**Center for Information Technology (CIT)**

**National Institutes of Health (NIH)**

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

**Information Technology (IT) Acquisition Clearance Checklist**

**Over \$3,000 to \$100,000**

*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}

+-----------------------------------------------------------------------+
| > **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 \$3,001  |
|     to \$100,000, 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 where it would be appropriate for CIT to be   |
|     responsible for conducting the required Clinger-Cohen review.     |
|                                                                       |
| > ***The checklists must be signed and dated***                       |
| >                                                                     |
| > ***before submitting to the Administrative Office.***               |
|                                                                       |
| []{.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}                                                             |
+-----------------------------------------------------------------------+

  -----------------------------------------------------------------------
  **1. What IT Hardware; IT Software; Telecommunications; IT Maintenance,
  Support or Services do you propose to purchase?**

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| > **2a. What is the total cost *(including the dollar amounts of the  |
| > base award period and any options or incremental funding            |
| > periods****)***?**                                                  |
| >                                                                     |
| > Base Period: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Estimated Dollar    |
| > Value: \$\_\_\_\_\_\_                                               |
| >                                                                     |
| > Option (or Incremental Funding) Period 1 (*if applicable*)          |
| > \_\_\_\_\_\_\_Estimated Dollar Value: \$\_\_\_\_\_\_                |
| >                                                                     |
| > Option (or Incremental Funding) Period 2 (*if applicable*)          |
| > \_\_\_\_\_\_\_Estimated Dollar Value: \$\_\_\_\_\_\_                |
|                                                                       |
| \[*Continue to list any other option/incremental funding periods and  |
| dollar values.*\]                                                     |
+-----------------------------------------------------------------------+
| **2b. If this is an IT services acquisition (including IT             |
| maintenance/support), how was the government cost estimate derived?** |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **3a. Is this request part of the Division's approved budgeted        |
| expenses?**                                                           |
|                                                                       |
| > □ Yes                                                               |
| >                                                                     |
| > □ No \[*If No, identify here the source of funding.*\]              |
+-----------------------------------------------------------------------+
| **3b. Identify the source of funding:**                               |
|                                                                       |
| > □ Management Fund                                                   |
| >                                                                     |
| > □ Service and Supply Fund                                           |
| >                                                                     |
| > □ Other (Please specify)                                            |
+-----------------------------------------------------------------------+
| **3c. If any funds are being expended on behalf of another (i.e. not  |
| CIT) entity, is there written assurance that CIT/NIH will recover     |
| these funds?**                                                        |
|                                                                       |
| > □ Yes                                                               |
| >                                                                     |
| > □ No \[If no, please explain\]                                      |
| >                                                                     |
| > □ N/A                                                               |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **4a. What method of acquisition will be used (*check all that        |
| apply*):**                                                            |
|                                                                       |
| **Open Market Order:**                                                |
|                                                                       |
| □ Contract \[FAR Part 15\]                                            |
|                                                                       |
| **GSA Federal Supply Schedule (FSS) Order -- Not Requiring a          |
