TMIP-J RFP HT003822R0001 Attachment 1 - DD254.pdf

CLASSIFICATION (When filled in): Unclassified

PREVIOUS EDITION IS OBSOLETE. Page 1 of 6DD FORM 254, APR 2018

DEPARTMENT OF DEFENSE

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

(The requirements of the National Industrial Security Program (NISP) apply to all security aspects of this effort involving classified information.)

OMB No. 0704-0567 OMB approval expires:

May 31, 2022

The public reporting burden for this collection of information, 0704-0567, is estimated to average 70 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 aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. 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.

RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.

1. CLEARANCE AND SAFEGUARDING

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

(See Instructions)

Secret

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

None (See instructions)

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

a. PRIME CONTRACT NUMBER (See instructions.)

HT0038-22-R-0001

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

HT0038-22-R-0001

DUE DATE (YYYYMMDD)

3. THIS SPECIFICATION IS: (X and complete as applicable.)

a. ORIGINAL (Complete date in all cases.)

DATE (YYYYMMDD)

20211119

b. REVISED (Supersedes all previous specifications.)

REVISION NO. DATE (YYYYMMDD)

c. FINAL (Complete Item 5 in all cases.) DATE (YYYYMMDD)

4. IS THIS A FOLLOW-ON CONTRACT? No Yes If yes, complete the following:

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

5. IS THIS A FINAL DD FORM 254? No Yes If yes, complete the following:

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

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

a. NAME, ADDRESS, AND ZIP CODE

TBD

b. CAGE CODE

TBD

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

TBD

7. SUBCONTRACTOR(S) (Click button if you choose to add or list the subcontractors -- but will still require a separate DD Form 254 issued by a prime contractor to each subcontractor) Add Row Remove Last Row Delete All Rows

a. NAME, ADDRESS, AND ZIP CODE b. CAGE CODE c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

8. ACTUAL PERFORMANCE (Click button to add more locations.) Add Row Remove Last Row Delete All Rows

a. LOCATION(S) (For actual performance, see instructions.)

Defense Health Agency 7700 Arlington Blvd Falls Church, VA 22042

b. CAGE CODE (If applicable, see Instructions.)

c. COGNIZANT SECURITY OFFICE(S) (CSO) (Name, Address, ZIP Code, Telephone required; Email Address optional)

9. GENERAL UNCLASSIFIED DESCRIPTION OF THIS PROCUREMENT

The Contractor shall provide a full range of engineering support services to the Joint Operational Medicine Information Systems (JOMIS) Program Management Office (PMO) in support of the sustainment of the Theater Medical Information Program- Joint software suite. Such services will include software enhancement, test and evaluation, server and software deployment and maintenance, information assurance, and operational support. The Contractor shall implement these capabilities using traditional software modification techniques and leverage mature development, security and operations (DevSecOps) pipeline including, but not limited to, continuous integration, continuous delivery (CI/CD) and Risk Management Framework (RMF) level 6.

PREVIOUS EDITION IS OBSOLETE. Page 2 of 6DD FORM 254, APR 2018

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

a. COMMUNICATIONS SECURITY (COMSEC) INFORMATION f. SPECIAL ACCESS PROGRAM (SAP) INFORMATION

b. RESTRICTED DATA g. NORTH ATLANTIC TREATY ORGANIZATION

(NATO) INFORMATION

c. CRITICAL NUCLEAR WEAPON DESIGN INFORMATION (CNWDI) (If CNWDI applies, RESTRICTED DATA must also be marked.) h. FOREIGN GOVERMENT INFORMATION

d. FORMERLY RESTRICTED DATA i. ALTERNATIVE COMPENSATORY CONTROL MEASURES

(ACCM) INFORMATION

e. NATIONAL INTELLIGENCE INFORMATION:

(1) Sensitive Compartmented Information (SCI)

(2) Non-SCI

j. CONTROLLED UNCLASSIFIED INFORMATION (CUI) (See instructions.)

k. OTHER (Specify) (See instructions.)

Performance In a Government Facility, CAC, NIPRNET, SIPRNET

11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: (X all that apply. See instructions. Provide details in Blocks 13 or 14 as set forth in the instructions.)

a. HAVE ACCESS TO CLASSIFIED INFORMATION ONLY AT

ANOTHER CONTRACTOR'S FACILITY OR A GOVERNMENT

ACTIVITY

(Applicable only if there is no access or storage required at contractor facility.

