PROGRAM: 494-S 

TITLE: Representative Payee, Beneficiary Recontact, and Disability Update Reports

AGENCY: Social Security Administration (SSA)

TERM: Starting Date of Award, and ending June 30, 2022

Basis of 

ITEM No. DESCRIPTION Award Unit Rate Total Unit Rate Total Unit Rate Total Unit Rate Total

I. COMPOSITION:

(a) Scannable Forms, Notices w/Micro-Perforated Payment Stub, Instruction

Sheets & Flyer..................................................................................................per 8-1/2 x 11" page.......... 125 $50.00 $6,250.00 NC $0.00 NC $0.00 NC $0.00

(b) Envelopes......................................................................................................................per envelope.......... 23 $50.00 $1,150.00 NC $0.00 NC $0.00 NC $0.00

II. TRANSMISSION TEST:

Transmission Test..................................................................................................................per test.......... 1 NC $0.00 NC $0.00 NC $0.00 NC $0.00

III. PROOFS:

(a) Scannable Forms, Notices w/ Micro-Perforated Payment Stub, Instruction

Sheets, and Flyer..............................................................................................per 8-1/2 x 11" page............ 43 $50.00 $2,150.00 NC $0.00 NC $0.00 $0.00 $0.00

(b) Envelopes......................................................................................................................per envelope............ 23 $50.00 $1,150.00 NC $0.00 NC $0.00 $0.00 $0.00

(c) PDF Soft Proof.................................................................................................................per product............ 43 $50.00 $2,150.00 NC $0.00 NC $0.00 $0.00 $0.00

IV. PRINTING, IMAGING, BINDING, AND CONSTRUCTION: 

(a) *Make-ready/setup charge........................................................................................................................... 92 $220.00 $20,240.00 NC $0.00 $80.00 $7,360.00 NC $0.00

(b) Scannable Forms and Notices with Micro-Perforated Payment Stub (8-1/2 X 11")..per 1,000 leaves 5,260 $9.25 $48,655.00 $16.50 $86,790.00 $11.50 $60,490.00 $5.03 $26,457.80

(c) Flyer (8-1/2 x 11")........................................................................................................per 1,000 flyers.......... 3,099 $7.03 $21,785.97 $16.50 $51,133.50 $5.68 $17,602.32 $2.01 $6,228.99

(d) Instruction Sheets (8-1/2 x 11")...........................................................per 1,000 instruction sheets........ 102 $7.03 $717.06 $16.50 $1,683.00 $7.10 $724.20 $5.71 $582.42

(e) Instruction Sheets (17 x 11" flat).........................................................per 1,000 instruction sheets........ 5,080 $12.93 $65,684.40 $8.00 $40,640.00 $12.07 $61,315.60 $2.25 $11,430.00

(f) BRM and CRM Return Envelopes (4 x 8-7/8").................................................per 1,000 envelopes........ 5,221 $6.33 $33,048.93 NC $0.00 $6.44 $33,623.24 $6.61 $34,510.81

(g) Mail-Out Envelope with Window (4-1/4 x 9-1/2").........................................per 1,000 envelopes......... 5,182 $8.17 $42,336.94 NC $0.00 $7.96 $41,248.72 $6.26 $32,439.32

V. PAPER: .....................................................................................................................Per 1,000 Leaves

(a) Scannable Forms, White OCR Bond (20-lb.)............................................................................................... 5,182 $5.72 $29,641.04 $6.00 $31,092.00 $7.21 $37,362.22 $7.09 $36,740.38

(b) Notices with Micro-Perforated Payment Stub: White Uncoated Text (50-lb.).................................... 78 $4.65 $362.70 $10.00 $780.00 $16.67 $1,300.26 $14.28 $1,113.84

(c) Flyer: White Writing (20-lb.)........................................................................................................................ 3,099 $5.72 $17,726.28 $6.00 $18,594.00 $5.68 $17,602.32 $6.05 $18,748.95

(d) Instruction Sheets (8-1/2 x 11"): White Uncoated Text (50-lb.)............................................................ 102 $4.65 $474.30 $6.00 $612.00 $5.68 $579.36 $12.97 $1,322.94

(e) Instruction Sheets (17 x 11" flat): White Uncoated Text (50-lb.)........................................................... 5,080 $4.65 $23,622.00 $8.00 $40,640.00 $12.07 $61,315.60 $12.90 $65,532.00

(f) BRM and CRM Return Envelope, White Writing (20-lb.)........................................................................ 4,454 $6.05 $26,946.70 $13.00 $57,902.00 $6.44 $28,683.76 $6.89 $30,688.06

(g) BRM Return Envelope, Colored Writing Envelope (20-lb.)..................................................................... 767 $7.09 $5,438.03 $18.00 $13,806.00 $8.85 $6,787.95 $8.25 $6,327.75

(h) Mail-Out Envelope with Window: White Writing Envelope (24-lb.); or, at contractor's option, 

White Uncoated Text (60-lb.)..................................................................................................................... 5,182 $8.17 $42,336.94 $14.50 $75,139.00 $7.96 $41,248.72 $6.91 $35,807.62

VI. ADDITIONAL OPERATIONS:

Destruction of Stocked Items...................................................................................per 1,000 pieces....... 1 $100.00 $100.00 NC $0.00 $1.00 $1.00 $0.00 $0.00

VII. GATHERING, INSERTING, PACKING, AND MAILING:

(a) Mailers........................................................................................................................per 1,000 Mailers....... 5,182 $20.20 $104,676.40 $10.00 $51,820.00 $19.60 $101,567.20 $13.10 $67,884.20

(b) WBDOC Bulk Envelopes: Packing and Sealing Shipping Containers........................per container....... 62 $15.00 $930.00 $100.00 $6,200.00 $5.00 $310.00 $0.00 $0.00

CONTRACTOR TOTALS $497,572.69 ---------------- $519,122.47 $375,815.08

DISCOUNT 0.25% $1,243.93 ---------------- 0.00% $0.00 0.00% $0.00

DISCOUNTED TOTALS $496,328.76 ---------------- $519,122.47 $375,815.08

AWARDED

NPC INC.

Claysburg, PA

AMSIVE (FORMERLY SOURCELINK)

Miamisburg, OH SourceLink Ohio, LLC

PINNACLE DATA SYSTEMS CURRENT CONTRACTOR

Suwanee, GA
U.S. GOVERNMENT PUBL ISHING OFFICE | Keeping America Informed | OFFICIAL | DIGITAL | SECURE

732 North Capitol Street NW, Washington, DC 20401-0001 

http://www.gpo.gov | www.facebook.com/USGPO | twitter.com/USGPO 

April 21, 2021

This is Amendment No. 1. The specifications in our invitation for bids on Program 494-S, scheduled for 

opening at 11:00 a.m., on April 30, 2021, are amended as follows: 

Bid Opening Date remains the same. 

On page 71 of 72, line item V.(i) is changed to V.(h). This change is due to a clerical error. 

Balance of specifications remains the same. 

Amended bid or acknowledgement of amendment must be submitted via email to: bidsapsdc@gpo.gov

for this solicitation. Telephone or facsimile acknowledgement is not acceptable.

 

Bidder must acknowledge receipt of this amendment prior to bid opening. Failure to acknowledge receipt 

of amendment, by amendment number, prior to bid opening time, may be reason for bid being declared 

nonresponsive. 

Sincerely, 

REBECCA SWAN 

Contracting Officer 
Program 494-S Page 1 of 72 

Specifications by MRN 

U.S. GOVERNMENT PUBLISHING OFFICE 

Washington, DC 

GENERAL TERMS, CONDITIONS, AND SPECIFICATIONS 

For the Procurement of 

Representative Payee, Beneficiary Recontact, and Disability Update Reports 

(Direct Mail Scannable Forms) 

as requisitioned from the U.S. Government Publishing Office (GPO) by the 

Social Security Administration (SSA) 

Single Award 

TERM OF CONTRACT: The term of this contract is for the period beginning Date of Award and ending June 30, 

2022, plus up to four (4) optional 12-month extension period(s) that may be added in accordance with the “OPTION 

TO EXTEND THE TERM OF THE CONTRACT” clause in SECTION 1 of this contract. 

NOTE: Contractor interfacing with SSA’s National File Transfer Management System (FTMS) for electronic 

transmission of files from SSA to the production facility will take place from Date of Award through December 31, 

2021. Actual (live) production begins January 1, 2022. 

BID OPENING: Bids shall be opened at 11:00 a.m., prevailing Washington, DC Time, on April 30, 2021, at the 

Government Publishing Office, Washington, DC. (Due to the COVID-19 pandemic, this will NOT be a public bid 

opening.) 

BID SUBMISSION: Due to the COVID-19 pandemic, the GPO physical office will NOT be open. Based on this, 

bidders must submit email bids to bidsapsdc@gpo.gov for this solicitation. No other method of bid submission will be 

accepted at this time. The program number and bid opening date must be specified in the subject line of the emailed 

bid submission. Bids received after 11:00 a.m. on the bid opening date specified above will not be considered for 

award. 

BID RESTRICTION: Due to travel restrictions as a result of COVID-19, bidders must have an SSA pre-approved 

security clearance at the bidder’s physical location(s) that will be used in the production of products for this contract. 

NOTE: If bidder does not have these requirements completed prior to bid submission, the bidder will be declared nonresponsible. 

BIDDERS, PLEASE NOTE: This program was formerly Program 490-S. These specifications have been 

extensively revised; therefore, all bidders are cautioned to familiarize themselves with all provisions of these 

specifications before bidding, with particular attention to: “SECURITY AND SUITABILITY REQUIREMENTS FOR 

GOVERNMENT PRINTING (NOV 2018)” requirements specified in Section 1. 

Abstracts of contract prices are available at https://www.gpo.gov/how-to-work-with-us/vendors/contract-pricing. 

For information of a technical nature, contact Cecilia Dominguez Castro on (202) 512-0307 or at 

cdominguezcastro@gpo.gov. 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 2 of 72 

494-S (06/22) 

SECTION 1. – GENERAL TERMS AND CONDITIONS 

GPO CONTRACT TERMS: Any contract which results from this Invitation for Bid will be subject to the applicable 

provisions, clauses, and supplemental specifications of GPO Contract Terms (GPO Publication 310.2, effective 

December 1, 1987 (Rev. 01-18)) and GPO Contract Terms, Quality Assurance through Attributes Program for Printing 

and Binding (GPO Publication 310.1, effective May 1979 (Rev. 09-19)). 

GPO Contract Terms (GPO Publication 310.2) – https://www.gpo.gov/docs/default-source/forms-and-standards-filesfor-vendors/contractterms2018.pdf. 

GPO QATAP (GPO Publication 310.1) – https://www.gpo.gov/docs/default-source/forms-and-standards-files-forvendors/qatap-rev-09-19.pdf. 

PREDOMINANT PRODUCTION FUNCTIONS: The predominant production functions are the printing of notices, 

the laser/ion deposition printing/imaging of data for the notices from electronically transmitted files (inkjet printing is 

not allowed), folding, inserting, presorting, mailing, and disposal of waste materials. Any bidder who cannot perform 

the predominant production functions of this contract will be declared non-responsible. 

SUBCONTRACTING: Contractor may subcontract the printing and manufacturing of envelopes, instruction sheets, 

and flyer. 

The contractor shall be responsible for enforcing all contract requirements outsourced to a subcontractor. 

If the contractor needs to add a subcontractor at any time after award, the subcontractor must be approved by the 

Government prior to production starting in that facility. If the subcontractor is not approved by the Government, then 

the contractor must submit new subcontractor’s information to the Government for approval 30 calendar days prior to 

the start of production at that facility. 

If the contractor plans to enter into a “Contractor Team Arrangement” or Joint Venture to fulfill any requirements of 

this contract, all parties must comply with the terms and regulations as detailed in the Printing Procurement Regulation 

(GPO Publication 305.3; Rev. 4-14). 

QUALITY ASSURANCE LEVELS AND STANDARDS: The following levels and standards shall apply to these 

specifications: 

Product Quality Levels: 

(a) Printing (page related) Attributes – Level III. 

(b) Finishing (item related) Attributes – Level III. 

Inspection Levels (from ANSI/ASQC Z1.4): 

(a) Non-destructive Tests – General Inspection Level I. 

(b) Destructive Tests – Special Inspection Level S-2. 

(c) Transparent, low-gloss, poly-type window material, covering the envelope window, must pass a readability test 

with a rejection rate of less than 1/4% when run through a USPS OCR scanner. 

(d) Exception: ANSI X3.17 “Character Set for Optical Character Recognition (OCR A)” shall apply to these 

specifications. The revisions of this standard which are effective as of the date of this contract are those which 

shall apply. 

(e) Exception: The Data Matrix 2D Barcodes must be in accordance with the requirements of ANSI MH 10.8.3M 

unless otherwise specified. 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 3 of 72 

494-S (06/22) 

(f) The payment portion below the micro-perforation on the “payment stub” (Title II – Final Accounting Notices), 

once detached, will be scanned and must function properly when processed through the current high-speed 

scanning equipment at SSA. A form is a reject and will be considered a major defect when its OCR print 

cannot be correctly deciphered on the first pass through the scanning equipment. (See “PRINTING,” 

“IMAGING,” “MICRO-PERFORATED PAYMENT STUB,” and “BINDING” specified herein for additional 

information regarding the perforated payment stub.) 

NOTE: Use of equipment or ink, which in any way adversely affects the scannability of the payment stub, will not be 

allowed. 

ANSI Standards may be obtained from the American National Standards Institute, 25 West 43rd Street, 4th Floor, New 

York, NY 10036. 

Specified Standards: The specified standards for the attributes requiring them shall be: 

Attribute Specified Standard 

P-7. Type Quality and Uniformity O.K. Press Sheet 

Special Instructions: In the event the inspection of press sheets is waived by the Government, the following list of 

alternative standards (in order of precedence) shall become the Specified Standards: 

P-7. O.K. Preproduction Test Sample; O.K. Proofs; Average Type Dimension; Electronic Media; Camera Copy; 

Manuscript Copy; Furnished Samples. 

NOTE: The forms produced under these specifications require precision spacing, printing, trimming, and folding and 

must be guaranteed to function properly when processed through an Integrated Image Based Data Capture System 

(IIBDCS). The barcoding must be easily readable by all standard barcode scanning devices regardless of the 

contractor’s method of reproducing the codes. (SSA equipment: hand-held barcode reader and high-speed scanners for 

Mailers 1 through 36 and the OPEX AS 3690 Scanner for micro-perforated payment stub for Mailers 19 through 24.). 

OPTION TO EXTEND THE TERM OF THE CONTRACT: The Government has the option to extend the term of 

this contract for a period of 12 months by written notice to the contractor not later than 30 days before the contract 

expires. If the Government exercises this option, the extended contract shall be considered to include this clause except, 

the total duration of this contract may not exceed five (5) years as a result of, and including, any extension(s) added 

under this clause. Further extensions may be negotiated under the “EXTENSION OF CONTRACT TERM” clause. See 

also “ECONOMIC PRICE ADJUSTMENT” for authorized pricing adjustment(s). 

EXTENSION OF CONTRACT TERM: At the request of the Government, the term of any contract resulting from 

this solicitation may be extended for such period of time as may be mutually agreeable to the GPO and the contractor. 

ECONOMIC PRICE ADJUSTMENT: The pricing under this contract shall be adjusted in accordance with this 

clause, provided that in no event will any pricing adjustment be made that would exceed the maximum permissible 

under any law in effect at the time of the adjustment. There will be no adjustment for orders placed during the first 

period specified below. Pricing will thereafter be eligible for adjustment during the second and any succeeding 

performance period(s). For each performance period after the first, a percentage figure will be calculated as described 

below and that figure will be the economic price adjustment for that entire next period. Pricing adjustments under this 

clause are not applicable to reimbursable postage or transportation costs, or to paper, if paper prices are subject to 

adjustment by separate clause elsewhere in this contract. 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 4 of 72 

494-S (06/22) 

For the purpose of this clause, performance under this contract will be divided into successive periods. The first period 

will extend from Date of Award through June 30, 2022 and the second and any succeeding period(s) will extend for 12 

months from the end of the last preceding period, except that the length of the final period may vary. The first day of 

the second and any succeeding period(s) will be the effective date of the economic price adjustment for that period. 

Pricing adjustments in accordance with this clause will be based on changes in the seasonally adjusted “Consumer Price 

Index For All Urban Consumers - Commodities Less Food” (Index) published monthly in the CPI Detailed Report by 

the U.S. Department of Labor, Bureau of Labor Statistics. 

The economic price adjustment will be the percentage difference between Index averages as specified in this paragraph. 

An index called the variable index will be calculated by averaging the monthly Indexes from the 12-month interval 

ending three (3) months prior to the beginning of the period being considered for adjustment. This average is then 

compared to the average of the monthly Indexes for the 12-month interval ending March 31, 2021 called the base 

index. The percentage change (plus or minus) of the variable index from the base index will be the economic price 

adjustment for the period being considered for adjustment. 

The Government will notify the contractor by contract modification specifying the percentage increase or decrease to be 

applied to invoices for orders placed during the period indicated. The contractor shall apply the percentage increase or 

decrease against the total price of the invoice less reimbursable postage or transportation costs and separately adjusted 

paper prices. Payment discounts shall be applied after the invoice price is adjusted. 

PAPER PRICE ADJUSTMENT: Paper prices charged under this contract will be adjusted in accordance with 

“Table 9 - Producer Price Indexes and Percent Changes for Commodity Groupings and Individual Items” in Producer 

Price Indexes report, published by the Bureau of Labor Statistics (BLS), as follows: 

NOTE: For the purpose of this contract, the Paper Price Adjustment will be based on the date of actual production. 

 Actual production begins January 1, 2022. 

1. BLS code 0913 for All Paper will apply to all paper required under this contract. 

2. The applicable index figures for the month of December 2021 will establish the base index. 

3. There shall be no price adjustment for the first three months of the contract. 

4. Price adjustments may be monthly thereafter, but only if the index varies by an amount (plus or minus) 

exceeding 5% by comparing the base index to the index for that month, which is two months prior to the 

month being considered for adjustment. 

5. Beginning with order placement in the fourth month, index variances will be calculated in accordance with the 

following formula: 

 X – base index 

__________________________ x 100 = ____________ % 

 base index 

 where X = the index for that month which is two months prior to the month being considered for adjustment. 

6. The contract adjustment amount, if any, will be the percentage calculated in 5 above less 5%. 

7. Adjustments under this clause will be applied to the contractor’s bid price(s) for Item V., “PAPER” in the 

“SCHEDULE OF PRICES” and will be effective on the first day of any month for which prices are to be 

adjusted. 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 5 of 72 

494-S (06/22) 

The Contracting Officer will give written notice to the contractor of any adjustments to be applied to invoices for orders 

placed during months affected by this clause. 

In no event, however, will any price adjustment be made which would exceed the maximum permissible under any law 

in effect at the time of the adjustment. The adjustment, if any, shall not be based upon the actual change in cost to the 

contractor, but shall be computed as provided above. 

The contractor warrants that the paper prices set forth in this contract do not include any allowance for any contingency 

to cover anticipated increased costs of paper to the extent such increases are covered by this price adjustment clause. 

SECURITY REQUIREMENTS: Protection of Confidential Information: 

(a) The contractor shall restrict access to all confidential information obtained from the Social Security 

Administration in the performance of this contract to those employees and officials who need it to perform the 

contract. Employees and officials who need access to confidential information for performance of the contract 

will be determined at the postaward conference between the Contracting Officer and the responsible contractor 

representative. 

(b) The contractor shall process all confidential information obtained from SSA in the performance of this contract 

under the immediate supervision and control of authorized personnel, and in a manner that will protect the 

confidentiality of the records in such a way that unauthorized persons cannot retrieve any such records. 

(c) The contractor shall inform all personnel with access to the confidential information obtained from SSA in the 

performance of this contract of the confidential nature of the information and the safeguards required to protect 

this information from improper disclosure. 

(d) For knowingly disclosing information in violation of the Privacy Act, the contractor and the contractor 

employees may be subject to the criminal penalties as set forth in 5 U.S.C Section 552a (i)(1), which is made 

applicable to contractors by 5 U.S.C. 552a (m)(1) to the same extent as employees of the SSA. For knowingly 

disclosing confidential information as described in section 1106 of the Social Security Act (42 U.S.C. 1306), 

the contractor and contractor’s employees may also be subject to the criminal penalties as set forth in that 

provision. 

(e) The contractor shall assure that each contractor employee with access to confidential information knows the 

prescribed rules of conduct and that each contractor employee is aware that he/she may be subject to criminal 

penalties for violations of the Privacy Act and/or the Social Security Act. 

When the contractor employees are made aware of this information, they will be required to sign the SSA-301, 

“Contractor Personnel Security Certification.” (See Exhibit A.) 

A copy of this signed certification must be forwarded to: Social Security Administration, Attn: Melissa Picone, 

DMIM, 3-B-10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401, or email to: 

melissa.picone@ssa.gov. A copy must also be forwarded to: U.S. Government Publishing Office, 732 North 

Capitol Street, NW, CSAPS, APS DC, Attn: Contracting Officer, Room C-838, Washington, DC 20401 (email 

address to be provided after award). 

(f) All confidential information obtained from SSA for use in the performance of this contract shall at all times, be 

stored in an area that is physically safe from unauthorized access. 
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494-S (06/22) 

(g) Performance of this contract may involve access to tax return information as defined in 26 U.S.C. Section 

6103(b) of the Internal Revenue Code (IRC). All such information must be handled as confidential and may 

not be disclosed without the written permission of SSA. For willingly disclosing confidential tax return 

information in violation of the IRC, the contractor and contractor employees may be subject to the criminal 

penalties set forth in 26 U.S.C. Section 7213. 

(h) The Government reserves the right to conduct on-site visits to review the contractor’s documentation and 

in-house procedures for protection of confidential information. 

SSA EXTERNAL SERVICE PROVIDER SECURITY REQUIREMENTS: This resource identifies the basic 

information security requirements related to the procurement of Information Technology (IT) services hosted externally 

to SSA’s Network.

The following general security requirements apply to all External Service Providers (ESP): 

a. The solution must be located in the United States, its territories, or possessions. 

NOTE: “United States” means the 50 States, the District of Columbia, Puerto Rico, the Northern Mariana 

Islands, American Samoa, Guam, the U.S. Virgin Islands, Johnston Island, Wake Island, and Outer 

Continental Shelf Lands as defined in the Outer Continental Shelf Lands Act (43 U.S.C. 1331, et seq.), but 

does not include any other place subject to U.S. jurisdiction or any U.S. base or possession within a foreign 

country (29 CFR 4.112). 

b. Upon request from the SSA Contracting Officer Technical Representative (COTR), the ESP shall provide 

access to the hosting facility to the U.S. Government or authorized agents for inspection and facilitate an 

on-site security risk and vulnerability assessment. 

c. The solution must meet Federal Information Processing Standards (FIPS) and guidance developed by the 

National Institute of Science and Technology (NIST) under its authority provided by the Federal Information 

Security Modernization Act (FISMA) to develop security standards for federal information processing systems, 

and Office of Management and Budget’s (OMB) Circular A-130 Appendix III. 

d. ESPs classified as Cloud Service Providers (CSP) must be FedRAMP authorized. Further information may be 

found at: http://www.gsa.gov/portal/category/102371. As part of these requirements, CSPs must have a 

security control assessment performed by a Third Party Assessment Organization (3PAO). 

e. The ESP shall submit to the SSA COTR documentation describing how the solution implements security 

controls in accordance with the designated categorization (FIPS 199) and the Minimum Security Requirements 

for Federal Information and Information Systems (FIPS 200) which requires the use of NIST SP 800-53 Rev 4 

before SSA provides data. 

f. All ESPs that process or store Personally Identifiable Information (PII) are considered a Moderate impact 

categorization. If PII or sensitive data (defined by the COTR) is stored or processed by the ESP, then the ESP 

shall provide a Security Authorization Package (SAP) created by an independent assessor. The SAP should 

include a System Security Plan (SSP), Security Assessment Report (SAR), Risk Assessment Report (RAR), 

and Plan of Action & Milestone Report (POA&M). The SAP must be reviewed by SSA before the SSA 

transfers data to the ESP. Refer to NIST SP 800-37 for more information on the Security Authorization 

Package. 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 7 of 72 

494-S (06/22) 

NOTE: PII is any information about an individual maintained by an agency, including (1) any information 

that can be used to distinguish or trace an individual’s identity, such as name, social security number, date 

and place of birth, mother’s maiden name, or biometric records; and (2) any other information that is linked 

or linkable to an individual, such as medical, educational, financial, and employment information. 

NOTE: Independent assessor is any individual or group capable of conducting an impartial assessment of 

security controls employed within or inherited by an information system. 

g. SSA will consider a self-assessment of security controls for solutions that do not involve sensitive information 

or PII. 

For additional security requirements and NIST 800-53, REV 4 organization defined parameters, refer to “ESP 

Additional Security Requirements” document. 

References - Refer to most up to date revision: 

 Federal Information Security Modernization Act (P.L. 113-283), December 2014. 

https://www.govinfo.gov/app/details/PLAW-113publ283

 Clinger-Cohen Act of 1996 also known as the “Information Technology Management Reform Act of 1996.” 

 Privacy Act (P.L. 93-579), December 1974. 

https://www.govinfo.gov/app/details/STATUTE-88/STATUTE-88-Pg1896

 Homeland Security Presidential Directive (HSPD‐12), “Policy for a Common Identification Standard for 

Federal Employees and Contractors,” August 27, 2004. 

https://www.dhs.gov/homeland-security-presidential-directive-12

 Revision of OMB Circular No. A–130, “Managing Information as a Strategic Resource,” July 28, 2016. 

https://www.govinfo.gov/content/pkg/FR-2016-07-28/pdf/2016-17872.pdf

 OMB Memorandum M-04-04, “E-Authentication Guidance for Federal Agencies,” December 16, 2003. 

https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/omb/memoranda/fy04/m04-04.pdf 

and 

ITL BULLETIN FOR DECEMBER 2011 REVISED GUIDELINE FOR ELECTRONIC 

AUTHENTICATION OF USERS HELPS ORGANIZATIONS PROTECT THE SECURITY OF THEIR 

INFORMATION SYSTEMS. 

https://csrc.nist.gov/csrc/media/publications/shared/documents/itl-bulletin/itlbul2011-12.pdf 

 FIPS PUB 199, National Institute of Standards and Technology Federal Information Processing Standards 

Publication 199, Standards for Security Categorization of Federal Information and Information Systems, 

February 2004. 

https://doi.org/10.6028/NIST.FIPS.199

 FIPS PUB 200, National Institute of Standards and Technology Federal Information Processing Standards 

Publication 200, Minimum Security Requirements for Federal Information and Information Systems, March 

2006. 

https://doi.org/10.6028/NIST.FIPS.200
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 8 of 72 

494-S (06/22) 

 FIPS 140-3 Security Requirements for Cryptographic Modules, March 22, 2019. 

https://csrc.nist.gov/publications/detail/fips/140/3/final

 NIST Special Publication 800-18, Guide for Developing Security Plans for Federal Information Systems, 

February 2006. 

https://doi.org/10.6028/NIST.SP.800-18r1 

 NIST SP 800-30, Guide for Conducting Risk Assessments, September 2012. 

https://doi.org/10.6028/NIST.SP.800-30r1 

 ITL Bulletin Contingency Planning for Information Systems NIST Special Publication (SP) 800-34, Rev. 1. 

https://csrc.nist.gov/CSRC/media/Publications/Shared/documents/itl-bulletin/itlbul2010-07.pdf 

 NIST SP 800‐37 Revision 2, Risk Management Framework for Information Systems and Organizations - A 

System Life Cycle Approach for Security and Privacy, December 2018. 

https://csrc.nist.gov/publications/detail/sp/800-37/rev-2/final

 NIST SP 800-47, National Institute of Standards and Technology Special Publication 800-47, Security Guide 

for Interconnecting Information Technology Systems, August 2002. 

https://csrc.nist.gov/publications/detail/sp/800-47/final

 NIST SP 800-53 Revision 4, Security and Privacy Controls for Federal Information Systems and 

Organizations, April 2013. 

https://csrc.nist.gov/publications/detail/sp/800-53/rev-4/final

 NIST SP 800-53A Revision 4, Assessing Security and Privacy Controls in Federal Information Systems and 

Organizations: Building Effective Assessment Plans, December 2014. 

https://csrc.nist.gov/publications/detail/sp/800-53a/rev-4/final

 NIST SP 800-60 Volume 1 Revision 1, Guide for Mapping Types of Information and Information Systems to 

Security Categories, August 2008. 

https://csrc.nist.gov/publications/detail/sp/800-60/vol-1-rev-1/final

 and 

NIST SP 800-60 Volume 2 Revision 1, Guide for Mapping Types of Information and Information Systems to 

Security Categories: Appendices, August 2008. 

https://csrc.nist.gov/publications/detail/sp/800-60/vol-2-rev-1/final

 OMB M-07-16, Safeguarding Against and Responding to the Breach of Personally Identifiable Information, 

May 22, 2007. 

https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/memoranda/2007/m07-16.pdf

See Exhibit B, “SSA External Service Provider Additional Security Requirements” for complete details regarding this 

requirement. 

Templates for Required Security Documents: 

 Exhibit C: Security Assessment Report (SAR) Template 

 Exhibit D: Risk Assessment Report (RAR) Template 

 Exhibit E: System Security Plan (SSP) Template 
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PHYSICAL SECURITY: Contractor’s facilities storing SSA assets and information are required to meet the 

Interagency Security Committee’s standard for Federal facilities. This information can be found in the “Facility 

Security Plan: An Interagency Security Committee Guide,” dated February 2015, 1st Edition. SSA reserves the right 

to inspect contractor facilities to ensure compliance with the ISC guidelines. If facilities are found deficient, the 

contractor must implement corrective actions within 45 calendar days of notification. Requirements can include, but not 

be limited to, the physical security countermeasures, such as access control systems, closed circuit television systems, 

intrusion detection systems, and barriers. 

Contractor must pass all External Service Provider Security and Physical Security requirements as specified above 

before the Government can award this contract. Any bidder who cannot obtain approval for any of these security 

requirements within 60 calendar days of approval of production plans and physical security inspection will be declared 

non-responsible. 

SECURITY WARNING: It is the contractor’s responsibility to properly safeguard Personally Identifiable Information 

(PII) from loss, theft, or inadvertent disclosure and to immediately notify the Government of any loss 

of PII. PII is “any information which can be used to distinguish or trace an individual’s identity, such as their name, 

social security number, biometric records, etc., alone or when combined with other personal or other identifying 

information which is linked or linkable to a specific individual, such as date and place of birth, mother’s maiden name, 

etc.” 

All employees working on this contract must: 

 Be familiar with current information on security, privacy, and confidentiality as they relate to the requirements 

of this contract. 

 Obtain pre-screening authorization before using sensitive or critical applications pending a final suitability 

determination as applicable to the specifications. 

 Lock or logoff their workstation/terminal prior to leaving it unattended. 

 Act in an ethical, informed, and trustworthy manner. 

 Protect sensitive electronic records. 

 Be alert to threats and vulnerabilities to their systems. 

 Be prohibited from having any mobile devices or cameras in sensitive areas that contain any confidential 

materials, including areas where shredding and waste management occurs. 

Contractor’s managers working on this contract must:

 Monitor use of mainframes, PCs, LANs, and networked facilities to ensure compliance with national and local 

policies, as well as the Privacy Act statement. 

 Ensure that employee screening for sensitive positions within their department has occurred prior to any 

individual being authorized access to sensitive or critical applications. 

 Implement, maintain, and enforce the security standards and procedures as they appear in this contract and as 

outlined by the contractor. 

 Contact the security officer within 24 hours whenever a systems security violation is discovered or suspected. 

Applicability: The responsibility to protect PII applies during the entire term of this contract and all option year terms 

if exercised. All contractors must secure and retain written acknowledgement from their employees stating they 

understand these policy provisions and their duty to safeguard PII. These policy provisions include, but are not limited 

to, the following: 

 Employees are required to have locking file cabinets or desk drawers for storage of confidential material, if 

applicable. 

 Material is not to be taken from the contractor’s facility without express permission from the Government. 

 Employees must safeguard and protect all Government records from theft and damage while being transported 

to and from contractor’s facility. 
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The following list provides examples of situations where PII is not properly safeguarded:

 Leaving an unprotected computer containing Government information in a non-secure space (e.g., leaving the 

computer unattended in a public place, in an unlocked room, or in an unlocked vehicle). 

 Leaving an unattended file containing Government information in a non-secure area (e.g., leaving the file in a 

break-room or on an employee’s desk). 

 Storing electronic files containing Government information on a computer or access device (flash drive, CD, 

etc.) that other people have access to (not password-protected). 

This list does not encompass all failures to safeguard PII but is intended to act as an alert to the contractor’s employees 

to situations that must be avoided. Misfeasance occurs when an employee is authorized to access Government 

information that contains sensitive or personally identifiable information and, due to the employee’s failure to exercise 

due care, the information is lost, stolen, or inadvertently released. 

Whenever the contractor’s employee has doubts about a specific situation involving their responsibilities for 

safeguarding PII, they should consult GPO and/or SSA. 

SECURITY AND SUITABILITY REQUIREMENTS FOR GOVERNMENT PRINTING (NOV 2018): 

NOTE: For the purposes of this contract, the Contracting Officer’s Representative (COR) or Contracting Officer’s 

Technical Representative (COTR) is the SSA representative/Program Lead. The terms “vendor” and “contractor” are 

used interchangeably throughout this contract. Additionally, the terms “business days” and “workdays” are used 

interchangeably throughout this contract. 

