Performance Work Statement (PWS).pdf

U.S. Marshals Service (USMS) Justice Prisoner and Alien Transportation System (JPATS) Charter Aircraft Services Performance

Work Statement

Original Revision February 14, 2024

Table of Contents

1. Background

2. Scope

2.1. Place of Performance

2.2. Period of Performance

2.3. Performance Guarantee

2.4. Block Hours / Block Time Definition

3. JPATS Responsibilities

4. Contractor Responsibilities

4.1. Aircraft Technical Requirements

4.2. Operational Requirements

4.3. Security

4.3.1. Pre-Award

4.3.2. Post-Award

4.3.3. Uniforms

4.4. Aircraft Fuel

4.5. Safety Management Program

4.6. Additional Aircraft

4.7. Pre-Lease / Post-Lease Inspection

4.8. Invoiceable Expenses

4.9. Non-Invoiceable Expenses

4.10. Minutes to Tenths Conversion Table

5. Reporting Requirements

5.1. Block Hours

5.2. Maintenance Delays

5.3. Cancelled Missions

6. Deliverables

6.1. Leased / Charter / Contract Personnel Expedited Clearance Request (USM-271)

6.2. Invoices

6.3. Lease Aircraft Flight Log

6.4. Performance Metrics

7. Performance Standards

7.1. Assessing Performance

1. Background

The primary mission of U.S. Marshals Service, Justice Prisoner and Alien Transportation System (JPATS) is the safe, secure, and efficient transportation of federal and non-federal prisoners and the provision of aircraft and flight crew for the support of other operational missions. Additional mission assignments include, but are not limited to, international flights in support of foreign extraditions, witness security and enforcement operations, strategic deployment of USMS and Special Operations Group personnel and equipment, and other special operations assigned by the USMS or as directed by the U.S. Attorney General.

2. Scope

JPATS has a requirement to charter one (1) twin engine, turbine powered jet aircraft that meets the technical requirements outlined in Section 4.1 and on an as needed basis, may also require additional aircraft as described in Section 4.6. Most missions will originate and terminate at Will Rogers World Airport in Oklahoma City, Oklahoma and the anticipated utilization of the aircraft is not-to-exceed one thousand (1000) block hours annually (Reference Section 2.4 for the definition of Block Hours). A typical week of missions may consist of three (3) flight days per week with seven (7) block hours per day, totaling twenty-one (21) block hours per week. The Contractor can anticipate performing approximately sixty (60) remain overnight (RON) missions during the base period and in each exercised option year with reimbursable mission travel costs (hotel and per diem). JPATS will provide the Contractor with a Weekly Flight Schedule (itinerary) via e-mail. Typically, the Weekly Flight Schedule will be provided no later than the close of business on Thursday the week prior; however, under certain conditions, there may be a need to make schedule changes (add / drop a stop or change the destination of a stop / stops) with a very short lead-time (possibly the same day). Upon receipt of notification of the Weekly Flight Schedule, the Contractor must provide the Aircraft Registration Number (“N”- number), the names of the crewmembers, and a USM- 271 Leased / Charter / Contract Personnel Expedited Clearance Request for each crewmember, if not already submitted, to ensure the security requirement are met.

The Contractor must have the ability to secure large aircraft (over 8 passenger seating) for other USMS and / or JPATS contingency / special missions originating from Oklahoma City, OK, Kansas City, MO, or any other location within the United States. JPATS will provide the passenger seating requirements, destinations, and any additional special requirements approximately seven (7) days in advance, but not later than seventy-two (72) hours prior to the scheduled mission. For planning purposes, the Contractor can anticipate performing approximately ten (10) international flights during the base period and in each exercised option year;

however, the actual number of international flights are mission dependent.

2.1. Place of Performance

Except for remain overnight (RON) missions and aircraft provided under Section 4.6, all missions will originate and terminate from 5900 Air Cargo Road, Will Rogers World Airport, Oklahoma City, Oklahoma.