| Statement of Work:**                                                  |
|                                                                       |
| □ Estimated award value › \$3,000 but not exceeding the Maximum Order |
| Threshold *(generally \$500,000*) of GSA FSS contract \[FAR Subpart   |
| 8.405-1(c)\]                                                          |
|                                                                       |
| **GSA Federal Supply Schedule (FSS) Order -- Requiring a Statement of |
| Work:**                                                               |
|                                                                       |
| □ Estimated award value › \$3,000 but not exceeding the Maximum Order |
| Threshold of the GSA FSS contract \[FAR Subpart 8.405-1(c)\]          |
|                                                                       |
| **Commercial Item Acquisition \[FAR Part 12\]:**                      |
|                                                                       |
| □ NIH (NITAAC) Government-wide Acquisition Contract (GWAC)            |
| (<http://nitaac.nih.gov/iw2.asp>):                                    |
|                                                                       |
| □ CIOSP2i                                                             |
| (<http://nitaac.nih.gov/downloads/ciosp2/CIOSP2_cvik_guidelines.pdf>) |
|                                                                       |
| □ ECS III                                                             |
| (<http://nitaac.nih.gov/downloads/ecs3/ecs3_cvik_guidelines.pdf>)     |
|                                                                       |
| □ ImageWorld2nd                                                       |
| (<http://nitaac.ni                                                    |
| h.gov/downloads/iw2/MasterMod2/IW2_cvik_guidelinesAttachmentJ-6.pdf>) |
|                                                                       |
| □ **Other Agency GWAC**                                               |
|                                                                       |
| > (<http://www.gsa.gov/Portal/gsa/ep/channelView.do?pageTypeId=8199&c |
| hannelPage=%252Fep%252Fchannel%252FgsaOverview.jsp&channelId=-15761>) |
|                                                                       |
| □ **NIH Blanket Purchase Agreement (BPA)**                            |
| (<http://silk.nih.gov/public/AQF1SSL.@www.bpa.report.dsncc>)          |
|                                                                       |
| □ **HHS-Wide Area Contract**                                          |
| ([http://intranet.hhs.gov/hwac](http://intranet.hhs.gov/hwac/))       |
|                                                                       |
| □ **GSA SmartBUY** (<http://isdp.nih.gov/information/Smartbuy.asp>)   |
+-----------------------------------------------------------------------+
| **4b. The proposed acquisition will be processed as (*check which one |
| applies*):**                                                          |
|                                                                       |
| > □ Full and Open Competition                                         |
| >                                                                     |
| > □ Less Than Full and Open Competition                               |
| >                                                                     |
| > \[*If Less Than Full and Open Competition, which one of the         |
| > following applies?*\]                                               |
| >                                                                     |
| > □ Sole source \[*Is a Certified, Minority 8(a) source*\]            |
| >                                                                     |
| > □ Sole source \[*Is not a Certified, Minority 8(a) source*\]        |
| >                                                                     |
| > □ The proposed acquisition is for a particular brand name, product, |
| > or a feature of a product, peculiar to one manufacturer, thereby    |
| > precluding consideration of a product manufactured by another       |
| > company (even when price competition may be obtained from more than |
| > one authorized reseller)                                            |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **5. Explain the specific requirement that motivated this             |
| acquisition.** Note that personal appeal items (e.g. cameras,         |
| VCRs,...) must have "written justification demonstrating the          |
| legitimate NIH purpose" for their purchase.                           |
|                                                                       |
| -   What needs to be accomplished in functional terms?                |
|                                                                       |
| -   How does this requirement relate to the NIH and CIT mission?      |
|                                                                       |
| -   How does the proposed acquisition meet this requirement and       |
|     support the NIH and CIT mission?                                  |
+-----------------------------------------------------------------------+