(a) Suitability Process 

The background investigation and adjudication processes are compliant with 5 CFR 731 or equivalent. Any new 

vendor personnel (i.e., those who have not previously received a suitability determination under this contract) 

requiring access to an SSA facility, site, information, or system, must complete and submit, through the CORCOTR, the documents listed in (a)(1) at least 30 workdays prior to the date vendor personnel are to begin work. 

The suitability process cannot begin until the vendor submits, and SSA receives, accurate and complete documents. 

(1) Suitability Document Submission 

a. Immediately upon award, the Company Point of Contact (CPOC) must provide to the Center for Suitability 

and Personnel Security (CSPS) and a copy to the Contracting Officer’s Representative (COR) for all 

vendor personnel requesting a suitability determination using a secured/encrypted email* with a password 

sent separately to dchr.ope.suitability@ssa.gov: 

(i) An e-QIP applicant listing including the names of all vendor personnel requesting suitability; 

(ii) Completed Optional Form (OF) 306, Declaration for Federal Employment. (See Exhibit F); 

(iii) Work authorization for non-United States (U.S.) born applicants, if applicable. 

b. The e-QIP applicant listing must include the vendor name, the Social Security Administration (SSA) 

vendor number, the CPOC’s name, the CPOC’s contact information, the COR’s name, the COR’s contact 

information, and the full name, Social Security Number, date of birth, place of birth (must show city and 

state if born in the U.S. OR city and country if born outside of the U.S.), and a valid email address for all 

vendor personnel requesting suitability. All spelling of names, email addresses, places, and numbers must 

be accurate and legible. 
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(2) e-QIP Application 

a. Once SSA receives all completed documents, listed in (a)(1), the Center for Suitability and Personnel 

Security (CSPS) will initiate the e-QIP process using the e-QIP applicant listing. CSPS will email the eQIP notification to the CPOC and COR inviting vendor personnel to the e-QIP website to electronically 

complete the background investigation form (Standard Form (SF) 85P, Questionnaire for Public Trust 

Positions). (See Exhibit G.) 

b. Vendor personnel will have up to 10 business days to complete the e-QIP application. The 10-day 

timeframe begins the day CSPS sends the invitation to the CPOC and COR. Vendor personnel must 

electronically sign the signature pages before releasing the application in e-QIP. Signature pages include 

the Certification, Release, and Medical Release pages for the SF 85P. Find information about the e-QIP 

process in the e-QIP Quick Reference Guide for e-QIP Applicants at https://nbib.opm.gov/e-qipbackground-investigations/. 

c. If vendor personnel need assistance with e-QIP logon and navigation, they can call the e-QIP Hotline at 1-

844-874-9940. 

(3) Fingerprinting 

a. The e-QIP notification email also provides vendor personnel with instructions to obtain electronic 

fingerprinting services. Vendor personnel must report for fingerprint services immediately upon 

completion and release of the e-QIP application and within 10 business days from the day CSPS sends the 

invitation. 

b. If vendor personnel cannot report to the designated fingerprint locations (in the notification email), CSPS 

will accept completed Field Division (FD) 258 fingerprint cards. (See Exhibit H.) The COR can provide 

the FD 258, if required. Vendor personnel must complete all fields on the FD 258. Incomplete fields may 

delay suitability processing. 

c. If the vendor needs to mail completed FD 258 fingerprint cards, the vendor can send them, via certified 

mail, along with a completed Vendor Personnel Suitability Cover Sheet to: Social Security Administration 

Center for Suitability and Personnel Security, Attn: Suitability Program Officer, 6401 Security Boulevard, 

2246 Annex Building, Baltimore, MD 21235. 

(4) Status Check 

If vendor personnel have completed each of the steps in (e) in their entirety and do not receive a suitability 

determination within 15 business days of their last submission, call 1-844-874-9940 to determine suitability 

status. 

(b) Suitability Determination 

(1) CSPS uses a Federal Bureau of Investigation fingerprint check as part of the basis for making a suitability 

determination. 

This determination is final unless information obtained during the remainder of the full background 

investigation, conducted by the Office of Personnel Management, is such that SSA would find the vendor 

personnel unsuitable to continue performing under this contract. CSPS will notify the CPOC and the COR of 

the results of these determinations. 

(2) SSA will not allow vendor personnel access to a facility, site, information, or system until CSPS issues a 

favorable suitability determination. A suitability determination letter issued by CSPS is valid only for 

performance on the vendor specified in the letter. 
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(3) If personnel have been cleared at a previous contractor’s facility and are to perform work under a new vendor, 

the CPOC must submit a fully completed, legible Contractor Personnel Rollover Request Form to the COR. 

(See Exhibit I.) CSPS will notify the CPOC, COR, and Contracting Officer (CO) of suitability to work under 

the new vendor. 

(c) Vendor Personnel Previously Cleared by SSA or Another Federal Agency

If vendor personnel previously received a suitability determination from SSA or another Federal agency, the CPOC 

should include this information next to the vendor personnel’s name on the initial applicant listing (see paragraph 

(a)(1)(b)) along with the OF 306. CSPS will review the information. If CSPS determines another suitability 

determination is not required, it will provide a letter to the CPOC and the COR indicating the vendor personnel 

were previously cleared under another Federal contract and do not need to go through the suitability determination 

process again. 

(d) Unsuitable Determinations

(1) The vendor must notify the contractor personnel of any unsuitable determinations as soon as possible after 

receipt of such a determination. 

(2) The vendor must submit requests for clarification for unsuitable determinations in writing within 30 calendar 

days of the date of the unsuitable determination to the email mailbox or address listed below. Vendor personnel 

must file their own requests; vendor may not file requests on behalf of vendor personnel. 

dchr.ope.suitclarify@ssa.gov

OR 

Social Security Administration; Center for Suitability and Personnel Security, Attn: Suitability Program 

Officer, 6401 Security Boulevard, 2246 Annex Building, Baltimore, MD 21235 

(e) Vendor Notification to Government 

The vendor shall notify the COR and CSPS within one business day if any vendor personnel are arrested or charged 

with a crime, or if there is any other change in the status of vendor personnel (e.g., leaves the company, no longer 

works under the vendor, the alien status changes, etc.) that could affect their suitability determination. 

The vendor must provide in the notification as much detail as possible, including, but not limited to: name(s) of 

vendor personnel whose status has changed, SSA vendor number, the type of charge(s), if applicable, date of arrest, 

the court date, jurisdiction, and, if available, the disposition of the charge(s). 

Email Procedures 

For the contractor’s convenience, SSA has included the following instructions to send emails with sensitive 

documentation or messages containing personally identifiable information (e.g., SSNs, etc.) securely to an SSA email 

address. Contractor is to consult their local information technology staff for assistance. If the contractor utilizes an 

alternate secure method of transmission, it is recommended that the contractor contact the recipient to confirm receipt. 

To Encrypt a File using WinZip 

i. Save the file to contractor’s hard drive. 

ii. Open Windows Explorer and locate the file. 

iii. Right click on the file. 

iv. Select “WinZip.” 
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v. Select “Add to Zip File.” 

vi. An Add box pops up. Near the bottom of the box is an “Options” area. 

vii. Click the “Encrypt added files” checkbox. 

viii. Click the “Add” button. 

ix. Check the “Hide Password” checkbox if not already checked. 

a. Enter a string of characters as a password composed of letters, numbers, and special characters 

(minimum 8 characters – maximum 64 characters). 

b. Select the 256-Bit AES encryption radio button. 

c. Click “OK.” 

x.

xi. The file has been encrypted successfully, and the new Zip file can now be attached to an email. 

Providing the Recipient with the Password 

Send the password to the intended recipient in a separate email message prior to sending the encrypted file or after 

sending the encrypted file. Do not send the password in the same email message to which the encrypted file is attached. 

If possible, it is recommended to provide the password to the COR-COTR by telephone or establish a predetermined 

password between the contractor and the COR-COTR. 

The COR-COTR should also submit the password in a separate email from the documentation when submitting to 

^DCHR OPE Suitability. Due to the large volume of submissions, the COR-COTR must always provide the password 

to ^DCHR OPE Suitability in a separate email, even if it is a pre-established password for a contract. 

Sending an encrypted Zip File via email

1. Compose a new message. 

2. Attach the Zip File. 

3. Send message. 

PREAWARD SURVEY: In order to determine the responsibility of the prime contractor or any subcontractor, the 

Government reserves the right to conduct an on-site pre-award survey at the contractor’s/subcontractor’s facility or to 

require other evidence of technical, production, managerial, financial, and similar abilities to perform, prior to the 

award of a contract. 

As part of the financial determination, the contractor in line for award may be required to provide one or more of the 

following financial documents: 

1) Most recent profit and loss statement 

2) Most recent balance sheets 

3) Statement of cash flows 

4) Current official bank statement 

5) Current lines of credit (with amounts available) 

6) Letter of commitment from paper supplier(s) 

7) Letter of commitment from any subcontractor 

The documents will be reviewed to validate that adequate financial resources are available to perform the contract 

requirements. Documents submitted will be kept confidential and used only for the determination of responsibility by 

the Government. 
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Failure to provide the requested information in the time specified by the Government may result in the Contracting 

Officer not having adequate information to reach an affirmative determination of responsibility. 

Additionally, the preaward survey will include a review of all subcontractors involved, along with their specific 

functions, and the contractor’s/subcontractor’s backup facility, quality control/recovery program, computer system, 

mail, material, personnel, production, and security control plans as required by this specification. 

If award is predicated on the purchase of production and/or systems equipment, the contractor must provide purchase 

order(s) with delivery date(s) of equipment to arrive, be installed and fully functional at least 120 calendar days prior to 

the start of live production on January 1, 2022. 

If the Government, during the Preaward survey, concludes that the contractor does not or cannot meet all of the 

requirements as described in this contract, the contractor will be declared non-responsive. 

PREAWARD PRODUCTION PLANS: As part of the preaward survey, the contractor shall present, in writing, to 

the Contracting Officer within five (5) workdays of being notified to do so by the Contracting Officer or his/her 

representative, detailed plans for each of the below activities. If the Government requests additional information after 

review of the production plans, the contractor must submit updated plans within two (2) workdays of request. 

Five (5) additional workdays will be permitted to provide a Security Authorization Package (SAP) as required. The 

contractor, at SSA’s discretion, may be granted three (3) additional workdays if additional information is required for 

the Security Authorization Package. The workday after notification to submit will be the first day of the schedule. 

Option Years: For each option year that may be exercised, the contractor will be required to review their plans and 

re-submit in writing the above plans detailing any changes and/or revisions that may have occurred. The revised plans 

are subject to Government approval and must be submitted to the Contracting Officer or his/her representative within 

five (5) workdays of notification of the option year being exercised. 

NOTE: If there are no changes/revisions, the contractor will be required to submit to the Contracting Officer or his/her 

representative a statement confirming that the current plans are still in effect. 

These proposed plans are subject to review and approval by the Government, and award will not be 

made prior to approval of same. The Government reserves the right to waive some or all of these 

plans. 

Backup Facility – The failure to deliver these notices in a timely manner would have an impact on the daily operations 

of SSA. Therefore, if for any reason(s) (act of God, labor disagreements, national emergencies, pandemics, etc.), the 

contractor is unable to perform at said location for a period longer than 24 hours, the contractor must have a backup 

facility with the capability of producing the notices. The contractor must operate the backup facility.

Plans for their contingency production must be prepared and submitted to the Contracting Officer as part of the 

preaward survey. These plans must include the location of the facility to be used, equipment available at the facility, 

security plans at the facility, and a timetable for the start of production at that facility. 

Part of the plans must also include the transportation of Government materials from one facility to another. The 

contractor must produce items from a test file at the new facility for verification of software prior to producing notices 

at this facility. SSA has the option to install a data connection into the contractor’s backup facility. 

NOTE: All terms and conditions of this contract will apply to the backup facility. Due to the time-sensitive nature of 

the notices produced on this contract, the contractor must maintain the original schedule set forth in this contract. 
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Quality Control Plan – The contractor must provide and maintain, within their organization, an independent quality 

assurance team of sufficient size and expertise. The team must monitor the operations performed and inspect the 

products of each operation to a degree and extent that will ensure the Government’s quality assurance, inspection, and 

acceptance provisions specified herein are met. The contractor must perform, or have performed, the process controls, 

inspections, and tests required to substantiate that the products provided under this contract conform to the 

specifications and contract requirements. The contractor must describe in detail their quality control/quality assurance 

and recovery plans describing how, when, and by whom the plans will be performed.

The quality control plan must also include examples and a detailed description of all quality control samples and their 

corresponding inspection reports or logs the contractor will keep to document the quality control inspections performed 

on each run. Furthermore, the plan must include the names of all quality assurance officials and describe their duties in 

relationship to the quality control plan. 

The quality control system must include all aspects of the job including mail flow and materials handling. The plan 

must also allow for a complete audit trail (e.g., it must be possible to locate any piece of mail at any time from the point 

it leaves the press up to and including the point at which the mail is off-loaded at the USPS facility). SSA will not 

request, as a routine matter, the contractor to produce pieces in transit within the contractor’s plant. 

The quality control plan must account for the number of pieces mailed daily and must also cover the security over the 

postage meters as well as the controls for the setting of the meters (if meters will be used). 

Quality Control Sample Plan – The plan must provide a description of how the contractor will create quality control 

samples for periodic samplings to be taken during the production run and provide for backup and 

re-running in the event of an unsatisfactory sample. The plan must contain control systems that will detect defective, 

missing, or mutilated pieces. 

The plan should include the sampling interval the contractor intends to utilize. The contractor will be required to create 

two (2) quality control samples every 4,000 notices. Mailers with low volumes (less than 4,000) will require at least one 

(1) set of samples to be produced. The samples are to be drawn from the production stream at the same time: 

 One (1) sample will be drawn, inspected, and retained as part of the contractor’s quality assurance records. 

 One (1) sample will be drawn for the Social Security Administration and packed with associated pieces from 

each print order and shipped to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-B-10-F 

Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401. 

Samples must be bulk shipped to SSA weekly for each print order. The contractor must ship the quality control samples 

for each particular print order within two (2) workdays of the mail date of that print order. 

The plans must detail the actions to be taken by the contractor when defective, missing, or mutilated items are 

discovered. These actions must be consistent with the requirements found in GPO Contract Terms (GPO Publication 

310.2, effective December 1, 1987 (Rev. 01-18)). 

The plan must monitor all aspects of the job including material handling and mail flow, to assure the production and 

delivery of these notices meet specifications and Government requirements. This includes maintaining 

100% accountability in the accuracy of imaging and mailing of all pieces throughout each run. The contractor must 

ensure that there are no missing or duplicate pieces. 

NOTE: Contractor must submit samples of the Automated Audit Report and 100% Accountability Summary Report. 

(See “100% ACCOUNTABILITY OF PRODUCTION AND MAILING.”) 
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The contractor must maintain quality control samples, inspection reports, and records for a period of no less than 210 

calendar days subsequent to the date of the check tendered for final payment by the Government Publishing Office. The 

Government will periodically verify that the contractor is complying with the approved quality control plan through onsite examinations and/or requesting copies of the contractor’s quality assurance records and quality assurance random 

copies. 

Computer System Plan – This plan must include a detailed listing of the contractor’s operating software platform and 

file transfer system necessary to interface with SSA’s National File Transfer Management System (FTMS) for 

electronic transmission of files from SSA. The plan must also include the media type on which files from SSA will be 

received to the extent that operator intervention (e.g., a tape mount) is not required at SSA or the contractor’s 

production facility. 

The system plan must demonstrate the contractor’s ability to provide complete hardware and software compatibility 

with SSA’s existing network. (See “FILE TRANSFER MANAGEMENT SYSTEM (FTMS) REQUIREMENTS.”) 

The contractor must complete a System Plan (see Exhibit J). 

Included with the Computer System Plan must be a resume for each employee responsible for the monitoring and the 

programming of the contractor’s computer system and file transmissions. If the contractor plans to use a consultant for 

either task, a resume must still be included. 

Mail Plan – This plan should include sufficient detail as to how the contractor will comply with all applicable U.S. 

Postal Service (USPS) mailing requirements as listed in the USPS Domestic and International Mail Manuals in effect at 

the time of the mailing and other USPS instructional material such as the Postal Bulletin. The contractor must also 

disclose how they will achieve multi-level USPS automated presort postal discounts as outlined in the contract. 

Material Handling and Inventory Control Plan – This plan should explain in detail how the following materials will 

be handled: incoming raw materials; work-in-progress materials; quality control inspection materials; USPS inspection 

materials; and all outgoing materials cleared for USPS pick-up/delivery. 

Personnel Plan – In conjunction with the required applicant listing (See “SECURITY AND SUITABILITY 

REQUIREMENTS FOR GOVERNMENT PRINTING (NOV 2018)”), this plan should include a listing of all 

personnel who will be involved with this contract. For any new employees, the plan should include the source of these 

employees and a description of the training programs the employees will receive to familiarize them with the 

requirements of this program. 

Production Plan – The contractor is to provide a detailed plan of the following: 

(a) List of all production equipment and equipment capacities to be utilized on this contract; 

(b) The production capacity currently being utilized on this equipment; 

(c) Capacity that is available for these workloads; and, 

(d) If new equipment is to be utilized, documentation of the purchase order, source, delivery schedule and 

installation dates are required. 

(e) The last leaf of the Title II - Final Accounting notices (Mailers 19 through 24) contain a micro-perforated 

payment stub. The contractor will be required to identify the payment stub page (English or Spanish) requiring 

perforation. Regarding the “select-a-perf” requirement, the contractor’s production plan must explain how they 

will handle imaging and collating the required micro-perforated sheet into the proper sequence of leaves. The 

plan shall also detail how the contractor intends to meet the critical margins associated with the scan line. (See 

“IMAGING” and “BINDING.”) 
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The contractor must disclose in their production plan their intentions for the use of any subcontractor(s). The plan must 

include the same information required from the contractor for all items contained under “SECURITY 

REQUIREMENTS” and “PREAWARD SURVEY.” If a subcontractor for any operation is added at any time after 

award, the contractor must submit the subcontractors proposed plans which are subject to review and approval by the 

Government. 

The subcontractor must be approved by the Government prior to production starting in that facility. If the subcontractor 

is not approved by the Government, then the contractor has 30 calendar days prior to production to submit to the 

Government the new subcontractor’s information. 

Security Control Plan – The contractor must maintain in operation, an effective security system where items by these 

specifications are manufactured and/or stored (awaiting distribution or disposal) to assure against theft and/or the 

product ordered falling into unauthorized hands. 

Contractor is cautioned that no Government provided information shall be used for non-government business. 

Specifically, no Government information shall be used for the benefit of a third party. 

The Government retains the right to conduct on-site security reviews at any time during the term of the contract. 

The plan shall contain at a minimum: 

(1) How Government files (data) will be secured to prevent disclosure to a third party; 

(2) How the disposal of waste materials will be handled; 

(3) How all applicable Government-mandated security/privacy/rules and regulations as cited in this contract 

must be adhered to by the contractor and/or subcontractor(s); 

(4) How contractors classified as Cloud Service Providers (CSP) will adhere to additional FedRAMP security 

control requirements. CSPs must have a security control assessment performed by a Third Party Assessment 

Organization (3PAO). Additional information is also available at: 

http://www.gsa.gov/portal/category/102371; 

(5) The contractor shall submit a System Authorization Package as described in the “SSA External Service 

Provider Security Requirements” section. The SSP, a part of this package, documents how the solution 

implements security controls in accordance with the designated FIPS 199 security categorization and the 

Minimum Security Requirements for Federal Information and Information Systems. This SSP requires the use 

of NIST SP 800-53 v4. The SAP should be completed by either an independent assessor or another Federal 

agency. 

Materials – The contractor is required to explain how all accountable materials will be handled throughout all phases of 

production. 

Production Area – The contractor must provide a secure area(s) dedicated to the processing and storage of data for 

SSA notices, either a separate facility dedicated to this product or a walled-in limited access area within the contractor’s 

existing facility. Access to the area(s) must be limited to security-trained employees involved in the production of 

notices. 

Part of the Production Area Plan must include a floor plan detailing the area(s) to be used, showing existing walls, 

equipment to be used, and the printing and finishing locations. 

Contractor must have, in place, a building security system that is monitored 24 hours a day, seven (7) days a week, and 

a badging/keypunch system that limits access to Government materials (data processing center/production facility and 

other areas where Government materials with PII are stored or are accessible) that is only accessible by approved 

personnel. Contractor must present this information, in detail, in the production area plan. 
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Disposal of Waste Materials – The contractor is required to demonstrate how all waste materials used in the production 

of sensitive SSA records (records containing PII information as identified in “SECURITY WARNING”) will be 

definitively destroyed (e.g., burning, pulping, shredding, macerating, or other suitable similar means). Electronic 

records must be definitively destroyed in a manner that prevents reconstruction. Sensitive records are records that are 

national security classified or exempted from disclosure by statute, including the Privacy Act or regulation. Definitively 

destroying the records means the material cannot be reassembled and used in an inappropriate manner in violation of 

law and regulations.

The contractor, at a minimum, must crosscut shred all documents into squares not to exceed one-quarter inch. All 

documents to be destroyed cannot leave the security of the building, must be destroyed at contractor’s printing site, and 

cannot be subcontracted. The contractor must specify the method planned to dispose of the material. 

UNIQUE IDENTIFICATION NUMBER: Unique identifying numbers will be used to track each individual notice, 

thereby providing 100% accountability. This enables the contractor to track each notice through completion of the 

project. The contractor will be required to create a test sample every 4,000 notices. Each file must have a minimum of 

one (1) test sample. This sample must have a unique number and must be produced on each notice. The contractor will 

generate a list of the unique identifying numbers for each sample. As samples are pulled, the unique numbers will be 

marked off the list. This enables the contractor to track which samples have been produced and pulled and what records 

have been produced. 

The contractor may create their own sequence number and run date to facilitate their presorting and inserting process 

but must maintain the original SSA identification number. 

RECOVERY SYSTEM: A recovery system will be required to ensure that all defective, missing, or mutilated pieces 

detected are identified, reprinted, and replaced. The contractor’s recovery system must use the unique sequential 

alpha/numeric identifiers assigned to each piece (including quality control samples) to aid in the recovery and 

replacement of any defective, missing, or mutilated pieces, and must be capable of tracking and/or locating 

any individual piece of mail from the time it leaves the press, up to and including when it is off-loaded at the U.S. 

Postal Service (USPS) facility. An explanation of the contractor’s sequential numbering system is required to 

understand the audit trail required for each and every piece. 

100% ACCOUNTABILITY OF PRODUCTION AND MAILING: Contractor must have a closed loop process* 

to determine that the data from the original print file is in the correct envelope with the correct number of pages and 

inserts. Notices requiring print regeneration must be reprinted from their original print image with the original job ID 

and piece ID remaining unchanged as each mail piece continues through the inserting life cycle. This process will 

repeat itself (since subsequent reprint runs may yield damages) until all mail pieces from the original print run have 

been inserted and accounted for. 

*Closed Loop Processing - A method for generating a plurality of mail pieces including error detection and reprinting 

capabilities. The method provides a mail handling process, which tracks processing errors with the use of a first and 

second scan code, which obtain information regarding each mail piece, diverts mail pieces in response to error 

detection, transmits such errors to a processor, and automatically generates a reconfigured print file to initiate reprints 

for the diverted mail pieces. 

Contractor will be responsible for providing a unique identifying number that will be used to track each individual 

notice, thereby providing 100% accountability and validating the integrity of every notice produced in all phases 

of printing, inserting, and mailing and to ensure all notices received from SSA were correctly entered into the U.S. 

Postal System. 
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NOTE: Contractor must have all hardware, programming and finalized reports in place to meet this requirement. The 

equipment must arrive, be installed and fully functional at least 120 calendar days prior to the start of live production on 

January 1, 2022. Contractor must submit a sample of their proposed Audit and Summary Reports with the required 

Preaward Production Plans for approval. The Government considers grounds for the immediate default of this contract 

if the contractor, at any time, is unable to perform or found not complying with any part of this requirement. 

Notice integrity shall be defined as follows: 

 Each notice must include all pages (and only those pages) intended for the designated recipient as contained 

in the print files received from SSA. 

 The contractor’s printing process must have automated systems, which can detect all sync errors, stop printing 

when detected, and identify, remove, and reprint all affected notices. 

Mailing integrity shall be defined as follows: 

 All notices received from SSA for each file date were printed, inserted, and entered correctly into the U.S. 

Postal System. 

The contractor is responsible for providing the automated inserted notice tracking/reporting systems and processes 

required to validate that 100% of all notices received from SSA were printed, all pages for each notice with the correct 

inserts are accounted for, inserted, and mailed correctly. 

The contractor’s inserting equipment must have automated systems that include notice coding and scanning technology 

capable of: 

(a) Uniquely identifying each notice and corresponding notice leaves within each individual file by mailer number 

and file date. 

(b) Unique identifier to be scanned during insertion to ensure all notices and corresponding notice leaves are 

present and accounted for. 

(c) Entrance Scanning: A camera system must electronically track and scan all leaves of each mail piece as the 

inserting equipment pulls them into the machine to ensure each mail piece was produced and inserted. If there 

is any variance on a mail piece or if a mail piece is not verified that all leaves are present, that piece and the 

piece prior to and immediately following must be diverted and sent back for reprint. All instances of variance 

must be logged. 

(d) Touch and Toss: All spoilage, diverted, mutilated, or mail piece that is acted upon directly by a human hand 

prior to sealing must be immediately recorded, discarded, properly destroyed, and automatically regenerated in 

a new print file for reprint. Exception – Intentionally diverted pieces due to a requirement for a product, which 

cannot be intelligently inserted and requires manual insertion such as a publication, can be sealed, re-scanned, 

and placed back into production. These must be programmed diverts and sent to a separate bin for processing 

to ensure they are not mixed with other problem diverts and logged into the Audit system as such. 

(e) Exit Scanning: A camera system must be mounted just aft of the inserting equipment. This camera system 

must read a unique code through the window of each mail piece and capable of identifying and reporting all 

missing notices that were lost or spoiled during production for each individual file by mailer number and file 

date. This system ensures that no missing mail pieces have been inadvertently inserted into another mail piece. 

The equipment must check the mail pieces after insertion, verify that all leaves are accounted for, and divert 

any suspect product. During exit scanning, if a sequence number is missing, the notice prior to and 

immediately after must be diverted. The equipment must divert all products that exhibit missing or out of order 
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sequence numbers and any other processing errors. All diverted pieces are to be automatically recorded and 

regenerated in a new print file for reprint. 

(f) Reconciliation: All notices and the amount of correct finished product must be electronically accounted for 

after insertion through the use of the audit system that is independent of the inserting equipment as well as 

independent of the operator. The sequence numbers for each file must be reconciled, taking into account any 

spoilage, duplicate, and/or diverted product. If the reconciliation yields divergent results, corrective action must 

be taken to locate the mail pieces that are causing any difference between the input and outputs of the inserting 

process. Therefore, all finished mail for that sequence run must be held in an accessible area until this 

reconciliation is complete. 

(g) Generate a new production file for all missing, diverted, or mutilated notices (reprint file). 

(h) Contractor must generate an Automated Audit Report from the information gathered from scanning for each 

mailer number, file date, and each notice (manual inputs are not allowed). This audit report will contain 

detailed information for each notice as outlined above for each individual file by mailer number and file date. 

Contractor must maintain this information for 210 calendar days after mailing. 

(i) Audit report must contain the following information: 

1. Job name 

2. Mailer number, file date, and mail date(s) 

3. Machine ID 

4. Date of production with start and end time for each phase of the run (i.e., machine ID). 

5. Start and end sequence numbers in each run 

6. Status of all sequence numbers in a run 

7. Total volume in run 

8. Status report for all incidents for each sequence number and cause (i.e., inserted, diverted, and reason for 

divert such as missing sequence number, missing leave, mutilated, duplicate, pulled for inspection, etc.) 

9. Bottom of audit report must contain total number of records for that run, quantity sent to reprint, number of 

duplicates, duplicates verified and pulled, total completed. 

10. Audit report must contain the same information for all the reprints married with the report as listed above 

showing that all pieces for each mailer number and file date are accounted for with corresponding date 

stamp of completion of each.

(j) Contractor must generate a final automated 100% Accountability Summary Report for each individual file by 

mailer number and file date. This information must be generated directly from the audit report. Manual inputs 

are not allowed. The 100% Accountability Summary Report must contain the following: 

1. Job Information - Job name, file date, mailer number, piece quantity, sequence start, and end number, 

if multiple batches for a single file include number of batches and batch number (i.e., 1 of 4, due date, 

etc.). 

2. Job Start Time and Job End Time 

3. Volume of sequence numbers associated with an individual file by mailer number and file date that 

were inserted and date completed. 

4. Volume of reprints that were inserted for each file date and when completed. 

5. Total volume inserted for each file date and final date and time that each batch was completed. 

A PDF copy of the summary report(s) and matching USPS Certificate of Bulk Mailing, USPS 3607R, and/or GPO 712 

form(s) must be emailed to Melissa Picone at melissa.picone@ssa.gov within two (2) workdays of mailing. 
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Contractor must submit a sample of their Audit and Summary Reports (see Exhibit K) with the required Preaward 

Production Plans for Government review and approval. The audit team must approve the audit and summary reports 

prior to award. During the term of the contract, NO changes are to be made to the approved audit and summary reports 

without prior approval from the audit team. The contractor must submit in writing a request to make changes to the 

audit and summary reports, along with samples of the proposed audit and summary reports for review and approval. 

Contractor must generate an automated audit report when necessary showing the tracking of all notices throughout all 

phases of production for each mail piece. This audit report will contain all information as outlined in item (i) above. 

Contractor is required to provide any requested Summary and/or Audit reports within one (1) hour of a request via 

email in MS Word, MS Excel, or PDF file to Melissa Picone at melissa.picone@ssa.gov. 

NOTE: The Government reserves the right to conduct an audit at any time during the term of the contract. The audit 

team will provide the contractor a minimum of a 24-hour notice prior to audit. If the contractor produces multiple SSA 

contracts, the audit team will provide a list of contracts and print orders they will require full audit reports, summary 

reports, and postal documentation for during the audit. 

The contractor must provide the required audit reports within one (1) hour of request; the audit team will grant one (1) 

hour for each report to be pulled. The audit team may request a full tour and demonstration of the accountability 

process at the time of the audit. A wrap-up meeting will occur at the conclusion of the audit. The audit team will review 

their findings with the contractor at this time. The contractor will need to provide in writing responses to all findings, 

questions, and concerns within one (1) week of the wrap-up meeting. If corrections are required to the contractor’s audit 

reports, the Government may grant the contractor 60 calendar days to complete the changes. The audit team must 

approve the audit and summary report changes prior to the contractor implementing the changes. Once the new report is 

approved, the contractor must update the sample of the audit and summary provided with the production plans. The 

Government considers grounds for the immediate default of this contract if the contractor, at any time, is unable to 

perform or found not in compliance with any part of this requirement. 

All notice tracking/reporting data must be retained in electronic form for 210 calendar days after mailing, and must be 

made available to SSA for auditing of contractor performance upon request. 

NOTE: The Government will not as a routine matter request the contractor produce individual pieces in transit within 

the plant; however, the contractor must demonstrate they will have an audit trail established that has the ability to 

comply with this type of request when and if the need arises. 

REQUEST FOR NOTICE PULLS FROM PRODUCTION: Due to the sensitivity of some of the notices in this 

contract, the Government may request that certain notices be removed from the production stream. When this occurs, 

the Government will supply the contractor with a list of Social Security Numbers (SSNs) that need to be pulled. 

The contractor must be able to run a sort to find and eliminate the notice from the production run. If the list is provided 

after the notice had been produced, the contractor must be capable of identifying the notice and pulling it from the 

production floor. It is anticipated that this will be an infrequent occurrence. 

ON-SITE REPRESENTATIVES: One (1) or two (2) full-time Government representatives may be placed on the 

contractor’s premises on a limited basis or throughout the term of the contract. 

The contractor will be required to provide one private office of not less than 150 square feet, furnished with at least one 

desk, two swivel arm chairs, secure internet access for Government laptop computers, a work table, and two 4-drawer 

letter-size file cabinets with combination padlock and pendaflex file folders or equal. 

On-site representative(s) may be stationed at the contractor's facility to: provide project coordination in receipt of 

transmissions; verify addresses; monitor the printing, folding, inserting, mail processing, quality control, sample 

selections and inspections; and, monitor the packing and staging of the mail. 
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These representatives will not have contractual authority and cannot make changes in the specifications or in contract 

terms, but will bring defects detected to the attention of the company Quality Control Officer. The representatives must 

have full and unrestricted access to all production areas where work on this program is being performed. 

POSTAWARD CONFERENCE: Unless waived by the Contracting Officer, the total requirements of the job as 

indicated in these specifications will be reviewed by Government representatives with the contractor’s representatives at 

the Social Security Administration (SSA), 6401 Security Boulevard, Baltimore, MD, 21235 immediately after award. 

At the Government’s option, the postaward conference may be held via teleconference. Person(s) that the contractor 

deems necessary for the successful implementation of the contract must be in attendance. 

PREPRODUCTION MEETING: A preproduction meeting covering the printing, imaging, folding, inserting, and 

mailing must be held at the contractor’s facility after award of the contract to review the contractor’s production plan 

and to establish coordination of all operations. Attending this meeting will be representatives from the Government 

Publishing Office, Social Security Administration, and U.S. Postal Service (USPS). The contractor must present and 

explain their final plan for the printing, imaging, folding, inserting, and mailing of all notices. NOTE: The Government 

reserves the right to waive the preproduction meeting. 

The contractor must meet with SSA Division of Mail and Postage Policy (DMPP) and USPS representatives to present 

and discuss their plan for mailing. The preproduction meeting will include a visit to the contractor’s mailing facility 

where the contractor is to furnish specific mail flow information. 