2.2. Period of Performance

Contract Year Period of Performance Base Period October 1, 2024 – September 30, 2025

Option Year 1 October 1, 2025 – September 30, 2026 Option Year 2 October 1, 2026 – September 30, 2027 Option Year 3 October 1, 2027 – September 30, 2028 Option Year 4 October 1, 2028 – September 30, 2029

52.217-8 Option (6 Months) October 1, 2029 – March 31, 2030

2.3. Performance Guarantee

JPATS will provide a minimum performance guarantee of six hundred (600) block hours during the base period and in each exercised option year (Reference Section 2.4 for the definition of Block Hours).

2.4. Block Hours / Block Time Definition

The time when the aircraft first moves for the purpose of flight until post flight parking for each flight segment flown.

3. JPATS Responsibilities

JPATS will provide training for completing Appendix A: Lease Aircraft Flight Log.

JPATS will provide the Contractor with a weekly flight schedule. Typically, the weekly flight schedule will be provided no later than the close of business on Thursday the week prior; however, under certain conditions, there may be a need to make schedule changes (add / drop a stop or change the destination of a stop / stops) with a very short lead-time (possibly the same day).

At a minimum, JPATS will perform a compliance audit of the Contractor’s facility and aircraft prior to contract award and annually thereafter.

4. Contractor Responsibilities

The Contractor must possess and maintain a 14 CFR Part 135 Air Carrier Certificate and all aircraft utilized in performance of this Performance Work Statement (PWS) must be listed in Operations Specification (OpSpec) D085 Aircraft Listing. The Contractor is responsible for providing the aircraft, flight crew, insurance, landing fees, maintenance, ground handling, flight planning, and any additional taxes or fees. The Contractor must provide all flight attendants required under their 14 CFR Part 135 Air Carrier Certificate and is responsible for all positioning and de-positioning of the aircraft to and from the originating point. Upon receipt of notification of the Weekly Flight Schedule, the Contractor must provide the Aircraft Registration Number (“N”- number), the names of the crewmembers, and a USM- 271 Leased / Charter / Contract Personnel Expedited Clearance Request for each crewmember, if not already submitted, to ensure the security requirement listed in Section 4.3 are met.

If a maintenance event occurs causing an aircraft to be unable to perform a scheduled mission or a mission is aborted during any segment of the mission due to a maintenance problem, the Contractor must attempt to secure another aircraft to prevent the mission from being cancelled. If the aircraft is unable to be repaired within seventy-two (72) hours, the Contractor must provide a replacement aircraft at no additional cost to the Government. The replacement aircraft must meet all requirements of this PWS, and any requested deviations from this PWS must be submitted to the Contracting Officer (CO) and Contracting Officer’s Representative (COR) for consideration. Should the Contractor elect to provide a wet leased aircraft, the crewmembers of the wet lease are required to complete a USM-271 Leased / Charter / Contract Personnel Expedited Clearance Request. Reference Section 4.3 for additional information.

4.1. Aircraft Technical Requirements

The aircraft must meet the following requirements:

• Listed on the Contractor’s 14 CFR Part 135 Air Carrier Certificate OpSpec D085 Aircraft Listing.

• A minimum of 8 total cabin seats.

• A minimum cabin height of five (5) feet six (6) inches.

• A minimum cabin payload capacity of 1,800 lbs.

• Have an operational satellite phone with at least one handset in the cabin for use by JPATS security personnel.

• Have a fully enclosed functional lavatory / toilet with external servicing provisions.

• Have an Auxiliary Power Unit (APU) capable of providing aircraft cabin and cockpit heating, cooling, and electrical power during ground operations.

• Have a minimum non-stop range of 1,700 nautical miles in still air departing from Will Rogers World Airport (KOKC) at 80 degrees Fahrenheit with a payload of 1,800 lbs. to a destination airport and then to fly 100 nautical miles to an alternate airport if required under 14 CFR Part 135.

4.2. Operational Requirements

The Contractor must strictly adhere to the following operational requirements:

• Contractor’s 14 CFR Part 135 Air Carrier Certificate must have no limitations prohibiting operations in the contiguous United States, Alaska, Canada, Central America, South America, or the Caribbean.

• Flight operations are required to begin within sixteen (16) hours of receiving mission notification.