See instructions.)

b. RECEIVE AND STORE CLASSIFIED DOCUMENTS ONLY

c. RECEIVE, STORE, AND GENERATE CLASSIFIED

INFORMATION OR MATERIAL

d. FABRICATE, MODIFY, OR STORE CLASSIFIED HARDWARE

e. PERFORM SERVICES ONLY

f. HAVE 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 A TEMPEST REQUIREMENT

j. HAVE OPERATIONS SECURITY (OPSEC) REQUIREMENTS

k. BE AUTHORIZED TO USE DEFENSE COURIER SERVICE

l. RECEIVE, STORE, OR GENERATE CONTROLLED UNCLASSIFIED

INFORMATION (CUI).

(DoD Components: refer to DoDI 5200.48, only for specific CUI protection requirements. Non-DoD Components: see instructions.)

m. OTHER (Specify) (See instructions.)

12. PUBLIC RELEASE

Any information (classified or unclassified) pertaining to this contract shall not be released for public dissemination except as provided by the National Industrial Security Program Operating Manual (NISPOM) or unless it has been approved for public release by appropriate U.S. Government authority.

Proposed public releases shall be submitted for review and approval prior to release to the appropriate government approval authority identified here with at least office and phone contact information and if available, an e-mail address. (See instructions)

DIRECT THROUGH (Specify below)

Defense Office of Prepublication and Security Review Rm. 2A534 Pentagon, Washington, DC 20301-1155

Public Release Authority:

No Public Release Authority

13. SECURITY GUIDANCE Add Signature Remove Last Signature Delete All Signatures

The security classification guidance for classified information needed for this 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. The field will expand as text is added. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted. Also allows for up to 6 internal reviewers to digitally sign. See instructions for additional guidance or use of the fillable PDF.)

The Theater Medical Information Program-Joint software suite integrates components of the Military Health System sustaining base systems and the Services' medical information systems to ensure timely inter-operable medical support for mobilization, deployment and sustainment of all Theater and deployed forces in support of any mission in hostile and non-hostile environs. TMIP-J enhances the clinical care and information capture at all levels of care in Theater, transmits critical information to the Theater Commander- the evacuation chain for combat and non-combat casualties, and forges the theater links of the longitudinal health record to the sustaining base and the Department of Veterans Affairs. Certain informations systems in the TMIP-J software suite reside in a SIPR environment and this data is considered restricted data (RD) and resides on the SIPRNet. Engineering support will require access to the SIPRNet in order to deploy and maintain the TMIP-J software suite.

1. All contractors performing on this contract must hold an Industrial Personnel Security Clearance of an interim SECRET or above IAW 32 CFR Part 117 National Industrial Security Program (NISPOM)

2. Contractors performing on this contract will receive or have to generate classified materials, emails and documents up to the TS/SCI

PREVIOUS EDITION IS OBSOLETE. Page 3 of 6DD FORM 254, APR 2018 level. Classified information will be handled IAW the National Industrial Security Program, DoD 5220.22-M.

3. Government issued CAC and SIPRNet Tokens are the property of the U.S. Government and will be returned to the COR by the cardholders upon completion of this contract, termination of employment, or removal from contract performance.

4. All information about this contract or details about the Government activity to include its personnel, information, equipment, facilities, activities, and operations will only be released to authorized personnel with an official "need to know" and will not be discussed with unauthorized persons, discarded as unclassified trash, posted on web pages, or released to the public without the COR's written approval.

5. Transmission of Controlled Unclassified Information (CUI) on this project shall be protected through the use of DoD Public Key Infrastructure (PKI) encryption or equivalent facility systems. At no time shall CUI or classified information be transmitted electronically by means other than approved Government systems and/or methods. See 10.a., 11.l. and CUI REQUIREMENTS FOR DOD CONTRACTORS below.

Reference 10.b. Restricted Data. Access to RESTRICTED DATA, information which is classified and controlled under the Atomic Energy Act of 1954 is required. A final U.S. Government (Top Secret or Secret) clearance is required for this project. Access to and dissemination of this information shall be governed by DoD Instruction 5210.02. Contractors shall not disclose RD to subcontractors without the prior written approval of the GCA.