  -----------------------------------------------------------------------
  **6. What are the expected benefits of the acquisition?** *How are you
  currently meeting the need, and how will the acquisition help in
  measurable ways, such as service delivery improvement, faster
  throughput, etc*.?

  -----------------------------------------------------------------------

+-----------------------------------------------------------------------+
| **7. Alternatives Analysis**                                          |
|                                                                       |
| > *Alternatives include: outsourcing, use of non-IT resources to      |
| > satisfy the requirement, use of existing IT resources, sharing IT   |
| > resources, use of commercial IT resources, process reengineering,   |
| > redesign of applications programs to better conform to standards    |
| > and changing conditions, revision of production schedules or job    |
| > streams, addition of equipment, upgrade to components of existing   |
| > equipment, replacement of an existing system with a compatible      |
| > system to handle the workload, and competitive replacement of the   |
| > existing IT resources system. Level of analysis should be           |
| > commensurate with total cost.*                                      |
|                                                                       |
| -   Compare and evaluate all feasible alternatives which will meet    |
|     the requirement.                                                  |
|                                                                       |
| -   How did you determine which alternative is most advantageous to   |
|     the government?                                                   |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **8. 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.                   |
| >                                                                     |
| > □ Yes, the proposed acquisition includes covered products and all   |
| > products will be in compliance with the above requirements. *If the |
| > purchase is being made through a contractor or subcontractor, the   |
| > contractor is required to ensure that all purchases are in          |
| > compliance.*                                                        |
| >                                                                     |
| > □ Yes, the proposed acquisition includes covered products. However, |
| > the Acquisition Official will be requested to approve an exemption  |
| > from the requirements.                                              |
| >                                                                     |
| > □ No, the proposed acquisition does not include any products        |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **9. 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)?**                                                      |
|                                                                       |
| > □ Yes \[*If Yes, check one of the following:*\]                     |
| >                                                                     |
| > □ The following CIT Official reviewed the terms and conditions of   |
| > the license agreement:                                              |
| >                                                                     |
| > \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ *(Please print or type the   |
| > name of the CIT Official.)*                                         |
| >                                                                     |
| > □ The terms and conditions of the licensing agreement need to be    |
| > reviewed prior to award.                                            |
| >                                                                     |
| > □ No. Review and approval of a licensing agreement is not           |
| > applicable to this acquisition.                                     |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **10a. Does this purchase comply with the NIH Enterprise Architecture |
| as specified at**                                                     |
| *[http://ente                                                         |
| rprisearchitecture.nih.gov](http://enterprisearchitecture.nih.gov/)?* |
|                                                                       |
| > □ Yes - If Yes, list the name of the Brick in which the product is  |
| > listed (must be either a tactical or strategic product):            |
| > \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                  |
| >                                                                     |
| > □ No - If No, provide the Architecture Exception Request Form OCITA |
| > Tracking Number for approved exceptions:                            |
| > \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                      |
| >                                                                     |
| > □ N/A - If N/A: The undersigned CIT Branch Chief/Lab Official 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.)*                      |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **10b. 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)                          |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **11. Will there be a requirement for special IT accommodation needs  |
| for persons with disabilities as directed in Section 508 of the       |
| Rehabilitation Act of 1973?**                                         |
|                                                                       |
| > □ Yes - If Yes, describe the requirements and how they will be      |
| > accommodated:                                                       |
| >                                                                     |
| > □ No                                                                |
| >                                                                     |
| > *Reference Links: <http://www.section508.gov/>,                     |
| > <http://www.access-board.gov/>, <http://www.buyaccessible.gov/>*    |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **12a. Information Security: Will the proposed acquisition involve    |
| contractor/subcontractor personnel who will (1) develop, (2) have the |
| ability to access sensitive information from, or (3) host and/or      |
| maintain a Federal information system(s)?**                           |
|                                                                       |
| > □ Yes \[*If Yes, complete the remaining items in Section No. 12 of  |
| > this checklist.*\]                                                  |
| >                                                                     |
| > □ No \[I*f No, skip the rest of question 12.*\]                     |
+-----------------------------------------------------------------------+
| **12b. Have the appropriate NIH information systems security          |
| provisions been incorporated in the Statement of Work?**              |
|                                                                       |
| > □ Yes                                                               |
| >                                                                     |
| > □ No \[If no, please explain here.\]                                |
+-----------------------------------------------------------------------+
| **12c. Attach a copy of the Statement of Work, and send a copy        |
| electronically to Dawn Farr <dfarr@mail.nih.gov> (CIT/ISSO).**        |
+-----------------------------------------------------------------------+
| **12d. Assess and Determine the Information Type \[Check the one      |
| which best applies.\]**                                               |
