Exh A CDRL A005 IT 28 Mar 2011.doc
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- N6134011R0039
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Exhibit A CDRLs
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CONTRACT DATA REQUIREMENTS LIST (CDRL)
(1 Data Item) Form Approved
OMB No. 0704-0188
The 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 the burden, to the Department of Defense, Executive Services Directorate (0704-0188). 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. Please do not return your form to the above organization. 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 |
| C. CATEGORY: |
| A LOTS I-V ASK \* MERGEFORMAT |
| TDP ______ |
| TM ______ |
| OTHER: LOGISTICS DATA |
| D. SYSTEM/ITEM |
| E. CONTRACT/PR NO. |
| F. CONTRACTOR |
| FRCMA-PAX CMSS |
| N61340-11-R-0039 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A005 |
| TECHNICAL REPORT – STUDY/SERVICES |
| INFORMATION TECHNOLOGY (IT) PERSONNEL SECURITY REPORT |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
TOTAL PRICE
| DI-MISC-80508B |
| SOW PARAs 3.1.4, 3.2.5, 4.3.1.3 & 4.7.2 |
| FRCMA-PAX SECURITY OFFICER |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10. FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| LT |
| REQUIRED |
| ASREQ |
| SEE BLK 16 |
| a. ADDRESSEE |
| b. COPIES |
| 8. APP CODE |
| F |
| 11. AS OF DATE |
| 13. DATE OF SUBSEQUENT SUBM. |
| Draft |
| Final |
SEE BLK 16
| Reg |
| Repro |
| 16. REMARKS |
| NAWCTSD PCO |
| LTR |
| ONLY |
1. BLK 4: ONLY DID PARAGRAPH 3 (C).(2) APPLIES. REFER TO ATTACHED ANNEX FORMAT. SUBMISSIONS SHALL BE A SECURITY REPORT FOR ALL EMPLOYEES (PRIME, SUBCONTRACTOR, CONSULTANTS AND TEMPORARY EMPLOYEES) REQUIRING ACCESS TO GOVERNMENT INFORMATION TECHNOLOGY (IT) SYSTEMS. FREEDOM OF INFORMATION ACT , PRIVACY ACT AND PERSONAL INFORMATION PROTECTION REQUIREMENTS AND MARKINGS APPLY.
2. BLK 4: DELETE PARA 2. SUBMISSION SHALL BE A MICROSOFT @ EXCEL 2003 SPREADSHEET FORMATTED IN ACCORDANCE WITH ANNEX TO EXHIBIT A (NOTE: SOCIAL SECURITY NUMBERS (SSNs) SHALL ONLY APPEAR ON REPORT SUBMITTED TO FRCMA-PAX SECURITY OFFICER). SUBMISSION TO FRCMA-PAX SECURITY OFFICER SHALL ALSO INCLUDE A COMPLETED SYSTEM AUTHORIZATION ACCESS REQUEST-NAVY (SAAR-N OPNAV 5239/14 FORM (IN .PDF FORMAT) FOR EACH EMPLOYEE. BLANK FORM MAY BE DOWNLOADED FROM THE FOLLOWING WEBSITE: http://www.navair.navy.mil/forms/OPNAV_5239_14%20SAAR_NRev%20(2).pdf
3. BLK 12: FIRST SUBMISSION SHALL BE DUE NO LATER THAN 5 WORKING DAYS PRIOR TO CONTRACTOR SUPPORT DATE (CSD) OR PRIOR TO LOGGING ON ACCESS TO GOVT ASSETS, WHICHEVER COMES FIRST.
4. BLK 13: UPDATED SUBMISSIONS DUE AS REQUIRED WITHIN (3) WORKING DAYS OF GAIN OR LOSS OF EMPLOYEE(S) THAT HAVE OR WILL ACCESS GOVERNMENT INFORMATION TECHNOLOGY (IT) SYSTEMS. ANNUAL SUBMISSIONS SHALL BE DUE 12 MONTHS AFTER CONTRACT AWARD THROUGH END OF CONTRACT.
5. THE GOVERNMENT WILLHAVE 20 WORKING DAYS FOR REVIEW AND ACCEPTANCE/REJECTION OF EACH SUBMISSION.
6. BLK 14: SUBMISSION SHALL BE AN ELECTRONIC ENCRYPTED COPY SENT VIA EMAIL. EMAIL SUBJECT LINE SHALL INCLUDE CONTRACT NUMBER, CDRL DATA ITEM NUMBER. CONTRACT, TITLE, AND DATE OF REPORT. (E.G. N61340-11-C-xxxx IT FRCMA CMSS- A005-MAY-11). EMAIL ADDRESSES ARE PROVIDED IN THE CONTRACT SCHEDULE. FILES SHALL BE ENCRYPTED USING WINZIP AES 256-BIT ENCRYPTION.
