A208 EUHW CDRL_Contractor Personnel Access List Report.docx

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item) Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 110 hours 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 this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY:

TDP ____ TM ____ OTHER __X_______

D. SYSTEM/ITEM

NEN

E. CONTRACT/PR NO.

End User Hardware (EUHW)

F. CONTRACTOR

1. DATA ITEM NO

A208

2. TITLE OF DATA ITEM

Contractor Personnel Access List Report

3. SUBTITLE

Listing of assigned cleared contractor personnel and NEN network access (IT Level I, II, III)

4. AUTHORITY (Data Acquisition Document No.)

SECNAV M-5239.2, June 2016

5. CONTRACT REFERENCE

PWS Paragraphs 3.6.c.

6. REQUIRING OFFICE

PMW 205

7. DD250 REQ

XX

9. DIST. STATEMENT

REQUIRED

F

10. FREQUENCY

MTHLY

12. DATE OF FIRST SUBMISSION

30 DAC

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT SUBMISSION

N/A

DRAFT

FINAL

16. REMARKS:

The Government/Contractor shall collaborate on the development of the initial delivery.

The Contractor Personnel Access List Report shall consist of an Excel Spreadsheet protected by encryption, appropriately marked as Personally Identifiable Information (PII), with password protection and uploaded to a restricted access drive folder location provided to Contractor by the Government (or by other electronic data form approved by the Government):

1. TAB A – Introduction

a. Statement of purpose and distribution restrictions

b. List of TAB Contents

2. TAB B – Listing of all personnel assigned to contract that have cleared access and/or network access (IT Level I, II, III). List will include:

POSITION NUMBER/TITLE (Based on TAB C Descriptions); LAST NAME; FIRST NAME; MIDDLE; EMAIL; CONTRACT#; COMPANY; START DATE ON CONTRACT; END DATE ON CONTRACT; CAC EXP DATE; DATE CAC REVOKED; DATE CAC RETURNED TO GOVERNMENT; PERSON ID (SSN); CLNC INVESTIGATION TYPE; INVESTIGATION CLOSED DATE; POSITION IT LEVEL REQUIREMENT; POSITION CSWF REQUIREMENT(S); CSWF CERT 1; CERT 1 EXP. DATE; CSWF CERT 2; CERT 2 EXP. DATE; CSWF CERT 3; CERT 3 EXP. DATE; ADMIN ROLE ASSIGNED; ADMIN ASSIGNED DATE; ADMIN DISABLED DATE; REMARKS AND NOTES.

This listing will report terminated personnel at least for one monthly cycle at which time they may be removed unless pending issues remain (e.g., CAC not returned to government, Security Incident, etc.)

3. TAB C – Position Descriptions identifying associated IT Level and CSWF requirements.

4. TAB D – Summary of Security Incidents (new and pending) and current status of each. Note this monthly reporting does not replace requirements for timelier reporting of security incidents; rather it is for tracking to completion of incident related actions.

Block 8: Approval is not required. However, the submission will be reviewed and may be rejected, based on its conforming to the requirements of the DD1423 and/or DID.

Block 9: Distribution Statement F. Further distribution only as directed by PMW 205 or higher DoD authority; 1 Jun 2018.

Block 14: Electronically delivered in pre-approved template format to PMW 205 Program Security via encrypted email with notification sent to CDRL Management Team.

See BLK 16

15. TOTAL

G. PREPARED BY

H. DATE

I. APPROVED BY

J. DATE

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED PAGE 1 OF 2