**Center for Information Technology (CIT)**

**National Institutes of Health (NIH)**

**U.S. Department of Health & Human Services (HHS)**

**Information Technology (IT) Acquisition Clearance Checklist \$3,000 or
less**

*The principal purpose of this clearance checklist is to fulfill the
requirements of the*

*Information Management Reform Act of 1996 \[Division E of the
Clinger-Cohen Act of 1996, P.L. 104-106\].*

[]{.mark}

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| > **INSTRUCTIONS:**                                                   |
| >                                                                     |
| > **[Do not complete this clearance checklist if any of the following |
| > conditions apply*:*]{.underline}**                                  |
|                                                                       |
| -   CIT is serving the role of a facilitator in processing the        |
|     acquisition for a non-CIT purchaser where the proposed IT         |
|     purchase principally supports the mission of the non-CIT          |
|     purchaser,                                                        |
|                                                                       |
| -   The non-CIT purchaser is responsible for the outcome of the       |
|     project for which the acquisition is intended,                    |
|     **[OR]{.underline}**                                              |
|                                                                       |
| -   Other factors exist where it would be inappropriate for CIT to be |
|     responsible for conducting the required Clinger-Cohen review.     |
|     *\[In this instance, the CIT staff member assisting in the        |
|     non-CIT requirement should obtain a written confirmation from the |
|     non-CIT purchaser that it is responsible for conducting the       |
|     Clinger-Cohen review.\]*                                          |
|                                                                       |
| > **[Do complete this clearance checklist prior to soliciting for IT  |
| > resources if:]{.underline}**                                        |
|                                                                       |
| -   The estimated cumulative dollar value of the award *(including    |
|     the cumulative value of any options/increments)* will be \$3000   |
|     or less, and                                                      |
|                                                                       |
| -   The IT resources *(defined as: IT Hardware; IT software,          |
|     telecommunications; IT maintenance, support or services)*         |
|     represent a significant part of the requirement (i.e., more than  |
|     an incidental part of the requirement)*,* and,                    |
|                                                                       |
| -   At least one of the following conditions apply:                   |
|                                                                       |
| ```{=html}                                                            |
| <!-- -->                                                              |
| ```                                                                   |
| -   CIT is processing the acquisition for a CIT requirement or for a  |
|     non-CIT purchaser where the requirement principally supports the  |
|     mission of CIT,                                                   |
|                                                                       |
| -   CIT is responsible for the outcome of the project for which the   |
|     acquisition is intended, **[OR]{.underline}**                     |
|                                                                       |
| -   Other factors exist making it appropriate for CIT to be           |
|     responsible for conducting the required Clinger-Cohen review.     |
|                                                                       |
| []{.mark}                                                             |
|                                                                       |
| Checklist questions should be directed to:                            |
|                                                                       |
| EO/PECO at (301) 496-6203, CITPECOSTAFF@mail.nih.gov.                 |
|                                                                       |
| Attn: Michele Mulholland France - Initial Point of Contact (POC),     |
| francem@mail.nih.gov                                                  |
|                                                                       |
| > Jenny Czajkowski, Director, EO/PECO JennyCz@mail.nih.gov.           |
|                                                                       |
| If you have any questions regarding IT procurement, please contact:   |
|                                                                       |
| Kevin Sullivan, Director, AMO/CIT, 301-435-2924,                      |
| [sullivak@mail.nih.gov](mailto:dk13s@nih.gov)                         |
|                                                                       |
| []{.mark}                                                             |
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**1. What IT Hardware; IT Software; Telecommunications; IT Maintenance,
Support or Services do you propose to purchase?**

**2. What is the total cost? If not funded by CIT, what is the source of
funding and is there written assurance that CIT/NIH will recover these
funds?**

**3. Explain the specific requirement that motivated this acquisition.**
What needs to be accomplished in functional terms and how does the
proposed acquisition meet this requirement and support the NIH and CIT
mission? *Note that personal appeal items (e.g. cameras, film, VCRs,...)
must have "written justification demonstrating the legitimate NIH
purpose" for their purchase.*

**4. What method of acquisition will be used (*check all that apply*):**

□ **[NIH Blanket Purchase
Agreement](http://silk.nih.gov/public/AQF1SSL.@www.bpa.report.dsncc)
(BPA)** (<http://silk.nih.gov/public/AQF1SSL.@www.bpa.report.dsncc>)

□ **Other:**
[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}
(describe)

> □ **Purchase Card** If using a Purchase Card, give a reference number
> such as an invoice number, transaction number, purchase order number,
> or confirmation
> number.[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline} []{.mark}

[]{.mark}

**5. If the proposed acquisition will include the acquisition of IT
hardware or products, are they in compliance with Federal energy level
and environmental requirements ([Energy Star]{.underline} and [Green
Purchasing]{.underline}) and do they meet the U.S. Department of
Energy's Federal Energy Management Program
([FEMP](http://www.eere.energy.gov/femp/)) specifications for standby
power?** For guidance on the energy and environmental attributes of a
proposed IT hardware product, see the *Electronic Product Environmental
Assessment Tool (EPEAT)* at <http://www.epeat.net/>. EPEAT is a system
that has been developed to help Federal staff evaluate, compare and
select desktop computers, notebooks and monitors based on their
environmental attributes.

**6. Does the proposed acquisition include a licensing agreement that
must be reviewed as required by [NIH Policy for Approval of Licensing
Agreements](http://www1.od.nih.gov/oma/manualchapters/contracts/6027/main.html)
[for Software and Other Information Products]{.underline} (NIH Manual
Chapter 6027)? If Yes, give the name of the CIT Official who reviewed
the terms and conditions of the license agreement.**

**7. If this purchase includes items covered by the NIH Enterprise
Architecture as specified at**
*[http://enterprisearchitecture.nih.gov](http://enterprisearchitecture.nih.gov/)**,***
**does it comply with the NIH Enterprise Architecture requirements?**

> \_\_\_\_Yes - list the name of the Brick in which the product is
> listed (must be either a tactical or strategic product):
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_No - provide the Architecture Exception Request Form OCITA
> Tracking Number for approved exceptions:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_N/A --The undersigned has checked the NIH Enterprise
> Architecture and there are no applicable guidelines for this purchase
> or it does not apply to this IT acquisition.
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> *(Please print or type name of CIT Official.)*.

**8**. **If this product or technology accesses or uses the network, is
it IPv6 compatible in accordance with OMB Memorandum
[M-05-22](http://www.whitehouse.gov/omb/memoranda/fy2005/m05-22.pdf)?**

> \_\_\_\_\_Yes
>
> \_\_\_\_\_If No, provide the Architecture Exception Request Form OCITA
> Tracking Number for approved exceptions
>  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 
>
> \_\_\_\_\_N/A (is not integral to, nor will it impede transition of
> the network backbone to IPv6 capable status)

**9. [HOW]{.underline} have appropriate security and privacy
requirements been met?**

+----------+-----------------------------------------+----------------+
| S        |                                         | Approval Date: |
| ignature |                                         |                |
|          |                                         |                |
| CIT      |                                         |                |
| Lab/or   |                                         |                |
| Branch   |                                         |                |
| Chief    |                                         |                |
+----------+-----------------------------------------+----------------+
| Print    |                                         |                |
| Name     |                                         |                |
+----------+-----------------------------------------+----------------+

**If using a Purchase Card, submit to Purchase Card holder. Otherwise
attach Purchase Request form and submit to Administrative Office.**