• Each mission must have two (2) FAA certificated pilots, with the appropriate Type Rating, regardless of the size of the aircraft or the requirements of the 14 CFR Part 135 Air Carrier Certificate.

• The aircraft must be positioned at the designated departure airport’s loading location and be available to load crew and passengers forty-five

(45) minutes prior to scheduled departure time.

• All crewmembers must be rested and capable of completing the scheduled mission within the crew’s flight and duty day limitations as defined by the applicable Federal Aviation Regulations.

• Prior to each departure, the crewmembers must contact JPATS Aircraft Dispatch at USMS-HQ-JPATS-Dispatchers@usdoj.gov or (405) 680- 3429, and provide the following information:

o Pilot’s name, o Aircraft Registration Number (Tail Number), o Departure airport, o Arrival airport, and o Anticipated arrival time.

4.3. Security

4.3.1. Pre-Award

Prior to commencing any services required by this Performance Work Statement (PWS), the Contractor must electronically complete and submit a USM-271 Leased / Charter / Contract Personnel Expedited Clearance Request to the Contracting Officer (CO) and Contracting Officer’s Representative (COR) for each crewmember anticipated to render services required by this contract.

4.3.2. Post-Award

The Contractor must ensure all crewmembers assigned to a JPATS mission have completed and have a favorably adjudicated USM-271 Leased / Charter / Contract Personnel Expedited Clearance Request.

If the Contractor assigns a crewmember to a JPATS mission that has not completed a USM-271, Leased / Charter / Contract Personnel Expedited mailto:USMS-HQ-JPATS-Dispatchers@usdoj.gov

Clearance Request, by no later than 4:00 p.m. Eastern Time (ET) on the day prior to the scheduled flight, the Contractor must electronically complete and submit a USM-271 Leased / Charter / Contract Personnel Expedited Clearance Request to the Contracting Officer (CO) and Contracting Officer’s Representative (COR).

4.3.3. Uniforms

All crewmembers onboard the aircraft must be in a uniform and have appropriate employee identification.

4.4. Aircraft Fuel

JPATS will be responsible for the costs of all aircraft fuel during the mission.

JPATS will purchase the fuel during the missions at DLA Government Contract Fuel locations with the Government Air Card. If a DLA Government Contract Fuel provider is not available at any of the stops, JPATS may require the Contractor to purchase the fuel and JPATS will reimburse the Contractor for the cost of the fuel. All expenses related to positioning and de-positioning to and from Oklahoma City, OK is the responsibility of the Contractor.

4.5. Safety Management Program

The Contractor must have an industry standard Safety Management Program with JPATS having unrestricted access to all reported safety incidents / accidents along with Contractor approved Corrective Actions for each.

4.6. Additional Aircraft

Contractor must have the ability to secure large aircraft (over 8 passenger seating) for other USMS or JPATS contingency / special missions originating from Oklahoma City OK, Kansas City, MO, or any other location within the United States. JPATS will provide the passenger seating requirements and routing (along with any additional requirements) approximately seven (7) days in advance, but not later than seventy-two (72) hours prior to the scheduled mission. When utilizing a third party contractor, JPATS will reimburse the Prime Contractor’s actual costs (which must be fair and reasonable) plus a firm fixed fee. When utilizing the Contractor’s fleet aircraft, the Contractor will submit a firm fixed price (fair and reasonable). In either case, funding will be added to the contract once a fair and reasonableness determination has been made.

4.7. Pre-Lease / Post-Lease Inspection

A Pre-Lease and Post-Lease Inspection will be conducted upon arrival and prior to departure of the aircraft in Oklahoma City. JPATS will return the aircraft to the fuel level equal to the amount onboard at arrival in Oklahoma City, OK.

4.8. Invoiceable Expenses

JPATS will only reimburse the Contractor for Block Hours incurred during the route (Reference Section 2.4 for the definition of Block Hours). The Contractor will submit invoices based on the actual number of Block Hours utilized during the mission route. Reference Section 6.2 for additional information.

JPATS will reimburse the Contractor for damage to the aircraft caused by government personnel or prisoners. The Contractor must immediately notify the Contracting Officer (CO) and Contracting Officer’s Representative (COR) in the event the aircraft sustains damage by government personnel or prisoners and provide a written statement no later than twenty-four (24) hours after the event.