The contractor must present documentation of the plant loading agreement and either a copy of the optional procedure, 

which has been negotiated with the USPS or a draft of the original procedure that the contractor intends to negotiate 

with the USPS for SSA approval. The contractor also needs to present SSA with a copy or a draft of the manifest 

(tracking system) to be used to accomplish the above. 

In addition, the contractor must be prepared to present detailed production plans, including such items as quality 

assurance, projected commencement dates, equipment loading, pallet needs, etc. The contractor is to provide the name 

of the representative responsible for the mailing operation and that individual’s backup. 

Person(s) that the contractor deems necessary for the successful implementation of the contract must be in attendance. 

ASSIGNMENT OF JACKETS, PURCHASE AND PRINT ORDERS: A GPO jacket number will be assigned and 

a purchase order issued to the contractor to cover the work performed. The purchase order will be supplemented by an 

individual print order for each job placed with the contractor. The print order, when issued, will indicate the quantity to 

be produced and any other information pertinent to the order. 

ORDERING: Items to be furnished under the contract must be ordered by the issuance of print orders by the 

Government. Orders may be issued under the contract from Date of Award through June 30, 2022, plus for such 

additional period(s) as the contract is extended. All print orders issued hereunder are subject to the terms and conditions 

of the contract. The contract shall control in the event of conflict with any print order. A print order shall be “issued” 

upon notification by the Government for purposes of the contract when it is electronically transmitted or otherwise 

physically furnished to the contractor in conformance with the schedule. 

REQUIREMENTS: This is a requirements contract for the items and for the period specified herein. 

Shipment/delivery of items or performance of work shall be made only as authorized by orders issued in accordance 

with the clause entitled “ORDERING.” The quantities of items specified herein are estimates only and are not 

purchased hereby. Except as may be otherwise provided in this contract, if the Government’s requirements for the items 

set forth herein do not result in orders in the amounts or quantities described as “estimated,” it shall not constitute the 

basis for an equitable price adjustment under this contract. 

Except as otherwise provided in this contract, the Government shall order from the contractor all the items set forth 

which are required to be purchased by the Government activity identified on page 1. 
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The Government shall not be required to purchase from the contractor, requirements in excess of the limit on total 

orders under this contract, if any. 

Orders issued during the effective period of this contract and not completed within that time shall be completed by the 

contractor within the time specified in the order, and the rights and obligations of the contractor and the Government 

respecting those orders must be governed by the terms of this contract to the same extent as if completed during the 

effective period of this contract. 

If shipment/delivery of any quantity of an item covered by the contract is required by reason of urgency prior to the 

earliest date that shipment/delivery may be specified under this contract, and if the contractor will not accept an order 

providing for the accelerated shipment/delivery, the Government may procure this requirement from another source. 

The Government may issue orders which provide for shipment/delivery to or performance at multiple destinations. 

Subject to any limitations elsewhere in this contract, the contractor shall furnish to the Government all items set forth 

herein which are called for by print orders issued in accordance with the “ORDERING” clause of this contract. 

PRIVACY ACT NOTIFICATION: This procurement action requires the contractor to do one or more of the 

following: design, develop, or operate a system of records on individuals to accomplish an agency function in 

accordance with the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable 

agency regulations. Violation of the Act may involve the imposition of criminal penalties as stated in 5 U.S.C. 552a 

(i)(1) CRIMINAL PENALTIES. It is incumbent upon the contractor to inform its officers and employees of the 

penalties for improper disclosure imposed by the Privacy Act of 1974, 5 U.S.C. 552a, specifically, 5 U.S.C. 552a (i)(1) 

CRIMINAL PENALTIES and m(1) GOVERNMENT CONTRACTORS. 

PRIVACY ACT 

(a) The contractor agrees: 

(1) to comply with the Privacy Act of 1974 and the rules and regulations issued pursuant to the Act in the 

design, development, or operation of any system of records on individuals in order to accomplish an 

agency function when the contract specifically identifies (i) the system or systems of records and (ii) the 

work to be performed by the contractor in terms of any one or combination of the following: (A) design, 

(B) development, or (C) operation; 

(2) to include the solicitation notification contained in this contract in every solicitation and resulting 

subcontract and in every subcontract awarded without a solicitation when the statement of work in the 

proposed subcontract requires the design, development, or operation of a system of records on individuals 

to accomplish an agency function; and 

(3) to include this clause, including this paragraph (3), in all subcontracts awarded pursuant to this contract 

which require the design, development, or operation of such a system of records. 

(b) In the event of violations of the Act, a civil action may be brought against the agency involved where the 

violation concerns the design, development, or operation of a system of records on individuals to accomplish 

an agency function, and criminal penalties may be imposed upon the officers or employees of the agency where 

the violation concerns the operation of a system of records on individuals to accomplish an agency function. 

For purposes of the Act when the contract is for the operation of a system of records on individuals to 

accomplish an agency function, the Contractor and any employee of the Contractor is considered to be an 

employee of the agency. 
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(c) The terms used in this clause have the following meanings: 

(1) “Operation of a system of records” means performance of any of the activities associated with maintaining 

the system of records including the collection, use, and dissemination of records. 

(2) “Record” means any item, collection or grouping of information about an individual that is maintained by 

an agency, including, but not limited to, his education, financial transactions, medical history, and criminal 

or employment history and that contains his name, or the identifying number, symbol, or other identifying 

particular assigned to the individual, such as a finger or voice print or a photograph. 

(3) “System of records” on individuals means a group of any records under the control of any agency from 

which information is retrieved by the name of the individual or by some identifying number, symbol, or 

other identifying particular assigned to the individual. 

ADDITIONAL EMAILED BID SUBMISSION PROVISIONS: The Government will not be responsible for any 

failure attributable to the transmission or receipt of the emailed bid including, but not limited to, the following: 

1. Illegibility of bid. 

2. Emails over 75 MB may not be received by GPO due to size limitations for receiving emails. 

3. The bidder’s email provider may have different size limitations for sending email; however, bidders are 

advised not to exceed GPO’s stated limit. 

4. When the email bid is received by GPO, it will remain unopened until the specified bid opening time. 

Government personnel will not validate receipt of the emailed bid prior to bid opening. GPO will use the 

prevailing time (specified as the local time zone) and the exact time that the email is received by GPO’s email 

server as the official time stamp for bid receipt at the specified location. 

PAYMENT: Submitting invoices for payment via the GPO fax gateway (if no samples are required) utilizing the GPO 

barcode coversheet program application is the most efficient method of receiving payment. Instruction for using this 

method can be found at the following web address: 

http://winapps.access.gpo.gov/fms/vouchers/barcode/ instructions.html. 

Invoices may also be mailed to: U.S. Government Publishing Office, Office of Financial Management, Attn: 

Comptroller, Stop: FMCE, Washington, DC 20401. 

For more information about the billing process, refer to the General Information of the Office of Finance web page 

located at: http://www.gpo.gov/finance/index.htm. 

Contractor’s billing invoice must be itemized in accordance with the items in the “SCHEDULE OF PRICES.”
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SECTION 2. – SPECIFICATIONS 

SCOPE: These specifications cover the production of mailing packages from six (6) identified workloads (total of 36 

mailers), consisting of English or Spanish personalized scannable forms; English or Spanish personalized notices with 

micro-perforated payment stub; English or Spanish instruction sheets; flyer (English only); Business Reply Mail (BRM) 

envelopes (English and Bilingual English/Spanish); Courtesy Reply Mail (CRM) envelopes (English and Bilingual 

English/Spanish); and, mail-out envelopes (English and Bilingual English/Spanish); requiring such operations as: the 

receipt and processing of transmitted data; composition; programming and setup; printing; imaging; binding; 

construction; inserting; packing; and distribution. 

TITLE: Representative Payee, Beneficiary Recontact, and Disability Update Reports. 

The six (6) identified workloads are as follows: 

Representative Payee Reports:

 1. Title II 

 2. Title XVI 

3. Title II – Final Accounting 

Beneficiary Recontact Reports:

4. Beneficiary Recontact 

Disability Update Reports:

 5. Title II 

 6. Title XVI 

NOTE: The Disability Update Reports also includes an Envelope Fulfillment Requirement. 

Future Workloads (during term of contract): During the term of this contract, the Government anticipates developing 

new notice workloads with the same requirements as the mailing packages described by these specifications. All terms 

and conditions in these specifications will apply to any future notice workloads. It is estimated that approximately one 

(1) to three (3) new notice workloads may be added during the term of this contract. File names/dataset names for the 

new mailers will be supplied to the contractor as they are developed. 

FREQUENCY OF ORDERS: Transmission of notices will be as follows: 

 Representative Payee Title II: Monthly print orders. 

 Representative Title XVI: Monthly print orders. 

 Representative Payee Title II – Final Accounting: Weekly print orders. 

 Beneficiary Recontact: Monthly print orders. 

 Disability Update Title II: Print orders will be issued in January, May, September. 

 Disability Update Title XVI: Print orders will be issued in January, July. 

NOTE: The January orders for Disability Update Title II and Disability Update Title XVI will be ordered on the same 

print order. 
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Below is an anticipated transmission schedule. Delays and changes to the schedule may occur. Contractor must be 

prepared to receive files 24/7/365. 

 Representative Payee Title II Notices will transmit between the 20th and 27th of each month. 

 Representative Payee Title XVI Notices will transmit on the first Saturday of each month (print order to be 

issued on the following Monday). 

 Representative Payee Title II – Final Accounting Notices will transmit on Sunday of each week (print order to 

be issued on the following Monday). 

 Beneficiary Recontact Notices will transmit between the 20th and 31st of each month. 

 Disability Update Title II Notices will transmit between the 21st and 31st of January, May, and September for 

February, June, and October mailings. 

 Disability Update Title XVI Notices will transmit between the 21st and 31st of January and July for February 

and August mailings. 

QUANTITY: The combined yearly total for all mailers (1 through 36) is approximately 5,181,500 notices per year 

broken down as follows: 

 Representative Payee Title II: Approximately 1,572,000 notices. 

 Representative Payee Title XVI: Approximately 1,572,000 notices. 

 Representative Payee Title II – Final Accounting: Approximately 39,000 notices. 

 Beneficiary Recontact: Approximately 102,000 notices. 

 Disability Update Title II Notices: Approximately 1,304,900 notices. 

 Disability Update Title XVI Notices: Approximately 591,600 notices. 

The quantities for Mailers 1 through 36 are approximate. The Government reserves the right to increase or decrease the 

quantity by up to 25% of the total number of notices ordered annually. This 25% includes the additional notices 

occasioned by the one (1) to three (3) new notice workloads that may be added during the term of this contract. 

The figures indicated below are estimates based on historical data of past production runs. Exact quantities will not be 

known until each run is electronically transmitted to the contractor. NO SHORTAGES WILL BE ALLOWED. 

Representative Payee Title II: 

Estimated 

 Mailer Form Number Language Request Quantity/Month 

Mailer 1 SSA-623-OCR-SM English First 58,600 

Mailer 2 SSA-623-OCR-SM English Second 18,400 

Mailer 3 SSA-623-OCR-SM-SP Spanish First 2,700 

Mailer 4 SSA-623-OCR-SM-SP Spanish Second 820 

Mailer 5 SSA-6230-OCR-SM English First 6,600 

Mailer 6 SSA-6230-OCR-SM English Second 2,000 

Mailer 7 SSA-6230-OCR-SM-SP Spanish First 65 

Mailer 8 SSA-6230-OCR-SM-SP Spanish Second 20 

Mailer 9 SSA-6234-OCR-SM English First 34,750 

Mailer 10 SSA-6234-OCR-SM English Second 6,900 

Mailer 11 SSA-6234-OCR-SM-SP Spanish First 100 

Mailer 12 SSA-6234-OCR-SM-SP Spanish Second 45 

Total Estimated Quantity/Month: 131,000 
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Representative Payee Title XVI:

Estimated 

 Mailer Form Number Language Request Quantity/Month 

Mailer 13 SSA-623-OCR-SM English First 64,500 

Mailer 14 SSA-623-OCR-SM English Second 24,500 

Mailer 15 SSA-6230-OCR-SM English First 4,000 

Mailer 16 SSA-6230-OCR-SM English Second 1,300 

Mailer 17 SSA-6234-OCR-SM English First 30,000 

Mailer 18 SSA-6234-OCR-SM English Second 6,700 

Total Estimated Quantity/Month: 131,000 

Representative Payee Title II – Final Accounting: 

Estimated 

 Mailer Form Number Language Request Quantity/Week 

Mailer 19 SSA-623-OCR-SM English First 350 

Mailer 20 SSA-623-OCR-SM-SP Spanish First 5 

Mailer 21 SSA-6230-OCR-SM English First 44 

Mailer 22 SSA-6230-OCR-SM-SP Spanish First 1 

Mailer 23 SSA-6234-OCR-SM English First 348 

Mailer 24 SSA-6234-OCR-SM-SP Spanish First 2 

Total Estimated Quantity/Week: 750 

Beneficiary Recontact: 

Estimated 

 Mailer Form Number Language Request Quantity/Month 

Mailer 25 SSA-1588-OCR-SM English Initial 6,500 

Mailer 26 SSA-1588-OCR-SM-SP Spanish Initial 200 

Mailer 27 SSA-1588-OCR-SM English Final 1,750 

Mailer 28 SSA-1588-OCR-SM-SP Spanish Final 50 

Total Estimated Quantity/Month: 8,500 

Disability Update: 

February Mailing – 

 Estimated 

 Mailer SFIC Form Number Language Workload Request Quantity 

Mailer 29 11111 SSA-455-OCR-SM English Title II First 250,000 

Mailer 30 22222 SSA-455-OCR-SM English Title II Second 94,000 

Mailer 31 33333 SSA-455-OCR-SM English Title II First 14,000 

Mailer 32 44444 SSA-455-OCR-SM English Title II Second 3,900 

Mailer 33 55555 SSA-455-OCR-SM English Title XVI First 151,500 

Mailer 34 66666 SSA-455-OCR-SM English Title XVI Second 76,500 

Mailer 35 77777 SSA-455-OCR-SM English Title XVI First 6,500 

Mailer 36 88888 SSA-455-OCR-SM English Title XVI Second 3,600 

Total Estimated Quantity/February: 600,000 
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June Mailing – 

 Estimated 

 Mailer SFIC Form Number Language Workload Request Quantity 

Mailer 29 11111 SSA-455-OCR-SM English Title II First 346,900 

Mailer 30 22222 SSA-455-OCR-SM English Title II Second 58,700 

Mailer 31 33333 SSA-455-OCR-SM English Title II First 16,000 

Mailer 32 44444 SSA-455-OCR-SM English Title II Second 3,400 

Total Estimated Quantity/June: 425,000 

August Mailing – 

 Estimated 

 Mailer SFIC Form Number Language Workload Request Quantity 

Mailer 33 55555 SSA-455-OCR-SM English Title XVI First 300,000 

Mailer 34 66666 SSA-455-OCR-SM English Title XVI Second 36,000 

Mailer 35 77777 SSA-455-OCR-SM English Title XVI First 16,000 

Mailer 36 88888 SSA-455-OCR-SM English Title XVI Second 1,500 

Total Estimated Quantity/August: 353,500 

October Mailing – 

 Estimated 

 Mailer SFIC Form Number Language Workload Request Quantity 

Mailer 29 11111 SSA-455-OCR-SM English Title II First 400,000 

Mailer 30 22222 SSA-455-OCR-SM English Title II Second 98,000 

Mailer 31 33333 SSA-455-OCR-SM English Title II First 15,500 

Mailer 32 44444 SSA-455-OCR-SM English Title II Second 4,500 

Total Estimated Quantity/October: 518,000 

ENVELOPE FULFILLMENT REQUIREMENT (WBDOC Bulk Envelope Shipment): Prior to the end of each 

contract year (around September), the Government will require a special fulfillment order for the envelopes shown 

below. 

A separate print order will be issued for the envelopes. 

The envelope quantities below are approximate. Exact quantities will not be known until the time of the order. 

Estimated 

Envelopes Quantity/Annual 

CRM Return Envelopes PO Box 4550 11,000 

CRM Return Envelopes PO Box 4550 (“not-LOW” with large 6-sided asterisk on front) 11,000 

CRM Return Envelopes PO Box 4556 11,000 

CRM Return Envelopes PO Box 4556 (“not-LOW” with large 6-sided asterisk on front) 11,000 

Mail-out envelopes (non-indicia) 120,000 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 29 of 72 

494-S (06/22) 

90-CALENDAR DAY VOLUMES: 

Representative Payee Reports: 

 90-Calendar 

Mail-out Envelopes Day Volume

Title II and Title II - Final Accounting Back: English/Spanish 402,750 

Title XVI Front: Address Service Requested 393,000 

Back: English Only 

90-Calendar 

Instruction Sheet (17 x 11” flat) Day Volume 

SSA-623-OCR-SM English 502,550 

SSA-623-OCR-SM-SP Spanish 10,625 

SSA-6230-OCR-SM English 42,272 

SSA-6230-OCR-SM-SP Spanish 268 

SSA-6234-OCR-SM English 239,574 

SSA-6234-OCR-SM-SP Spanish 461 

 90-Calendar 

Flyer Day Volume 

Title II and Title XVI English Only 774,750 

 90-Calendar 

BRM Envelope Day Volume

Title II: 

White PO Box 6230 Back: English/Spanish Items 7 and 8 203,895 

White PO Box 6230 Back: English/Spanish Items 6, 7, and 8 104,550 

Pink PO Box 6232 Back: English/Spanish Items 7 and 8 63,720 

Pink PO Box 6232 Back: English/Spanish Items 6, 7, and 8 20,835 

Title XVI:

White PO Box 6231 Back: English/Spanish Items 7 and 8 205,500 

White PO Box 6231 Back: English/Spanish Items 6, 7, and 8 90,000 

Pink PO Box 6237 Back: English/Spanish Items 7 and 8 77,400 

Pink PO Box 6237 Back: English/Spanish Items 6, 7, and 8 20,100 

Title II – Final Accounting: 

White PO Box 6230 Front: * Indicator Back: English/Spanish Items 7 and 8 5,200 

White PO Box 6230 Front: * Indicator Back: English/Spanish Items 6, 7 and 8 4,550 

Green PO Box 3430 Back: English/Spanish 9,750 

Beneficiary Recontact Reports:

 90-Calendar 

Mail-out Envelope Day Volume 

Beneficiary Recontact 25,500 

 90-Calendar 

Instruction Sheet (8-1/2 x 11”) Day Volume 

SSA-1588-SM English 24,750 

SSA-1588-SM-SP Spanish 750 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 30 of 72 

494-S (06/22) 

 90-Calendar 

CRM Envelope Day Volume

White PO Box 5888 20,100 

White PO Box 5888 Front: “2” Indicator 5,400 

Disability Update Reports: The Disability Update Reports are quarterly notices. All components of the Disability 

Update Reports are excluded from the 90-calendar day surplus/inventory. 

NUMBER OF PAGES AND TRIM SIZES:

No. of Pages Trim Size 

Scannable Forms 2 pages (1 leaf) 8-1/2 x 11” 

Personalized Notice with Payment Stub 4 pages (2 leaves) 8-1/2 x 11” 

Flyer 1 page 8-1/2 x 11” 

Instruction Sheets 2 pages (1 leaf) 8-1/2 x 11” 

4 pages 8-1/2 x 11” (folded down from 17 x 11”) 

White, Pink, and Green BRM Envelopes Face and back 4 x 8-7/8”, plus flap 

White CRM Envelopes Face and back 4 x 8-7/8”, plus flap 

Mail-out Envelopes Face and back 4-1/4 x 9-1/2” with window, plus flap 

NOTE: The trim sizes for the envelopes are after manufacturing. 

GOVERNMENT TO FURNISH: 

Representative Payee – Manuscript copy for two (2) mail-out envelopes, 11 BRM envelopes, 24 scannable forms, six 

(6) personalized notices with micro-perforated payment stub, six (6) four-page instruction sheets, and one (1) flyer. 

Beneficiary Recontact – Manuscript copy for one (1) mail-out envelope, two (2) CRM envelopes, four (4) scannable 

forms, and two (2) single-leaf instruction sheets. 

Disability Update – Manuscript copy for three (3) mail-out envelopes, four (4) CRM envelopes, eight (8) scannable 

forms, and one (1) four-page instruction sheet. 

Samples for positioning of asterisk on Not-Low Personalized Scannable Forms. 

Vendor Record Specifications via email. 

At the Government’s option, camera copy or electronic files (PostScript format) for the recycled paper logo and legend 

(English and Spanish) may be furnished. 

Camera copy for the Facing Identification Mark (FIM) and ZIP+4 Intelligent Mail Barcode (IMB) required for the 

BRM and CRM envelopes. 

Coding Accuracy Support System (CASS) Certificate. 

National Change of Address (NCOA) Certificate. 

PS Form 3615 (Mailing Permit Application and Customer Profile). 

Mailing Indicia (“Postage and Fees Paid”). 

SSA will provide an Official Government Postage Meter head only, but will not supply the meter mail machine. All 

meter equipment and supplies must be borne by the contractor. 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 31 of 72 

494-S (06/22) 

A data connection between the contractors specified location and the nearest available SSA network interface location 

or SSA’s National Computer Center in Baltimore, MD. 

EXHIBITS: 

Exhibit A: Contractor Personnel Security Certification (Form SSA-301) 

Exhibit B: SSA External Service Provider Additional Security Requirements 

Exhibit C: Security Assessment Report (SAR) Template 

Exhibit D: Risk Assessment Report (RAR) Template 

Exhibit E: System Security Plan (SSP) Template 

Exhibit F: Declaration for Federal Employment (Optional Form 306) 

Exhibit G: Questionnaire for Public Trust Positions (Standard Form (SF) 85P) 

Exhibit H: Fingerprint Card (FD-258) 

Exhibit I: Contractor Personnel Rollover Request Form 

Exhibit J: System Plan 

Exhibit K: Audit and Summary Reports 

Exhibit L: Minimum Volume Reduction Program (MVRP) Request Letter 

Exhibit M: Detailed Meter Usage Report 

Exhibit N: Postage Meter Activity Log 

Identification markings such as register marks, commercial identification marks of any kind, etc., except GPO imprint, 

form number, and revision date, carried in the furnished electronic files or furnished copy, must not print on the 

finished product. 

CONTRACTOR TO FURNISH: All materials and operations, other than those listed under “GOVERNMENT TO 

FURNISH,” necessary to produce the product(s) in accordance with these specifications. 

Secure File Transfer Protocol (SFTP) Site: Contractor is required to set up, establish, and maintain an SFTP site that 

multiple users at SSA can access for passing PDF notice validation samples and other information that contains PII to 

SSA and back. Contractor cannot send any notices or information that contain PII via email. Appropriate log-on 

instructions and protocol must be provided at time of award. 

Performance of Finished Product: The forms produced under these specifications require precision spacing, printing, 

trimming, and folding and must be guaranteed to function properly when processed through an Integrated Image Based 

Data Capture System (IIBDCS). The barcoding must be easily readable by all standard barcode scanning devices 

regardless of the contractor’s method of reproducing the codes. (SSA equipment: hand-held barcode reader and highspeed scanners for Mailers 1 through 36 and the OPEX AS 3690 Scanner for micro-perforated payment stub for 

Mailers 19 through 24). 

DATESET NAMES: The dataset names listed below may not be the final dataset names transmitted to the contractor. 

If there are changes, final dataset names will be provided to the contractor at the postaward conference. 

WORKLOAD MAILER DATASET NAME 

Representative Payee 

Title II 1 OLBG.NDA.vendor.RPAPROD.CSACCFIR.ryymmdd

2 OLBG.NDA.vendor.RPAPROD.CSACCSEC.ryymmdd 

3 OLBG.NDA.vendor.RPAPROD.CSACCSP1.ryymmdd 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 32 of 72 

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4 OLBG.NDA.vendor.RPAPROD.CSACCSP2.ryymmdd

5 OLBG.NDA.vendor.RPAPROD.CSMLTFIR.ryymmdd 

6 OLBG.NDA.vendor.RPAPROD.CSMLTSEC.ryymmdd 

7 OLBG.NDA.vendor.RPAPROD.CSMLTSP1.ryymmdd

8 OLBG.NDA.vendor.RPAPROD.CSMLTSP2.ryymmdd 

9 OLBG.NDA.vendor.RPAPROD.CSORGFIR.ryymmdd 

10 OLBG.NDA.vendor.RPAPROD.CSORGSEC.ryymmdd

11 OLBG.NDA.vendor.RPAPROD.CSORGSP1.ryymmdd

12 OLBG.NDA.vendor.RPAPROD.CSORGSP2.ryymmdd 

Representative Payee 

Title XVI 13 OLBG.BTI.vendor.Z01RPALT.ryymmdd 

14 OLBG.BTI.vendor.Z02RPALT.ryymmdd 

15 OLBG.BTI.vendor.Z01R6230.ryymmdd 

16 OLBG.BTI.vendor.Z02R6230.ryymmdd 

17 OLBG.BTI.vendor.Z01R6234.ryymmdd 

18 OLBG.BTI.vendor.Z02R6234.ryymmdd 

Representative Payee 

Title II – Final Accounting 19 OLBG.NDA.vendor.RPAPROD.CSFACFIR.ryymmdd 

20 OLBG.NDA.vendor.RPAPROD.CSFACSP1.ryymmdd 

21 OLBG.NDA.vendor.RPAPROD.CSFAMFIR.ryymmdd 

22 OLBG.NDA.vendor.RPAPROD.CSFAMSP1.ryymmdd 

23 OLBG.NDA.vendor.RPAPROD.CSFAOFIR.ryymmdd

24 OLBG.NDA.vendor.RPAPROD.CSFAOSP1.ryymmdd 

Beneficiary Recontact 25 OLBG.BTI.vendor.SARCONIE.ryymmdd

26 OLBG.BTI.vendor.SARCONIS.ryymmdd

27 OLBG.BTI.vendor.SARCONFE.ryymmdd

28 OLBG.BTI.vendor.SARCONFS.ryymmdd 

Disability Update 

Title II* 29 OLBG.BTI.vendor.MAILER1.T02FRE.ryymmdd 

30 OLBG.BTI.vendor.MAILER2.T02SRE.ryymmdd 

31 OLBG.BTI.vendor.MAILER1.T02FRS.ryymmdd 

32 OLBG.BTI.vendor.MAILER2.T02SRS.ryymmdd 

Disability Update 

Title XVI* 33 OLBG.BTI.vendor.MAILER1.T16FRE.ryymmdd 

34 OLBG.BTI.vendor.MAILER2.T16SRE.ryymmdd 

35 OLBG.BTI.vendor.MAILER1.T16FRS.ryymmdd 

36 OLBG.BTI.vendor.MAILER2.T16SRS.ryymmdd 

CERTIFIED MAIL: Contractor will be required to process Special Notice Option (SNO) mail pieces using USPS 

certified mail. 

Dataset names for SSA-623, SSA-6230, SSA-1588, and SSA-455 Certified Mail files are as follows. NOTE: There 

are no Certified Mail Files for SSA-6234. See “DISTRIBUTION.” 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 33 of 72 

494-S (06/22) 

WORKLOAD MAILER DATASET NAME (Certified Mail) 

Representative Payee 

Title II 1 OLBG.NDA.vendor.RPAPROD.CSACCE1C.ryymmdd

2 OLBG.NDA.vendor.RPAPROD.CSACCE2C.ryymmdd

3 OLBG.NDA.vendor.RPAPROD.CSACCS1C.ryymmdd 

4 OLBG.NDA.vendor.RPAPROD.CSACCS2C.ryymmdd 

5 OLBG.NDA.vendor.RPAPROD.CSMLTE1C.ryymmdd

6 OLBG.NDA.vendor.RPAPROD.CSMLTE2C.ryymmdd 

7 OLBG.NDA.vendor.RPAPROD.CSMLTS1C.ryymmdd

8 OLBG.NDA.vendor.RPAPROD.CSMLTS2C.ryymmd 

Representative Payee 

Title XVI 13 OLBG.BTI.vendor.Z01RPALC.ryymmdd

14 OLBG.BTI.vendor.Z02RPALC.ryymmdd

15 OLBG.BTI.vendor.Z016230C.ryymmdd

16 OLBG.BTI.vendor.Z026230C.ryymmdd

Representative Payee 

Title II – Final Accounting 19 OLBG.NDA.vendor.RPAPROD.CSFACE1C.ryymmdd

20 OLBG.NDA.vendor.RPAPROD.CSFACS1C.ryymmdd

21 OLBG.NDA.vendor.RPAPROD.CSFAME1C.ryymmdd 

22 OLBG.NDA.vendor.RPAPROD.CSFAMS1C.ryymmdd

Beneficiary Recontact 25 OLBG.BTI.vendor.NCRTPRD.SARCONIE.ryymmdd

26 OLBG.BTI.vendor.NCRTPRD.SARCONIS.ryymmdd

27 OLBG.BTI.vendor.NCRTPRD.SARCONFE.ryymmdd 

28 OLBG.BTI.vendor.NCRTPRD.SARCONFS.ryymmdd 

Disability Update 

Title II* 29 OLBG.BTI.vendor.CERTPRD.T02MLR1E.ryymmdd 

30 OLBG.BTI.vendor.CERTPRD.T02MLR2E.ryymmdd 

31 OLBG.BTI.vendor.CERTPRD.T02MLR1S.ryymmdd

32 OLBG.BTI.vendor.CERTPRD.T02MLR2S.ryymmdd 

Disability Update 

Title XVI* 33 OLBG.BTI.vendor.CERTPRD.T16MLR1E.ryymmdd 

34 OLBG.BTI.vendor.CERTPRD.T16MLR2E..ryymmdd 

35 OLBG.BTI.vendor.CERTPRD.T16MLR1S.ryymmdd 

36 OLBG.BTI.vendor.CERTPRD.T16MLR2S.ryymmdd 

*The SSA provided data files for the Disability Update Reports (Mailers 29 through 36) are divided into separate 

English and Spanish files. However, ALL Disability Update Report mailers including the scannable forms, instruction 

sheets, and mail-out envelopes will print in English ONLY. The only exception for these mailers is the bilingual CRM 

return envelopes, which will print with both English and Spanish language on the back of the envelopes. 

NOTE: The Disability Update live production files correspond to the following Scanning Form Identification Codes 

(SFIC) (see locations 1 through 5 of the Vendor Record Specifications) and use either PO Box 4550, Wilkes-Barre, PA 

18767-4550 (Title II) or PO Box 4556, Wilkes-Barre, PA 18767-4556 (Title XVI) as follows: 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 34 of 72 

494-S (06/22) 

Title II SFIC PO Box

OLBG.BTI.vendor.MAILER1.T02FRE.ryymmdd 11111 4550 

OLBG.BTI.vendor.MAILER2.T02SRE.ryymmdd 22222 4550 

OLBG.BTI.vendor.MAILER1.T02FRS.ryymmdd 33333 4550 

OLBG.BTI.vendor.MAILER2.T02SRS.ryymmdd 44444 4550 

Title XVI SFIC PO Box 

OLBG.BTI.vendor.MAILER1.T16FRE.ryymmdd 55555 4556 

OLBG.BTI.vendor.MAILER2.T16SRE.ryymmdd 66666 4556 

OLBG.BTI.vendor.MAILER1.T16FRS.ryymmdd 77777 4556 

OLBG.BTI.vendor.MAILER2.T16SRS.ryymmdd 88888 4556 

In the production file, the RYYMMDD represents the weekly or monthly run date. For example, if the run date for 

October 01, 2020 notices is 10/01/20, the RYYMMDD in the file name will be “R201001.” 

MAKE-UP OF MAILERS: A record containing variable data will be transmitted for each mailing address. Each 

record will contain all variable data relevant to that address. Any alteration of the notice content in the file is not 

permitted. 