Note *: DO NOT RECEIVE SAAR-N FORMS , ONLY SPREADSHEET DATA WITH NO SSN..
Note: ** RECIEVES SPREADSHEET WITH SSN’S AND SAAR-N FORMS.
7. BLK 9: THE FOLLOWING STATEMENT SHALL BE INCLUDED ON THE DELIVERABLE:
DISTRIBUTION F: DISTRIBUTION AUTHORIZED ONLY AS DIRECTED BY THE CONTROLLING OFFICE (FRCMA-PAX SECURITY OFFICER), (ADMINISTRATIVE OR OPERATIONAL USE ONLY), (10 NOV 2009). OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED TO THE COMMANDING OFFICER, NAVAL AIR WARFARE CENTER, TRAINING SYSTEMS DIVISION, (NAWCTSD PCO, CODE 25332), 12350 RESEARCH PARKWAY, ORLANDO, FL 32826-3275.
NAWCTSD PJM *
FRCMA PAX COR *
FRCMA-PAX ACOR *
FRCMA-PAX SECURITY OFF * *
| 15. TOTAL ▬▬▬▬► |
| 0 |
| 0 |
| 4 |
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
| L. DANIELS, NAWCTSD PJM |
| 28 Mar 2011 |
| B. HICKS, NAWC TSD PDX |
| 28 Mar 2011 |
DD FORM 1423-1, FEB 2001
PREVIOUS EDITION MAY BE USED
Page 1 of 2 Pages
ANNEX TO EXHIBIT A - CDRL A005 Page 2 of 2 IT Personnel Security Report The following Excel Spreadsheet shall be completed and submitted to FRCMA-PAX SECURITY OFFICER along with the completed SAAR-N forms with full SSN (Needed for JPAS entry):
The following Excel Spreadsheet shall be completed and submitted to all other BLK 14a distribution addressees whose report is identified to be WITHOUT the SAAR-N forms and “NO” SSN’s:
_1357550010.xls Privacy Act Notice
Privacy Act Notice
This spreadsheet will contain Privacy Act Data information upon completion which shall be safeguarded in accordance with the Privacy Act of 1975. Electronic transmittal of the spreadsheet to the NAVAIR Security office (as required by the CDRL) shall be encrypted. The contractor assumes all liability for loss or inadvertent release of information if this data is transmitted by any other means, is released by the contractor to any other parties, or if the data is compromised via storage on the contractor's computer system.
SAAR-N Info
Site Manager: Name/Signature Date: dd/mm/yy CDRL #: A005
Wep System: FRCMA-PAX CMSS Location: NAS PATUXENT RIVER, MD COR: Name/Signature/ Date (ddmmyy)
Contractor: XYZ, Inc Contract #: N61340-11-C-____ NOTE: PRIVACY ACT APPLIES NOTE: PRIVACY ACT APPLIES
| User's | |||||||||||
| Last Name (In alphabetical order) | First Name | MI | Suffix | Social Secuirty Number ###-##-###: | Citizenship: US, FN, or Other____ | Employee Type: Civ/ Mil/ Contractor ____ | Organization: | Office/Dept/Work Center: | Official User Email Address | IA Training & Awareness Annual Certificate Date | Date of User Signature |
| (SAAR-N) : | Type Access Required (Authorized or Priviledged): | User Rqrs Access to UNCLAS or CLASSIFIED _______: | Contract No. /Expiration Date: | Type / Date (yyyymmdd) of Background Investigation: | Security Clearance Level: | IT Level Designation (Level I, 2, 3): | FRCMA-PAC Security Manager Name / Phone: | FRCMA Security Manager Remarks: | FRCMA-PAX Security Mgr Validation Date (yyyymmdd): | COR | |
| Name: | COR | ||||||||||
| Email & Phone#: | Date System Access Authorized (yyyymmdd): | Date System Access Withdrawn by COR or Security Mgr: | Requested IT System /s for Access (separate IT system by comma's): |
Smith John A Jr 123-56-7890 US Contractor, XYZ Inc FRCMA-PAX, MD X50 John.Smith.CTR@navy.mil 4/25/07 4/25/07 Authorized CLASS / Secret N61340-11-C-____ / Expires 30 Nov 2013 NACLC / 20101225 SECRET 3 ATC M. Security/ (301) 342-#### Validated NACLC-20100125/ SECRET Level 3 20111017 Joe Navy Joseph.Navy@navy.mil / (301) 342-0000 COR authorized 20111025 TBD NMCI, N-ERP, EDA, NOD, NALCOMIS