The Contractor must submit invoices of the material and labor required to repair the damage.

JPATS will reimburse the Contractor for expenses incurred for the crewmembers lodging and per diem (IAW FAR 31.205-46) for missions that remain overnight (RON) outside of Oklahoma City, OK.

JPATS will reimburse the Contractor’s expenses (ex: airspace transit fees, communications fees, ground handling fees to include landing fees, airport use fees, custom and processing fees, and services of a personal ground handler utilized to expedite and coordinate ground operations, if required) for international flights with the exception of Puerto Rico and Alaska.

4.9. Non-Invoiceable Expenses

The Contractor is responsible for the following costs:

• Flight crew,

• Insurance,

• Maintenance,

• All positioning and de-positioning of the aircraft to and from the originating point,

• Flight planning,

• Ground handling, which includes, but not limited to:

o External ground electrical power, o Lavatory servicing, o Ground heating and cooling services, o De-icing, and o Aircraft storage fees.

• Landing fees, and

• Any additional taxes or fees.

JPATS will not provide reimbursement for any other costs or fees incurred by the Contractor unless specifically permitted in this PWS.

4.10. Minutes to Tenths Conversion Table

The Contractor must utilize the Minutes to Tenths Conversion Table below when calculating Block Time, Flight Time, and submitting invoices for this contract.

Minutes Tenths 1-2 0 3-8 .1 9-14 .2

15-20 .3 21-26 .4 27-32 .5 33-38 .6 39-44 .7 45-50 .8 51-56 .9 57-59 1.0

5. Reporting Requirements

5.1. Block Hours

The Contractor must notify the Contracting Officer (CO) and Contracting Officer’s Representative (COR) in writing whenever it has reason to believe that the total number of block hours the Contractor expects to incur in the next 30 days will exceed 75% of the not-to-exceed amount specified in the schedule or 750 block hours.

5.2. Maintenance Delays

The Contractor must notify the Contracting Officer (CO) and Contracting Officer’s Representative (COR) if a scheduled mission departure is anticipated to be delayed by thirty (30) minutes or more. This notification must include the reason for the delay, the action(s) being taken, and the anticipated departure time. The Contractor must provide periodic (hourly) updates (or as soon as available) to this information.

5.3. Cancelled Missions

The Contractor must notify the Contracting Officer (CO) and Contracting Officer’s Representative (COR) if a maintenance event occurs causing an aircraft to be unable to perform a scheduled mission or a mission is aborted during any segment of the mission due to a maintenance problem. This notification must include the reason for the cancellation, the action(s) being taken, and the anticipated return to service date and time. The Contractor must provide periodic updates to this information.

6. Deliverables

6.1. Leased / Charter / Contract Personnel Expedited Clearance Request (USM-271)

The Contractor must electronically complete and submit a USM-271 Leased / Charter / Contract Personnel Expedited Clearance Request, to the Contracting Officer (CO) and Contracting Officer’s Representative (COR), for each crewmember that does not have a valid security clearance from JPATS, no later than 4:00 p.m. Eastern Time (ET), on the day prior to the scheduled flight.

6.2. Invoices

The Contractor is required to submit invoices no later than three (3) days after the completion of services rendered under this contract on the appropriate Contract Line Item Number (CLIN). All invoices will be submitted to the Contracting Officer (CO), Contracting Officer’s Representative (COR), and to JPATS.AcctPay@usdoj.gov.

6.3. Lease Aircraft Flight Log

The Contractor will complete the Lease Aircraft Flight Log in Appendix A and submit it to the JPATS Aviation Enforcement Officer in Charge (AEOIC) of each mission. The Lease Aircraft Flight Log must be submitted with the invoices no later than three (3) days after the completion of each mission. All Lease Aircraft Flight Logs will be submitted to the Contracting Officer (CO), Contracting Officer’s Representative (COR), and to JPATS.AcctPay@usdoj.gov.