Representative Payee Title II: The Representative Payee Title II mailers are divided into 12 categories by dataset 

name: 

Mailer 1 Personalized English Scannable Form (SSA-623-OCR-SM) – First Request 

 Flyer 

 English Instruction Sheet (SSA-623-OCR-SM) 

 White BRM Envelope (PO Box 6230) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 2 Personalized English Scannable Form (SSA-623-OCR-SM) – Second Request 

 Flyer 

 English Instruction Sheet (SSA-623-OCR-SM) 

 Pink BRM Envelope (PO Box 6232) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 3 Personalized Spanish Scannable Form (SSA-623-OCR-SM-SP) – First Request 

 Spanish Instruction Sheet (SSA-623-OCR-SM-SP) 

 White BRM Envelope (PO Box 6230) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 4 Personalized Spanish Scannable Form (SSA-623-OCR-SM-SP) – Second Request 

 Spanish Instruction Sheet (SSA-623-OCR-SM-SP) 

 Pink BRM Envelope (PO Box 6232) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 5 Personalized English Scannable Form (SSA-6230-OCR-SM) – First Request 

 Flyer 

 English Instruction Sheet (SSA-6230-OCR-SM) 

 White BRM Envelope (PO Box 6230) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Back: English/Spanish) 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 35 of 72 

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Mailer 6 Personalized English Scannable Form (SSA-6230-OCR-SM) – Second Request 

Flyer 

 English Instruction Sheet (SSA-6230-OCR-SM) 

 Pink BRM Envelope (PO Box 6232) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 7 Personalized Spanish Scannable Form (SSA-6230-OCR-SM-SP) – First Request 

 Spanish Instruction Sheet (SSA-6230-OCR-SM-SP) 

 White BRM Envelope (PO Box 6230) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 8 Personalized Spanish Scannable Form (SSA-6230-OCR-SM-SP) – Second Request 

 Spanish Instruction Sheet (SSA-6230-OCR-SM-SP) 

 Pink BRM Envelope (PO Box 6232) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 9 Personalized English Scannable Form (SSA-6234-OCR-SM) – First Request 

 Flyer 

 English Instruction Sheet (SSA-6234-OCR-SM) 

 White BRM Envelope (PO Box 6230) (Back: English/Spanish Items 6, 7, and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 10 Personalized English Scannable Form (SSA-6234-OCR-SM) – Second Request 

Flyer 

 English Instruction Sheet (SSA-6234-OCR-SM) 

 Pink BRM Envelope (PO Box 6232) (Back: English/Spanish Items 6, 7, and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 11 Personalized Spanish Scannable Form (SSA-6234-OCR-SM-SP) – First Request 

 Spanish Instruction Sheet (SSA-6234-OCR-SM-SP) 

 White BRM Envelope (PO Box 6230) (Back: English/Spanish Items 6, 7, and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 12 Personalized Spanish Scannable Form (SSA-6234-OCR-SM-SP) – Second Request 

 Spanish Instruction Sheet (SSA-6234-OCR-SM-SP) 

 Pink BRM Envelope (PO Box 6232) (Back: English/Spanish Items 6, 7, and 8) 

 Mail-out Envelope (Back: English/Spanish) 

Representative Payee Title XVI: The Representative Payee Title XVI mailers are divided into six (6) categories 

by dataset name: 

Mailer 13 Personalized English Scannable Form (SSA-623-OCR-SM) – First Request 

 Flyer 

 English Instruction Sheet (SSA-623-OCR-SM) 

 White BRM Envelope (PO Box 6231) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Front: Address Service Requested) (Back: English Only) 

Mailer 14 Personalized English Scannable Form (SSA-623-OCR-SM) – Second Request 

 Flyer 

 English Instruction Sheet (SSA-623-OCR-SM) 

 Pink BRM Envelope (PO Box 6237) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Front: Address Service Requested) (Back: English Only) 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 36 of 72 

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Mailer 15 Personalized English Scannable Form (SSA-6230-OCR-SM) – First Request 

 Flyer 

 English Instruction Sheet (SSA-6230-OCR-SM) 

 White BRM Envelope (PO Box 6231) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Front: Address Service Requested) (Back: English Only) 

Mailer 16 Personalized English Scannable Form (SSA-6230-OCR-SM) – Second Request 

 Flyer 

 English Instruction Sheet (SSA-6230-OCR-SM) 

 Pink BRM Envelope (PO Box 6237) (Back: English/Spanish Items 7 and 8) 

 Mail-out Envelope (Front: Address Service Requested) (Back: English Only) 

Mailer 17 Personalized English Scannable Form (SSA-6234-OCR-SM) – First Request 

 Flyer 

 English Instruction Sheet (SSA-6234-OCR-SM) 

 White BRM Envelope (PO Box 6231) (Back: English/Spanish Items 6, 7, and 8) 

 Mail-out Envelope (Front: Address Service Requested) (Back: English Only) 

Mailer 18 Personalized English Scannable Form (SSA-6234-OCR-SM) – Second Request 

 Flyer 

 English Instruction Sheet (SSA-6234-OCR-SM) 

 Pink BRM Envelope (PO Box 6237) (Back: English/Spanish Items 6, 7, and 8) 

 Mail-out Envelope (Front: Address Service Requested) (Back: English Only) 

Representative Payee Title II – Final Accounting: The Representative Payee Title II – Final Accounting mailers are 

divided into six (6) categories by dataset name: 

Mailer 19 Personalized English Scannable Form (SSA-623-OCR-SM) – First Request 

 Personalized English Notice with Micro-Perforated Payment Stub 

 English Instruction Sheet (SSA-623-OCR-SM) 

 White BRM Envelope (PO Box 6230) (Front: * Indicator; Back: English/Spanish Items 7 and 8) 

 Green BRM Envelope (PO Box 3430) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 20 Personalized Spanish Scannable Form (SSA-623-OCR-SM-SP) – First Request 

 Personalized Spanish Notice with Micro-Perforated Payment Stub 

 Spanish Instruction Sheet (SSA-623-OCR-SM-SP) 

 White BRM Envelope (PO Box 6230) (Front: * Indicator; Back: English/Spanish Items 7 and 8) 

 Green BRM Envelope (PO Box 3430) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 21 Personalized English Scannable Form (SSA-6230-OCR-SM) – First Request 

 Personalized English Notice with Micro-Perforated Payment Stub 

 English Instruction Sheet (SSA-6230-OCR-SM) 

 White BRM Envelope (PO Box 6230) (Front: * Indicator; Back: English/Spanish Items 7 and 8) 

 Green BRM Envelope (PO Box 3430) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 22 Personalized Spanish Scannable Form (SSA-6230-OCR-SM-SP) – First Request 

 Personalized Spanish Notice with Micro-Perforated Payment Stub 

 Spanish Instruction Sheet (SSA-6230-OCR-SM-SP) 

 White BRM Envelope (PO Box 6230) (Front: * Indicator; Back: English/Spanish Items 7 and 8) 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 37 of 72 

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 Green BRM Envelope (PO Box 3430) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 23 Personalized English Scannable Form (SSA-6234-OCR-SM) – First Request 

 Personalized English Notice with Micro-Perforated Payment Stub 

 English Instruction Sheet (SSA-6234-OCR-SM) 

 White BRM Envelope (PO Box 6230) (Front: * Indicator; Back: English/Spanish Items 6, 7, and 8) 

 Green BRM Envelope (PO Box 3430) 

 Mail-out Envelope (Back: English/Spanish) 

Mailer 24 Personalized Spanish Scannable Form (SSA-6234-OCR-SM-SP) – First Request 

 Personalized Spanish Notice with Micro-Perforated Payment Stub 

 Spanish Instruction Sheet (SSA-6234-OCR-SM-SP) 

 White BRM Envelope (PO Box 6230) (Front: * Indicator; Back: English/Spanish Items 6, 7, and 8) 

 Green BRM Envelope (PO Box 3430) 

 Mail-out Envelope (Back: English/Spanish) 

Beneficiary Recontact: The Beneficiary Recontact mailers are divided into four (4) categories by dataset name: 

Mailer 25 Personalized English Scannable Form (SSA-1588-SM) – Initial Request 

 English Instruction Sheet (SSA-1588-SM) 

 White CRM Envelope (PO Box 5888) 

 Mail-out Envelope 

Mailer 26 Personalized Spanish Scannable Form (SSA-1588-SM-SP) – Initial Request 

 Spanish Instruction Sheet (SSA-1588-SM-SP) 

 White CRM Envelope (PO Box 5888) 

 Mail-out Envelope 

Mailer 27 Personalized English Scannable Form (SSA-1588-SM) – Final Request 

 English Instruction Sheet (SSA-1588-SM) 

 White CRM Envelope (PO Box 5888) (Front: “2” Indicator) 

 Mail-out Envelope 

Mailer 28 Personalized Spanish Scannable Form (SSA-1588-SM-SP) – Final Request 

 Spanish Instruction Sheet (SSA-1588-SM-SP) 

 White CRM Envelope (PO Box 5888) (Front: “2” Indicator) 

 Mail-out Envelope 

Disability Update: It is expected that all Disability Update files will contain records for “not-LOW” mailers. See 

“NOT-LOW PERSONALIZED SCANNABLE FORMS” for further requirements. 

Disability Update Title II: The Disability Update Title II mailers are divided into four (4) categories by dataset name: 

Mailer 29 SFIC 11111, PO Box 4550 

 Personalized English Scannable Form (SSA-455-OCR-SM) – First Request 

 English Instruction Sheet (SSA-455-OCR-SM) 

 White CRM Envelope (PO Box 4550) 

 Mail-out Envelope 

 “not-LOW” (6-Sided Asterisk) 

 Personalized English Scannable Form (SSA-455-OCR-SM) – First Request (Front: * Indicator) 

 White CRM Envelope (PO Box 4550) (Front: * Indicator) 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 38 of 72 

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Mailer 30 SFIC 22222, PO Box 4550 

Personalized English Scannable Form (SSA-455-OCR-SM) – Second Request 

 English Instruction Sheet (SSA-455-OCR-SM) 

 White CRM Envelope (CRM) (PO Box 4550) 

 Mail-out Envelope 

“not-LOW” (6-Sided Asterisk) 

Personalized English Scannable Form (SSA-455-OCR-SM) – Second Request (Front: * Indicator) 

 White CRM Envelope (CRM) (PO Box 4550) (Front: * Indicator) 

Mailer 31 SFIC 33333, PO Box 4550 

 Personalized English Scannable Form (SSA-455-OCR-SM) – First Request 

 English Instruction Sheet (SSA-455-OCR-SM) 

 White CRM Envelope (PO Box 4550) 

 Mail-out Envelope 

“not-LOW” (6-Sided Asterisk) 

Personalized English Scannable Form (SSA-455-OCR-SM) – First Request (Front: * Indicator) 

 White CRM Envelope (PO Box 4550) (Front: * Indicator) 

Mailer 32 SFIC 44444, PO Box 4550 

 Personalized English Scannable Form (SSA-455-OCR-SM) – Second Request 

 English Instruction Sheet (SSA-455-OCR-SM) 

 White CRM Envelope (PO Box 4550) 

 Mail-out Envelope 

“not-LOW” (6-Sided Asterisk) 

Personalized English Scannable Form (SSA-455-OCR-SM) – Second Request (Front: * Indicator) 

 White CRM Envelope (PO Box 4550) (Front: * Indicator) 

Disability Update Title XVI: The Disability Update Title XVI mailers are divided into four (4) categories by dataset 

name: 

Mailer 33 SFIC 55555, PO Box 4556 

 Personalized English Scannable Form (SSA-455-OCR-SM) – First Request 

 English Instruction Sheet (SSA-455-OCR-SM) 

 White CRM Envelope (PO Box 4556) 

 Mail-out Envelope (Front: Address Service Requested) 

“not-LOW” (6-Sided Asterisk) 

Personalized English Scannable Form (SSA-455-OCR-SM) – First Request (Front: * Indicator) 

 White CRM Envelope (PO Box 4556) (Front: * Indicator) 

Mailer 34 SFIC 66666, PO Box 4556 

 Personalized English Scannable Form (SSA-455-OCR-SM) – Second Request 

 English Instruction Sheet (SSA-455-OCR-SM) 

 White CRM Envelope (PO Box 4556) 

 Mail-out Envelope (Front: Address Service Requested) 

“not-LOW” (6-Sided Asterisk) 

Personalized English Scannable Form (SSA-455-OCR-SM) – Second Request (Front: * Indicator) 

 White CRM Envelope (PO Box 4556) (Front: * Indicator) 

 Personalized English Scannable Form (SSA-455-OCR-SM) – First Request 
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 English Instruction Sheet (SSA-455-OCR-SM) 

 White CRM Envelope (PO Box 4556) 

 Mail-out Envelope (Front: Address Service Requested) 

“not-LOW” (6-Sided Asterisk) 

Personalized English Scannable Form (SSA-455-OCR-SM) – First Request (Front: * Indicator) 

 White CRM Envelope (PO Box 4556) (Front: * Indicator) 

Mailer 36 SFIC 88888, PO Box 4556 

 Personalized English Scannable Form (SSA-455-OCR-SM) – Second Request 

 English Instruction Sheet (SSA-455-OCR-SM) 

 White CRM Envelope (PO Box 4556) 

 Mail-out Envelope (Front: Address Service Requested) 

 

“not-LOW” (6-Sided Asterisk) 

Personalized English Scannable Form (SSA-455-OCR-SM) – Second Request (Front: * Indicator) 

 White CRM Envelope (PO Box 4556) (Front: * Indicator) 

TRANSMISSION: Upon award of this contract, the Government will determine the connectivity method between 

SSA and the contractor. Internet Protocol (IP) will be the connection protocol for the transmissions. The connectivity 

method will be through the Internet using an encrypted VPN tunnel, or the Government will place an order for a 

dedicated circuit to be installed within 60 calendar days of award between the contractor’s location and SSA’s network 

interface location. Either connectivity method will be encrypted with the AES256 encryption algorithm. For the Internet 

option to be used the contractor must have an Internet ready VPN IPSec capable hardware device. The Government will 

not be responsible for any cost associated with the VPN Internet connection that the contractor may incur. The 

connection method is at the sole discretion of the Government. The cost of the dedicated circuit connection will be 

borne by the Government. 

The Government shall not be responsible for installation delays of data connections due to any external influences such 

as employee strikes, weather, supplies, etc., which conditions are beyond the control of the Government. 

If a dedicated circuit is deemed necessary, SSA will provide the dedicated data connection, including a router, and 

firewall at the contractor’s specified locations. The contractor shall provide adequate rack space for securing the router 

and firewall; the contractor shall provide a dedicated analog dial-up line within eight (8) feet of the router. This 

dedicated analog dial-up line will be used for router management and access for troubleshooting. The line must be in 

place and active prior to the installation of the circuit/router. 

In addition, upon contract award, the contractor shall provide a complete delivery address with nearest cross-street, 

contact name, and phone number for installation of data transmission services and equipment. The contractor’s contact 

person shall be available for delivery of services at the specified location. The Government shall not be responsible for 

incorrect or lack of address information nor for non-availability of contact person(s) at the delivery site. 

It is the contractor’s responsibility to notify SSA when systems or data line problems arise and transmission(s) cannot 

take place. SSA’s first point of contact for systems or data line problems shall be the HELP DESK at (877) 697-4889. 

The contractor must also notify DMIM at melissa.picone@ssa.gov or by phone at (410) 965-3350. 

Any reprogramming and/or reformatting of data supplied by wire transmission or VPN Internet transmission 

necessitated due to the contractor’s method of production shall be the responsibility of the contractor. It is solely the 

contractor’s responsibility to ensure proper printing and inserting in their environment. 
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FILE TRANSFER MANAGEMENT SYSTEM (FTMS) REQUIREMENTS: The contractor shall provide the 

capability to interface with SSA’s National File Transfer Management System (FTMS) for electronic transmission of 

notice files from SSA to the production facility. SSA will provide the necessary data connection into the contractor’s 

location. At the discretion of SSA, the line speed may be either increased or decreased depending on utilization. The 

contractor must provide, at their expense, the equipment and operating software platform and the file transfer software 

required at their location. The contractor assumes all responsibility for configuration, maintenance, and troubleshooting 

of their equipment and software. 

SSA utilizes, and the contractor must provide compatibility with, Managed File Transfer software from TIBCO. The 

contractor may implement the Managed File Transfer Platform Server that has embedded software encryption capable 

of being enabled. The personal computers/servers must have the capability to run Managed File Transfer software with 

encryption enabled using IP protocols on Windows, UNIX (i.e., IBM’s AIX, SUN or HP), or z/OS platforms. 

SSA will not permit any private class A, B, or C IP addresses (i.e., 10.xxx.xxx.xxx type IP addresses) from external 

users on its network. At connection time to SSA, the contractor will be provided a suitable IP address for access to 

SSA’s network via a firewall. SSA will provide the necessary subnet(s) for connection at the remote site. The contractor 

will be responsible for their own name/address translation to fulfill the intended purpose of data transfers. SSA will 

provide Managed File Transfer node information to the contractor as required to accomplish file transfers. 

The contractor may determine the media type on which files from SSA will be received, to the extent that operator 

intervention (e.g., a tape mount) is not required at SSA or the contractor’s production facility. Simultaneous multiple 

transmission sessions must be possible on the contractor’s equipment. All files transmitted by the SSA will be written 

as Physical Sequential or “flat” files at the contractor’s location and will be distinguished with a “run date” in the 

contractor’s file name. Virtual Storage Access Method files and Generation Data Groups, supported by IBM/MVS or 

IBM z/OS operating systems, are not permitted under this contract. The contractor’s storage format must not preclude 

the availability of the Managed File Transfer software Checkpoint/Restart feature. 

NOTE: The contractor may not use VM/VSE/ESA on a mainframe system, as this hampers automated file transmission. 

The contractor’s FTMS software shall be operational for the receipt of data files 24 hours a day, 7 days a week, unless 

otherwise specified by the Government. The communications protocol between SSA and the contractor shall be the 

Internet Protocol (IP). The contractor must specify the type of Local Area Network (LAN) connection that will be used 

at the location where the SSA connection is to be installed. The contractor is responsible for providing complete 

hardware and software compatibility with SSA’s existing network. Production file transfers will be established 

according to SSA’s standard procedures for transmission control, dataset naming, and resource security. The 

contractor’s file management system must accommodate multiple file transmission sessions without intervention at 

either end. The contractor must have sufficient capacity to support the number of concurrent transmission file sessions 

as dictated by SSA. 

The above will apply, regardless of the number of workloads transmitted to the contractor daily. If the contractor is 

awarded multiple SSA notice workloads, there must be sufficient capacity at the contractor’s production facility to 

accept transmission of all files according to their schedules. 

In the event that any transmission cannot be processed due to media problems, link problems, or data transmission 

circuit/connection outages, the contractor shall notify SSA’s HELP DESK operations immediately at (877) 697-4889 

and report required observations and findings. 

Transmission of production files shall be the standard, automated technique. In the event that the transmission network 

is unavailable for a time period deemed critical by the Government, the files may, at the Government’s option, be 

processed at the SSA print/mail facility. 

NOTE: The contractor must not compress files. 
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All data provided by the Government or duplicates made by the contractor or their representatives and any resultant 

printouts must be accounted for and kept under strict security to prevent their release to any unauthorized persons. Data 

may not be duplicated in whole or in part for any other purpose than to create material to be used in the performance of 

this contract. 

Any duplicate data and any resultant printouts must be destroyed by the contractor. Data provided to the contractor 

must be retained for 21 workdays after mailing.

FOR QUALITY CONTROL AND AUDITING PURPOSES: The contractor must not merge file dates and mailers 

during processing, printing and mailing All files transmitted by SSA will be physical sequential. Any alteration of the 

notice content in the file is not permitted. 

PREPRODUCTION TESTS: Prior to the commencement of production of orders placed under this contract, the 

contractor will be required to demonstrate their ability to perform the contract requirements by performing the following 

tests – 

 Transmission Test 

 Preproduction Validation Test 

o Scannable Forms Validation Test 

o Micro-Perforated Payment Stub Validation Test 

o Construction Samples Validation Test 

The Government will furnish electronic test files at the postaward conference, or shortly thereafter, to be used in 

performing the Transmission Test and the Preproduction Validation Tests. 

Failure by the contractor to perform any of the tests listed above to the satisfaction of the Government may be cause for 

default. 

The Government reserves the right to waive the requirements of any or all of these tests. The contractor will be notified 

at the postaward conference if any test(s) will be waived. 

NOTE: All PDF’s containing PII must be sent via SFTP. 

Transmission Test: After the appropriate data connection has been installed, the contractor will be required to receive, 

within one (1) workday, data for approximately 945,000 notices (Mailers 1 through 36). These files will be sent 

concurrently, and the contractor will be need to demonstrate their ability to receive them simultaneously. 

The contractor will be required to perform a Record Count Verification and a Coding Accuracy Support System 

(CASS) certification within one (1) workday after the complete transmission of the test files. 

The contractor will be required to copy the files to their own system and email Melissa Picone at 

melissa.picone@ssa.gov with the exact counts received (broken down by dataset name), before proceeding with any 

other processing. 

The contractor will be required to run the test file through their CASS certification system to ensure there are no 

problems with the reading of the address file. The contractor will be required to report to SSA with the test results. 

SSA will respond within one (1) workday of receipt thereof. 

Preproduction Validation Tests: Prior to commencement of production of orders placed under this contract, the 

Government will furnish electronic test files shortly after the postaward conference to be used in performing the 

Preproduction Validation Tests. 
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The Government will issue a print order for the preproduction validation tests. 

Upon completion of all validation test requirements, the contractor will be reimbursed for all applicable costs in 

accordance with “SECTION 4. - SCHEDULE OF PRICES.” If the contractor fails to meet all test requirements, they 

will not be reimbursed for any associated costs. 

The contractor must perform the preproduction validation tests in their facilities and on their equipment using their 

personnel. 

Scannable Forms Validation Test: 

Within five (5) workdays after receipt of the Government’s approval on the 36 Scannable Form proofs, the contractor 

must conduct a Scannable Forms Validation Test and furnish 3,200 printed samples (50 samples each of Mailers 1 

through 36 Regular and Certified) for validation. Forms must be complete and include all variable data from the 

Government furnished test files. 

Mailers 1 through 24 – The contractor must submit the 50 printed samples as follows:

 25 test samples directly to: Social Security Administration, Attn: Representative Payee Analyst, Analysis 

Staff, Wilkes-Barre Direct Operations Center, Room 341, 1150 East Mountain Drive, Wilkes-Barre, PA 

18702-7997 

 25 DUPLICATE test samples directly to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-B10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401 

The container and accompanying documentation for both locations must include the GPO Jacket, Purchase Order, and 

Program Numbers. 

Mailers 25 through 28 – The contractor must submit the 50 printed samples as follows: 

 25 test samples directly to: Social Security Administration, Attn: Beneficiary Recontact Analyst, Analysis 

Staff, Wilkes-Barre Direct Operations Center, Room 341, 1150 East Mountain Drive, Wilkes-Barre, PA 

18702-7997 

 25 DUPLICATE test samples directly to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-B10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401 

The container and accompanying documentation for both locations must include the GPO Jacket, Purchase Order, and 

Program Numbers. 

Mailers 29 through 36 – The contractor must submit the 50 printed samples as follows: 

 25 test samples directly to: Social Security Administration, Attn: CDR Analyst, Wilkes-Barre Direct 

Operations Center, Room 341, 1150 East Mountain Drive, Wilkes-Barre, PA 18702-7997 

 25 DUPLICATE test samples directly to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-B10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401 

The container and accompanying documentation for both locations must include the GPO Jacket, Purchase Order, and 

Program Numbers. 

SSA will test these samples on their scanner and barcode reading device(s) as specified in these specifications. 
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The Government will approve, conditionally approve, or disapprove the preproduction validation samples within five 

(5) workdays of the receipt thereof. Approval or conditional approval shall not relieve the contractor from complying 

with the specifications and all other terms and conditions of the contract. A conditional approval shall state any further 

action required by the contractor. 

If the Government disapproves the samples, the Government at its option may require the contractor to submit additional 

samples for inspection and testing, in the time and under the terms and conditions specified in the notice of rejection. 

Additional samples must be furnished and necessary changes made at no additional cost to the Government. 

In the event the Government disapproves the additional samples, the contractor may be deemed to have failed to make 

delivery within the meaning of the default clause in which event this contract shall be subject to termination for default. A 

notice of disapproval shall state the reasons thereof. 

Submit revised samples, if necessary, due to author’s alterations (AA’s) by the Government, within three (3) workdays 

after receipt of notification and furnished materials. Revised sample copies will be available for pick up within three (3) 

workdays. 

Using the Government furnished test files, the contractor is required to furnish one (1) complete set of 

PDF files of the Scannable Forms Validation Test Samples. The PDF samples are to be uploaded to the SFTP site. The 

contract must send an email to melissa.picone@ssa.gov once the upload is complete. 

Micro-Perforated Payment Stub Validation Test: 

Within five (5) workdays after receipt of the Governments final approval on the six (6) Title II – Final Accounting 

Personalized Notices with Micro-Perforated Payment Stub proofs, the contractor must conduct a Micro-Perforated 

Payment Stub Validation Test and furnish 500 printed samples (50 samples each of Mailers 19 through 24 Regular and 

Certified) for validation of the alpha-numeric scan line. 

Notices with Payment Stub must be complete and include all variable data from the Government furnished test files. 

The micro-perforation on the payment stub page must be precisely located, and the payment stub must function 

properly when processed through the current high-speed scanning equipment owned by SSA. A form is a reject when 

its OCR print cannot be correctly deciphered on the first pass through the specified reading equipment. 

The contractor must submit the 50 printed samples as follows: 

 

 25 test samples directly to: Danielle N. McCray, Program Analyst, OAS 7th Floor NW, Mid-Atlantic Program 

Service Center, 300 Spring Garden Street, Philadelphia, PA 19123 

 25 DUPLICATE test samples directly to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-B10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401 

The container and accompanying documentation for both locations must include the GPO Jacket, Purchase Order, and 

Program Numbers. 

The Government will approve, conditionally approve, or disapprove the preproduction validation samples within five 

(5) workdays of the receipt thereof. Approval or conditional approval shall not relieve the contractor from complying 

with the specifications and all other terms and conditions of the contract. A conditional approval shall state any further 

action required by the contractor. 

Construction Samples Validation Test: 
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Within five (5) workdays after the Government renders an “O.K. to Print” on all the necessary components including 

the Preproduction Validation Tests for the Scannable Forms and Title II – Final Accounting Notices with MicroPerforated Payment Stub, the contractor must conduct a Construction Samples Validation Test and furnish 960 sample 

notice packages (15 samples each of Mailers 1 through 36 Regular and Certified) of the final completed product. 

The samples must be complete and include all variable data from the Government furnished test files, inserted into the 

mail-out envelope with all required inserts and envelopes, leaving the mail-out envelope unsealed. 

The contractor will be required to have all the necessary inserts and envelopes completed prior to beginning this 

validation test. 

The contractor must send the test samples directly to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-

B-10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401. The container and accompanying 

documentation must include the GPO Jacket, Purchase Order, and Program Numbers. 

The Government will approve, conditionally approve, or disapprove the preproduction validation samples within five 

(5) workdays of the receipt thereof. Approval or conditional approval shall not relieve the contractor from complying 

with the specifications and all other terms and conditions of the contract. A conditional approval shall state any further 

action required by the contractor. 

The Government may require the contractor to make changes to the formats of the scannable forms, notices with microperforated payment stub, instruction sheets, flyer, or envelopes at any time during the term of the contract. Whenever 

such copy changes are required, all aspects of the “test schedule” (proofs, schedule, and quantity of test samples) must 

be maintained. Live production of all the mailers will continue during this transition period. 

COMPOSITION: 

Text and form work will be required. 

Contractor will be required to typeset all scannable forms and personalized notices with micro-perforated payment stub 

utilizing Century Schoolbook, or similar serif typeface. The FORM ID number located in the form identifier box at the 

top of each scannable form must be set in OCR A 18-point typeface. 

Contractor will be required to typeset all instruction sheets utilizing Century Schoolbook, or similar serif typeface. The 

numbers/letters located within the boxes of each instruction sheet will be typeset utilizing OCR handprinted characters 

typeface unless otherwise specified. 

Contractor will be required to typeset all envelopes utilizing Helvetica, or similar typeface. 

SSA reserves the right to require samples and to judge the suitability of any alternate typeface offered in order to make 

an award, which is deemed to be in the best interest of the Government. 

The entirety of each category of composition (text, tabular, and display) must be identical throughout the product(s) 

ordered under these specifications. Contractor is to match the type size on the manuscript copy. Exact spacing of scan 

boxes and variable data must be maintained for readability on pre-programmed scanning equipment. 

Form work will be defined as matter set in all sizes and will include vertical, horizontal, and diagonal rules, box heads, 

numbered lines, checkboxes, arrows, type matter, etc., positioned in the proper location to provide spaces for 

information to be filled in individually. 
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PROOFS: 

 When ordered: 

Six (6) sets of digital content proofs of all components (scannable forms, personalized notices with microperforated payment stub, instruction sheets, flyer, BRM/CRM envelopes, and mail-out envelopes) will be 

required. Proofs must be created using the same Raster Image Processor (RIP) that will be used to produce the 

product. Proofs must be collated with all elements in their proper position (not pasted up), imaged face and 

back, trimmed, and folded to the finished size as required for each item. 

For the envelopes, the proofs must show all margins and dimensions, indicate trim marks, show flap, and 

window size and placement, as applicable. 

 When ordered:

One (1) press quality Adobe Acrobat (most current version) PDF soft proof (for content only – showing all 

elements) using the same Raster Image Processor (RIP) that will be used to produce the final printed product. 

PDF proof will be evaluated for text flow, image position, and color breaks. Proof will not be used for color 

match. 

For the envelopes, the PDF proofs must show all margins and dimensions, indicate trim marks, show flap, and 

window size and placement, as applicable. 

SSA reserves the right to make changes to all proofs. The Government may require one (1) or more sets of revised 

proofs before rendering an “O.K. to Print.” 

The contractor will be responsible for performing all necessary proofreading to ensure that the proofs are in conformity 

with the copy submitted. 

If any contractor’s errors are serious enough in the opinion of GPO to require revised proofs, the revised proofs are to 

be provided at no additional expense to the Government. No extra time can be allowed for this reproofing operation; 

such operations must be accomplished within the original production schedule allotted in the specifications. 

The contractor must not print prior to receipt of an “O.K. to Print.” 

STOCK/PAPER: The specifications of all paper furnished must be in accordance with those listed herein or listed for 

the corresponding JCP Code numbers in the “Government Paper Specification Standards No. 13” dated September 

2019. 

Government Paper Specification Standards No. 13 – https://www.gpo.gov/docs/default-source/forms-and-standardsfiles-for-vendors/vol_13.pdf. 

Color of paper furnished must be of a uniform shade and a close match by visual inspection of the JCP and/or attached 

color sample(s). The Contracting Officer reserves the right to reject shipments of any order printed on paper the color of 

which, in his or her opinion, materially differs from that of the color sample(s). 

All paper used in each order must be of a uniform shade. 

Scannable Forms: White Optical Character Recognition (OCR) Bond, basis weight: 20 lbs. per 500 sheets, 17 x 22”, 

equal to JCP Code O-25. 

Personalized Notices with Micro-Perforated Payment Stub: White Uncoated Text, basis weight: 50 lbs. per 500 

sheets, 25 x 38”, equal to JCP Code A60. 
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Flyer: White Writing, basis weight: 20 lbs. per 500 sheets, 17 x 22”, equal to JCP Code D10. 

Instruction Sheets: White Uncoated Text, basis weight: 50 lbs. per 500 sheets, 25 x 38”, equal to JCP Code A60. 

BRM and CRM Return Envelopes: White, Pink, or Green Writing Envelope, basis weight: 20 lbs. per 500 sheets, 17 x 

22”, equal to JCP Code V20. NOTE: The Pink Writing must be a match of Pantone 210, and the Green Writing must 

be a match of Pantone 344. At contractor’s option, the pink envelopes may be surface tinted match Pantone 210, and 

the green envelopes may be surface tinted to match Pantone 344. Surface tinting must cover all exposed surfaces (front 

and back) of the envelope when sealed. 

Envelope color must meet USPS print reflectance difference requirements.

Mail-out Window Envelopes: White Writing Envelope, basis weight: 24 lbs. per 500 sheets, 17 x 22”, equal to JCP 

V20; or, at contractor’s option, White Uncoated Text, basis weight: 60 lbs. per 500 sheets, 25 x 38”, equal to JCP Code 

A60. 

PRINTING: All printing/imaging must have a minimum resolution of 600 x 600 dpi. NOTE: Inkjet printing is NOT 

ALLOWED. 

The Government reserves the right to make changes to the envelopes or to the format/text of the forms, personalized 

notices, payment stubs, instruction sheets, or flyer at any time during the term of this contract. Notification of a 

proposed change will be given with sufficient time for the contractor to allow for the change, and submit proofs to the 

Government. The contractor is not to preprint or maintain more than a 90-calendar day surplus/inventory of the 

instruction sheets, flyer, and envelopes as required by this contract. NOTE: The Disability Update Reports are 

quarterly notices. All components of the Disability Update Reports are excluded from the 90-calendar day 

surplus/inventory. 

In the event that the agency makes changes to any or all of the instruction sheets, flyer, or envelopes, the Government 

will exhaust the current supply before requiring the contractor to begin using the updated components. The Government 

will not be required to purchase from the contractor the surplus/inventory of any stocked items remaining on-hand in 

excess of what was authorized when an envelope or format/text change is implemented. However, if a revision occurs 

which requires destruction of any stocked item, contractor will be allowed to charge for only those line items applicable 

in accordance with the “SCHEDULE OF PRICES.” 

Scannable Forms: Print face and back, head-to-head, in black ink only. 

Personalized Notice with Micro-Perforated Payment Stub: Print face and back, head-to-head, in black ink only. 

Flyer: Print face only in black ink. 

Instruction Sheets: Print face and back, head-to-head, in black ink only. 

ALL Envelopes: Print face and back (after manufacturing) in black ink only. Printing must be in accordance with the 

requirements for the style envelope ordered. All printing must comply with all applicable U.S. Postal Service 

regulations. The envelope must accept printing without feathering or penetrating to the reverse side. 

All envelopes require a security tint (straight-line tint is not acceptable) printed on the inside (back - before 

manufacturing) in black ink. The contractor may use their own design but must guarantee that the product will ensure 

complete opacity and prevent show through of any material contained therein. NOTE: The inside of the BRM and 

CRM return envelopes must contain a clear area (no pantograph design) (approximate 3-1/2 x 5/8” in size), behind the 

IMB to ensure the readability by U.S. Postal Service equipment. 
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BRM Envelopes: Face of envelopes to be in BUSINESS REPLY FORMAT. Print Facing Identification Marks (FIM) 

and Intelligent Mail Barcodes (IMB) using the camera copy provided for each envelope. Contractor is responsible for 

placing the FIM and IMB on the mailing piece according to the current U.S. Postal Service Domestic Mail Manual. 

CRM Envelopes: Face of envelopes to be in COURTESY REPLY FORMAT. Print Facing Identification Marks (FIM) 

and Intelligent Mail Barcodes (IMB) using the camera copy provided for each envelope. Contractor is responsible for 

placing the FIM and IMB on the mailing piece according to the current U.S. Postal Service Domestic Mail Manual. 

NOTE: The mail-out envelope for the Representative Payee and the Title XVI (Continuing Disability Review (CDR)) 

notices must contain the ADDRESS SERVICE REQUESTED endorsement on the front of the envelope. 

RECYCLED PAPER LOGO AND LEGEND: See Government Paper Specification Standards No. 13 for recycled 

content requirements. If recycled paper is used, the recycled paper logo and legend must be printed in black ink as follows: 

Scannable Forms/Personalized Notices: The English recycled paper logo and legend must be printed on the first page 

of the English scannable forms/personalized notices in the bottom left-hand corner. The Spanish recycled paper logo 

and legend must be printed on the first page of the Spanish scannable forms/personalized notices in the bottom lefthand corner. 