Reference 10.d. Formerly Restricted Data. Information that is removed from the Restricted Data category upon a joint determination by the Department of Energy (or antecedent agencies) and the Department of Defense that such information relates primarily to the military utilization of atomic weapons and that such information can be safeguarded adequately as classified defense information. For Foreign Dissemination however, it is treated in the same manner as Restricted Data. Information of this category shall not be disseminated outside official channels without the consent of the originator. Access to and dissemination of this information shall be governed by DoD Instruction 5210.02. Access to FORMERLY RESTRICTED DATA requires a final U.S. Government clearance at the (Secret or Top Secret) level.

Reference 10.j. CUI Information. (Applies if block 10j is marked yes; mark 11l. yes also) Controlled Unclassified Information under this contract shall be safeguarded as specified in DoDI 5200.48 "DoD Controlled Unclassified Information (CUI)". Contractor will have access to unclassified information requiring safeguarding and dissemination control in alignment with specific laws, regulations, or government-wide policies (Formerly identified as For Official Use Only (FOUO), Privacy Act information, Sensitive but unclassified, or Law Enforcement Sensitive). Contractor shall follow the safeguarding requirements in DoDI 5200.48. DoD Freedom of Information Act Program applies.

Reference 10.k. Performance in Government Facilities. (Mark block 10k yes) This contract requires personnel to perform work in direct support of the DHA staff and will require individuals to work within Government controlled facilities. All contractor personnel under this contract who have access to classified information must possess a U.S. clearance. The Contract Monitor will provide security classification guidance for the performance of this contract.

In and Out Processing: This contract requires personnel to perform work in direct support of, the DHA staff and will require individuals to obtain and maintain government issued building access cards to enable performance within Government controlled facilities. As such, all contractor personnel are required to in-process with the Administration Directorate prior to reporting for work. As a condition of this contract, all personnel issued government access cards are required to ensure the card is returned to the DHA Security Office upon removal from the contract or termination of employment under this contract.

Reference 10.k. Common Access Cards. This contract requires personnel to obtain the Government issued Common Access Card (CAC) in order to provide identification for access government computer systems and physical access to facilities. Personnel must meet and maintain investigative and adjudicative requirements specified in DoDI 5200.46, and immediately report to the GCA any issues affecting CAC eligibility. Government issued credentials are the property of the United States Government and must be returned when no longer required for performance on this contract. Return CACs to: Defense Health Agency, Administration and Management (J-1), Infrastructure Support Division. CACs will not be used to access information systems, facilities, or installations that are outside the performance requirements of this contract. CACs will be used only by the individual to whom it was issued and will not be used for or by any other person. The contractor will immediately notify the GCA if a CAC is lost, stolen, or otherwise missing. Replacement CACs will require the contractor employee to obtain a signed memo from the Defense Health Agency, Administration and Management (J-1), Infrastructure Support Division, requesting a new CAC be issued.

Reference 10.k. NIPRNET access required. (Mark block 10k yes) This contract requires the contractor to access and use the Unclassified government computer system known as the NIPRNET at locations identified by the government customer. All provisions of DoD Risk Management Framework (RMF) apply. This system is Unclassified only, and inappropriate or improper use of the system will result in a reportable incident to the DCSA. NIPRNET as well as other unclassified systems or equipment (e.g. printers, facsimile) will not be used to

PREVIOUS EDITION IS OBSOLETE. Page 4 of 6DD FORM 254, APR 2018 process classified information. NIPRNET systems will be used only for an official Government purpose. Inappropriate or improper use of the NIPRNET system will result in a reportable incident to the Defense Counterintelligence and Security Agency (DCSA).

Reference 10.k. SIPRNET access required. This contract requires the contractor to access and use the Classified government computer system known as the SIPRNET at locations identified by the government customer. All provisions of DoD Risk Management Framework (RMF) apply. This system is authorized for use to but not exceeding the TS/SCI level, and inappropriate or improper use of the system will result in a reportable incident to the Defense Counterintelligence and Security Agency (DCSA).