6.4. Performance Metrics

The Contractor must provide performance metrics to ascertain aircraft reliability and availability rates as well as Contractor performance. This monthly report, as a minimum, must include:

• The total number of scheduled and completed flights and flight legs,

• Maintenance delays, defined as any maintenance related issue that delays the scheduled departure time by thirty (30) minutes or more, and a detailed explanation of the delay,

• Maintenance cancellations, and a detailed explanation of the cancellation, and

• Requests for changing the JPATS published aircraft flight schedule, and a detailed explanation for the requested change.

7. Performance Standards

JPATS will primarily utilize the Contractor’s existing Quality Assurance System under Federal Acquisition Regulation (FAR) 12.208, Contract Quality Assurance, but will also assess the Contractor using a Quality Assurance Surveillance Program, and the Performance Standards referenced in Section 7.1.

mailto:JPATS.AcctPay@usdoj.gov mailto:JPATS.AcctPay@usdoj.gov

7.1. Assessing Performance

JPATS will utilize the table below for assessing performance of the Contractor.

The table includes the PWS Section Number, Performance Standard, Acceptable Quality Level, and Monitoring Method.

PWS Number Performance Standard

Acceptable Quality Level

Monitoring Method

Possess and Maintain a 14

CFR Part 135 Air Carrier Certificate

100%

Periodic review of Contractor’s 14

CFR Part 135 Air Carrier Certificate and FAA-certificated

Aircraft Operators listing.

Mission Cancellations due to Maintenance Events

98%

Monthly review of mission completion metrics.

4, 4.1

Utilize Aircraft on the Contractor’s 14 CFR Part 135

Air Carrier Certificate

OpSpec D085

100%

Periodic review of Contractor’s 14

CFR Part 135 Air Carrier Certificate and FAA-certificated

Aircraft Operators listing.

4.2

Utilization of Two

(2) FAA

Certificated Pilots Per Mission

100%

Periodic review and spot-check adherence to

PWS.

4.2

Aircraft Available for Passenger Loading Forty-

Five (45) Minutes Prior to

Scheduled Departure Time

98%

Periodic review and spot-check adherence to

PWS.

4.3.1 – 4.3.2

All Crewmembers have a Favorably

Adjudicated

USM-271

100% Review of Lease

Aircraft Flight Log.

Appendix A: Lease Aircraft Flight Log

Aircraft #: Location: Trip #: Mission Category: Date:

Flight Crew

PIC

SIC

OTHER

OTHER

OTHER

Duty Time

Start End

Total Block Hours

Leg Pilot Flying

Airport ID Block Time Flight Time Weather Takeoff Inst Landings Fuel Consumption From To Out In Total Off On Total Day Night Day Night Appr Day Night Add Total At Landing

All Times Must be Recorded in Zulu Time

Remarks / Notes:

JUSTICE PRISONER AND ALIEN TRANSPORTATION SYSTEM

AIRCRAFT PRE & POST LEASE INSPECTION

The following areas are to be inspected by the JPATS Air Operations Maintenance personnel prior to accepting and prior to returning aircraft that are leased. A visual inspection shall be performed for general condition with particular attention to damage, scratches, crazing, excessive corrosion, loose fasteners, missing panels, worn areas, and evidence of fluid leaks. Area condition shall be indicated in the blocks provided. Unacceptable conditions or defects shall be noted on the discrepancy section of this form.

Some items may be N/A per Lease Agreement.

AIRCRAFT REGISTRATION NUMBER: _____________________________

AIRCRAFT MODEL / SERIAL NUMBER: _____________________________

LEASE DURATION (est): ________________ TYPE OF AIRCRAFT LEASE: [ ] DRY (JPATS pilots)

[ ] WET (Commercial pilots)

PRE-LEASE INSPECTION PERFORMED BY: ____________________ ________________

Signature Date

POST-LEASE INSPECTION PERFORMED BY: ____________________ ________________

Signature Date

A = Acceptable/Good B = Broken/Damaged M = Missing S = Soiled/Dirty N/A = Not Applicable

