED DATA

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION

d. FORMERLY RESTRICTED DATA

e. INTELLIGENCE INFORMATION

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI f.

g. NATO INFORMATION

h. FOREIGN GOVERNMENT INFORMATION

i. LIMITED DISSEMINATION INFORMATION

j. FOR OFFICIAL USE ONLY INFORMATION

k. (Specify)

a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT ANOTHER

CONTRACTOR'S FACILITY OR A GOVERNMENT ACTIVITY

b. RECEIVE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE AND GENERATE CLASSIFIED MATERIAL

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

e. PERFORM SERVICES ONLY

f. ACCESS TO U.S. CLASSIFIED INFORMATION OUTSIDE THE U.S., PUERTO RICO, U.S. POSSESSIONS AND TRUST TERRITORIES

g. BE AUTHORIZED TO USE THE SERVICES OF DEFENSE TECHNICAL INFORMATION

CENTER (DTIC) OR OTHER SECONDARY DISTRIBUTION CENTER

h. REQUIRE A COMSEC ACCOUNT

i. HAVE TEMPEST REQUIREMENTS

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE THE DEFENSE COURIER SERVICE

l. (Specify)

CLEARANCE

FACILITY

THIS SPECIFICATION

PRIME

SOLICITATION OR OTHER NUMBER

THIS SPECIFICATION

ORIGINAL

FINAL

IS If

IS If

CONTRACTOR

NAME, COGNIZANT

SUBCONTRACTOR

NAME, COGNIZANT

ACTUAL

LOCATION COGNIZANT

GENERAL

SPECIAL ACCESS INFORMATION

OTHER

HAVE

OTHER

DD FORM 254, DEC 1999 PREVIOUS EDITION IS OBSOLETE.

12. RELEASE. Any information (classified or unclassified) pertaining to this contract shall not be released for public dissemination except as provided by the Industrial Security Manual or unless it has been approved for public release by appropriate U.S. Government authority. Proposed public releases shall be submitted for approval prior to release a.

Direct Through (Specify)

d. ADDRESS (Include Zip Code)

Yes No to the Directorate for Freedom of Information and Security Review, Office of the Assistant Secretary of Defense (Public Affairs)* for review.

*In the case of non-DoD User Agencies, requests for disclosure shall be submitted to that agency.

13. The security classifiection guidance needed for this classified 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. Add additional pages as needed to provide complete guidance.)

14. Requirements, in addition to ISM requirements, 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 cognizant security office. Use Item 13 if additional space is needed.)

Yes No15. Elements of this contract are outside the inspection responsibility of the cognizant security office.

(If Yes, explain and identify specific areas or elements carved out and the activity responsible for inspections. Use Item 13 if additional space is needed.)

16. CERTIFICATION AND SIGNATURE. Security requirements stated herein are complete and adequate for safeguarding the classified information to be released or generated under this classified effort. questions shall be referred to the official named below.

b. TITLE c. (Include Area Code) e.

17. DISTRIBUTION

a. CONTRACTOR

b. SUBCONTRACTOR

c. COGNIZANT SECURITY OFFICE FOR PRIME AND SUBCONTRACTOR

d. U.S. ACTIVITY RESPONSIBLE FOR OVERSEAS SECURITY ADMINISTRATION

e. ADMINISTRATIVE CONTRACTING OFFICER f.

PUBLIC

TYPED NAME OF CERTIFYING OFFICIAL

SECURITY GUIDANCE.

ADDITIONAL SECURITY REQUIREMENTS.

INSPECTIONS.

All

TELEPHONE

SIGNATURE

REQUIRED

OTHERS AS NECESSARY

DD FORM 254 (BACK), DEC 1999

TBD

TBD

WRIGHT-PATTERSON

AFB, OH 45433-7641

See item #13

Arlington, VA 22202

Room 2C757, 1155 Defense Pentagon Washington, DC 20301-1155 security: The National Industrial Security Program Operation Manual (NISPOM), Feb 2006, applies.

a Ref Blk 10j: See DoDM 5200.01, Volume 4, DoD Information Security Program. Controlled Unclassified Information (CUI), Enclosures 3&4 and DoD 5400, 7-R.Air Force Manual 33-302, DoD Freedom of Information Act (FOIA) Program for requirements. Protection of unclassified DoD information not approved for public release on non-DoD information systems shall be protected IAW DoDI 8582.01 , Security of Unclassified DoD information on non-DoD Information Systems, Enclosure 3.

b. Ref Blk11a: Using activity will provide security classification guidance for performance on this contract. On base performance of this contract at the identified location, the contractor shall apply derivative classification and markings consistent with the source material.

c. Blk 11j: Provide the information requested by the Notification of Government Security Activity and Visitor Group Security Agreement clause, Air Force Federal Acquisition Regulation Supplement (AFFARS) 5352.204-9000, tom88 ABW/IPD, 1801 Tenth st, Wright Patterson AFB, OH 45433-7625, 88ABW.IPD.INDUSTRAL.SECURITY@us.af.mil

d. Program Manager: Dwayne Eldridge, DISAM, Phone (837) 713-3529.

e. Security POC: Pat White, DISAM, Phone (937) 713-3529.

f. Contracting Officer Representative (COR): William E. Rimpo, DISAM (937) 713-3239

g. Ref Blk 17e: (ACO) Woodrow W. Bell, DSCA 12th St. South, Arlington, VA 22202-5408, Phone (703) 697-8952

h. Ref Blk 17e: 88 ABW/IPD, 1801 10TH ST, WPAFB, OH 45433-7625, 88ABW.IPD.INDUSTRAL.SECURITY@us.af.mil; patricia.a.white248.civ@mail.mil