Reference 11.a. Have access to classified information ONLY at a government activity. When block 11.a. is marked yes, block 8.a. must identify the actual U.S. Government work location. If this is the case, block 1.b. would be marked NONE. All classified information/ material shall be provided by the Government Contracting Activity (GCA) and safeguarded at the approved actual performance site.

Reference 11l. Receive, Store or Generate CUI Information. (Applies if block 10j is marked yes) Controlled Unclassified Information under this contract shall be safeguarded as specified in DoDI 5200.48, "DoD Controlled Unclassified Information (CUI)". Contractor will have access to unclassified information requiring safeguarding and dissemination control in alignment with specific laws, regulations, or government-wide policies (Formerly identified as For Official Use Only (FOUO), Privacy Act information, Sensitive but Unclassified, or Law Enforcement Sensitive). Contractor shall follow the safeguarding requirements in DoDI 5200.48. DoDM 5400.07, DoD Freedom of Information Act Program applies.

Reference 11.m. IT Operation and Support Positions. Contractor will require access to sensitive unclassified government automated information systems (AIS) at different levels. Contractor must comply with the attached WHS IT Policy Bulletin 2004-0003.

CUI REQUIREMENTS FOR DOD CONTRACTORS

The following procedures will be used to protect Controlled Unclassified Information (CUI) documents and materials:

1) HANDLING: Access to CUI material shall be limited to those employees needing the material to perform their duties. The CUI marking is assigned to documents and material created by a DoD User Agency. CUI is not a classification, but requires extra precautions to ensure it properly safeguarded and disseminated and is not released to the public without government authorization.

2) MARKING: Mark unclassified documents containing CUI: “CUI" at the top and bottom of each page, include the CUI warning box, and the CUI Designation Indicator Block as required in DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 2. In a classified document:

a) Mark individual paragraph containing only CUI, but not classified material by placing “(CUI)" at the beginning of the portion.

b) Mark top and bottom of each page with classified material with the highest security classification of the material on the page.

c) If the document or material contains CUI under the category of Controlled Technical Information (CTI), use of distribution statements is required. See DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 2.

d) If a classified document contains CUI material or if the classified material becomes CUI when declassified, place the following statement on the bottom of the cover or the first page under the classification marking: “NOTE: If declassified, review the document to make sure the material is not still CUI. If it does, then it must have the appropriate safeguarding, dissemination controls, and CUI markings applied.

e) Mark other records such as computer print outs, photographs, films, tapes, or slides in accordance with DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 2 so the receiver or viewer knows the it contains CUI material.

f) Mark a message containing material in accordance with DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 2. Unclassified messages containing CUI material must show the abbreviation (CUI) before the text begins.

g) Ensure documents transmitting CUI material call attention to any attachments containing CUI.

h) CUI material released to a contractor by a DoD user agency must have the following statement on the front page or cover:

THIS DOCUMENT CONTAINS CUI MATERIAL AND MUST BE REVIEWED BY A GOVERNMENT REPRESENTATIVE UNDER THE REQUIREMENTS OF DODI 5200.48, DODI 5230.09, and DODI 5230.29.

3) STORAGE: During normal duty hours, place CUI material in an out-of-sight location if your work area is accessible to persons who do not have an authorized government purpose for access to the material. After normal duty hours, store CUI material to prevent unauthorized

PREVIOUS EDITION IS OBSOLETE. Page 5 of 6DD FORM 254, APR 2018 access. File with other unclassified records in unlocked files or desks when internal building security is provided and the file is marked as CUI. When there is no internal security, locked buildings or rooms usually provide adequate after hours protection. For additional protection, store CUI material in locked containers such as file cabinets, desks, or bookcases. Expenditure of funds for security containers or closed areas solely for the protection of CUI material is prohibited.

4) TRANSMISSION: CUI documents and materials may be transmitted via first class mail, parcel post or for bulky shipments-fourth class mail. Within the CONUS discussion of CUI material on the telephone is authorized if necessary for the performance of the contract and no alternative is available. Electronic transmission of CUI (voice, data, or facsimile) should be by approved secure communications systems whenever practical. If there is a fax transmission, the sender must ensure the intended receiver is available to receive it or a cover sheet will be used to allow carrying it to the final recipient to avoid unauthorized disclosure of the CUI.

