CDRL PM-29 System Access Request.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved (1 Data Item) OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 220 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:

TDP TM OTHER

General

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

Logistic Support Services W52P1J-15-R-0195

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

PM-29 System Access / Restricted Information Access Request

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

PWS Para. 1.3.13 COR

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

NO See Blk 16 See Blk 16 b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FINAL

See Blk 16 As needed Reg Repro

16. REMARKS COR 1

Block 10 – Upon in-processing of personnel or change in need for personnel access.

Block 11 – Employee in-processing / change in need date.

Block 12 – Upon in-processing of personnel or change in need for personnel access.

Contractor format acceptable; must be fillable PDF with electronic signature of requesting employee and supervisor.

The Contractor’s format shall provide, but not limited to:

a. In-processing/request date.

b. Suspense date for access (if needed).

c. Follow-up request date (should be prior to suspense date, if possible)

d. Name of employee(s).

e. Employee Nationality.

f. Position / Duty Title.

g. Current security clearance / current background investigation status.

h. Reason for request.

i. Required access areas (folders, systems, locations)

j. Army Information Systems (AIS) requirements/accounts needed.

ALL DAYS INDICATED ARE CALENDAR DAYS UNLESS OTHERWISE

ANNOTATED.

15. TOTAL 1

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

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of 1 Pages