Flyer: The English recycled paper logo and legend must be printed in the bottom left-hand corner of the page. 

Instruction Sheets: The English recycled paper logo and legend must be printed on the last page of the English 

instruction sheets in the bottom left-hand corner. The Spanish recycled paper logo and legend must be printed on the 

last page of the Spanish instruction sheets in the bottom left-hand corner. 

Envelopes: The English recycled paper logo and legend must be printed on the back of all envelopes in the bottom 

left-hand corner. If the envelope is bilingual, then the Spanish recycled paper logo and legend must also be printed 

on the back in the bottom right-hand corner. 

IMAGING: Contractor will be required to convert furnished data from the electronic transmission for laser/ion 

deposition printing in black ink with a minimum resolution of 600 x 600 dpi, utilizing Century Schoolbook, or similar 

serif typeface on the scannable forms in accordance with the following: 

Inkjet printing is NOT ALLOWED. 

Variable Data: 

Form SSA-623-OCR-SM 

Face of Scannable Form – Maximum 28 type lines of alphanumeric characters (includes form identifier located in the 

box at the top of each form), Data Matrix 2D barcode located at the top of each form (7/16” to the right of the form 

identifier box), plus the Intelligent Mail Barcode (IMB). 

Back of Scannable Form – 2 type lines of alphanumeric characters matching the barcodes on the back of the form, 1 

type line of alphanumeric characters located in the form identifier box at the top of each form, plus Data Matrix 2D 

barcode located at the top of each form (1/4” to the right of the form identifier box). 
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Form SSA-6230-OCR-SM 

Face of Scannable Form – Maximum 27 type lines of alphanumeric characters (includes form identifier located in the 

box at the top of each form), Data Matrix 2D barcode located at the top of each form (7/16” to the right of the form 

identifier box), plus the Intelligent Mail Barcode (IMB). 

Back of Scannable Form – 2 type lines of alphanumeric characters matching the barcodes on the back of the form, 1 

type line of alphanumeric characters located in the form identifier box at the top of each form, plus Data Matrix 2D 

barcode located at the top of each form (1/4” to the right of the form identifier box). 

Form SSA-6234-OCR-SM 

Face of Scannable Form – Maximum 30 type lines of alphanumeric characters (includes form identifier located in the 

box at the top of each form), Data Matrix 2D barcode located at the top of each form (7/16” to the right of the form 

identifier box), plus the Intelligent Mail Barcode (IMB). 

Back of Scannable Form – 2 type lines of alphanumeric characters matching the barcodes on the back of the form, 1 

type line of alphanumeric characters located in the form identifier box at the top of each form, plus Data Matrix 2D 

barcode located at the top of each form (1/4” to the right of the form identifier box). 

Form SSA-1588-OCR-SM

Face of Scannable Form – Maximum 11 type lines of alphanumeric characters (includes form identifier located in the 

box at the top of each form), Data Matrix 2D barcode located at the top of each form (7/16” to the right of the form 

identifier box), plus the Intelligent Mail Barcode (IMB). 

Back of Scannable Form – No variable data on back of forms. 

Form SSA-455-OCR-SM

Face of Scannable Form – Maximum 20 type lines of alphanumeric characters plus the Intelligent Mail Barcode 

(IMB). 

Back of Scannable Form – 4 type lines of alphanumeric characters with 2 of the 4 type lines matching the barcodes. 

The Scanning Form Identification Code (SFIC) will consist of a 5-digit number printed using the OCR A font. All 

variable data for the Report Period, Beneficiary, Telephone Number, and Claim Number must be printed using the 

OCR A font. 

For those fields that will contain data of varying length (PNA 1 - 6, Beneficiary’s Name, and Reporting Period), the 

contractor must make the adjustment (i.e., close up the extra space) in the printing of those fields on the scannable 

form. 

Contractor must determine type size (largest size that can be accommodated in the available space) subject to SSA 

approval. 

Scan Lines on Face of Forms: 

Representative Payee (Title II, Title II – Final Accounting) 

Form SSA-623-OCR-SM – Maximum 60 characters printed on two lines (line 1: 28 characters; line 2: 32 characters), 

OCR A font. 
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Form SSA-6230-OCR-SM – Maximum 70 characters printed on two lines (line 1: 35 characters; line 2: 35 characters), 

OCR A font. 

Form SSA-6234-OCR-SM – Maximum 70 characters printed on two lines (line 1: 28 characters; line 2: 42 characters), 

OCR A font. 

Representative Payee (Title XVI) 

Form SSA-623-OCR-SM – Maximum 79 characters printed on two lines (line 1: 40 characters; line 2: 39 characters), 

OCR A font. 

Form SSA-6230-OCR-SM – Maximum 79 characters printed on two lines (line 1: 40 characters; line 2: 39 characters), 

OCR A font. 

Form SSA-6234 OCR-SM – Maximum 84 characters printed on two lines (line 1: 42 characters; line 2: 42 characters), 

OCR A font. 

Beneficiary Recontact 

Form SSA-1588-OCR-SM – Maximum 53 characters printed on two lines (line 1: 35 characters; line 2: 18 characters), 

OCR A font.

Disability Update (Title II, Title XVI) 

Form SSA-455-OCR-SM – Maximum 96 characters printed on three lines (line 1: 32 characters; line 2: 32 characters; 

line 3: variable up to 32 characters maximum), OCR A font. NOTE: Character set required includes the “/”. 

NOTE: All scan lines located on the face of any of the scannable forms must not fall on a fold. 

Scan lines must be printed using the OCR A font. The OCR printing must read continuously on an Integrated Image 

Based Data Capture System (IIBDCS). The reject rate due to manufacturing deficiencies shall not exceed 0.65% of the 

items when run on the specified reading equipment. A form is a reject when its OCR print cannot be correctly 

deciphered on the first pass through the specified reading equipment. Acceptability of the lot for OCR readability will 

be based on the number of rejected items in a sample of the size specified in ANSI/ASQC Z1.4, General Inspection 

Level I, with AQL equal to 0.65%. For OCR evaluation, the sampling unit of production will be an individual form. 

OCR tests are independent of tests and evaluations of all other product characteristics and have separate AQL’s and 

sample sizes. At the Government’s option, the sample may consist of sequential items from one or more portions of the 

lot rather than a random sample. 

ANSI X3.17 “Character Set for Optical Character Recognition (OCR A)” shall apply to these specifications. The 

revisions of this standard which are effective as of the date of this contract are those which shall apply. 

ANSI Standards may be obtained from the American National Standards Institute, 25 West 43rd Street, 4th Floor, New 

York, NY 10036. 

MICRO-PERFORATED PAYMENT STUB: The Representative Payee Title II – Final Accounting personalized 

notice contains a micro-perforated payment stub with an alphanumeric scan line. The alphanumeric scan line must be 

printed using the OCR A font. The payment stub page is part of the notice itself and will be electronically transmitted. 

The payment stub page is the only page that should contain the micro-perforation. 
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The payment stub portion, once detached, will be scanned. It is critical that the bottom of the OCR A scan line be 

1/2 inch from the bottom and 1/4 inch from the right leading edge on the payment stub page. The payment stub 

produced must be guaranteed to function properly when processed through the current high-speed scanning equipment 

at SSA. A form is a reject when its OCR print cannot be correctly deciphered on the first pass through the specified 

reading equipment. 

The contractor must not use magnetic ink to print the payment stub as it will affect its ability to scan. Use of equipment 

or ink, which in any way adversely affects the ability to scan the payment stub, will not be allowed. 

NOT-LOW PERSONALIZED SCANNABLE FORMS: The Disability Update Title II and Title XVI notices are 

expected to include “not-LOW” mailers. The contractor is required to review the ORB field (location 285, Scanline 2, 

Field 3) for all records. 

For every record containing an “M” or “H” in the ORB field, the contractor must image a large (48-point) 6-sided 

asterisk in Times New Roman on the front of the scannable form. The 6-sided asterisk must be positioned 7/16” from 

the top and 2-7/8” from the left edge on the front of the scannable form. Follow furnished samples. 

Forms printed with the 6-sided asterisk are described as “not-LOW” personalized scannable mailer forms. 

When an asterisk is printed on a “not-LOW” scannable form, the CRM return envelope included with the form must 

also have a large (48-point) 6-sided asterisk in Times New Roman printed on the front. The 6-sided asterisk must be 

positioned 1-11/16” from the top and 1-3/8” from the left edge on the front of the CRM return envelope. 

If the value for location 285 (Scanline 2, Field 3, the ORB field) is “L” or blank, DO NOT print an asterisk on the 

scannable form or on the CRM return envelope. 

It is expected that all scheduled mailings will include “not-LOW” mailers. Upon selection of records for a scheduled 

printing, the contractor will be advised of the amount of “not-LOW” mailers in the selection by type (Title II and/or 

Title XVI) and if they are first-time or second-time mailers. When possible, the contractor will be notified in advance of 

estimated quantities for “not-LOW” mailings. 

BARCODE REQUIREMENTS: The scannable forms contain Data Matrix 2D barcodes and Standard 3 of 9 

barcodes. (See manuscript copy for precise placement and size of barcodes.) Barcodes must not interfere with the fold 

or any wording on the forms. 

Carbon black ink must be used to image barcodes. Barcodes must not fall on a fold. Contractor will be required to have 

the necessary equipment to perform all quality assurance tests and to verify the accuracy of the barcodes and scannable 

lines during the term of this contract. 

Data Matrix 2D Barcode: 

Representative Payee (Title II, Title XVI, Title II – Final Accounting): Two (2) Data Matrix 2D barcodes will be 

required on all SSA-623, SSA-6230, and SSA-6234 scannable forms as follows: 

Face: Located at the top, 7/16” to the right of the form identifier box of each form. Height is 1/2”, plus or minus 1/16”; 

length/width is 1/2”, plus or minus 1/16”. 

Back: Located at the top, 1/4” to the right of the form identifier box of each form. Height is 1/2”, plus or minus 1/16”; 

length/width is 1/2”, plus or minus 1/16”. 

NOTE: At least 1/8” margin (quiet zone) is required top, bottom, left, and right of each Data Matrix 2D barcode. 
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The Data Matrix 2D barcodes must contain the following data elements: 

Form ID: 4 positions (6230, 6231, 6232, 6233, 6234, 6235, 6236, 6237, 6239). 

 Page Number: 1 position (1 for face, 2 for back). 

Language: 1 position (E for English, S for Spanish). 

 Second Request: 1 position (Y for yes, N for no, and F for final accounting). 

 Printer Information: variable length (contractor’s name). 

 Edition Date: 6 positions (2 positions for month, 4 positions for year; value must always reflect the 

edition date on form). 

Scan Lines: variable length (see “IMAGING, Scan Lines on Face of Forms”). 

Beneficiary Recontact: One (1) Data Matrix 2D barcode will be required on all SSA-1588 scannable forms as follows: 

Face: Located at the top, 7/16” to the right of the form identifier box of each form. Height is 1/2”, plus or minus 1/16”; 

length/width is 1/2”, plus or minus 1/16”. 

NOTE: At least 1/8” margin (quiet zone) is required top, bottom, left, and right of each Data Matrix 2D barcode. 

The Data Matrix 2D barcode must contain the following data elements: 

Form ID: 4 positions (1588) 

Page Number: 1 position (1 for face) 

Language: 1 position (E for English, S for Spanish) 

Request: 1 position (value 1 = first request, value 2 = final request) 

 Printer Information: variable length (contractor’s name) 

Edition Date: 6 positions (2 positions for month, 4 positions for year; value must always reflect the 

edition date on form) 

Scan Lines: 53 positions (See “IMAGING, Scan Lines on Face of Forms”) 

 Beneficiary’s First Name: 15 positions 

 Beneficiary’s Middle Initial: 1 position 

 Beneficiary’s Surname: 20 positions 

Disability Update (Title II, Title XVI): Two (2) Data Matrix 2D barcodes will be required on all SSA-455 scannable 

forms as follows: 

Face: Located at question 1.b, 5/16” to the left of 1.b2 and 1.b3. Height is 5/8”, plus or minus 1/16”; length/width is 

5/8”, plus or minus 1/16”. 

Back: Located in the top margin, 1/4” down from the leading edge of the form, and 1-1/2” in from the left edge of the 

form. Height is 5/8”, plus or minus 1/16”; length/width is 5/8”, plus or minus 1/16” centered in the margin. 

NOTE: At least 1/8” margin (quiet zone) is required top, bottom, left, and right of each Data Matrix 2D barcode. 

The Data Matrix 2D barcodes must contain the following data elements: 

Form Number: 7 positions (SSA-455) 

Revision Date: 6 positions, (2 positions for month, 4 positions for year; value must always reflect the 

edition date on form) 

Form Side: 1 position (F for Front, B for Back) 

Request: 1 position (value 1 = first request, value 2 = second request) 

Mail Date: 8 positions (MMDDYYYY = Month/Day/Year) 

Scan Line 1: 32 positions (123456789/C1/1952/0000/12345678/) 

Scan Line 2: 32 positions (3/---/L/0012/022016/1/8/S11/123/) 
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Scan Line 3: variable length, maximum 32 positions (ANYCITY /PA/1234567890/) (See 

“IMAGING, Scan Lines on Face of Forms”) 

End: 3 positions (EOD for End of Data) 

Example: SSA-455,102018,F,1,02102019,123456789/C1/1952/0000/12345678/,3/---/L/0012/022016/1/8/S11/123/, 

ANYCITY /PA/1234567890/,EOD 

Data columns are to be preceded and followed by the standard Data Matrix 2D barcode start/stop patterns, left row 

indicator, and right row indicator. Additionally, a delimiter character (comma) must be inserted between each element. 

The Data Matrix 2D barcodes must be in accordance with the requirements of ANSI MH 10.8.3M, unless otherwise 

specified. 

The Data Matrix 2D barcodes produced under these specifications must be guaranteed to function properly when 

processed through an Integrated Image Based Data Capture System (IIDBCS). The barcoding must be readable by all 

standard barcode scanning devices regardless of the contractor’s method of reproducing the codes. 

Standard 3 of 9 Barcode: The Standard 3 of 9 barcode consists of a maximum 16 characters. Two (2) barcodes will 

be required on the back of the Representative Payee (Title II, Title XVI, Title II – Final Accounting) and Beneficiary 

Recontact scannable forms; and one (1) barcode will be required on the back of the Disability Update (Title II, Title 

XVI) scannable forms as follows: 

Representative Payee (Title II, Title XVI, Title II – Final Accounting): 

First Barcode: Type of Event (TOE). 6 characters + start/stop = 8 characters encoded. Height is 1/2”, plus or minus 

1/16”, density of 6.6 CPI. A standard 1/2” margin (quiet zone) is required left and right of each barcode. 

A. If the Processing Center Code (PC Code) is 0 through 6, the barcode should be: 

Position Code

 1 start 

 2 8 

 3 6 

 4 1 

 5 0 

 6 0 

 7 4 

 8 stop 

B. If the PC Code is 7 or 8, the barcode should be: 

Position Code

 1 start 

 2 8 

 3 6 

 4 1 

 5 0 

 6 8 

 7 6 

 8 stop 
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Second Barcode: (Social Security Number (SSN), PC Code, 0, 1, 8, and 9). 14 characters + start/stop = 16 characters 

encoded. Height is 1/2”, plus or minus 1/16”, density of 6.6 CPI. A standard 1/2” margin (quiet zone) is required left 

and right of each barcode. 

Position Field/Entry

 1 *start/stop 

 2-10 SSN 

 11 PC Code 

 12 0 

 13 1 

 14 8 

 15 9 

 16 *start/stop 

NOTE: The Title XVI forms selection process does not always identify a processing center code (PC Code). The 

contractor must force a PC Code of “0” (zero) for the barcode on the reverse side of the form on Title XVI selections 

unless a PC Code is present in the files. This will allow the barcode to be used for Title XVI forms. If 

the PC Code is “0,” the PC field on the face of the form must be blank. If a PC Code of 1 through 8 is present, then that 

number must be part of the barcode and must be shown in the PC field on the face of the form. 

Beneficiary Recontact: 

First Barcode: Type of Event (TOE). The Toe for all Beneficiary Recontact Forms is 270. The Toe is 

6 characters + start/stop = 8 characters encoded. Minimum length is 1-3/4” and maximum length is 1-7/8” (not 

including the quite zones). Height is 1/2”, plus or minus 1/16”. The “TOE 270” is literally interpreted just to the right 

of the TOE bar. A standard 1/2” margin (quiet zone) is required left and right of each barcode. 

A. The barcode interpretation should be: 

Position Code 

 1 start 

 2 8 

 3 6 

 4 1 

 5 0 

 6 6 

 7 8 

 8 stop 

Second Barcode: (Social Security Number (SSN), PC Code, 0, 1, 8, and 1). 14 characters + start/stop = 16 characters 

encoded. Minimum length is 3-1/2” and maximum length is 3-3/4” (not including the quiet zones). Height is 1/2”, plus 

or minus 1/16”. A standard 1/2” margin (quiet zone) is required left and right of each barcode. 

 Position Code 

 1 start (*) 

 2-10 SSN 

 11 PC Code 

 12 0 

 13 1 

 14 8 

 15 1 

 16 stop (*) 
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Disability Update (Title II, Title XVI): 

Barcode: (Social Security Number (SSN), PC Code, 0, 1, 8, and 9). 14 characters + start/stop (*) = 16 characters 

encoded. Height is 1/2”, plus or minus 1/16”, density of 6.6 CPI (Font C3901J). A standard 1/2” margin (quiet zone) 

is required left and right of each barcode. 

 Position Code 

 1 start (*) 

 2-10 SSN 

 11 PC Code 

 12 0 

 13 1 

 14 8 

 15 9 

 16 stop (*) 

Type of Event (TOE): The TOE Code will not be shown on the back of the Disability Update scannable forms in a 

barcode format. The letters “TOE” and the numbers “290,” “790,” and “990” should be displayed on the back of the 

scannable form as follows: 

If the file contains Title XVI records, Processing Center Code (PC) 0 through 6, then the TOE Code Visual Display 

should read: TOE 290. 

A. If the file contains Title II records, Processing Center Code (PC) 0 through 6, then the TOE Code Visual 

Display should read: TOE 790. 

B. If the file contains Title II records, Processing Center Code (PC) 7 or 8, then the TOE Code Visual Display 

should read: TOE 990. 

The SSN is literally interpreted between the TOE and SSN/SSNZ barcodes, the TOE, SSN/SSNX and PI literally 

interpreted directly below the SSN. The PI value should reflect the PC code printed on the front of the form. 

The SSN is to be printed landscape style in the center of the form. 

All encoded data is to be preceded and followed by the Standard 3 of 9 barcode start/stop (*) code. Additionally, where 

blanks occur in fields identified for conversion to barcode, these blanks should be expressed as barcoded blanks. 

The Standard 3 of 9 barcode must be in accordance with the requirements of AIM Uniform Symbology Specifications, 

Code 39 and ANSI X3.182-1990 (Barcode Print Quality Guidelines), unless otherwise specified. 

PRESS SHEET INSPECTION: Final makeready press sheets may be inspected and approved at the contractor’s plant 

for the purpose of establishing specified standards for use during the actual press run. Upon approval of the sheets, 

contractor is charged with maintaining those standards throughout the press run (within QATAP tolerances when 

applicable) and with discarding all makeready sheets that preceded approval. See GPO Publication 315.3 (Guidelines 

for Contractors Holding Press Sheet Inspections) issued January 2015. NOTE: A press sheet inspection is for the 

purpose of setting specific standards that are to be maintained throughout the entire run. It does not constitute a prior 

approval of the entire run. 

Viewing Light: Press sheets will be viewed under controlled conditions with 5000 degrees Kelvin overhead luminaries. 

The viewing conditions must conform to ISO 3664-2009. A viewing booth under controlled conditions with 5000 

degrees Kelvin overhead luminaries with neutral gray surroundings must be provided. 
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NOTE: When a press sheet inspection is required, the Government will notify the contractor. A press sheet 

inspection(s) may be required at the contractor’s/subcontractor’s plant before production begins on any new or existing 

workload. 

MARGINS: Margins on the scannable forms must be a minimum of 1/4” on all sides. Contractor is to follow furnished 

manuscript copy, electronic file, or other given instruction for proper margins on the instruction sheets, flyer, 

personalized notice with micro-perforated payment stub, and envelopes. 

BINDING: 

Scannable Forms: Trim four sides. 

Final Accounting Notice with Micro-Perforated Payment Stub: Trim four sides. 

Stub Requirement: The last leaf of the English and the Spanish Title II – Final Accounting Personalized Notices 

requires a full horizontal micro-perforation 3-1/2” up from bottom of page and runs along the entire 8-1/2” length 

dimension. Only the payment stub page is to contain the perforation. 

Flyer: Trim four sides. 

Instruction Sheets: 

Representative Payee and Disability Update – Fold from 17 x 11” flat size down to 8-1/2 x 11”, trim three sides. 

Beneficiary Recontact – Trim four sides.

CONSTRUCTION: 

White, Pink, and Green BRM Return Envelopes (4 x 8-7/8”): Envelope must be open side with side seams and a 

gummed, fold-over flap for sealing. Flap depth is at contractor’s option but must meet all USPS requirements. Flap 

must be coated with suitable remoistenable glue the entire length of flap that will securely seal the return envelope for 

mailing. Adhesive must not adhere to the contents of the envelope. 

NOTE: The white and pink BRM return envelopes must accommodate the scannable form when folded as specified 

under “GATHERING AND INSERTING.” The green BRM return envelope must accommodate the Micro-Perforated 

Payment Stub. 

White CRM Return Envelopes (4 x 8-7/8”): Envelope must be open side with side seams and a gummed, fold-over 

flap for sealing. Flap depth is at contractor’s option, but must meet all USPS requirements. Flap must be coated with 

suitable remoistenable glue the entire length of flap that will securely seal the return envelope for mailing. Adhesive 

must not adhere to the contents of the envelope. 

NOTE: The white CRM return envelopes must accommodate the scannable form when folded as specified under 

“GATHERING AND INSERTING.” 

White Mail-out Envelopes (4-1/4 x 9-1/2”): Envelope must be open side with side seams or high-cut diagonal seams, 

at contractor’s option, and a gummed, fold-over flap for sealing. Flaps must be coated with a suitable glue that will 

securely seal the envelope without adhering to contents, permit easy opening by the recipient, and not permit resealing 

of the envelope. Mail-out envelope to be securely sealed on all sides and must remain sealed under normal mailing 

conditions. 
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Representative Payee and Beneficiary Recontact Envelopes– Flap depth is at contractor’s option, but must meet all 

USPS requirements. Face of envelope to contain one die-cut address window (1-5/8 x 4-1/4” in size) with slightly 

rounded corners. Window to be positioned 7/8” from the bottom edge and 1/2” from the left edge. 

Disability Update Envelopes – Flap depth must be at least 1-1/2”. Face of envelope to contain one die-cut address 

window (1-1/2 x 4-1/16” in size) with slightly rounded corners. Window to be positioned 1/2” from the bottom edge 

and 5/8” from the left edge. 

Contractor has the option to adjust the size of the window openings (subject to SSA approval) providing the visibility of 

the mailing address and IMB on the form is not obscured and other extraneous information is not visible when material 

is inserted into the envelope. 

Windows are to be covered with a suitable transparent, low-gloss, poly-type material that must be clear of smudges, 

lines, and distortions. Poly-type material must be securely affixed to the inside of the envelope so as not to interfere 

with insertion of contents. Window material must meet the current USPS readability standards/requirements. 

GATHERING AND INSERTING: Gather and fold (as specified below) for insertion into the mail-out envelope. 

 Scannable Forms: Fold from 8-1/2 x 11” flat size down to 8-1/2 x 3-2/3” with two parallel accordion folds, 

title out. The recipient’s name and address must be visible through the window envelope when inserted into 

mail-out envelope. NOTE: Scan lines located on the face and barcodes located on the face and back of the 

scannable forms must not fall on a fold.

 Final Accounting Notice with Micro-Perforated Payment Stub: Fold the 4-page notice (two 8-1/2 x 11” 

leaves) from 8-1/2 x 11” flat size down to 8-1/2 x 3-2/3” with two parallel accordion folds. NOTE: Microperforation to fall on fold. 

 For the Title II – Final Accounting workload, the Final Accounting Personalized Notice with Micro-Perforated 

Payment Stub sheets will nest behind the Final Accounting Personalized Scannable Form to create a 6-page 

form/notice. The recipient’s name and address on the Scannable Form must be visible through the window 

envelope when inserted into the mail-out envelope. Additionally, it is the contractor’s responsibility to ensure 

that the Final Accounting Personalized Notice with Micro-Perforated Payment Stub imaged with recipient’s 

name and other personal information will match with the scannable form (which contains 2-D barcodes with 

personalized data) for the same recipient. 

 Flyer: Fold from 8-1/2 x 11” flat size down to 8-1/2 x 3-2/3” for insertion into mail-out envelope. 

 Instruction Sheets: 

Representative Payee and Disability Update – Fold from 8-1/2 x 11” down to 8-1/2 x 3-2/3” for insertion into 

mail-out envelope. 

Beneficiary Recontact – Fold from 8-1/2 x 11” flat size down to 8-1/2 x 3-2/3” for insertion into mail-out 

envelope. 

Contractor to follow furnished samples for proper order of insertion of items into mail-out envelopes. 

Mailers 1, 2, 5, 6, 9, 10 (Title II English) – Each constructed mailer consists of five components: (1) a personalized 

scannable form, (2) BRM envelope, (3) an instruction sheet, (4) flyer, and (5) a mail-out envelope in which components 

1 through 4 are inserted into for mailing. Contractor to follow construction sample for proper insertion of components 1 

through 4 into component 5. 
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Mailers 3, 4, 7, 8, 11, 12 (Title II Spanish) – Each constructed mailer consists of four components: (1) a personalized 

scannable form, (2) BRM envelope, (3) an instruction sheet, and (4) a mail-out envelope in which components 1 

through 3 are inserted into for mailing. Contractor to follow construction sample for proper insertion of components 1 

through 3 into component 4. 

Mailers 13 through 18 (Title XVI) – Each constructed mailer consists of five components: (1) a personalized scannable 

form, (2) BRM envelope, (3) an instruction sheet, (4) flyer, and (5) a mail-out envelope in which components 1 through 

4 are inserted into for mailing. Contractor to follow construction sample for proper insertion of components 1 through 4 

into component 5. 

Mailers 19 through 24 (Title II-Final Accounting) – Each constructed mailer consists of six components: (1) a 

personalized scannable form, (2) a personalized notice w/micro-perforated payment stub, (3) a white BRM envelope, 

(4) a green BRM envelope, (5) an instruction sheet, and (6) a mail-out envelope in which components 1 through 5 are 

inserted into for mailing. Contractor to follow construction sample for proper insertion of components 1 through 5 into 

component 6. 

Mailers 25 through 28 (Beneficiary Recontact) – Each constructed mailer consists of four components: (1) a 

personalized scannable form, (2) CRM envelope, (3) an instruction sheet, and (4) a mail-out envelope in which 

components 1 through 3 are inserted into for mailing. Contractor to follow construction sample for proper insertion of 

components 1 through 3 into component 4. 

Mailers 29 through 36 (Title II and Title XVI) – Each constructed mailer consists of four components: (1) a 

personalized scannable form, (2) CRM envelope, (3) an instruction sheet, and (4) a mail-out envelope in which 

components 1 through 3 are inserted into for mailing. Contractor to follow construction sample for proper insertion of 

components 1 through 3 into component 4. 

Seal all mail-out envelopes. 

For all mailers, it is the contractor’s responsibility to assure that only the computer-generated address and Intelligent 

Mail barcode (IMB) on the form will be visible through the window in the mail-out envelope and that only one form is 

inserted into each envelope. 

It is the contractor’s responsibility to assure that the correct package material is inserted into the mail-out envelope. 

PACKING (WBDOC Bulk Envelope Shipment): Pack suitable in shipping containers not to exceed 40 pounds 

when fully packed. 

All shipments which fill less than a shipping container must be packaged with materials of sufficient strength and 

durability, and in such a manner that will guarantee that the envelopes will not be damaged and the package will not 

open or split when shipping. The contractor is responsible for proper packing of all items shipped. 

LABELING AND MARKING (WBDOC Bulk Envelope Shipment): Contractor to download the “Labeling and 

Marking Specifications” form (GPO Form 905, R. 7-15) from gpo.gov, fill in appropriate blanks, and attach to shipping 

containers (wood boxes or corrugated crates). 

PRODUCTION INSPECTION: Production inspection(s) may be required at the contractor’s/subcontractor’s plant 

for the purpose of establishing that the receipt of transmitted files; the printing of notices/forms, instruction sheets, 

flyer, and envelopes; the imaging, collating, folding, inserting, and mailing are being accomplished in accordance with 

contract quality attributes and requirements. 

A production inspection is for the purpose of setting specific standards that are to be maintained throughout the entire 

run. It does not constitute a prior approval of the entire run. A production inspection(s) may be required at the 

contractor’s/subcontractor’s plant before production begins on any new workload. 
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When a production inspection is required, the Government will notify the contractor. 

DISTRIBUTION: 

 Deliver f.o.b. destination (on the first order and whenever SSA makes a significant change to the language, 

format, or appearance of a form/notice) 15 complete sample mailers of each form/notice type (along with any 

required insert(s)) inserted into mail-out envelopes. (DO NOT SEAL ENVELOPES.) Samples must be 

delivered to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-B-10-F Annex Building, 6401 

Security Boulevard, Baltimore, MD 21235-6401. 

 Deliver f.o.b. destination (on the first order and whenever SSA makes a copy change to any envelope) as 

follows: 

o 10 printed samples of each envelope to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-

B-10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401 

o 10 printed samples of the seven (7) Disability Update envelopes to: Social Security Administration, Attn: 

CDR Analyst, Wilkes-Barre Direct Operations Center, Room 341, 1150 E Mountain Drive, Wilkes-Barre 

PA, 18702-7997. 

 Deliver f.o.b. destination all required quality control samples to: Social Security Administration, Attn: Melissa 

Picone, DMIM, 3-B-10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401. 

 Mail f.o.b. contractor’s city each individual mailer. (The contractor is responsible for all costs incurred in 

transporting the mailers to the U.S. Postal Service facility.) 

 Deliver f.o.b. destination the WBDOC Bulk Envelopes to: Social Security Administration, Wilkes-Barre Direct 

Operations Center, Attn: CDR Workload, Room 264, 1150 East Mountain Drive, Wilkes-Barre, PA 18702-

7997 via Small Package Common Carrier (SPCC) with Third-Party Billing (499 pounds or less) or 

Reimbursable Freight (500 pounds or more). NOTE: Wilkes-Barre, PA delivery hours are 7:00 a.m. to 3:00 

p.m. (based on local prevailing times, on normal Government workdays). 

Small Package Common Carrier – Third-Party Billing: SPCC Third-Party Billing is for the WBDOC Bulk Envelope 

Order shipment ONLY.

Packages weighing up to and including 499 pounds are to be made by SPCC except those destined for Post Office 

Boxes, APO/FPO, and United States Possessions and Territories. 

The contractor will be responsible for providing the carrier the following: 

1. All packages addressed and sorted to meet the requirements of the small package common carrier. NOTE: 

Contractor may be required to apply special SPCC Bar Code labels. 

2. Separate common carrier pickup records for each print order. The contractor must annotate the pickup records with 

the requisition number and the print order number. 

3. A shipping manifest which includes: 

(a) The name of the contractor, the requisition number, the print order number, the common carrier account/ 

shipper number. 
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(b) A listing which includes each addressee’s account number or office code (when provided on SSA supplied 

address labels), address, city, state, ZIP code, common carrier delivery zone, weight, and package identification 

number (if applicable) of each package shipped to each addressee. 

(c) The listing must be grouped by pickup, and each group must be identified with the pickup record number. This 

number must correspond to the number on the form(s) which the contractor is required to obtain from the 

carrier for compliance purposes. The listing must be in either account number or ZIP code order within each 

group. 

(d) The summary information for each group must include the total number of packages, the total weight, and the 

total shipping cost. 

The contractor will be required to ship via SPCC charging the cost to SSA’s Third-Party account number, which will be 

provided after award. 

Reimbursable Freight: A single shipment to one address weighing 500 pounds or more are to be shipped by 

reimbursable freight. The contractor will be responsible for selection of carrier and must ship by the most reasonable 

method to ensure prompt delivery and safe arrival at all destinations for shipments requiring Commercial Bills of 

Lading. 

All costs are to be billed on the contractor’s invoices at the actual cost which the contractor paid for these services. 

Shipments must be made direct to the destination(s) stated on the print order. 

Unless otherwise indicated, truck deliveries must be made at the point of destination between the hours of 8:30 a.m. and 

3:00 p.m., local prevailing time, on normal Government workdays. Shipments must be delivered as specified. 

Domestic First-Class Letter-Size Mail: The contractor is required to prepare domestic First-Class letter-size mail in 

accordance with appropriate USPS rules and regulations including the USPS Domestic Mail Manual and Postal 

Bulletins, in effect at the time of the mailing. 

When volumes warrant, SSA requires the use of Permit Imprint. The contractor must use SSA’s “Postage and Fees Paid 

First Class Mail” permit imprint mailing indicia printed on each mail piece. Each mail piece sent under this payment 

method must bear a permit imprint indicia showing that postage is paid. Permit imprint indicia may be printed directly 

on mail pieces. Permit imprint mailings must contain at least 200 pieces or 50 pounds. 

The contractor is cautioned to use the permit imprint only for mailing material produced under this contract. 