|                                                                       |
| > □ Administrative, Management and Support Information                |
| >                                                                     |
| > \[Reference:                                                        |
| > <http                                                               |
| ://csrc.nist.gov/publications/nistpubs/800-60/SP800-60V2-final.pdf>\] |
| >                                                                     |
| > \_\_\_\_\_\_\_\_\_\_\                                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| >                                                                     |
| > \[*List here which Information Type(s) from NIST SP 800-60, Volume  |
| > II, Appendix C, are applicable to this proposed acquisition.*\]     |
| >                                                                     |
| > □ Mission Based Information \[Reference:                            |
| > <http                                                               |
| ://csrc.nist.gov/publications/nistpubs/800-60/SP800-60V2-final.pdf>\] |
| >                                                                     |
| > \_\_\_\_\_\_\_\_\_\_\                                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| >                                                                     |
| > *List here which Information Type(s) from NIST SP 800-60, Volume    |
| > II, Appendix D, are applicable to this proposed acquisition.*\]     |
+-----------------------------------------------------------------------+
| > **12e. Assess and Determine Security Categories and Levels** \[*for |
| > each category, check the level that applies to this proposed        |
| > acquisition*\]:                                                     |
|                                                                       |
| Confidentiality Level: □ Low □ Moderate □ High                        |
|                                                                       |
| Integrity Level: □ Low □ Moderate □ High                              |
|                                                                       |
| Availability Level: □ Low □ Moderate □ High                           |
|                                                                       |
| Overall Level: □ Low □ Moderate □ High                                |
|                                                                       |
| (Reference:                                                           |
| <ht                                                                   |
| tp://csrc.nist.gov/publications/nistpubs/800-60/SP800-60V2-final.pdf> |
| and <http://irm.cit.nih.gov/security/table1.htm>)                     |
+-----------------------------------------------------------------------+
| **12f. Assess and Assign Position Sensitivity Designations:**         |
|                                                                       |
| > \[Reference: <http://irm.cit.nih.gov/security/table2.htm>\]         |
| >                                                                     |
| > List the estimated number of contractor employees that will require |
| > each of the following position sensitivity designations:            |
| >                                                                     |
| > Number range CHAPTER**Level 6: Sensitive - High Risk** **(Requires  |
| > Suitability Determination with a BI).**                             |
| >                                                                     |
| > Contractor employees assigned to a Level 6 position are subject to  |
| > a Background Investigation (BI).                                    |
| >                                                                     |
| > **Level 5: Sensitive - Moderate Risk** **(Requires Suitability      |
| > Determination with NACIC).**                                        |
| >                                                                     |
| > Contractor employees assigned to a Level 5 position with no         |
| > previous investigation and approval shall undergo a National Agency |
| > Check and Inquiry Investigation plus a Credit Check (NACIC), a      |
| > Minimum Background Investigation (MBI), or possibly a Limited       |
| > Background Investigation (LBI).                                     |
| >                                                                     |
| > **Level 4: Classified** **(Requires Special Access Clearance with   |
| > an SSBI).**                                                         |
| >                                                                     |
| > Contractor employees assigned to a Level 4 position are subject to  |
| > a Single Scope Background Investigation (SSBI).                     |
| >                                                                     |
| > **Level 3: Classified** **(Requires Top Secret Clearance with an    |
| > SSBI).**                                                            |
| >                                                                     |
| > Contractor employees assigned to a Level 3 position are subject to  |
| > a Single Scope Background Investigation (SSBI).                     |
| >                                                                     |
| > **Level 2: Classified** **(Requires Confidential or Secret          |
| > Clearance with an LBI).**                                           |
| >                                                                     |
| > Contractor employees assigned to a Level 2 position shall undergo a |
| > Limited Background Investigation (LBI).                             |
| >                                                                     |
| > **Level 1: Non Sensitive** **(Requires Suitability Determination    |
| > with an NACI).**                                                    |
| >                                                                     |
| > Contractor employees assigned to a Level 1 position are subject to  |
| > a National Agency Check and Inquiry Investigation (NACI).           |
+-----------------------------------------------------------------------+
| **12g. CIT Information Systems Security Officer (ISSO) Review and     |
| Approval (*required when the NIH information security provisions have |
| been incorporated into the Statement of Work):***                     |
|                                                                       |
| > Approved:                                                           |
| >                                                                     |
| > Signature CIT ISSO Date                                             |
| >                                                                     |
| > Print or type name                                                  |
+-----------------------------------------------------------------------+

**[CIT REQUIRED SIGNATURES FOR ALL CLEARANCE CHECKLISTS:]{.underline}**

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

+----------+------------------------------------------+---------------+
| S        |                                          | Approval      |
| ignature |                                          | Date:         |
|          |                                          |               |
| CIT AO   |                                          |               |
+----------+------------------------------------------+---------------+
| Print    |                                          |               |
| Name     |                                          |               |
+----------+------------------------------------------+---------------+

Attach Purchase Request Form and submit to Administrative Office.