5) RELEASE: CUI material shall not be released outside of the contractor’s facility except to the representative of DoD or PFPA.

6) DESTRUCTION: When the CUI material no longer meets the threshold for safeguarding and dissemination, it shall be immediately decontrolled, be processed through the records management process, and destroyed by the approved methods identified in DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 1 precluding its disclosure to unauthorized individuals by rendering it unreadable, indecipherable, and irrecoverable.

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form) Show Attachment Bar

PFPA SSD SAB

NAME & TITLE OF REVIEWING OFFICIAL

James Davis PFPA Industrial Security Program Manager

SIGNATURE

NAME & TITLE OF REVIEWING OFFICIAL

DHA Security Branch Government Representative

SIGNATURE

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, are established for this contract.

No Yes 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 CSO. The field will expand as text is added or you can also use item 13. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted.

(See instructions for additional guidance or use of the fillable PDF.)

1. Cyber-security requirements are contained within the contract in Section F.5. of RFP.

2. Privacy Act and Health Insurance Portability and Accountability Act (HIPPA) requirements are contained in the contract. Section F.5 of

RFP.

15. INSPECTIONS

Elements of this contract are outside the inspection responsibility of the CSO.

No Yes If Yes, explain and identify specific areas and government activity responsible for inspections. The field will expand as text is added or you can also use item

13. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted.

(See instructions for additional guidance or use of the fillable PDF.)

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)

a. GCA NAME

Defense Health Agency

b. ACTIVITY ADDRESS CODE (AAC) OF THE CONTRACTING OFFICE (See Instructions)

HT0038

c. ADDRESS (Include ZIP Code) 1700 N Moore St Floor 12 Arlington, VA 22209

d. POC NAME

Anthony J. Delicati

e. POC TELEPHONE (Include Area Code)

+1 (726) 203-0036

f. EMAIL ADDRESS (See Instructions) anthony.j.delicati.civ@mail.mil

17. CERTIFICATION AND SIGNATURES

Security requirements stated herein are complete and adequate for safeguarding the classified information to be released or generated under this classified effort. All questions shall be referred to the official named below. Upon digitally signing Item 17h, no changes can be made as the form will be locked.

a. TYPED NAME OF CERTIFYING OFFICIAL (Last, First, Middle Initial) (See Instructions)

Delicati, Anthony J.

b. TITLE

Contracting Officer

PREVIOUS EDITION IS OBSOLETE. Page 6 of 6DD FORM 254, APR 2018

c. ADDRESS (Include ZIP Code) 1700 N Moore St Floor 12 Arlington, VA 22209

d. AAC OF THE CONTRACTING OFFICE (See Instructions)

HT0038

e. CAGE CODE OF THE PRIME CONTRACTOR

(See Instructions.)

f. TELEPHONE (Include Area Code)

+1 (726) 203-0036

g. EMAIL ADDRESS (See Instructions) anthony.j.delicati.civ@mail.mil

h. SIGNATURE

i. DATE SIGNED (See Instructions)

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

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. OTHER AS NECESSARY (If more room is needed, continue in Item 13 or on additional page if necessary.)

DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 254, APR 2018

NEEDS DD67

DEPARTMENT OF DEFENSE

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

(The requirements of the National Industrial Security Program (NISP) apply to all security aspects of this effort involving classified information.)

OMB No. 0704-0567 OMB approval expires:

May 31, 2022 The public reporting burden for this collection of information, 0704-0567, is estimated to average 70 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 aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. 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.

RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.

1. CLEARANCE AND SAFEGUARDING

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

3. THIS SPECIFICATION IS: (X and complete as applicable.)

a. ORIGINAL (Complete date in all cases.)

b. REVISED (Supersedes all previous specifications.)

4. IS THIS A FOLLOW-ON CONTRACT?

If yes, complete the following:

Classified material received or generated under

5. IS THIS A FINAL DD FORM 254?

If yes, complete the following:

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

7. SUBCONTRACTOR(S) (Click button if you choose to add or list the subcontractors -- but will still require a separate DD Form 254 issued by a prime contractor to each subcontractor)

8. ACTUAL PERFORMANCE (Click button to add more locations.)

10. CONTRACTOR WILL REQUIRE ACCESS TO: (X all that apply. Provide details in Blocks 13 or 14 as set forth in the instructions.)

e. NATIONAL INTELLIGENCE INFORMATION:

11. IN PERFORMING THIS CONTRACT, THE CONTRACTOR WILL: (X all that apply. See instructions. Provide details in Blocks 13 or 14 as set forth in the instructions.)

