DD14231_A034_Cyber Incident Report.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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:

TDP ________ TM _______ OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

Page of Pages

1. Use/Relationship: The After Action Report (AAR) provides information about each cyber incident.

2. Submission Format and Instructions.

The report shall be in the contractor's format and contain the following:

1. Company point of contact information (address, position, telephone, email)

2. Data Universal Numbering System (DUNS) Number

3. Contract number(s) or other type of agreement affected or potentially affected

4. Contracting Officer or other type of agreement point of contact (address, position, telephone, email)

5. USG Program Manager point of contact (address, position, telephone, email)

6. Contract or other type of agreement clearance level (Unclassified, Confidential, Secret, Top Secret, Not applicable)

7. Facility CAGE code

8. Facility Clearance Level (Unclassified, Confidential, Secret, Top Secret, Not applicable)

9. Impact to Covered Defense Information

10. Ability to provide operationally critical support

11. Date incident discovered The contractor shall segregate Department of Navy (DON) Covered Defense Information (CDI) from contractor information, when feasible.

BLK 9: The following information shall be included on the deliverable: DISTRIBUTION STATEMENT E: Distribution authorized to DoD components only. Other requests must be referred to PEO C4I or the SPAWAR Office of Congressional and Public Affairs (SPAWAR 00P)

WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., sec. 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violation of these export laws are subject to severe criminal penalties. Disseminate in accordance with the provisions of DoD Directive 5230.25.

BLK 12: Due within 15 days after discovery of each cyber incident.

BLK 14: The contractor shall submit the Cyber Incident Report to the Defense Cyber Crime Center (DC3) via the online reporting portal at: https://dcise.cert.org/ and concurrently provide a copy of LT to KO and COR.