Contractors are strongly encouraged to apply for an exception in the Domestic Mail Manual section 604.5.1.2 called the 

Minimum Volume Reduction Provision (MVRP) through their local BMEU (see Exhibit L, MVRP Request Letter, for 

local BMEU). 

The MVRP provides an exception to the “200 pieces or 50 pounds” rule for Permit Imprint mailings (including 

certified and foreign mail). With the MVRP exception, contractors will be allowed to mail pieces under the 200 pieces 

or less than 50 pounds on a permit imprint eliminating metering, this includes certified and foreign mail. Mailers must 

submit USPS postal paperwork electronically, including piece level barcode information. Contractor will be required to 

contact USPS prior to any MVRP expiration date (if specified by USPS). All MVRP agreements must be current. 

This workload may contain various weight pieces. The contractor is strongly encouraged to use manifest mail when 

postal regulations allow. The contractor must have a Manifest Mailing System (MMS) for First-Class Mail, which has 

been approved by USPS to document postage charges for this mailing. Each mail piece must be identified with a unique 

identification number or with a keyline containing a unique identification number and rate information about the piece. 

Requirements for the MMS are contained in Publication 401 “USPS Guide to the Manifest Mailing System” in effect at 

the time of the mailing. 
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NOTE: A copy of the USPS approval for the MMS must be presented at the postaward conference. 

If a Government Meter Is Required: All meter equipment and supplies must be borne by the contractor. SSA will 

provide an Official Government Postage Meter head only, but will not supply the meter mail machine. SSA will fund 

the postage for meters through the USPS’ Official Mail Accounting System (OMAS). 

The contractor is responsible for the security of the Government postage meters and access is to be restricted to 

authorized personnel only. The contractor is to advise all staff that there is a penalty for the private use of official 

Government postage meters (39USC3203). 

Contractors should always maintain sufficient postage on the Government meter. The contractor should contact SSA if 

they are not sure of how much postage to load or frequency. 

The contractor is required to submit spoiled postage/postage error envelope(s)/meter strip(s) and prepare a Postal 

Service Form 3533, Application for Refund of Fees, Products and Withdraw of Customer Accounts. Forms are not 

obtainable from the United States Postal Service (USPS) website since they contain a barcode making each form 

unique. Contractors will go to local Post Offices, postal retail units, or Bulk Mailing Units to obtain the hardcopy 

version of the revised PS Form 3533. USPS will credit the postage refund to SSA through the Official Mail Accounting 

System (OMAS). SSA requires the contractor to submit a copy of Form 3533 along with the associated print order in 

which the spoilage occurred and all other postal documentation to the SSA Program Lead. 

The contractor must have approval from SSA’s Postage Meter Accountability Team for turn-in of postage meter(s) to 

the meter manufacturer (e.g., excess meter, defective meter, etc.). If the contractor requires a replacement postage 

meter, USPS credits any remaining postage to SSA through the USPS’ Official Mail Accounting System (OMAS), or 

the meter manufacturer may transfer the remaining postage from the old meter to the new meter. The contractor should 

be sure to document the last meter reading (postage remaining amount) before the meter is checked out of service. The 

contractor may receive a PS Form 3601-C, Postage Meter Activity Report from the meter manufacturer. The contractor 

is to forward a copy of this report to SSA within three (3) workdays of the transaction. 

The Government reserves the right to request the contractor to upload funds at any time. These uploads are in addition 

to any routine meter replenishments. As a result of the postage uploads, the contractor may receive a Postage Meter 

Reset Activity Report Statement from the meter manufacturer. If received, the contractor should retain this 

documentation for 12 months. 

Contractor is not to relocate any Government postage meter containing SSA postage funds to any other building. 

Contractor is required to contact the SSA Program Lead before any movement of a Government postage meter 

containing SSA postage funds. 

The contractor is required to prepare all metered mail in accordance with the rules and regulations in USPS’s Domestic 

Mail Manual and International Mail Manual. 

Contractors should not receive invoicing for meter rentals. If the contractor receives an invoice, they are to contact the 

SSA Program Lead immediately. 

Contractor Sites Using “Official Government” Postage Meters with Automated Reporting Capability (Detailed): 

Postage meters with “Detailed Account Reporting” are capable of providing detailed meter usage reports (Exhibit M). 

Contractors utilizing meters with the detailed account reporting are required to provide copies of detailed meter usage 

reports to SSA with each print order. The detailed report must be contract/print order specific. 

NOTE: If the contractor produces multiple SSA contracts, they must submit a separate detailed report for each contract 

and each print order. 
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When setting up the detail report for SSA, contractors must set up the meter to record usage via contract program 

number, mailer number, and file date. The contractor may have to utilize the account and subaccount feature in order to 

capture the contract program number, mailer number, and file date. 

Contractors utilizing detailed reporting will be required to utilize the postage meter account feature for each SSA print 

program. If a contractor requires assistance with setup and operating the “accounting” features of the postage meters, 

contractor is to contact SSA along with the meter manufacturer. 

Contractor Sites Using an SSA Postage Meter Activity Log (Manual Process): Contractors using mailing equipment 

that cannot support a postage meter with an internal accounting feature and/or is not capable of providing SSA with the 

detailed reporting will be required to complete an SSA Postage Meter Activity Log (Exhibit N). Contractors must 

submit a copy of the Postage Meter Activity Log to SSA with each print order. The Postage Meter Activity Log must be 

contract/print order specific. 

NOTE: If the contractor produces multiple SSA contracts, they must submit a separate SSA Postage Meter Activity 

Log for each contract and each print order. 

Every field must contain an entry or an N/A if the field does not apply. SSA will return incomplete or incorrect activity 

logs to the contractor for correction. 

If a primary meter fails and a backup or replacement meter is needed to complete the workload, the contractor will need 

to document the primary meter log in the note field (i.e., meter failed) and create a new activity log documenting the 

necessary fields to use with the backup or replacement meter. 

The contractor is required to obtain the maximum USPS postage discounts possible in accordance with the USPS FirstClass Domestic Mail automated and non-automated mail discount structure in effect at the time of mailing: 

(a) Automation (5-digit); (b) Automation (3-digit); (c) Automation (AADC); (d) Automation (Mixed AADC) 

(e) Non-automation (Presorted); and (f) Non-automation (Single Piece). 

Mail addressed to United States territories and possessions (e.g., American Samoa, Federated States of Micronesia, 

Guam, Marshall Islands, Northern Mariana Islands, Palau, Puerto Rico and U.S. Virgin Islands, Wake Island) and 

Military Overseas Addresses (APO/FPO mail) is Domestic Mail, not International Mail, and should be included in the 

discount sorting above. 

To maximize automation discounts, Intelligent Mail Barcode (IMB) barcoding, delivery address placement and 

envelopes used for the mailing are among the items that must comply with USPS requirements for automationcompatible mail in effect at the time of the mailing. 

Contractor will be required to produce and use a USPS Intelligent Mail Barcode (IMB) Full-Service option and achieve 

the maximum postage discounts available with this option. The contractor will be required to comply with USPS 

requirements and place the IMB on all mail pieces of this workload. The contractor is required to be capable of 

achieving the postage discounts available with the Full-Service option of the IMB program. The Full-Service option 

requires the contractor to use Postal One. 

SSA will provide the contractor with a 6-digit Mailer Identifier (MID) for the mailing. The Mailer Identifier (MID) is a 

field within the Intelligent Mail barcode that is used to identify the owner of the mail. 

USPS has instituted a verification procedure called a “tap” test. This test is used to screen all mailings with barcoded 

inserts for proper barcode spacing within the envelope window. When the insert showing through the window is moved 

to any of its limits inside the envelope, the entire barcode must remain within the barcode clear zone. In addition, a 

clear space must be maintained that is at least 0.125 (1/8) inch between the barcode and the left and right edges of the 

window and at least 0.028-inch clearance between the Intelligent Mail Barcode and the top and bottom edges of the 

window. 
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All letters in a mailing must pass the “tap” test in order to obtain the maximum postal discounts for the agency. The 

contractor will be responsible for payment of any additional postage resulting from a loss of postage discounts due to 

failure to pass the “tap” test because of inaccuracy or failure to conform to USPS specifications. 

The contractor should be aware that USPS uses the Mail Evaluation Readability Look-up Instrument (MERLIN) to 

evaluate barcodes. If MERLIN is in effect in the contractor’s geographic area, the contractor must ensure that all 

barcoded mail meets the new barcode standards. The contractor will be responsible for payment of any additional 

postage resulting from a loss of such discounts due to failure of the contractor-generated barcodes to pass the MERLIN 

test because of inaccuracy or failure to conform to USPS specifications. 

The contractor is required to fill in all applicable items on USPS form(s) and submit in duplicate to the entry post 

office. The post office will return a verified copy of USPS form(s) to the contractor. The contractor must immediately 

forward a copy to the ordering agency identifying the program number, print order number, and jacket number, as 

appropriate. 

National Change of Address (NCOA) and Coding Accuracy Support System (CASS): Addresses for this contract 

will come from SSA’s Master Beneficiary Record (MBR) and Supplemental Security Record (SSR). SSA will provide 

certificates indicating that the addresses have been matched against USPS certified Coding Accuracy Support System 

(CASS) ZIP Code software. The contractor must generate an Intelligent Mail Barcode (IMB) from the ZIP+4 data on 

SSA’s files. 

SSA will provide a certificate indicating the MBR (Title II) addresses have been processed by a licensed National 

Change of Address service vendor. New CASS and NCOA certificates will be provided to the contractor by SSA as 

required by the USPS Domestic Mail Manual. 

“ADDRESS SERVICE REQUESTED” endorsement must appear on the SSR (Title XVI) notice envelopes in one of 

the locations approved by USPS. (This endorsement must not be used on the MBR (Title II) notice envelopes). 

All versions mailed will have a printed “Postage and Fees Paid” First Class Mail permit mailing indicia. The contractor 

is cautioned that this “Postage and Fees Paid” indicia may be used only for the purpose of mailing material produced 

under this contract. 

All copies mailed must conform to the appropriate regulations in the USPS manuals for “Domestic Mail.” 

USPS Certified Mail: During the term of this contract, it is anticipated that SSA will require some of the mailers be 

sent certified or registered mail.

In the event that any of these notices are Special Notice Option (SNO), the mail pieces included in these mailings will 

be required to be mailed using USPS Certified Mail. The contractor will prepare these mail pieces according to USPS 

regulations contained in the Domestic Mail Manual (DMM) under section 503.3.0, Certified Mail. Notices associated 

with the certified mail file shall be inserted into envelopes and processed as certified mail. The contractor must place 

the current U.S. Postal Service 20-digit certified number and barcode on the envelope. The contractor must prepare the 

file as a separate permit imprint mailing of identical weight pieces using the appropriate U.S. Postal Service mailing 

statement. 

Certificate of Conformance: When using Permit Imprint Mail, the contractor must complete GPO Form 712 – 

Certificate of Conformance (Rev. 10-15), and the appropriate mailing statement(s) supplied by the USPS. A fillable 

GPO Form 712 Certificate of Conformance can be found at https://www.gpo.gov/how-to-work-with-us/vendors/formsand-standards. 
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Mailing Documentation: The contractor must provide SSA with complete copies of all documents used by USPS to 

verify and accept the mail (e.g., computer records of presort ZIP+4, barcode breakdown, press runs, etc.) including 

USPS 3607R and/or GPO’s Form 712 (Certificate of Conformance) and/or Certificate of Bulk mailing, etc. Each 

document must be noted with file date and mailer number. 

The contractor must place the number that is on top of the GPO Form 712 (the number that starts with “A”) in the 

space provided on the USPS mailing statements. If no space is provided on the mailing statement, place the number in 

the upper right margin of the mailing statement. The contractor will use SSA’s Federal Agency Cost Code 276-00020, 

which must be placed on all mailing documents. All copies must be legible and include both obverse and reverse side. 

Within 72 hours of completion of each print order, the contractor must provide PDF copies of the mail documentation, 

USPS 3607R, GPO 712, and/or Certificate of Bulk mailings along with a copy of the corresponding 100% 

Accountability Summary Reports via email to Melissa Picone at melissa.picone@ssa.gov. All copies must be legible 

and include both obverse and reverse sides. 

Furnished material, proofs, and USPS validated copies of postal documentation must be delivered (via overnight carrier 

or as PDF copies via email, as applicable) to: Social Security Administration, Attn: Melissa Picone, DMIM, 3-B-10-F 

Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401. 

Upon completion of this contract, the contractor must email a PDF file (current version) of the instruction sheets, flyer, 

and all envelopes to Melissa Picone at melissa.picone@ssa.gov. 

All expenses incidental to picking up and returning materials (as applicable), submitting and picking up proofs (as 

applicable), and furnishing sample copies must be borne by the contractor. 

Billing Documentation: Within five (5) workdays following the completion of each print order, the contractor must 

submit via email one (1) copy of the contractor’s billing invoice showing amount of billing invoice to 

melissa.picone@ssa.gov. The original invoice will be sent to the U.S. Government Publishing Office. (See 

“PAYMENT.”) 

QUALITY CONTROL SAMPLES: Each box of quality control samples should contain the samples for a particular 

print order in a separate box. The contractor must ship the quality control samples each week within two (2) workdays 

of the last mailing date of the print order. 

SCHEDULE: Adherence to this schedule must be maintained. Contractor must not start production of any job prior to 

receipt of the individual print order (GPO Form 2511). 

In the event that it becomes necessary for the contractor to deviate from the specified mail-out date or the quantity to be 

mailed, SSA must be notified immediately. 

When required, furnished material and hard copy proofs must be picked up from and delivered to: Social Security 

Administration, Attn: Melissa Picone, DMIM, 3-B-10-F Annex Building, 6401 Security Boulevard, Baltimore, MD 

21235-6401. 

If applicable, furnished manuscript/camera copy and/or electronic media must be returned with hard copy proofs. 

When ordered, contractor to email PDF proofs as instructed by SSA. 

Manuscript copy, camera copy, PDF file, or electronic media for forms, notices with micro-perforated payment stub, 

instruction sheets, flyer, and envelopes will be provided at the postaward conference or immediately following 

postaward. 
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Proof Schedule: The following schedules begin the workday after notification of availability of print order and 

furnished materials; the workday after notification will be the first workday of the schedule. 

Initial Proofs:

 When ordered, contractor to submit all required proofs for scannable forms, personalized notices with microperforated payment stub, instructions sheets, flyer, and envelopes within seven (7) workdays of receipt of 

furnished materials. 

 Proofs will be withheld no more than five (5) workdays from receipt at the ordering agency until they are made 

available for pickup for hard copy proofs or until receipt of corrections/changes/“O.K. to Print” via email for 

PDF soft proofs. (NOTE: The first workday after receipt of proofs at the ordering agency is day one (1) of the 

hold time.) 

 When required due to AAs, contractor to submit revised proofs within three (3) workdays of receipt of the 

author’s alterations. 

 Revised proofs will be withheld no more than three (3) workdays from receipt at the ordering agency until they 

are made available for pickup for hard copy proofs or until receipt of corrections/changes/“O.K. to Print” via 

email for PDF soft proofs. (NOTE: The first workday after receipt of proofs at the ordering agency is day one 

(1) of the hold time.) 

Proofing (other than initial start-up): 

 When ordered, contractor to submit all required proofs for scannable forms, personalized notices with microperforated payment stub, instructions sheets, flyer, and envelopes within five (5) workdays of receipt of 

furnished materials. 

 Proofs will be withheld no more than five (5) workdays from receipt at the ordering agency until they are made 

available for pickup for hard copy proofs or until receipt of corrections/changes/“O.K. to Print” via email for 

PDF soft proofs. (NOTE: The first workday after receipt of proofs at the ordering agency is day one (1) of the 

hold time.) 

 When required due to AAs, contractor to submit revised proofs within three (3) workdays of receipt of the 

author’s alterations. 

 Revised proofs will be withheld no more than three (3) workdays from receipt at the ordering agency until they 

are made available for pickup for hard copy proofs or until receipt of corrections/changes/“O.K. to Print” via 

email for PDF soft proofs. (NOTE: The first workday after receipt of proofs at the ordering agency is day one 

(1) of the hold time.) 

Preproduction Test Schedules:

Transmission Test:

 The contractor will be required to receive approximately 945,000 notices (Mailers 1 through 36) within one (1) 

workday. 

 The contractor will be required to perform a Record Count Verification and CASS certification within one (1) 

workday after the complete transmission of the test files. 

 SSA will verify that the counts match and notify the contractor within one (1) workday. 
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Preproduction Validation Tests: 

 Scannable Forms Validation Test – 

o Within five (5) workdays after receipt of the Government’s approval on the 36 Scannable Form proofs, the 

contractor must conduct a Scannable Forms Validation Test and furnish 3,200 printed samples (50 samples 

each of Mailers 1 through 36 Regular and Certified) for validation. 

o The Government will approve, conditionally approve, or disapprove the preproduction validation samples 

within five (5) workdays of the receipt thereof. 

 Micro-Perforated Payment Stub Validation Test – 

o Within five (5) workdays after receipt of the Government’s final approval on the six (6) Title II – Final 

Accounting Personalized Notices with Micro-Perforated Payment Stub proofs, the contractor must conduct 

a Micro-Perforated Payment Stub Validation Test and furnish 500 printed samples (50 samples each of 

Mailers 19 through 24 Regular and Certified) for validation of the alphanumeric scan line. 

o The Government will approve, conditionally approve, or disapprove the preproduction validation samples 

within five (5) workdays of the receipt thereof. 

 Construction Samples Validation Test – 

o Within five (5) workdays after the Government renders an “O.K. to Print” on all the necessary components 

including the Preproduction Validation Tests for the Scannable Forms and Title II – Final Accounting 

Notices with Micro-Perforated Payment Stub, the contractor must conduct a Construction Samples 

Validation Test and furnish 960 sample notice packages (15 samples each of Mailers 1 through 36 Regular 

and Certified) of the final completed product. 

o The Government will approve, conditionally approve, or disapprove the preproduction validation samples 

within five (5) workdays of the receipt thereof. 

Production Schedule: 

Workday - The term “workday” is defined as Monday through Friday* each week, exclusive of the days on which 

Federal Government holidays are observed. 

Federal Government Holidays are as follows: New Year’s Day, Martin Luther King’s Birthday, President’s Day, 

Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, and Christmas Day. 

*NOTE: The contractor’s FTMS software shall be operational for the receipt of data files 24 hours a day, seven (7) 

days a week, unless otherwise specified by the Government. (See “FILE TRANSFER MANAGEMENT SYSTEM 

(FTMS) REQUIREMENTS” for additional information). 

Print orders will be issued as follows: 

Representative Payee – 

Title II – between the 20th and 27th of each month 

Title XVI – on the Monday following the first Saturday of each month 

Title II – Final Accounting – on the Monday following each Sunday of each week 
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Beneficiary Recontact – between the 20th and 31st of each month 

Disability Update – 

Title II – between the 21st and 31st of January, May, and September 

Title XVI – between the 21st and 31st of January and July 

The following schedules begin the workday after receipt of print order; the workday after receipt will be the first 

workday of the schedule. 

Regular Schedule (Monthly) – 

Representative Payee Title II (Mailers 1 through 12), Title XVI (Mailers 13 through 18) and Beneficiary Recontact 

(Mailers 25 through 28) – Complete production and mailing must be made within 10 workdays after receipt of print 

order. 

Regular Schedule (Weekly) – 

Representative Payee Title II-Final Accounting (Mailers 19 through 24) – Complete production and mailing must be 

made within five (5) workdays after receipt of print order. 

Regular Schedule (Quarterly) – 

Disability Update Title II (Mailers 29 through 32), Title XVI (Mailers 33 through 36) – Complete production and 

mailing must be made within 10 workdays after receipt of print order. 

WBDOC Bulk Envelope Shipment – Complete production and distribution must be made within 30 workdays after 

receipt of print order. 

PRESS SHEET AND PRODUCTION INSPECTIONS: The contractor must notify the GPO of the date and time 

that the press sheet or production inspection can be performed. In order for proper arrangements to be made, 

notification must be given at least seven (7) workdays prior to the inspection(s). Notify the U.S. Government 

Publishing Office, Quality Control for Published Products, Washington, DC 20401 at (202) 512-0542 AND Melissa 

Picone via email at melissa.picone@ssa.gov. Telephone calls to GPO will only be accepted between the hours of 8:00 

a.m. and 2:00 p.m., prevailing Eastern Time, Monday through Friday. NOTE: See contract clauses, paragraph 14(e) (1), 

Inspections and Tests in GPO Contract Terms (GPO Publication 310.2, effective December 1, 1987 (Rev.1-18)). When 

supplies are not ready at the time specified by the contractor for inspection, the Contracting Officer may charge to the 

contractor the additional cost of the inspection. 

NOTE: If the backup facility is used for the production of these notices, the Government will require a press sheet 

inspection. Prior to production in that facility, notification must be given at least seven (7) workdays in advance of 

production start-up. 

The ship/deliver date indicated on the print order is the date products ordered for delivery f.o.b. destination must be 

delivered to the destinations specified and products ordered for mailing/shipping f.o.b. contractor’s city must be 

delivered to the post office or picked up by SPCC. 

Unscheduled material such as shipping documents, receipts or instructions, delivery lists, and labels will be furnished 

with the order or shortly thereafter. In the event such information is not received in due time, the contractor will not be 

relieved of any responsibility in meeting the shipping schedule because of failure to request such information. 
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For compliance reporting purposes, the contractor is to notify the U.S. Government Publishing Office of the date of 

shipment or delivery. Upon completion of each order, contractor must contact the Shared Support Services Compliance 

Section via email at compliance@gpo.gov. Personnel receiving the email will be unable to respond to questions of a 

technical nature or to transfer any inquiries. 
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SECTION 3. – DETERMINATION OF AWARD

The Government will determine the lowest bid by applying the prices offered in the “SCHEDULE OF PRICES” to the 

following units of production, which are the estimated requirements to produce one (1) year’s production under this 

contract. These units do not constitute, nor are they to be construed as, a guarantee of the volume of work which may be 

ordered under this contract for a like period of time. 

The following item designations correspond to those listed in the “SCHEDULE OF PRICES.”

I. (a) 125 

 (b) 23 

II. 1 

III. (a) 43 

 (b) 23 

 (c) 43 

IV. (a) 92 

 (b) 5,260 

 (c) 3,099 

 (d) 102 

 (e) 5,080 

 (f) 5,221 

 (g) 5,182 

V. (a) 5,182 

 (b) 78 

 (c) 3,099 

 (d) 102 

 (e) 5,080 

 (f) 4,454 

 (g) 767 

 (h) 5,182 

VI. 1 

VII. (a) 5,182 

 (b) 62 
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SECTION 4. – SCHEDULE OF PRICES 

Bids offered are f.o.b. contractor’s city for all mailing/shipping and f.o.b. destination to Baltimore, MD and WilkesBarre, PA. 

Bidder must make an entry in each of the spaces provided. Bids submitted with any obliteration, revision, or alteration 

of the order and manner of submitting bids may be declared nonresponsive. 

An entry of NC (No Charge) shall be entered if bidder intends to furnish individual items at no charge to the 

Government. 

Bids submitted with NB (No Bid), NA (Not Applicable), or blank spaces for an item may be declared nonresponsive. 

The Contracting Officer reserves the right to reject any offer that contains prices for individual items of production 

(whether or not such items are included in the “DETERMINATION OF AWARD”) that are inconsistent or unrealistic 

in regard to other prices in the same offer or to GPO prices for the same operation if such action would be in the best 

interest of the Government. 

All billing invoices submitted to the GPO shall be based on the most economical method of production. Fractional 

parts of 1,000 will be prorated at the per-1,000 rate. 

Contractor’s billing invoice must be itemized in accordance with the line items in the “SCHEDULE OF PRICES.” 

Cost of all required paper must be charged under Item V., “PAPER.” 

I. COMPOSITION: Prices offered must include the cost of all required materials and operations necessary for the 

complete composition of the products listed in accordance with these specifications. 

Any change in the format on any page or on any envelope will be charged under line item (a) or (b), as applicable. 

For line item I.(a), a charge will be allowed for each 8-1/2 x 11” page. 

(a) Scannable Forms, Notices with Micro-Perforated Payment Stub, 

 Instruction Sheets, and Flyer ...........................................................per 8-1/2 x 11” page ..... $___________ 

(b) Envelopes ................................................................................................... per envelope ...... $___________ 

II. TRANSMISSION TEST: Price offered must include all costs incurred in performing the Transmission Test as 

specified in these specifications. These costs shall cover but are not limited to: machine time, personnel, all 

required materials, transmissions, electronic prepress, plates, paper, printing, imaging, collating, inserting, mail 

preparation, and any other operations necessary to produce the required quantities of the product in the time 

specified and in accordance with specifications. 

Transmission Test ................................................................................................... per test ...... $___________ 

 ______________ 

(Initials) 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 70 of 72 

494-S (06/22) 

III. PROOFS: For line item III.(a), a charge will be allowed for each 8-1/2 x 11” page. 

(a) Scannable Forms, Notices with Micro-Perforated Payment Stub, 

Instruction Sheets, and Flyer ...........................................................per 8-1/2 x 11” page ..... $___________ 

(b) Envelopes ................................................................................................... per envelope ...... $___________ 

(c) PDF Soft Proof ............................................................................................. per product ...... $___________ 

IV. PRINTING, IMAGING, BINDING, AND CONSTRUCTION: Prices offered must be all-inclusive for 

printing, imaging, binding, and construction as required, and must include the cost of all required materials 

(excluding paper) and operations necessary for the complete production of the products listed in accordance with 

these specifications. 

 (a) *Makeready/setup charge ...................................................................................................... $___________ 

*Contractor will be allowed only one (1) makeready/setup charge per order. This combined charge shall include all 

materials and operations necessary to makeready and/or setup the contractor’s equipment for that run. Invoices 

submitted with more than one makeready/setup charge per order will be disallowed. 

(b) Scannable Forms and Notices with 

Micro-Perforated Payment Stub (8-1/2 x 11”) ...................................... per 1,000 leaves ...... $___________ 

 (c) Flyer (8-1/2 x 11”) ................................................................................. per 1,000 flyers ...... $___________ 

 (d) Instruction Sheets (8-1/2 x 11”) ........................................... per 1,000 instruction sheets ...... $___________ 

 (e) Instruction Sheets (17 x 11” flat) ......................................... per 1,000 instruction sheets ...... $___________ 

 (f) BRM and CRM Return Envelopes (4 x 8-7/8”) .............................. per 1,000 envelopes ...... $___________ 

 (g) Mail-out Envelope with Window (4-1/4 x 9-1/2”) .......................... per 1,000 envelopes ...... $___________ 

V. PAPER: Payment for all paper supplied by the contractor under the terms of these specifications, as ordered on the 

individual print order, will be based on the net number of leaves furnished for the product(s) ordered. The cost of 

any paper required for makeready or running spoilage must be included in the prices offered. 

 Computation of the net number of leaves will be based on the following: 

 Scannable Forms (8-1/2 x 11”) - A charge will be allowed for each page-size leaf. 

 Notices with Micro-Perforated Payment Stub (8-1/2 x 11”) - A charge will be allowed for each page-size leaf. 

 Flyer and Instruction Sheets (8-1/2 x 11”) - A charge will be allowed for each page-size leaf. 

 Instruction Sheets (17 x 11”) - A charge will be allowed for each page-size leaf. 

 ALL Envelopes - One leaf will be allowed for each envelope. 

 ______________ 

(Initials) 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 71 of 72 

494-S (06/22) 

Per 1,000 Leaves 

 (a) Scannable Forms: White OCR Bond (20-lb.) ........................................................................ $___________ 

 (b) Notices with Micro-Perforated Payment Stub: White Uncoated Text (50-lb.) ....................... $___________ 

 (c) Flyer: White Writing (20-lb.) ................................................................................................. $___________ 

 (d) Instruction Sheets (8-1/2 x 11”): White Uncoated Text (50-lb.) ............................................ $___________ 

 (e) Instruction Sheets (17 x 11” flat): White Uncoated Text (50-lb.) .......................................... $___________ 

 (f) BRM and CRM Return Envelope: White Writing Envelope (20-lb.) .................................... $___________ 

 (g) BRM Return Envelope: Colored Writing Envelope (20-lb.) ................................................. $___________ 

(i) Mail-out Envelope with Window: White Writing Envelope (24-lb.); 

or, at contractor’s option, White Uncoated Text (60-lb.) ....................................................... $___________ 

VI. ADDITIONAL OPERATIONS:

 Destruction of Stocked Items ...................................................................... per 1,000 pieces ...... $___________ 

VII. GATHERING, INSERTING, PACKING, AND MAILING: Prices offered must include the cost of all 

required materials and operations necessary for the mailing of the notice(s) (including cost of collating (single or 

multiple leaves) in proper sequence and folding to required size in accordance with these specifications; insertion 

of all appropriate items, as required, into mail-out envelope); the packing and shipping of the WBDOC envelopes 

(including the cost of packing; all necessary wrapping and packing materials; labeling and marking); and, the 

distribution in accordance with these specifications. 

 (a) Mailers .................................................................................................per 1,000 mailers ...... $___________ 

(b) WBDOC Bulk Envelopes: 

Packing and sealing shipping containers.................................................... per container ...... $___________ 

 ______________ 

(Initials) 
Representative Payee, Beneficiary Recontact, and Disability Update Reports Page 72 of 72 

494-S (06/22) 

SHIPMENTS: Shipments will be made from: City ________________________ State ____________________.

The city(ies) indicated above will be used for evaluation of transportation charges when shipment f.o.b. contractor’s 

city is specified. If no shipping point is indicated above, it will be deemed that the bidder has selected the city and state 

shown below in the address block, and the bid will be evaluated and the contract awarded on that basis. If shipment is 

not made from evaluation point, the contractor will be responsible for any additional shipping costs incurred. 

DISCOUNTS: Discounts are offered for payment as follows: ___________ Percent ___________ Calendar Days. See 

Article 12 “Discounts” of Solicitations Provisions in GPO Contract Terms (Publication 310.2). 

AMENDMENT(S): Bidder hereby acknowledges amendment(s) number(ed) ____________________________. 

BID ACCEPTANCE PERIOD: In compliance with the above, the undersigned agree, if this bid is accepted within 

____________ calendar days (60 calendar days unless a different period is inserted by the bidder) from the date for 

receipt of bids, to furnish the specified items at the price set opposite each item, delivered at the designated point(s), in 

exact accordance with specifications. NOTE: Failure to provide a 60-day bid acceptance period may result in 

expiration of the bid prior to award. 

BIDDER’S NAME AND SIGNATURE: Unless specific written exception is taken, the bidder, by signing and 

submitting a bid, agrees with and accepts responsibility for all certifications and representations as required by the 

solicitation and GPO Contract Terms – Publication 310.2. When responding by email, fill out and return one copy of all 

pages in “SECTION 4. – SCHEDULE OF PRICES,” including initialing/signing where indicated. Valid electronic 

signatures will be accepted in accordance with the Uniform Electronic Transactions Act, §2. Electronic signatures must 

be verifiable of the person authorized by the company to sign bids. Failure to sign the signature block below may 

result in the bid being declared non-responsive. 

Bidder _____________________________________________________________________________________ 

 (Contractor’s Name) (GPO Contractor’s Code) 

___________________________________________________________________________________________ 

 (Street Address) 

___________________________________________________________________________________________ 

 (City – State – Zip Code) 

By _________________________________________________________________________________________ 

 (Signature and Title of Person Authorized to Sign this Bid) (Date) 

 ___________________________________________________________________________________________ 

(Printed Name) (Telephone Number) 

___________________________________________________________________________________________ 

(Email) (Fax Number) 

___________________________________________________________________________________________ 

THIS SECTION FOR GPO USE ONLY 

Certified by: __________ Date: __________ Contracting Officer: __________ Date: __________ 

(Initials) (Initials) 

_____________________________________________________________________________________________
EXHIBIT A
Page 1

 

CONTRACTOR PERSONNEL SECURITY CERTIFICATION

 

Purpose: This form is used for contractor personnel to certify that they understand SSA's security and 

confidentiality requirements.

 

I understand the SSA security and confidentiality requirements and agree that:

 

1. I will follow all SSA rules of conduct and security policy/privacy rules/regulations. 

 

2. I agree not to construct and maintain, for a period of time longer than required by the contract, any file 

containing SSA data unless explicitly agreed to by SSA in writing as part of the task documentation. 

 

3. I agree to safeguard SSA information, whether electronic or hardcopy, in secured and locked containers 

during transportation. 

 

4. I will use all computer software according to Federal copyright laws and licensing agreements.

 

5. I agree to keep confidential any third-party proprietary information which may be entrusted to me as part of 

the contract. 

 

6. I will comply with systems security requirements contained in the SSA Systems Security Handbook. 

 

7. I will not release or disclose any information subject to the Privacy Act of 1974, the Tax Return Act of 1976, 

SSA Regulation 1 and section 1106 of the Social Security Act to any unauthorized person. 

 

8. I understand that disclosure of any information to parties not authorized by SSA may lead to criminal 

prosecution under Federal law. 

 

 

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Form SSA-301 (2-98) 
Page 3

 

 

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_______________________________________________________________________ 

Form SSA-301 (2-98) 
Resource Page: SSA External Service Provider Security Guidance Page 1

EXHIBIT B

SSA External Service Provider Additional Security Requirements

DSPP Home

All External Service Providers (ESP) are subject to the following security requirements:

 All ESPs are subjected to SSA’s Security Authorization Process, which will entail security testing and

evaluation of the in-place security controls. For more information, see NIST SP 800-37, Revision 2 - Risk

Management Framework for Information Systems and Organizations - A System Life Cycle Approach for

Security and Privacy, December 2018.  ESPs must follow NIST SP 800-53 Revision 4 Recommended Security Controls for Federal Information

Systems and Organizations for protecting Low or Moderate impact level information as categorized by FIPS

199 for the information system. Note: Systems that contain Personally Identifiable Information (PII) are

considered “Moderate”.