AREAS TO INSPECT INSPECTION

CODES

1. Fuel Load: Total on Board (Circle: Lbs Gals) Pre: _______ Post: _______

2. Cockpit Section Pre Post

a. Ensure all required documents are on board

1. Aircraft Log Book(s) (N/A) [ ] [ ]

2. Deferred Maintenance Log(N/A) [ ] [ ]

3. MEL (N/A) [ ] [ ]

4. Airplane Flight Manual (N/A) [ ] [ ]

5. Weight & Balance Data (N/A) [ ] [ ]

6. Seating Configuration / LOPA (N/A) [ ] [ ]

7. Aircraft Registration [ ] [ ]

8. Aircraft Airworthiness Certificate [ ] [ ]

b. Seat assemblies and covers (N/A) [ ] [ ]

c. Instruments and control panels (N/A) [ ] [ ]

3. Optional Equipment.

a. Over-water equipment (Life Rafts, Life Vests, ELT) (N/A) [ ] [ ]

b. Aft facing seats (N/A) [ ] [ ]

c. Long Range Navigation (GPS) (N/A) [ ] [ ]

Attachment #1

AIRCRAFT PRE & POST LEASE INSPECTION

AREAS TO INSPECT Pre Post

4. Fuselage section:

a. Nose radome and exterior surface [ ] [ ]

b. Pitot heads and static vents [ ] [ ]

c. Access doors [ ] [ ]

d. Baggage compartment(s) [ ] [ ]

e. Cockpit windshields [ ] [ ]

f. Cabin windows [ ] [ ]

5. Engine & APE section.

a. #1 intake, cowling, exhaust, and pylon [ ] [ ]

b. #2 intake, cowling, exhaust, and pylon [ ] [ ]

c. #3 intake, cowling, exhaust, and pylon (If applicable) [ ] [ ]

d. APU intake, exhaust, and general area [ ] [ ]

6. Empennage section:

a. Exterior surface [ ] [ ]

b. Access doors [ ] [ ]

c. Leading edges [ ] [ ]

d. Rudder control surfaces [ ] [ ]

e. Elevator control surfaces

7. Left wing section:

a. Exterior surface [ ] [ ]

b. Leading edge controls [ ] [ ]

c. Light assembly and lenses [ ] [ ]

d. Flap control surfaces [ ] [ ]

e. Aileron control surfaces [ ] [ ]

8. Right wing section:

a. Exterior surfaces [ ] [ ]

b. Leading edge controls [ ] [ ]

c. Light assembly and lenses [ ] [ ]

d. Flap control surfaces [ ] [ ]

e. Aileron control surfaces [ ] [ ]

9. Landing gear section:

a. Nose wheel assembly [ ] [ ]

b. Nose wheel well and strut area [ ] [ ]

c. Nose gear doors [ ] [ ]

d. Left wheel and brake assembly [ ] [ ]

e. Left wheel well [ ] [ ]

f. Left strut and doors [ ] [ ]

g. Right wheel and brake assembly [ ] [ ]

h. Right wheel well [ ] [ ]

i. Right strut and doors [ ] [ ]

AIRCRAFT PRE & POST LEASE INSPECTION

AREAS TO INSPECT Pre Post

10. Cabin section:

a. Air stairs assembly [ ] [ ]

b. Forward galley, and aft door assemblies [ ] [ ]

c. Galley area (NO LIQUOR ALLOWED) [ ] [ ]

d. Lavatory areas [ ] [ ]

e. Seat assemblies and covers [ ] [ ]

f. Seat table trays [ ] [ ]

g. Seat-back pockets [ ] [ ]

h. Arm rest and covers [ ] [ ]

i. Ash trays and / or blanking covers [ ] [ ]

j. Sidewalls, window shades, and floor vents [ ] [ ]

k. Carpet, flooring, and track lighting [ ] [ ]

l. Overhead bins [ ] [ ]

NOTE: Refer to Advisory Circular (AC 91-37A), Truth in Leasing for additional information

AIRCRAFT PRE & POST LEASE INSPECTION

PRE-LEASE INSPECTION DISCREPANCIES

POST LEASE INSPECTION DISCREPANCIES

Form USM-271 Rev. 05/19 Page of

U.S. Department of Justice United States Marshals Service Leased/Charter/Contract Personnel Expedited Clearance Request