12. PUBLIC RELEASE

Any information (classified or unclassified) pertaining to this contract shall not be released for public dissemination except as provided by the National Industrial Security Program Operating Manual (NISPOM) or unless it has been approved for public release by appropriate U.S. Government authority. Proposed public releases shall be submitted for review and approval prior to release to the appropriate government approval authority identified here with at least office and phone contact information and if available, an e-mail address. (See instructions)

13. SECURITY GUIDANCE

The security classification guidance for classified information needed for this 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. The field will expand as text is added. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted. Also allows for up to 6 internal reviewers to digitally sign. See instructions for additional guidance or use of the fillable PDF.)

List of Attachments (All Files Must be attached Prior to Signing, i.e., for any digital signature on the form)

14. ADDITIONAL SECURITY REQUIREMENTS

Requirements, in addition to NISPOM requirements for classified information, 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 CSO. The field will expand as text is added or you can also use item 13. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted. (See instructions for additional guidance or use of the fillable PDF.)

15. INSPECTIONS

Elements of this contract are outside the inspection responsibility of the CSO.

If Yes, explain and identify specific areas and government activity responsible for inspections. The field will expand as text is added or you can also use item 13. When removing any expanded text area, use delete key or backspace key, then click out of the text field for it to shrink after the text has been deleted. (See instructions for additional guidance or use of the fillable PDF.)

16. GOVERNMENT CONTRACTING ACTIVITY (GCA) AND POINT OF CONTACT (POC)

17. CERTIFICATION AND SIGNATURES

Security requirements stated herein are complete and adequate for safeguarding the classified information to be released or generated under this classified effort. All questions shall be referred to the official named below. Upon digitally signing Item 17h, no changes can be made as the form will be locked.

18. REQUIRED DISTRIBUTION BY THE CERTIFYING OFFICIAL

9.0.0.2.20120627.2.874785 DD 254, "DoD Contract Security Classification Specification" Show Attachment Bar

7700 Arlington Blvd Falls Church, VA 22042

1. All contractors performing on this contract must hold an Industrial Personnel Security Clearance of an interim SECRET or above IAW 32 CFR Part 117 National Industrial Security Program (NISPOM)

2. Contractors performing on this contract will receive or have to generate classified materials, emails and documents up to the TS/SCI level. Classified information will be handled IAW the National Industrial Security Program, DoD 5220.22-M.

3. Government issued CAC and SIPRNet Tokens are the property of the U.S. Government and will be returned to the COR by the cardholders upon completion of this contract, termination of employment, or removal from contract performance.

4. All information about this contract or details about the Government activity to include its personnel, information, equipment, facilities, activities, and operations will only be released to authorized personnel with an official "need to know" and will not be discussed with unauthorized persons, discarded as unclassified trash, posted on web pages, or released to the public without the COR's written approval.

5. Transmission of Controlled Unclassified Information (CUI) on this project shall be protected through the use of DoD Public Key Infrastructure (PKI) encryption or equivalent facility systems. At no time shall CUI or classified information be transmitted electronically by means other than approved Government systems and/or methods. See 10.a., 11.l. and CUI REQUIREMENTS FOR DOD CONTRACTORS below.

Reference 10.b. Restricted Data. Access to RESTRICTED DATA, information which is classified and controlled under the Atomic Energy Act of 1954 is required. A final U.S. Government (Top Secret or Secret) clearance is required for this project. Access to and dissemination of this information shall be governed by DoD Instruction 5210.02. Contractors shall not disclose RD to subcontractors without the prior written approval of the GCA.

Reference 10.d. Formerly Restricted Data. Information that is removed from the Restricted Data category upon a joint determination by the Department of Energy (or antecedent agencies) and the Department of Defense that such information relates primarily to the military utilization of atomic weapons and that such information can be safeguarded adequately as classified defense information. For Foreign Dissemination however, it is treated in the same manner as Restricted Data. Information of this category shall not be disseminated outside official channels without the consent of the originator. Access to and dissemination of this information shall be governed by DoD Instruction 5210.02. Access to FORMERLY RESTRICTED DATA requires a final U.S. Government clearance at the (Secret or Top Secret) level.