 ESPs must document all deployed (applicable) and planned controls for an information system in a System

Security Plan that is in NIST-compliant format. SSA will provide the SSP template to be completed.

 ESPs classified as Cloud Service Providers (CSP) must adhere to additional FedRAMP security control

requirements. Further information may be found at: http://www.gsa.gov/portal/category/102371. As

part of these requirements, CSPs must have a security control assessment performed by a Third Party

Assessment Organization (3PAO).

 Upon request from SSA, the ESP shall provide the following network security information and

documentation for review and audit purposes:  All information security control artifacts required to support the Security Assessment and

Authorization (SA&A) process.  Intrusion Detection Systems (IDS) configuration.  Network firewall configuration.  Server and network device patching schedules and compliance.  Server, network device, and security logs.  Detailed hardware inventory including servers, network devices, and storage.

ESPs are required to adhere to NIST 800-53 Rev 4 security control framework based on their assigned categorization.

The following sections outline additional security controls and SSA organizational defined parameters for NIST 800- 53, Rev 4. Security requirements below are applicable to low and moderately categorized systems unless otherwise

designated. For additional information or supplement guidance for these controls, refer to Appendix F - SECURITY

CONTROL CATALOG in NIST 800-53, Rev 4.
Resource Page: SSA External Service Provider Security Guidance Page 2

Account Management Requirements

The purpose of the following is to address requirements for account and session management for External Service

Providers (ESPs). SSA Additional Requirements for ESPs:

 AC-2 - ESPs must employ individual account types on external service provider systems. The use of group,

anonymous or temporary accounts is strictly prohibited.

 AC-2 - ESPs must demonstrate the implementation of an approval process that describes how system

accounts are created, deleted, disabled, or modified. The process should account for roles in the system

and the appropriate authorizations to grant access. Public-facing systems may use a registration process in

place of the approval process.

 AC-2(3) - A deactivation process is required to manage inactive accounts. The process must describe how

the system identifies and deactivates inactive accounts that have not been in use for 90 days or more. ESPs

must automatically disable inactive accounts after 90 days and then remove these disabled accounts after

1 year.

 AC-2(4) - ESPs must provide the capability to produce a record of all account management activities that

occur on the system and develop an automated method to submit these records in the form of a report to

SSA.

 AC-6 - ESP administrator accounts and privileged user accounts must be customized to only allow access to

specific roles and functions on the system. ESP must provide a list of these functions to the Contract Officer

Technical Representative (COTR). (Moderate and High categorized systems only).

 AC-7 - ESPs must enforce a limit of 3 consecutive invalid login attempts by a user during a 20-minute period

and automatically lock the account/node for 30 minutes when the maximum number of unsuccessful

attempts is exceeded. The account shall remain locked for 30 minutes. (Moderate and High categorized

systems only).

 AC-8 - ESPs providing services to SSA internal users must display the internally used and approved warning

banner.

 The SSA internal banner is as follows:  Only authorized users can access the system.  The system is a U.S. Government computer system subject to Federal law.  Unauthorized attempts to access or modify any part of SSA’s systems are prohibited and

subject to disciplinary, civil action or criminal prosecution.

If the system is serving the public as its user base, the system must display a warning banner containing

language that is appropriate to the application. The SSA COTR must approve the public warning banner

language prior to implementation.

 AC-11 - ESPs must enforce termination of user sessions after 30 minutes of inactivity. Users must

authenticate again after sessions are terminated in order to continue using the application. (Moderate and

High categorized systems only).

 AC-17(4) - ESPs must restrict remote access to approved administrative functions and accounts.
Resource Page: SSA External Service Provider Security Guidance Page 3

Awareness and Training Requirements

The purpose of the following is to address requirements for awareness and training for External Service Providers

(ESPs).

SSA Additional Requirements for ESPs:

 AT-2 - ESP contractors and their employees or sub-contractors must complete SSA provided security

awareness training at least annually.

 AT-3 - ESPs must provide role-based training to all employees who fulfill special roles or duties in regards

to SSA data or systems.

 AT-4 - ESPs must retain and produce records of role based training completions for 3 years.

Auditing Requirements

The purpose of the following is to address requirements for auditing for External Service Providers (ESPs).

SSA Additional Requirements for ESPs:

 AU-2 - ESPs must maintain an audit log of transactions create, modify, or delete SSA information.

 AU-2 - ESPs must maintain an audit log of the following events: Logon/logoff events, account management,

privilege or role changes, and administrator activity.  AU-5 - ESPs must report any failure of audit processing that occurs to the SSA COTR within 24 hours.

 AU-6 - ESPs must review and analyze information system audit record for indications of inappropriate or

unusual activity and report those findings to SSA COTR within 24 hours. ESPs must support monitoring and

review of the system for unusual or inappropriate activity daily. This activity must be provided to the COTR

immediately for review.

 AU-6 - ESPs must provide user and transaction log reports to SSA when requested.  AU-7(1) - ESPs must allow for scoping of audit criteria for efficient reporting capability.

 AU-11 - ESPs must retain online audit logs for 90 days.  AU-11 - ESPs must retain audit records for seven (7) years.

Security Assessments and Authorization Requirements

The purpose of the following is to address requirements for security assessments and authorization for External

Service Providers (ESPs).

SSA Additional Requirements for ESPs:

 CA-2 - ESPs must develop an assessment plan that includes:

o Annual assessment of a subset of controls
Resource Page: SSA External Service Provider Security Guidance Page 4

o Triennial comprehensive assessment (full scope)

o Assessments as needed when a significant change occurs on the system.

 CA-2 - ESP and COTR must define what a significant change is and require a new assessment whenever a

significant change occurs. Significant change is defined in NIST Special Publication 800-37 Revision 1,

Appendix F.

 CA-3 - The contractor shall document in the SSA security plan, all connections to contractor resources made

to external information systems, and applications. Examples of connections would include: connections to

subcontractor sites, connections used for remote administration, connections made to contractor’s

company/corporate networks, etc. These connections shall be reviewed and monitored on an ongoing

basis, at least annually to determine the need for ongoing use by the contractor management. (Moderately

categorized systems only).

 CA-5 - For any security reports issued to the contractor, including internal independent reviews, the

contractor is responsible for developing a POA&M that identifies corrective actions and/or mitigating

controls for any identified vulnerabilities. Contractors shall report to COTR POA&M progress at least

monthly. In addition, the contractor must provide artifacts to update POA&M items at least 7 days prior to

milestone completion date to ensure SSA has sufficient time to review.

 CA-7 - ESP must monitoring the effectiveness of its security controls on a continual basis and take

appropriate corrective actions as necessary to ensure SSA data is protected from unauthorized access,

modification or disclosure.

Configuration Management Requirements

The purpose of the following is to address requirements for configuration management for External Service

Providers.

SSA Additional Requirements for ESPs:

 CM-2(3) - ESPs must define and deploy an approved device configuration on each device used to provide

services to SSA at least annually.  CM-6 - ESPs must periodically scan the device configuration of each device used to provide services to SSA

and identify deviations from the approved device configuration. Deviations shall be logged and corrected

within 24 hours. The ESP shall submit device scan reports to SSA upon request.

 CM-8 - ESPs must maintain an inventory all IT assets that store, process, or transmit SSA data and provide

to SSA upon request.  CM-9 - The contractor shall maintain a configuration management plan that addresses the roles,

responsibilities, processes, and procedures to manage inventory throughout the lifecycle.

Contingency Planning Requirements

The purpose of the following is to address requirements for contingency planning for External Service Providers.

SSA Additional Requirements for ESPs:
Resource Page: SSA External Service Provider Security Guidance Page 5

 CP-2 - ESP must submit a contingency plan that will support and meet the SSA supplied recovery objectives

and must be maintained, reviewed and, if necessary updated at least annually.

 CP-9 - ESPs must encrypt all Media used for backup and archiving purposes using Federal Information

Processing Standard (FIPS) 140-2 compliant solutions. (Moderate and High categorized systems only).

Identification and Authentication Requirements

The purpose of the following is to address requirements for identification and authentication for External Service

Providers (ESPs).

SSA Additional Requirements for ESPs:

 IA-2(12) - Identity, Authorization and Access Management (IdAAM) - The External Service Providers must

seamlessly integrate with the SSA’s Federation Service. This service is based on oAuth and SAML (Security

Assertion Markup Language) 2.0 standards and enables SSA to meet its two factor authentication

requirements as specified in Homeland Security Presidential Directive (HSPD)-12, dated August 12, 2004.

This service enables SSA to leverage an internal Microsoft’s Active Directory to create a single SSA-Wide

directory of all users. Currently, SSA users are required to authenticate using their SSA HSPD-12 PIV Smart

Card at the workstation. In certain acceptable instances, users can revert to user name and password, while

the Department is transitioning to HSPD-12 PIV Smart Card Authentication. The External Service Providers

must support both authentications methods.

 IA-6 - ESPs must mask all fields on a system that has a logon screen that requires credentials, to prevent

unauthorized exposure.

 IA-7 - The ESP must encrypt credentials used for e-authentication. The encryption solution must be

compliant with FIPS 140-2. (Moderate and High categorized systems only).

Incident Response Requirements

The purpose of the following is to address requirements for incident response for External Service Providers.

SSA Additional Requirements for ESPs:

 IR-6 - ESPs will receive the incident response capability timeframe and reporting requirements from the SSA

COTR.  IR-6 - ESPs Incident Response plan must require all security incidents of US CERT categories 1,2,3,4 and 6

must be reported to SSA COTR.  IR-7 - ESPs are responsible for notifying the appropriate SSA COTR when there is a security incident that has

been categorized 1,2,3,4 or 6 per US CERT regulations. The COTR is authorized to issue orders to take down

external systems or components to perform IR, forensics, further loss of data, etc.

Maintenance Requirements

The purpose of the following is to address requirements for maintenance for External Service Providers.
Resource Page: SSA External Service Provider Security Guidance Page 6

SSA Additional Requirements for ESPs:

 MA-2 - ESP must retain records of maintenance activities performed on IT devices used to provide services

to SSA. Maintenance activity logs must be made available upon request.

 MA-2 - IT equipment and media used to provide services to SSA must be sanitized prior to removal from

the ESP’s facility for maintenance or disposal purposes. The ESP must maintain a log as evidence that the

IT equipment or media was sanitized prior to removal. Logs must be made available upon request. Refer

to NIST SP 800-88 for more information on media sanitization.

Media Protection Requirements

The purpose of the following is to address requirements for media protection for External Service Providers.

SSA Additional Requirements for ESPs:

 MP-2 - Removable media used to store SSA data must be encrypted using a FIPS 140-2 compliant encryption

solution.

 MP-3 - ESP must label or mark (human readable) all media containing PII or other sensitive SSA data as “SSA

Confidential Unclassified Information”. (Moderate and High categorized systems only).

 MP-4 - ESP must have a documented process describing how IT equipment and media are controlled to

ensure the security and confidentiality of SSA data.

 MP-5 - ESP must maintain chain of custody for IT equipment and media during transport outside of

controlled-access facilities. Authorized personnel must perform transport of media outside of controlled

areas.

Planning Requirements

The purpose of the following is to address requirements for the planning for External Service Providers (ESPs).

SSA Additional Requirements for ESPs:

 PL-2 - ESP must develop a System Security Plan (SSP) compliant with NIST SP 800-18. The SSP shall be

submitted to the SSA COTR.  PL-2 - ESP must conduct an annual security review of the solution used to provide services to SSA. The

System Security Plan (SSP) must be updated to reflect changes affecting the security of SSA data.

 PL-4 - The SSA COTR will provide the SSA Rules of Behavior (within the SSA Information System Security

Handbook) for ESP systems that support internal users providing services to SSA. The rules of behavior

ensure users are familiar with information security, privacy, and confidentiality practices.

Personnel Security Requirements

The purpose of the following is to address requirements for personnel security for External Service Providers.

SSA Additional Requirements for ESPs:
Resource Page: SSA External Service Provider Security Guidance Page 7

 PS-4 - ESP must terminate employee and sub-contractor access to the solution used to provide services to

SSA immediately upon reassignment or separation.

 PS-6 - ESP personnel who are granted access to IT equipment, media or data used to provide services to

SSA must agree and sign a non-disclosure agreement prohibiting unauthorized disclosure of SSA data

encountered in the performance of their duties.

 PS-7 - ESP sub-contractors are bound to the same security requirements as employees.

 PS-8 - ESP must inform the SSA project officer of any violation of security requirements within 24 hours.

Risk Assessment Requirements

The purpose of the following is to address requirements for risk assessment for External Service Providers (ESPs).

SSA Additional Requirements for ESPs:

 RA-3 - ESPs shall conduct a risk assessment to assess the risk and magnitude of harm that could result from

the unauthorized access, use, disclosure, disruption, modification, or destruction of sensitive SSA

information. The risk assessment should be reviewed annually and updated every three years or when a

significant change occurs.

 RA-5 - ESP must scan IT equipment used to provide services to SSA for security vulnerabilities at least

monthly. The contractor must use a commercially available scanning tool. The scanning must include

vulnerabilities identified in DHS national vulnerability database. Vulnerability scan reports must be retained

for 12 months and submitted to the SSA COTR upon request.

System and Communication Requirements

The purpose of the following is to address requirements for system and communications for External Service

Providers (ESPs).

SSA Additional Requirements for ESPs:

 SC-4 - ESP must logically or physically segregate SSA data from that of other customer if a multi-tenant

environment is used to provide services to SSA. (Moderate and High categorized systems only).

 SC-7(1) - ESPs shall physically allocate publicly accessible information system components to separate

subnetworks with separate physical network interfaces.

 SC-7(4) - ESPs must provide traffic flow policy for each managed interface to SSA COTR for review and

approval prior to implementation.

 SC-8 - ESP must encrypt PII and other sensitive SSA data when stored on persistent storage devices, or when

transmitted over approved system interconnections, using a FIPS 140-2 compliant encryption solution

(Moderate and High categorized systems only).

 SC-10 - ESPs must terminate user sessions automatically after 15 minutes of inactivity. (Moderate and High

categorized systems only).

 SC-15 - ESPs use of collaborative computing devices (e.g., networked whiteboards, cameras, and

microphones) on systems hosting /processing/ shall have their remote activation capability

removed/disabled.
Resource Page: SSA External Service Provider Security Guidance Page 8

 SC-17 - For all ESPs, who manage information systems, the information system shall utilize automated

mechanisms with supporting procedures in place for digital certificate generation, installation, and

distribution. Subscriber key pairs are generated and stored using FIPS 140-2 Security Level 2 or higher

cryptographic modules. The same public/private key pair is not to be used for both encryption and digital

signature. Private keys are protected using, at a minimum, a strong password. A certificate is revoked if the

associated private key is compromised; management requests revocation; or the certificate is no longer

needed. (Moderate and High categorized systems only).

 SC-18 - Mobile code is software that is executed from a host machine to run scripts on a client machine,

including animation scripts, movies, etc. Mobile code is a powerful computing tool that can introduce risks

to the user’s information system. Whenever an ESP is developing or deploying the mobile code technology,

this shall be identified in the ESP’s security plan to SSA. Contractors, who use mobile code, shall be subject

to a source code review by SSA personnel to ensure that there is no potential risk in introducing malicious

code into the contractor/user’s environment. (Moderate and High categorized systems only).

System and Information Integrity Requirements

The purpose of the following is to address requirements for system and information integrity for External Service

Providers.

SSA Additional Requirements for ESPs:

 S1-2 - ESPs will remediate discovered flaws in the information system according to a process that is

approved by the COTR.  SI-3 - ESP must submit alerts on malicious code detection and actions performed on malicious code to the

SSA COTR for review.

 SI-4 - The ESP shall employ tools and techniques to monitor events on the information system to detect

attacks, vulnerabilities, and detect, deter, and report on unauthorized use of the information system.

Whenever there is an elevated security level, the monitoring efforts shall be increased as necessary to

enable deterrence, detection, and reporting to take place so that corrective actions shall be made to the

networked environment.

 SI-5 - ESPs must receive advisories (from US CERT) on a regular basis and take appropriate actions as

necessary.

 SI-11 - The information system shall identify security relevant error conditions and handle error conditions

in an expeditious manner. (Moderate and High categorized systems only).
EXHIBIT C
UNCLASSIFIED // FOR OFFICIAL USE ONLY 

UNCLASSIFIED // FOR OFFICIAL USE ONLY 

TEMPLATE VERSION (V1.3 FY17) - REMOVE BEFORE PUBLISHING

Security Assessment Report 

Social Security Administration 

(SSA) 

<System Name> (<Acronym>)

Security Categorization: <Enter Categorization>

<DRAFT/FINAL> Version <x.x>

<Month DD, YYYY>

Prepared by 

8229 Boone Blvd., Suite 750 

Vienna, VA 22182 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY ii 

<INSTRUCTIONS: Orange, bracketed text indicates instructions on how a section should be completed or 

sample text, which should be replaced with project specific information or removed. Ensure sample text is 

turned from orange to black where necessary (e.g., headings shall be changed to the standard heading 

color), and all instructions are removed (including this paragraph). Remove the template ID (e.g., TMP V1.3 

FY17) from the footer before publishing. All black text shall remain unchanged.> 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iii 

Assessment Summary 

This document describes the Federal Information Security Modernization Act (FISMA) Security Assessment

Report (SAR) for Social Security Administration (SSA). The primary purpose of this document is to deliver

the independent security assessment findings for <System Name> (hereafter known as <System 

Acronym>). These findings will lead to the initiation of corrective actions or for making risk-based 

decisions. This independent security assessment supports the U.S. Government’s mandate that all 

U.S. Federal information systems comply with FISMA of 2014. 

The assessment took place between <MM DD, YYYY> and <MM DD, YYYY>. The independent 

security assessment followed the approved the Security Assessment Plan (SAP). All deviations from the 

approved SAP are located in Table 7. 

The table below represents the aggregate risk identified from the independent security assessment. 

Table 1: Executive Summary of Risks 

 NOTE: Total is the sum of high, moderate, and low risks with operationally required 

risks being represented as a subset of this total. 

Risk Category Total % of Total Risks 

High <# high risks> <% of total risks> 

Moderate <# moderate risks> <% of total risks> 

Low <# low risks> <% of total risks> 

Total Risks <Sum of all H, M, L 

risks> 

100% 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iv 

Document Revision History 

Version Date Description Author 

1.0 <10/02/2015> Initial release Coalfire 

<1.1> <10/26/2015> <Final template updates FY17> Coalfire 

<1.2> <10/24/2017> <Template updates for FY17> Coalfire 

 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY v 

Table of Contents 

1 INTRODUCTION ....................................................................................................................... 1

1.1 Applicable Laws and Regulations ............................................................................................... 1

1.2 Applicable Standards and Guidance ........................................................................................... 1

1.3 Purpose ....................................................................................................................................... 2

2 SCOPE ................................................................................................................................... 3

2.1 Applicable Security Controls ....................................................................................................... 3

2.2 System Name/Title ...................................................................................................................... 3

2.3 Assessment Documentation ....................................................................................................... 4

2.4 Location of Components Tested ................................................................................................. 4

2.5 Subsystems, Users and Interfaces ............................................................................................. 4

2.6 Assessment Inventory ................................................................................................................. 5

3 SYSTEM OVERVIEW ................................................................................................................ 6

3.1 Security Categorization ............................................................................................................... 6

3.2 System Description and Purpose ................................................................................................ 6

4 ASSESSMENT METHODOLOGY ................................................................................................. 7

4.1 Perform Tests .............................................................................................................................. 7

4.1.1 Assessment Deviations ............................................................................................................. 7

4.2 Identification of Vulnerabilities ..................................................................................................... 7

4.3 Consideration of Threats ............................................................................................................. 8

4.4 Perform Risk Analysis ............................................................................................................... 14

5 SECURITY ASSESSMENT RESULTS ........................................................................................ 16

5.1 Security Assessment Summary ................................................................................................ 17

6 NON-CONFORMING CONTROLS .............................................................................................. 18

6.1 Risks Corrected During Testing ................................................................................................ 18

6.2 Risks with Mitigating Factors ..................................................................................................... 18

6.3 Risks Remaining Due to Operational Requirements ................................................................ 18

7 RISKS KNOWN FOR INTERCONNECTED SYSTEMS ................................................................... 20

8 RECOMMENDATIONS ............................................................................................................. 20

APPENDIX A. ACRONYMS AND TERMS ...................................................................................... 21

APPENDIX B. SECURITY RISK TRACEABILITY MATRIX (SRTM) .................................................. 24

APPENDIX C. INFRASTRUCTURE SCAN RESULTS ....................................................................... 25

Infrastructure Scans: Inventory of Items Scanned .............................................................................. 25

Infrastructure Scans: Raw Scan Results ............................................................................................ 25

Infrastructure Scans: False Positive Reports ...................................................................................... 25

APPENDIX D. DATABASE SCAN RESULTS ................................................................................. 26

Database Scans: Inventory of Databases Scanned ........................................................................... 26

Database Scans: False Positive Reports ........................................................................................... 26

APPENDIX E. WEB APPLICATION SCAN RESULTS...................................................................... 27

Web Application Scans: Inventory of Web Applications Scanned ...................................................... 27

Web Application Scans: False Positive Reports ................................................................................. 27

APPENDIX F. ASSESSMENT RESULTS ....................................................................................... 28
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY vi 

APPENDIX G. PENETRATION TEST REPORT ............................................................................... 29

APPENDIX H. SECURITY ASSESSMENT REPORT SIGNATURE ...................................................... 30

 

List of Tables 

Table 1: Executive Summary of Risks .......................................................................................................... iii

Table 2: Identified Security Controls Assessed ............................................................................................ 3

Table 3: Information System Name and Title ................................................................................................ 3

Table 4: Location of Components ................................................................................................................. 4

Table 5: Users and Interfaces ....................................................................................................................... 5

Table 6: Hardware and Software Inventory .................................................................................................. 5

Table 7: List of Assessment Deviations ........................................................................................................ 7

Table 8: Threat Categories and Type Identifiers........................................................................................... 8

Table 9: Potential Threats ............................................................................................................................. 9

Table 10: Likelihood Definitions from NIST 800-30 Rev. 1 Publication ....................................................... 14

Table 11: Impact Definitions from NIST 800-30 Rev. 1 Publication ............................................................. 14

Table 12: Risk Exposure Ratings from NIST 800-30 Rev. 1 Publication .................................................... 15

Table 13: Risk Exposure ............................................................................................................................. 18

Table 14: Summary of Risks Corrected During Testing ............................................................................. 18

Table 15: Summary of Risks with Mitigating Factors .................................................................................. 18

Table 16: Summary of Risks Remaining Due to Operational Factors ........................................................ 19

Table 17: Risks from Interconnected Systems ........................................................................................... 20

Table 18: Acronyms and Terms .................................................................................................................. 21

Table 19: Security Test Procedure Workbook ............................................................................................ 24

Table 20: Inventory of Items Scanned ........................................................................................................ 25

Table 21: Raw Scan Results ....................................................................................................................... 25

Table 22: Infrastructure Scans: False Positive Reports .............................................................................. 25

Table 23: Inventory of Databases Scanned ................................................................................................ 26

Table 24: Database Scans: False Positive Reports ................................................................................... 26

Table 25: Inventory of Web Applications Scanned ..................................................................................... 27

Table 26: Web Application Scans: False Positive Reports ......................................................................... 27

Table 27: Summary of System Security Risks from FISMA Testing ........................................................... 28

Table 28: SAR Signatures ........................................................................................................................... 30
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 1 

1 Introduction 

This SAR document for <System Acronym> is required by the National Institute of Standards and 

Technology (NIST) 800-53 Revision 4 (Rev 4) document. This SAR contains unbiased and factual 

security findings by an independent security assessment team. This SAR contains the <System Acronym>

system specific security controls tested as per the Security Assessment Plan (SAP) approved by SSA Office 

of Information Security (OIS), the <System Acronym> Security Authorization Manager (SAM), and the 

Coalfire (formally Veris Group) Project Manager (PM). The implementation status of these controls identify 

the residual risk (risk remaining after controls have been implemented). These controls are required per 

NIST 800-53 Rev. 4 to address known information system vulnerabilities. The results are in support of SSA 

Security Authorization program goals, efforts, and activities necessary to achieve compliance with FISMA 

security requirements. 

1.1 Applicable Laws and Regulations 

• Computer Fraud and Abuse Act [Public Law (PL) 99-474, 18 U.S. Code (USC) 1030] 

• E-Authentication Guidance for Federal Agencies [Office of Management and Budget (OMB) M-04-

04] 

• FISMA of 2014 [PL 113-283] 

• Freedom of Information Act (FOIA) As Amended in 2002 [PL 104-232, 5 USC 552] 

• Guidance on Inter-Agency Sharing of Personal Data – Protecting Personal Privacy [OMB M-01-05] 

• Homeland Security Presidential Directive(HSPD)-7, Critical Infrastructure Identification, 

Prioritization and Protection [HSPD-7] 

• Internal Control Systems [OMB Circular A-123] 

• Management of Federal Information Resources [OMB Circular A-130] 

• Management’s Responsibility for Internal Control [OMB Circular A-123, Revised 12/21/2004] 

• Privacy Act of 1974 as amended [5 USC 552a] 

• Protection of Sensitive Agency Information [OMB M-06-16] 

• Records Management by Federal Agencies [44 USC 31] 

• Responsibilities for the Maintenance of Records About Individuals by Federal Agencies [OMB 

Circular A-108, as amended] 

• Security of Federal Automated Information Systems [OMB Circular A-130, Appendix III] 

1.2 Applicable Standards and Guidance 

• A NIST Definition of Cloud Computing [NIST SP 800-145] 

• Computer Security Incident Handling Guide [NIST SP 800-61, Revision 2] 

• Contingency Planning Guide for Federal Information Systems [NIST SP 800-34, Revision 1] 

• Engineering Principles for Information Technology Security (A Baseline for Achieving Security) 

[NIST SP 800-27, Revision A] 

• Assessing Security and Privacy Controls in Federal Information Systems and Organizations [NIST 

SP 800-53A, Revision 4] 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 2 

• Security and Privacy Controls for Federal Information Systems and Organizations [NIST SP 800-

53, Revision 4] 

• Guide for Developing Security Plans for Federal Information Systems [NIST SP 800-18, Revision 

1] 

• Guide for Applying the Risk Management Framework to Federal Information Systems: A Security 

Life Cycle Approach [NIST SP 800-37, Revision 1] 

• Guide for Mapping Types of Information and Information Systems to Security Categories [NIST SP 

800-60, Revision 1] 

• Guide for Security-Focused Configuration Management of Information Systems [NIST SP 800-128] 

• Information Security Continuous Monitoring for Federal Information Systems and Organizations 

[NIST SP 800-137] 

• Managing Information Security Risk: Organization, Mission, and Information System View [NIST 

SP 800-39] 

• Minimum Security Requirements for Federal Information and Information Systems [FIPS 

Publication 200] 

• Personal Identity Verification (PIV) of Federal Employees and Contractors [FIPS Publication 201-

2] 

• Recommended Security Controls for Federal Information Systems [NIST SP 800-53, Revision 4] 

• Guide for Conducting Risk Assessments [NIST SP 800-30, Revision 1] 

• Security Considerations in the System Development Life Cycle [NIST SP 800-64, Revision 2] 

• Security Requirements for Cryptographic Modules [Federal Information Processing Standard 

(FIPS) Publication 140-2] 

• Standards for Security Categorization of Federal Information and Information Systems [FIPS 

Publication 199] 

• Technical Guide to Information Security Testing and Assessment [NIST SP 800-115] 

1.3 Purpose 

The purpose of this document is to provide the System Owner (SO) and the SSA Authorization Official (AO)

with a detailed level of the residual risk for <System Acronym>. An independent security assessment team 

conducted a test for each system specific security control implemented by SSA stakeholders. These 

tests include a combination of interviews, document examinations, and actual technical testing of controls 

when applicable. These controls each had implementation statements listed in the <System Acronym>

System Security Plan (SSP). These statements identified how the controls are in place and the 

assessment team tested the controls based on that criteria. Additionally, the testing ensures the controls 

are in are in compliance with the FISMA baseline security control requirements as defined in NIST 800-53 

Rev 4. FISMA mandates that all Federal Agencies will comply with the NIST 800-53 Rev. 4 standards. 

Assessors from the independent security assessment team are members of contracted Coalfire Federal 

Services (formally Veris Group). 

The system specific security controls for this assessment are in section 2.1 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 3 

2 Scope 

2.1 Applicable Security Controls 

The applicable security controls as listed in the <System Acronym> SAP are in Table 2 of this <System 

Acronym> SAR. The security control assessment authorized by OIS and the <System Acronym> SAM 

gives authority to the Coalfire Independent Security Assessment team to assess the listed controls. 

Table 2: Identified Security Controls Assessed 

Security Control Family Security Control 

Access Control AC-2, AC-2(2), AC-2(3), AC-2(4) 

Awareness and Training 

Audit and Accountability AU-7(1) 

Security Assessment and Authorization CA-5, CA-6 

Configuration Management CM-9 

Contingency Planning 

Identification and Authentication IA-2, IA-(3), IA-5, IA-5(1) 

Planning PL-2, PL-2(3), PL-8 

Personnel Security PS-4, PS-5 

Risk Assessment RA-2, RA-3 

System and Services Acquisition SA-3, SA-4(9), SA-5, SA-8, SA-9, SA-9(2), SA-11 

System and Communications Protection SC-4, SC-39 

System and Information Integrity SI-10, SI-11, SI-16 

2.2 System Name/Title 

The <System Acronym> system unique identifier and system acronyms are in Table 3. Due to the 

number of applications located within <System Acronym>, <only two of the subsystems> fall within the 

scope of this assessment. The authority to use a representative sample is located within NIST 800-53 

Rev 4 Guide for Assessing the Security Controls in Federal Information Systems and Organizations. 

Table 3: Information System Name and Title 

Information System Name: <System Name> 

Information System Acronym: <System Acronym> 

Information System Identifier <System Identifier> 

Security Categorization: (High, Moderate, Low) <Categorization> 

PII data: (Yes/No) <Yes/No> 

e-Authentication Application: (Yes/No) <Yes/No> 

Production Data Used In Development/Test 

Environment (Yes/No) 

<Yes/No> 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 4 

Federal Tax Information (Yes/No) <Yes/No> 

2.3 Assessment Documentation 

Documentation used by the independent assessment team to perform the assessment of the <System 

Acronym> subsystems include the following: 

• <System Acronym> System Security Plan (SSP) 

• <System Acronym> Security Assessment Plan (SAP) 

• Security Operation Division (SOC) Nessus scanner with McAfee, McAfee ePolicy 

Orchestrator (EPO) instance scan statistic reports 

• SSA Information Security Policy (ISP) 

• The <System Acronym> Boundary Scope Memo (BSM) 

• The <System Acronym> Information System Contingency Plan (ISCP) 

• The <System Acronym> Federal Information Processing Standards Publication (FIPS) 199 

2.4 Location of Components Tested 

The physical locations of all the different functional components supporting the testing of the <System 

Acronym> information system is in Table 4. 

Table 4: Location of Components 

System Physical Location and Addresses 

Production Environment Site 

Name 

Address Description of Components 

<EXAMPLE: National Computer 

Center (NCC)>

6401 Security Blvd 

Baltimore, MD 21235 

Production Environment (i.e., 

hardware ) 

(Primary Support) 

Development/Test 

Environment Site Name 

Address Description of Components 

<EXAMPLE: National Support 

Center (NSC)>

3500 Campus Drive, Suite 106 

Urbana, MD 21704 

Development and Testing

Environment (Integration 

Testing) 

Disaster Recovery 

Environment Site Name 

Address Description of Components 

<EXAMPLE: Secondary Support 

Center (SSC)>

3004 Tower Blvd 

Durham, NC 27707 

Production Environment (i.e., 

hardware) 

(Secondary/Failover Support) 

Contractor Owned 

Environment Site Name 

Address Description of Components 

 

2.5 Subsystems, Users and Interfaces 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 5 

The <System Acronym> system contains the following subsystems, users and interfaces that were tested 

as part of this assessment. They are contained within the embedded Error! Reference source not found.. 

<Complete the embedded spreadsheet with system specific information.>

Table 5: Users and Interfaces 

T2 Internet - Users 

and Interfaces.doc

<Embed the applicable system’s Users and Interface, EXAMPLE attached.>

2.6 Assessment Inventory 

The <System Acronym> hardware and software inventories provided by the SO’s are in Table 6. 

<Complete the embedded spreadsheet with system specific information.> 

Table 6: Hardware and Software Inventory 

T2 Internet - 

HW-SW Inventory.xl

<Embed the applicable system’s Hardware and Software Inventory, EXAMPLE attached.> 

 NOTE: Any changes to the scope of the Authorization Boundary after the Boundary 

Scope Meeting and finalization of the Boundary Scope Memo (BSM) may impact the 

overall Independent Verification and Validation (IV&V) schedule. 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 6 

3 System Overview 

3.1 Security Categorization 

The FIPS 199 Security Categorization of a Federal Information and Information System publication

determines the risk impact level of data vulnerability exploitation. The identified impact level sets the

security control baseline that needs to be tested. The categorization for <System Acronym> determined 

by the FIPS 199 publication is a Moderate baseline. The NIST 800-53 Rev 4. <Moderate> baseline of 

controls are assessed during the security assessment. 