OMB Number 1105-0097 (Exp. 05/31/2025)

1. Last Name: 2. First Name: 3. Middle Name (Full):

4. Other Names Used: 5. Social Security Number:

6. Date of Birth: 7. Place of Birth: 8. Citizenship:

9. Gender (M or F): 10. Race: 11. Height: 12. Weight (lbs.): 13. Eye Color:

14. Home Address - Street: 15. City: 16. State: 17. ZIP Code:

18. Driver's License #: 19. Issuing State: 20. Occupation (Pilot / Flight Attendant / Mechanic / Nurse / Other):

21. List all of the U.S. states you have lived in within the past 10 years (use state abbreviations):

22. Have you ever been arrested?

YesNo

23. If yes, list charge/violation/disposition:

CERTIFICATION: I certify that the statements made by me on this form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I have read and understand the information on the second page of this form, and I authorize the use and release of this information in accordance with the stated purpose.

24. Signature of Applicant: 25. Printed Name: 26. Date:

TO BE COMPLETED BY USMS PERSONNEL

1. NCIC Check Completed By: 2. Date: 3. Time:

4. Wanted Person? Yes No 5. Criminal History? Yes No

6. Remarks:

TO BE COMPLETED BY THE USMS JUSTICE PRISONER AND ALIEN TRANSPORTATION SYSTEM (JPATS)

1. NCIC Check Received By: 2. Date: 3. Time:

4. Clearance Granted? Yes No

5. Remarks:

Attachment #2

Page of

PURPOSE OF THIS FORM

The U.S. Government conducts criminal checks to establish that applicants or incumbents either employed by the Government or working for the Government under contract are eligible for the job. The U.S. Marshals Service will use this form to conduct a National Criminal Information Center (NCIC) check for each temporary contractor (working on contract 6 months or less and require physical access only) to determine eligibility to work on U.S. Marshals Service contracts.

AUTHORITY TO REQUEST THIS INFORMATION

The U.S. Government is authorized to ask for this information under 5 CFR 731, Suitability Regulations. Your Social Security number is needed to keep records accurate, because other people may have the same name and birth date. Executive Order 9397 also asks Federal agencies to use this number to help identify individuals in agency records.

THE BACKGROUND CHECK PROCESS

The U.S. Marshals Service inputs the information from this completed form into the NCIC Database and conducts a pre-employment name check through the National Crime Information Center (NCIC). The system will produce a criminal history report, that is reviewed by designated U.S. Marshals Service personnel. The designated U.S. Marshals Service personnel will determine the eligibility of the temporary contractor based upon the information provided by the check.

FINAL DETERMINATION ON YOUR ELIGIBILITY

Final determination on your eligibility for a position is the responsibility of the U.S. Marshals Service. You may be provided the opportunity personally to explain, refute, or clarify any information before a final decision is made.

AUTHORIZATION AND RELEASE

I hereby authorize the U.S. Marshals Service and other authorized Federal agencies to obtain any information required from the Federal government and/or state agencies, including but not limited to, the Federal Bureau of Investigation (FBI), the Defense Investigation Service (DIS), the U.S. Office of Personnel Management (OPM), the U.S. Department of Homeland Security (DHS), (if applicable). This authorization is valid for one year from the date this form was signed.

I have been notified of any employer’s right to require a criminal history records check as a condition of employment. I understand that I may request a copy of such records as may be available to me under the law. I understand that I have a right to challenge the accuracy and competencies of any information contained in the report. I also understand that this information will be treated as privileged and confidential information. Case files are handled under the procedures for safeguarding records.

I release any individual, including records custodians, any component of the U.S. Government or the individual State Criminal History Repository supplying information, from all liability for damages that may result on account of compliance, or any attempts to comply with this authorization. This release is binding, now and in the future, on my heirs, assigns, associates, and personal representative(s) of any nature. Copies of this authorization that show my signature are as valid as the original release signed by me.