Reference 10.j. CUI Information. (Applies if block 10j is marked yes; mark 11l. yes also) Controlled Unclassified Information under this contract shall be safeguarded as specified in DoDI 5200.48 "DoD Controlled Unclassified Information (CUI)". Contractor will have access to unclassified information requiring safeguarding and dissemination control in alignment with specific laws, regulations, or government-wide policies (Formerly identified as For Official Use Only (FOUO), Privacy Act information, Sensitive but unclassified, or Law Enforcement Sensitive). Contractor shall follow the safeguarding requirements in DoDI 5200.48. DoD Freedom of Information Act Program applies.

Reference 10.k. Performance in Government Facilities. (Mark block 10k yes) This contract requires personnel to perform work in direct support of the DHA staff and will require individuals to work within Government controlled facilities. All contractor personnel under this contract who have access to classified information must possess a U.S. clearance. The Contract Monitor will provide security classification guidance for the performance of this contract.

In and Out Processing: This contract requires personnel to perform work in direct support of, the DHA staff and will require individuals to obtain and maintain government issued building access cards to enable performance within Government controlled facilities. As such, all contractor personnel are required to in-process with the Administration Directorate prior to reporting for work. As a condition of this contract, all personnel issued government access cards are required to ensure the card is returned to the DHA Security Office upon removal from the contract or termination of employment under this contract.

Reference 10.k. Common Access Cards. This contract requires personnel to obtain the Government issued Common Access Card (CAC) in order to provide identification for access government computer systems and physical access to facilities. Personnel must meet and maintain investigative and adjudicative requirements specified in DoDI 5200.46, and immediately report to the GCA any issues affecting CAC eligibility. Government issued credentials are the property of the United States Government and must be returned when no longer required for performance on this contract. Return CACs to: Defense Health Agency, Administration and Management (J-1), Infrastructure Support Division. CACs will not be used to access information systems, facilities, or installations that are outside the performance requirements of this contract. CACs will be used only by the individual to whom it was issued and will not be used for or by any other person. The contractor will immediately notify the GCA if a CAC is lost, stolen, or otherwise missing. Replacement CACs will require the contractor employee to obtain a signed memo from the Defense Health Agency, Administration and Management (J-1), Infrastructure Support Division, requesting a new CAC be issued.

Reference 10.k. NIPRNET access required. (Mark block 10k yes) This contract requires the contractor to access and use the Unclassified government computer system known as the NIPRNET at locations identified by the government customer. All provisions of DoD Risk Management Framework (RMF) apply. This system is Unclassified only, and inappropriate or improper use of the system will result in a reportable incident to the DCSA. NIPRNET as well as other unclassified systems or equipment (e.g. printers, facsimile) will not be used to process classified information. NIPRNET systems will be used only for an official Government purpose. Inappropriate or improper use of the NIPRNET system will result in a reportable incident to the Defense Counterintelligence and Security Agency (DCSA).

Reference 10.k. SIPRNET access required. This contract requires the contractor to access and use the Classified government computer system known as the SIPRNET at locations identified by the government customer. All provisions of DoD Risk Management Framework (RMF) apply. This system is authorized for use to but not exceeding the TS/SCI level, and inappropriate or improper use of the system will result in a reportable incident to the Defense Counterintelligence and Security Agency (DCSA).

Reference 11.a. Have access to classified information ONLY at a government activity. When block 11.a. is marked yes, block 8.a. must identify the actual U.S. Government work location. If this is the case, block 1.b. would be marked NONE. All classified information/material shall be provided by the Government Contracting Activity (GCA) and safeguarded at the approved actual performance site.

Reference 11l. Receive, Store or Generate CUI Information. (Applies if block 10j is marked yes) Controlled Unclassified Information under this contract shall be safeguarded as specified in DoDI 5200.48, "DoD Controlled Unclassified Information (CUI)". Contractor will have access to unclassified information requiring safeguarding and dissemination control in alignment with specific laws, regulations, or government-wide policies (Formerly identified as For Official Use Only (FOUO), Privacy Act information, Sensitive but Unclassified, or Law Enforcement Sensitive). Contractor shall follow the safeguarding requirements in DoDI 5200.48. DoDM 5400.07, DoD Freedom of Information Act Program applies.