&C&"Arial,Bold"&12ANNEX TO EXHIBIT A - CDRL A005) Information Technology Personnel Security Report For FRCMA-PAX SECURITY MGR
&LPrivacy Act Notice:
This spreadsheet contains Privacy Act Data information which shall be safeguarded in accordance with the Privacy Act of 1975.&R&P
Joseph.Navy@navy.mil / (301) 342-0000
Sheet2
Duty Location Company Code Emp
NAVAIR HQ Patuxent River, MD HQ Civ
NAVAIR HQ North Island, CA TSD Mil
NAVAIR HQ China Lake, CA NAPRA CSS
NAVAIR HQ Jacksonville, FL NATEC FN
NAVAIR HQ Lakehurst, NJ NAWCAD
NAVAIR HQ Pt Mugu, CA NAWCWD
NAPRA Atsugi, Japan Non NAVAIR
NAWCTSD Orlando, FL
NATEC North Island, CA
NAWCAD Patuxent River, MD
NAWCWD China Lake, CA
NAWCWD Pt Mugu, CA
NAWCAD Lakehurst, NJ
_1357549738.xls Privacy Act Notice
Privacy Act Notice
This spreadsheet will contain Privacy Act Data information upon completion which shall be safeguarded in accordance with the Privacy Act of 1975. Electronic transmittal of the spreadsheet to the NAVAIR Security office (as required by the CDRL) shall be encrypted. The contractor assumes all liability for loss or inadvertent release of information if this data is transmitted by any other means, is released by the contractor to any other parties, or if the data is compromised via storage on the contractor's computer system.
SAAR-N Info
Site Manager: Name/Signature Date: dd/mm/yy CDRL #: A005
Wep System: FRCMA-PAX CMSS Location: NAS PATUXENT RIVER, MD COR: Name/Signature/Date (dd/mm/yy)
Contractor: XYZ, Inc Contract #: N61340-11-C-____ DO NOT ENTER SSN: NOTE: PRIVACY ACT APPLIES NOTE: PRIVACY ACT APPLIES
| User's | ||||||||||
| Last Name (In alphabetical order) | First Name | MI | Suffix | Citizenship: US, FN, or Other____ | Employee Type: Civ/ Mil/ Contractor ____ | Organization: | Office/Dept/Work Center: | Official User Email Address | IA Training & Awareness Annual Certificate Date | Date of User Signature |
| (SAAR-N) : | Type Access Required (Authorized or Priviledged): | User Rqrs Access to UNCLAS or CLASSIFIED _______: | Contract No. /Expiration Date: | Type / Date (yyyymmdd) of Background Investigation: | Security Clearance Level: | IT Level Designation (Level I, 2, 3): | FRCMA-PAC Security Manager Name / Phone: | FRCMA Security Manager Remarks: | FRCMA-PAX Security Mgr Validation Date (yyyymmdd): | COR |
| Name: | COR | |||||||||
| Email & Phone#: | Date System Access Authorized (yyyymmdd): | Date System Access Withdrawn by COR or Security Mgr: | Requested IT System /s for Access (separate IT system by comma's): |
Smith John A Jr US Contractor, XYZ Inc FRCMA-PAX, MD X50 John.Smith.CTR@navy.mil 4/25/07 4/25/07 Authorized CLASS / Secret N61340-11-C-____ / Expires 30 Nov 2013 NACLC / 20101225 SECRET 3 ATC M. Security/ (301) 342-#### Validated NACLC-20100125/ SECRET Level 3 20111017 Joe Navy Joseph.Navy@navy.mil / (301) 342-0000 COR authorized 20111025 TBD NMCI, N-ERP, EDA, NOD, NALCOMIS
&C&"Arial,Bold"&12ANNEX TO EXHIBIT A - CDRL A005) Information Technology Personnel Security Report For FRCMA-PAX COR
&LPrivacy Act Notice:
This spreadsheet contains Privacy Act Data information which shall be safeguarded in accordance with the Privacy Act of 1975.&R&P
Joseph.Navy@navy.mil / (301) 342-0000
Sheet2
Duty Location Company Code Emp
NAVAIR HQ Patuxent River, MD HQ Civ
NAVAIR HQ North Island, CA TSD Mil
NAVAIR HQ China Lake, CA NAPRA CSS
NAVAIR HQ Jacksonville, FL NATEC FN
NAVAIR HQ Lakehurst, NJ NAWCAD
NAVAIR HQ Pt Mugu, CA NAWCWD
NAPRA Atsugi, Japan Non NAVAIR
NAWCTSD Orlando, FL
NATEC North Island, CA
NAWCAD Patuxent River, MD
NAWCWD China Lake, CA
NAWCWD Pt Mugu, CA
NAWCAD Lakehurst, NJ
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