PRIVACY ACT OF 1974 COMPLIANCE INFORMATION

Solicitation of information contained herein is authorized by Executive Order 10450 and may be used as a basis for eligibility determinations. The USMS describes how your information will be maintained in the Privacy Act system of record notice published in the Federal Register at 67 FR 59864, 69 (September 24, 2002). Disclosure of the information by you is voluntary. Information may be transferred as a routine use to appropriate Federal, state, local, or foreign agencies when relevant to civil, criminal or regulatory investigation, prosecutions, or pursuant to a request by DHS or such other agency is in connection with the hiring or retention of an employee, the issuance of a license, grant, or other benefit. Information also may be transferred as a routine use to a duly authorized official engaged in an investigation or settlement of a grievance, complaint, or appeal filed by an employee. Failure to provide information requested on this form may result in the government’s inability to determine your eligibility for the position applied for or occupied, and may affect your prospects for employment or continued employment under a government contract, or at a Federal facility, or with a government license.

PRIVACY ACT ROUTINE USES

Records or information in this system of records may be disclosed to the following parties when it has been determined by the Department of Justice that such a need exists:

(1) Designated officers and employees of agencies, offices, and other establishments in the executive, legislative, and judicial branches of the Federal Government, in connection with the hiring or continued employment of an employee or contractor, the conduct of a suitability or security investigation of an employee or contractor, or the grant, renewal, suspension, or revocation of a security clearance, to the extent that the information is relevant and necessary to the hiring agency's decision.

(2) Designated officers and employees of state or local (including the District of Columbia) law enforcement or detention agencies in connection with the hiring or continued employment of an employee or contractor, where the employee or contractor would occupy or occupies a position of public trust as a law enforcement officer or detention officer having direct contact with the public or with prisoners or detainees, to the extent that the information is relevant and necessary to the recipient agency's decision.

(3) In the event that a record in this system, either alone or in conjunction with other information, indicates a violation or potential violation of law -- criminal, civil, or regulatory in nature -- the relevant records may be referred to the appropriate federal, state, local, foreign, or tribal law enforcement authority or other appropriate agency charged with the responsibility for investigating or prosecuting such violation or charged with enforcing or implementing such law.

(4) A Member of Congress or staff acting upon the Member's behalf when the Member or staff requests the information on behalf of and at the request of the individual who is the subject of the record.

(5) The National Archives and Records Administration and the General Services Administration in records management inspections conducted under the authority of 44 U.S.C. 2904 and 2906.

(6) An actual or potential party to litigation or the party's authorized representative for the purpose of negotiation or discussion on such matters as settlement, plea bargaining, or in informal discovery proceedings.

(7) Such recipients and under such circumstances and procedures as are mandated by federal statute or treaty.

PUBLIC REPORTING BURDEN STATEMENT

Public reporting burden for this collection of information is estimated to average 5 minutes 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 aspects of this collection of information, including suggestions for reducing this burden, to JPATS, U.S. Marshals Service, 1251 NW Briarcliff Parkway, Suite 300, Kansas City, MO 64116. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

INSTRUCTIONS FOR LEASED/CHARTER PERSONNEL TO COMPLETE THIS FORM

1. Complete all fields. Type or print legibly in blue or black ink. If no response is necessary or applicable, indicate this on the form (for example, enter "None" or "N/A"). If you find that you cannot report an exact date, approximate or estimate the date to the best of your ability and indicate this by marking "APPROX." or

"EST."

2. Any changes that you make to this form after you sign it must be initialed and dated by you. Under certain limited circumstances, USMS may modify the form consistent with your intent.

3. You must use U.S. Postal Service 2-letter state abbreviations when you fill out this form. Do not abbreviate the names of cities or foreign countries.

4. All telephone numbers must include area codes.

5. All dates provided on this form must be in Month/Day/Year (mm/dd/yy) or Month/Year (mm/yy) format. Use numbers (1-12) to indicate months. For example, May 27, 1972 should be shown as 5/27/72.

6. Question 9 (nine) should be answered from the following available choices in NCIC: F-Female; M-Male; or U-Unknown

7. Question 10 (ten) should be answered from the following available choices in NCIC: I-American Indian or Alaskan Native; A-Asian or Pacific Islander;

B-Black; U-Unknown; W-White or White Hispanic

8. If you need additional space to complete this form, please use a separate blank sheet of paper.