Reference 11.m. IT Operation and Support Positions. Contractor will require access to sensitive unclassified government automated information systems (AIS) at different levels. Contractor must comply with the attached WHS IT Policy Bulletin 2004-0003.

CUI REQUIREMENTS FOR DOD CONTRACTORS

The following procedures will be used to protect Controlled Unclassified Information (CUI) documents and materials:

1) HANDLING: Access to CUI material shall be limited to those employees needing the material to perform their duties. The CUI marking is assigned to documents and material created by a DoD User Agency. CUI is not a classification, but requires extra precautions to ensure it properly safeguarded and disseminated and is not released to the public without government authorization.

2) MARKING: Mark unclassified documents containing CUI: “CUI" at the top and bottom of each page, include the CUI warning box, and the CUI Designation Indicator Block as required in DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 2. In a classified document:

a) Mark individual paragraph containing only CUI, but not classified material by placing “(CUI)" at the beginning of the portion.

b) Mark top and bottom of each page with classified material with the highest security classification of the material on the page.

c) If the document or material contains CUI under the category of Controlled Technical Information (CTI), use of distribution statements is required. See DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 2.

d) If a classified document contains CUI material or if the classified material becomes CUI when declassified, place the following statement on the bottom of the cover or the first page under the classification marking: “NOTE: If declassified, review the document to make sure the material is not still CUI. If it does, then it must have the appropriate safeguarding, dissemination controls, and CUI markings applied.

e) Mark other records such as computer print outs, photographs, films, tapes, or slides in accordance with DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 2 so the receiver or viewer knows the it contains CUI material.

f) Mark a message containing material in accordance with DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 2. Unclassified messages containing CUI material must show the abbreviation (CUI) before the text begins.

g) Ensure documents transmitting CUI material call attention to any attachments containing CUI.

h) CUI material released to a contractor by a DoD user agency must have the following statement on the front page or cover:

THIS DOCUMENT CONTAINS CUI MATERIAL AND MUST BE REVIEWED BY A GOVERNMENT REPRESENTATIVE UNDER THE REQUIREMENTS OF DODI 5200.48, DODI 5230.09, and DODI 5230.29.

3) STORAGE: During normal duty hours, place CUI material in an out-of-sight location if your work area is accessible to persons who do not have an authorized government purpose for access to the material. After normal duty hours, store CUI material to prevent unauthorized access. File with other unclassified records in unlocked files or desks when internal building security is provided and the file is marked as CUI. When there is no internal security, locked buildings or rooms usually provide adequate after hours protection. For additional protection, store CUI material in locked containers such as file cabinets, desks, or bookcases. Expenditure of funds for security containers or closed areas solely for the protection of CUI material is prohibited.

4) TRANSMISSION: CUI documents and materials may be transmitted via first class mail, parcel post or for bulky shipments-fourth class mail. Within the CONUS discussion of CUI material on the telephone is authorized if necessary for the performance of the contract and no alternative is available. Electronic transmission of CUI (voice, data, or facsimile) should be by approved secure communications systems whenever practical. If there is a fax transmission, the sender must ensure the intended receiver is available to receive it or a cover sheet will be used to allow carrying it to the final recipient to avoid unauthorized disclosure of the CUI.

5) RELEASE: CUI material shall not be released outside of the contractor’s facility except to the representative of DoD or PFPA.

6) DESTRUCTION: When the CUI material no longer meets the threshold for safeguarding and dissemination, it shall be immediately decontrolled, be processed through the records management process, and destroyed by the approved methods identified in DoDI 5200.48 and PFPA CUI Interim Guidance SOP, VOL 1 precluding its disclosure to unauthorized individuals by rendering it unreadable, indecipherable, and irrecoverable.

text:

PFPA SSD SAB

PFPA Industrial Security Program Manager rep: DHA Security Branch Government Representative

2. Privacy Act and Health Insurance Portability and Accountability Act (HIPPA) requirements are contained in the contract.