3.2 System Description and Purpose 

<In the sections below, insert a general description of the information system. Use a description that is 

consistent with the description found in the SSP. The description must only differ from the description in 

the SSP if additional information is going to be included that is not available in the SSP or if the description 

in the SSP is not accurate.> 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 7 

4 Assessment Methodology 

A summary of the assessment methodologies used to conduct the security assessment for the <System 

Acronym> subsystems are in the following steps: 

 Perform tests on the listed controls in the <System Acronym> SAP and record the results 

 Identify vulnerabilities related to <System Acronym>

 Identify known threats and determine which threats are associated with the cited vulnerabilities 

 Analyze risks based on vulnerabilities and associated threats after mitigating controls 

are implemented 

 Recommend corrective actions for controls that are not satisfied (other than satisfied) 

 Document all security assessment results, which include identified unmitigated risks, 

mitigated risks, and recommend corrective actions. 

4.1 Perform Tests 

Coalfire Federal Services performed security tests on the <System Acronym> subsystems, which 

concluded on <MM DD, YYYY>. The results of the tests are documented within the Security Risk

Traceability Matrix (SRTM) in Appendix B. The SRTM serves as input to this SAR. 

4.1.1 Assessment Deviations 

Table 7 contains any deviations from the SAP if applicable. Coalfire Federal Services did not deviate from

the testing plan. 

Table 7: List of Assessment Deviations 

Deviation ID Deviation Description Justification 

 

4.2 Identification of Vulnerabilities 

Coalfire Federal Services conducts an assessment to identify vulnerabilities for <System 

Acronym> subsystems. These vulnerabilities should have controls in place to mitigate the risk of 

exploitation. 

A vulnerability is an inherent weakness in an information system that can be exploited by a threat or 

threat agent, resulting in an undesirable impact on the protection of the confidentiality, integrity, or 

availability of the system (application and associated data). A vulnerability may be due to a design 

flaw or error in a configuration that makes the network or a host on the network, susceptible to malicious 

attacks from local or remote users. Vulnerabilities can exist in multiple areas of the system or facilities, 

such as in firewalls, application servers, Web servers, operating systems, or fire suppression systems. 

Whether or not a vulnerability has the potential to be exploited by a threat depends on a number of 

variables including (but not limited to): 

• The strength of the security controls in place 

• The ease at which a human actor could purposefully launch an attack 

• The probability of an environmental event or disruption in a given local area 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 8 

An environmental disruption is usually unique to a geographic location. Depending on the level of the risk

exposure, the successful exploitation of a vulnerability can vary from disclosure of information about the

host to a complete compromise of the host. Risk exposure to organizational operations can affect the

business mission, functions, and/or reputation of the organization. 

4.3 Consideration of Threats 

A threat is an adversarial force or phenomenon that could affect the availability, integrity, or confidentiality

of an information system, its networks, and the facility that houses the hardware and software. A threat

agent is an element that provides the delivery mechanism for a threat. An entity that initiates the launch of

a threat agent is referred to as a threat actor. 

A threat actor might purposefully launch a threat agent (e.g., a terrorist igniting a bomb). A threat actor

could also be a trusted employee that acts as an agent by making an unintentional human error (e.g., a

trusted employee clicks on a phishing email that downloads malware). Threat agents may also be

environmental in nature with no purposeful intent (e.g., a hurricane). Threat agents working alone, or in

concert, exploit vulnerabilities to create incidents. FISMA categorizes threats using a threat origination

taxonomy of purposeful (P), unintentional (U), or environmental (E) type threats as described in Table 8. 

Table 8: Threat Categories and Type Identifiers 

Threat Origination Category Type Identifier 

Threats launched purposefully P 

Threats created by unintentional human or machine error U 

Threats caused by environmental agents or disruptions E 

Threat actors for a variety of reasons launch purposeful threats and the reasons may never be fully known.

Curiosity, monetary gain, political gain, social activism, revenge or many other driving forces could motivate

threat actors. It is possible that some threats could have more than one threat origination category. 

Some threat types are more likely to occur than others are. FISMA considers threat types to help 

determine the likelihood that a vulnerability could be exploited. The threat table shown in 

Table 9 describes typical threats to information systems; these threats have been considered for <System 

Acronym>.
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Table 9: Potential Threats 

ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

T-1. Alteration U, P, E Alteration of data, files, or records. ModiT-2. Audit 

Compromise P 

An unauthorized user gains access to the audit trail and could cause audit records to be deleted or modified, or prevents future audit records from being recorded, thus masking a security relevant event. 

Modior destr

T-3. Bomb P An intentional explosion. 

Modior destr

T-4. Communications 

Failure U, E Cut fiber optic lines, trees falling on telephone lines. 

T-5. Compromising 

Emanations P 

Eavesdropping can occur via electronic media directed against large scale electronic facilities that do not process classified National Security Information. 

Disclosure 

T-6. Cyber Brute 

Force P 

Unauthorized user could gain access to the information systems by random or systematic guessing of passwords, possibly supported by password cracking utilities. 

Disclosure 

Modior destr

T-7. Data Disclosure 

Attack P 

An attacker uses techniques that could result in the disclosure of sensitive information by exploiting weaknesses in system design or configuration. 

Disclosure 

T-8. Data Entry Error U 

Human inattention, lack of knowledge, and failure to cross-check system activities could contribute to errors becoming integrated and ingrained in automated systems. 

Modi

T-9. Denial of Service 

Attack P 

An adversary uses techniques to attack a single target rendering it unable to respond; could cause denial of service for users of the targeted information systems. 
So

Secu

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 10 

ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

T-10. Distributed Denial 

of Service Attack P 

An adversary uses multiple compromised information systems to attack a single target; could cause denial of service for users of the targeted information systems. 

T-11. Earthquake E 

Seismic activity can damage the information system or its facility. Refer to the following document for earthquake probability maps http://pubs.usgs.gov/of/2008/1128/pdf/OF08-

1128_v1.1.pdf . 

Dest

T-12. Electromagnetic 

Interference E, P 

Disruption of electronic and wire transmissions could be caused by high frequency (HF), very high frequency (VHF), and ultra-high frequency (UHF) communications devices (jamming) or sun spots. 

T-13. Espionage P The illegal, covert act of copying, reproducing, recording, photographing or intercepting sensitive 

information. 

Disclosure Modi

T-14. Fire E, P Fire can be caused by arson, electrical problems, lightning, chemical agents, or other unrelated proximity 

fires. 

Dest

T-15. Floods E Water damage caused by flood hazards can be caused by proximity to local flood plains. Flood maps and base 

flood elevation must be considered. 

Dest

T-16. Fraud P 

Intentional deception regarding data or information about an information system could compromise the confidentiality, integrity, or availability of an information 

system. 

Disclosure 

Modior destr

T-17. 

Hardware or Equipment Failure 

E Hardware or equipment may fail due to a variety of 

reasons. 

T-18. Hardware 

Tampering P An unauthorized modification to hardware that alters the proper functioning of equipment in a manner that Modi
So

Secu

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 11 

ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

degrades the security functionality provided by the asset. 

T-19. Hurricane E A category 1, 2, 3, 4, or 5 land falling hurricane could impact the facilities that house the information systems. DestT-20. Malicious 

Software P Software that damages a system such a virus, Trojan, or worm. Modi

or destr

T-21. Phishing Attack P 

Adversary attempts to acquire sensitive information such as usernames, passwords, or SSNs, by pretending to be communications from a legitimate/trustworthy source. Typical attacks occur via email, instant messaging, or comparable means; commonly directing users to Web sites that appear to be legitimate sites, while actually stealing the entered information. 

Disclosure 

Modior destr

T-22. Power 

Interruptions E 

Power interruptions may be due to any number of reasons such as electrical grid failures, generator failures, uninterruptable power supply (UPS) failures (e.g. spike, surge, brownout, or blackout). 

T-23. Procedural Error U An error in procedures could result in unintended 

consequences. 

Disclosure 

Modior destr

T-24. Procedural 

Violations P Violations of standard procedures. Disclosure 

Modior destr

T-25. Resource 

Exhaustion U 

An errant (buggy) process may create a situation that 

exhausts critical resources preventing access to services. 
So

Secu

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ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

T-26. Sabotage P Underhanded interference with work. 

Modior destr

T-27. Scavenging P Searching through disposal containers (e.g., dumpsters) to acquire unauthorized data. Disclosure T-28. Severe Weather E 

Naturally occurring forces of nature could disrupt the operation of an information system by freezing, sleet, hail, heat, lightning, thunderstorms, tornados, or snowfall. 

Dest

T-29. Social 

Engineering P 

An attacker manipulates people into performing actions, divulging confidential information, or providing access to computer systems or facilities. 

Disclosure 

T-30. Software 

Tampering P 

Unauthorized modification of software (e.g., files, programs, database records) that alters the proper operational functions. 

Modior destr

T-31. Terrorist P An individual performing a deliberate violent act could use a variety of agents to damage the information 

system, its facility, and/or its operations. 

Modior destr

T-32. Theft P An adversary could steal elements of the hardware. T-33. Time and State P 

An attacker exploits weaknesses in timing or state of functions to perform actions that would otherwise be prevented (e.g., race conditions, manipulation of user state). 

Disclosure Modi

T-34. Transportation 

Accidents E 

Transportation accidents include train derailments, river barge accidents, trucking accidents, and airline 

accidents. Local transportation accidents typically occur when airports, sea ports, railroad tracks, and major trucking routes occur in close proximity to systems facilities. Likelihood of HAZMAT cargo must 

Dest
So

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TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 13 

ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

be determined when considering the probability of local transportation accidents. 

T-35. Unauthorized 

Facility Access P 

An unauthorized individual accesses a facility which may result in comprises of confidentiality, integrity, or availability. 

Disclosure 

Modior destr

T-36. Unauthorized 

Systems Access P An unauthorized user accesses a system or data. Disclosure 

Modior destr

T-37. Volcanic Activity E 

A crack, perforation, or vent in the earth’s crust followed by molten lava, steam, gases, and ash forcefully ejected into the atmosphere. For a list of volcanoes in the U.S. see: http://volcanoes.usgs.gov/about/volcanoes/volcanolist.

php . 

Dest
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Security Assessment Report (SAR) 

Version <X.X>

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4.4 Perform Risk Analysis 

NIST identifies risk assessment as the first process in the risk management methodology. Organizations

use the risk assessment to determine the extent of the potential threat and the risk associated with an

information system. NIST defines Risk as “a function of the likelihood of a given threat-source’s exercising

a particular vulnerability and the resulting impact of the adverse event on the organization”. The outcome

of performing risk analysis yields risk exposure metrics that can be used to make risk-based decisions. 

The FISMA risk analysis process is a qualitative risk analysis. In qualitative risk analysis, the risk level of

exploiting a threat may be subjective and the justification for each risk is explained in terms of probability.

The following tables have probabilities associated with the likelihood and the impact level of the risk. For

example, when a system is easy to exploit, it has a “Very High” likelihood that a threat could exploit the

vulnerability. Likelihood definitions and probabilities are in Table 10. 

Note: The likelihood levels should not be confused or used interchangeably with the security categorization

of the system even though they use the some of the same terminology. The security categorization is

determined by the sensitivity of the data residing on the information system and is in the FIPS 199

publication. 

Table 10: Likelihood Definitions from NIST 800-30 Rev. 1 Publication 

Likelihood 

Probability Level 

Description 

Very Low If the threat event is initiated or occurs, it is almost certain to have adverse impacts. 

Low If the threat event is initiated or occurs, it is unlikely to have adverse impacts. 

Moderate If the threat event is initiated or occurs, it is somewhat likely to have adverse

impacts. 

High If the threat event is initiated or occurs, it is highly likely to have adverse impacts. 

Very High If the threat event is initiated or occurs, it is almost certain to have adverse impacts. 

Impact refers to the magnitude of potential harm to the information system (or its data) by successful

vulnerability exploitation. Definitions for the impact are in Table 11. Since exploitation has not yet occurred,

these values are perception values based on available information system information if the exploitation of

a vulnerability can cause significant loss to a system (or its data) then the impact is “Very High”. 

Table 11: Impact Definitions from NIST 800-30 Rev. 1 Publication 

Impact 

Probability 

Description 

Very Low The threat event could be expected to have a negligible adverse effect on

organizational operations, organizational assets, individuals other organizations, or 

the Nation. 

Low The threat event could be expected to have a limited adverse effect on

organizational operations, organizational assets, individuals other organizations, or 

the Nation. A limited adverse effect means that, for example, the threat event might: 

(i) cause a degradation in mission capability to an extent and duration that the 

organization is able to perform its primary functions, but the effectiveness of the 

functions is noticeably reduced; (ii) result in minor damage to organizational assets; 

(iii) result in minor financial loss; or (iv) result in minor harm to individuals 
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Moderate The threat event could be expected to have a serious adverse effect on

organizational operations, organizational assets, individuals other organizations, or 

the Nation. A serious adverse effect means that, for example, the threat event might: 

(i) cause a significant degradation in mission capability to an extent and duration 

that the organization is able to perform its primary functions, but the effectiveness 

of the functions is significantly reduced; (ii) result in significant damage to 

organizational assets; (iii) result in significant financial loss; or (iv) result in 

significant harm to individuals that does not involve loss of life or serious lifethreatening injuries. 

High The threat event could be expected to have a severe or catastrophic adverse

effect on organizational operations, organizational assets, individuals, other

organizations, or the Nation. A severe or catastrophic adverse effect means that, for 

example, the threat event might: (i) cause a severe degradation in or loss of mission 

capability to an extent and duration that the organization is not able to perform 

one or more of its primary functions; (ii) result in major damage to organizational 

assets; (iii) result in major financial loss; or (iv) result in severe or catastrophic harm 

to individuals involving loss of life or serious life-threatening injuries. 

Very High The threat event could be expected to have multiple severe or catastrophic

adverse effects on organizational operations, organizational assets, individuals,

other organizations, or the Nation. 

The combination of the Likelihood Probability and the Impact Probability creates the risk exposure. The risk

exposure matrix shown in Table 12 presents the same likelihood and impact severity ratings as those found

in NIST SP 800-30 Rev. 1 Risk Management Guide for Information Technology Systems. 

Table 12: Risk Exposure Ratings from NIST 800-30 Rev. 1 Publication 

Likelihood Impact 

Very Low Low Moderate High Very High 

Very High Very Low Low Moderate High Very High 

High Very Low Low Moderate High Very High 

Moderate Very Low Low Moderate Moderate High 

Low Very Low Low Low Low Moderate 

Very Low Very Low Very Low Very Low Very Low Very Low 

Using Table 12 as a reference, Coalfire Federal Services reviewed all identified vulnerabilities and assigned

a risk exposure located in the <System Acronym> SRTM in Appendix B. 

Documenting the results of security control testing creates a record of the security posture for the system

at a given moment in time. The record can be used by the AO to make risk-based decision and to create

plans of action to mitigate unacceptable residual risks. 

FISMA requires that a Plan of Action and Milestones (POA&M) be developed. The POA&M is a mitigation

plan designed to address specific residual security risks and includes information on costing, resources,

and target dates for remediation efforts resolving the identified security weaknesses. The plan is utilized as

the primary mechanism for tracking all the residual risks and other issues. SSA will leverage the SAR to

create a POA&M for <System Acronym>. 
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5 Security Assessment Results 

This section describes all security risks found during assessment. The following elements for each security

risk are reported. 

• Identifier 

• Name 

• Source of Discovery 

• Description 

• Affected internet protocol (IP) Address/Hostname/Database 

• Applicable Threats 

• Likelihood (before mitigating controls/factors) 

• Impact (before mitigating controls/factors) 

• Risk Exposure (before mitigating controls/factors) 

• Risk Statement 

• Mitigating Controls/Factors 

• Likelihood (after mitigating controls/factors) 

• Impact (after mitigating controls/factors) 

• Risk Exposure (after mitigating controls/factors) 

• Recommendation 

Below is a description of the SAR security risk elements. 

• Identifier: All weaknesses are assigned a vulnerability identifier (ID) in the form of V#-Security 

Control ID. For example, the first vulnerability listed would be reported as V1-AC-2(2) if the 

vulnerability is for control ID AC-2(2). If there are multiple vulnerabilities for the same security 

control ID, the first part of the vulnerability ID must be incremented, for example V1-AC-2(2), V2-

AC-2(2). 

• Name: A short, unique name for each vulnerability. 

• Source of Discovery: The source of discovery refers to the method that was used to discover the 

vulnerability (e.g., web application scanner, manual testing, security test procedure workbook, 

interview, document review). References must be made to scan reports, security test case 

procedure IDs, staff that were interviewed, manual test results, and document names. All scans 

reports are attached in Appendix C, Appendix D, Appendix E, and Appendix F. Results of manual 

tests can be found in Appendix G. If the source of discovery is from one of the security test 

procedure workbooks, a reference must point to the workbook name, the sheet number, and the 

cell number. Workbook tests results are found in Appendix B. If the source of discovery is from 

an interview, the date of the interview and the people who were present at the interview are named. 

If the source of discovery is from a document, the document must be named. 
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• Description: All security weaknesses must be described in enough detail to be reproduced by the 

stakeholder, the Information System Security Officer (ISSO), or the AO. If a test was performed 

manually, the exact manual procedure and any relevant screenshots must be included. If a test 

was performed using a tool or scanner, a description of the reported scan results for that 

vulnerability must be included along with the vulnerability identifier (e.g., Common Vulnerabilities 

and Exposures (CVE), Common Vulnerability Scoring System (CVSS), Nessus Plugin ID) and 

screenshots of the particular vulnerability being described. If the tool or scanner reports a severity 

level, that level must be reported in this section. Any relevant login information and role information 

must be included for vulnerabilities discovered with scanners or automated tools. If any security 

weaknesses affect a database transaction, a discussion of atomicity violations must be included. 

• Affected IP Address/Hostname(s)/Database: For each reported vulnerability, all affected IP 

addresses/hostnames/databases must be included. If multiple hosts/databases have the same 

vulnerability, list all affected hosts/databases. 

• Applicable Threats: The applicable threats describe the unique threats that have the ability to 

exploit the security vulnerability. (Use threat numbers from Error! Reference source not found..) 

• Likelihood (before mitigating controls/factors): Very High, High, Moderate, Low, or Very Low 

(see Error! Reference source not found.). 

• Impact (before mitigating controls/factors): Very High, High, Moderate, Low, or Very Low (see 

Error! Reference source not found.). 

• Risk Exposure (before mitigating controls/factors): Very High, High, Moderate, Low, or Very 

Low (see Error! Reference source not found.). 

• Risk Statement: Provide a risk statement that describes the risk to the business. (See examples 

in Error! Reference source not found.). Also indicate whether the affected machine(s) is/are 

internally or externally facing. 

• Mitigating Controls/Factors: Describe any applicable mitigating controls/factors that could 

downgrade the likelihood or risk exposure. Also indicate whether the affected machine(s) is/are 

internally or externally facing. Include a full description of any mitigating factors and/or 

compensating controls if the risk is an operational requirement. 

• Likelihood (after mitigating controls/factors): Moderate or Low (see Error! Reference source 

not found.) after mitigating control/factors have been identified and considered. 

• Impact (after mitigating controls/factors): Moderate or Low (see Error! Reference source not 

found.) after mitigating control/factors have been identified and considered. 

• Risk Exposure (after mitigating controls/factors): Moderate or Low (see Error! Reference 

source not found.) after mitigating controls/factors have been identified and considered. 

• Recommendation: The recommendation describes how the vulnerability should be resolved. 

Indicate if there are multiple ways that the vulnerability could be resolved or recommendation for 

acceptance of operational requirement. 

5.1 Security Assessment Summary 

<Two (2) vulnerabilities, (0 high, zero moderate, 2 low)> have been discovered as part of the manual 

security assessment testing. Vulnerability scans provided did not provide enough information to provide 

analysis of scan vulnerability to assessment result. 
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The vulnerabilities summary is contained in the following embedded file: 

Table 13: Risk Exposure 

T2 Risk Exposure 

Table.xlsx

<Embed applicable system’s Risk Exposure table, EXAMPLE attached.> 

6 Non-conforming Controls 

In some cases, the initial risk exposure to the system has been adjusted due to either corrections that 

occurred during testing or to other mitigating factors. Additional detail is provided in the following sections. 

6.1 Risks Corrected During Testing 

Any risks that were discovered during the testing of the <System Acronym> subsystems and subsequently 

mitigated prior to authorization are listed in Table 14. Coalfire Federal Services verified risks corrected 

during testing. The verification method used to determine correction is noted in the right-hand column of 

Table 14. 

Table 14: Summary of Risks Corrected During Testing 

Identifier Description Source of 

Discovery 

Initial Risk 

Exposure 

Remediation 

Description 

Date of 

Remediation 

Verification 

Statement/Testing 

Procedures 

 

6.2 Risks with Mitigating Factors 

Risks that have had their severity levels changed due to mitigating factors are summarized in Table 15.

The factors used to justify changing the initial risk exposure rating are noted in the right-hand column of the

table. See Table 13 for more information on these risks. 

Table 15: Summary of Risks with Mitigating Factors 

Identifier Description Source of 

Discovery 

Initial Risk 

Exposure 

Current Risk 

Exposure 

Description of 

Mitigating 

Factors 

 

6.3 Risks Remaining Due to Operational Requirements 

Risks that reside in the <system acronym> that cannot be corrected due to operational constraints are 

summarized in Error! Reference source not found.. An explanation of the operational constraints and 

risks are included in Error! Reference source not found. as well as in the appropriate security assessment 

test cases and SSP. Because these risks will not be corrected, they are not tracked in the POA&M. See 

Error! Reference source not found.for more information on these risks. 
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Table 16: Summary of Risks Remaining Due to Operational Factors 

Identifier Description Source of Discovery Current Risk Exposure Operational 

Requirements 

Rationale 

 
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7 Risks Known for Interconnected Systems 

Inherent relationships between the system and other interconnected systems may affect the overall system

security posture. A summary of the risks known for systems that connect to <System Acronym> is provided 

in Table 17. 

Table 17: Risks from Interconnected Systems 

System Authorization 

Date/Status 

Date of POA&M Control Family 

Identifier 

 

8 Recommendations 

<System Acronym> subsystem risks that were discovered during the assessment have an impact on 

the security posture of the SSA Federal Agency as a whole. These risks must be mitigated and Coalfire 

Federal Services has made recommendations in the Risk Exposure section, Table 14. These

recommendations should be addressed by the SAM, system owners, OIS, and other stakeholders that have

a responsibility for the controlling the overall risk of <System Acronym>. 

 
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Appendix A. Acronyms and Terms 

Acronyms and terms used throughout this SAR are defined in Table 18. 

Table 18: Acronyms and Terms 

Acronym/Term SAR Acronym Definitions

AC Associate Commissioner 

AC Access Control 

AO Authorizing Official 

ARB Architecture Review Board 

ART Analysis and Reporting Tool 

AU Audit and Accountability 

BRI Benefit Rate Increase 

BSM Boundary Scope Memo 

CA Security Assessment and Authorization 

CCB Configuration Control Board 

CIC Customer Information Control System 

CM Configuration Management 

CMP Contingency Management Plan 

COTR Contract Officer’s Technical Representative 

CSAM Cyber Security Assessment & Management 

CSO Component Security Officer 

CVE Common Vulnerabilities and Exposures 

CVSS Common Vulnerability Scoring System 

DCS Deputy Commissioner for Systems 

DSPP Division of Security Policy & PII 

EPECS Electronic Personal Enrollment Credential System 

EPO ePolicy Orchestrator 

FIPS Federal Information Processing Standard 

FISMA Federal Information Security Modernization Act 

FOIA Freedom of Information Act 

HRMIS Human Resources Management Information System 

HRODS Human Resources Operational Data Store 

HSPD Homeland Security Presidential Directive 

IA Identification and Authentication 

ID Identification 
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IP Internet Protocol 

ISCP Information System Contingency Plan 

ISO Information Security Officers

ISP Information Security Policy

ISSO Information System Security Officer 

LIS Low Income Subsidy 

NIST National Institute of Standards and Technology 

NSC National Support Center 

OIS Office of Information Security 

OMB Office of Management and Budget 

OSOHE Office of Systems Operations and Hardware Engineering

OTSO Office of Telecommunications and Systems Operations 

PAM Payment Application Modernization 

PCCB Project Configuration Control Board

PIN Personal Identification Number

PIV Personal Identification Verification 

PL Public Law 

PL (Control) Planning 

PM Program Manager 

POA&M Plan of Action and Milestones 

PRIDE Project Resource Guide 

PS (Control) Personnel Security 

P, U, E Purposeful, Unintentional, Environmental 

SA System and Services Acquisition 

SAM Security Authorization Manager 

SAP Security Assessment Plan 

SARA Security Administration Report Application (User Guide)

SAR Security Assessment Report

SC Systems and Communications Protection 

SDLC System Development Life Cycle 

SI System and Information Integrity 

SMACS Security Management Access Control Systems

SO System Owner

SOC Security Operation Division 
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SP Special Publication 

SRC System Release Certificate

SRTM Security Requirements Traceability Matrix

SSA Social Security Administration 

SSC Secondary Support Center 

SSP System Security Plan 

SVR Security Violations Report

Threat An adversarial force or phenomenon that could affect the availability,

integrity, or confidentiality of an information system, its networks, and the

facility that houses the hardware and software.

Threat Actor An entity that initiates the launch of a threat agent is referred to as a threat

actor. 

Threat Agent An element that provides the delivery mechanism for a threat. 

UPS uninterruptable power supply 

USC United States Code 

Vulnerability An inherent weakness in an information system that can be exploited by a

threat or threat agent, resulting in an undesirable impact in the protection

of the confidentiality, integrity, or availability of the system (application and

associated data). 
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Appendix B. Security Risk Traceability Matrix (SRTM) 

The Security Risk Traceability Matrix (SRTM) with test results and test procedures are within the following

embedded document in Table 19. 

Table 19: Security Test Procedure Workbook 

T2 SRTM 

Worksheet.xlsx

<Embed the applicable system’s Security Risk Traceability Matrix (SRTM), EXAMPLE attached.>
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Appendix C. Infrastructure Scan Results 

The Nessus scanner along with the McAfee ePolicy Orchestrator (EPO) deployed by the SOC was used to

scan SSA servers. Associated Windows Database servers that have the EPO agent deployed within the

<System Acronym > boundary were scanned. The other <System Acronym> servers did not have 

any vulnerability scanning tools available, which allowed for scanning of mainframe or storage hardware, 

and therefore were not scanned. 

Infrastructure Scans: Inventory of Items Scanned 

Table 20 provides an inventory of infrastructure items scanned during this assessment. 

Table 20: Inventory of Items Scanned 

T2 Scanned 

Inventory Items.xlsx

<Embed the applicable system’s Inventory of Items Scanned, EXAMPLE attached.>

Infrastructure Scans: Raw Scan Results 

Table 21 has the <System Acronym> raw scan results: 

Table 21: Raw Scan Results 

T2 Raw Scan 

Results.xlsx

<Embed the applicable system’s Raw Scan Results, EXAMPLE attached.>

Infrastructure Scans: False Positive Reports 

Table 22 provides a list of false positive reports collected during infrastructure scans if applicable. 

Table 22: Infrastructure Scans: False Positive Reports 

ID# IP Address Scanner Severity Level Finding False Positive 

Explanation 

 
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Appendix D. Database Scan Results 

Database scan results are included in this appendix. 

Database Scans: Inventory of Databases Scanned 

Table 23 provides an inventory of any databases scanned during this assessment if applicable. 

Table 23: Inventory of Databases Scanned 

IP Address Hostname Software and Version Function Comment 

 

Database Scans: False Positive Reports 

Table 24 provides a list of false positive reports collected during database scans if applicable. 

Table 24: Database Scans: False Positive Reports 

ID# IP Address Scanner Severity Level Finding False Positive 

Explanation 

 
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Appendix E. Web Application Scan Results 

Web application scan results are included in this appendix. 

Web Application Scans: Inventory of Web Applications 

Scanned 

Table 25 provides an inventory of all web applications scanned during this assessment if applicable. 

Table 25: Inventory of Web Applications Scanned 

Login URL IP Address of Login Host Function Comments 

 

Web Application Scans: False Positive Reports 

Table 26 provides a list of false positive reports collected during web application scans if applicable. 

Table 26: Web Application Scans: False Positive Reports 

ID# IP Address Scanner Severity Level Finding False Positive 

Explanation 

 
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Appendix F. Assessment Results 

Assessment results are summarized in Table 27. 

Table 27: Summary of System Security Risks from FISMA Testing 

Risk Level Assessment Test Cases Total 

High <# high risks> <% of total risks> 

Moderate <# moderate risks> <% of total risks> 

Low <# low risks> <% of total risks> 

Operationally 

Required 

<# operationally required 

high risks> 

<% of total risks> 

Total <Sum of all H, M, L risks> 100%

 NOTE: Total is the sum of high, moderate, and low risks with operationally required 

risks being represented as a subset of this total. 
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Appendix G. Penetration Test Report 

<Update the text below to reflect actual penetration test results for this assessment. Embed the penetration 

test report as appropriate.> 

Coalfire Federal Services is not authorized as per the Statement of Work (SOW) to perform a formal

Penetration Test for the <System Acronym> Batch and Internet Services subsystems. Therefore, no data 

from a penetration test is available for this assessment. 
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Appendix H. Security Assessment Report Signature 

Table 28: SAR Signatures 

Acceptance and Signature 

I have read the above Security Assessment Report prepared by the third party assessment organization,

Coalfire Federal Services. I acknowledge the assessment was completed as per the <System 

Acronym> SAP and understand the findings detailed herein. 

Security Authorization Manager/ 

<SAM>: 

OIS Division of Compliance and 

Assessments Director: 

<DD> 
EXHIBIT D
UNCLASSIFIED // FOR OFFICIAL USE ONLY 

UNCLASSIFIED // FOR OFFICIAL USE ONLY 

Social Security Administration (SSA) 

Security Categorization: <Enter Categorization>

Risk Assessment Report (RAR)

FOR 

<System Name> (<Acronym>) 

<DRAFT/FINAL> Version <x.x>

<Month DD, YYYY>

Prepared by 

Office of Information Security
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY ii 

<INSTRUCTIONS: Orange, bracketed text indicates instructions on how a section should be 

completed or sample text, which should be replaced with project specific information or removed. 

Ensure sample text is turned from orange to black where necessary (e.g., headings shall be 

changed to the standard heading color), and all instructions are removed (including this paragraph). 

All black text shall remain unchanged.>
Social Security Administration 

<System Name> 

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Version <x.x>

FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iii 

Document Revision History 

Revision 

History Date Summary of Changes Author 

1.0 <Month DD, YYYY> Initial release <name>

<x.x> <Month DD, YYYY> <description> <name>

<x.x> <Month DD, YYYY> <description> <name>
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Table of Contents 

1 RISK ASSESSMENT REPORT (RAR) BACKGROUND ...................................................... 6

2 RAR EXECUTIVE SUMMARY FOR <SYSTEM NAME> ...................................................... 6

3 <SYSTEM NAME> SYSTEM PURPOSE .............................................................................. 6

3.1 System Name/Title/Unique Identifier ........................................................................................... 6

3.2 Responsible Organization ............................................................................................................ 7

3.3 Security Categorization ................................................................................................................ 8

4 RISK ASSESSMENT APPROACH ....................................................................................... 8

4.1 Risk Assessment Purpose ........................................................................................................... 8

4.2 Risk Assessment Objective ......................................................................................................... 8

4.3 Risk Assessment Scope .............................................................................................................. 9

4.4 Limitations .................................................................................................................................... 9

4.5 Risk Assessors ............................................................................................................................ 9

4.6 Results ....................................................................................................................................... 10

4.7 Recommendation ....................................................................................................................... 11

5 SUMMARY OF FINDINGS .................................................................................................. 12

APPENDIX A. REFERENCE DOCUMENTS .......................................................................... 15
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List of Tables 

Table 1: <SYSTEM ACRONYM> Points of Contact ..................................................................................... 7

Table 2: <System Name> Security Categorization ....................................................................................... 8

Table 3: Assessment Team Points of Contact ......................................................................................... 9

Table 4: Overall Risk Level ......................................................................................................................... 10

Table 5: <SYSTEM ACRONYM> Results Summary .................................................................................. 12

Table 6: Acronym List ................................................................................................................................. 14
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1 Risk Assessment Report (RAR) Background 

The Office of Management and Budget (OMB) directive requires the Social Security Administration (SSA) 

to assess and re-authorize its major information technology (IT) systems at least once every three years 

and in the event of a major change, when that change occurs. This information must be reported in the 

annual Federal Information Security Modernization Act (FISMA) report to OMB and Congress during the 

fourth quarter (Q4) of each year. OMB has directed Chief Information Officers (CIO) of Federal agencies to 

follow the guidance found in the National Institute of Standards and Technology (NIST) Special Publication 

(SP) 800-37 Revision 1, Guide for Applying the Risk Management Framework to Federal Information 

Systems, to assess and re-authorize their information systems. This security authorization process contains 

subordinate efforts including performing risk-based reviews of the systems, developing/updating system 

security plans (SSP), and assessing and testing the security controls implemented for SSA’s information 

systems. 

2 RAR Executive Summary for <System Name> The Office of Information Security (OIS) contracted with Coalfire Federal Services, a third party assessment 

organization (3PAO), to conduct a system specific risk assessment on <system name> (<ACRONYM>). 

The acting Director of the Division of Compliance and Assessments, and the Security Authorization 

Manager (SAM) of <SYSTEM ACRONYM> approved the controls selected for this risk assessment. Thirtytwo (32) controls were tested over eleven (11) different NIST 800-53 Rev 4 control families. These controls 

were selected out of the <system categorization> baseline due to <SYSTEM ACRONYM> being 

categorized as a <system categorization> system as per the FIPS 199. During the assessment, there were 

<55 manual tests conducted, 62 interviews, and 84 document examinations>. Each of these is a 

requirement of a specific control. At the conclusion of the assessment, two controls were identified as “not 

implemented”. It should be noted that these controls have since been identified as common and should be 

added to the common control list. The controls that were not implemented, identified as PS4 (personnel 

termination), and PS 5 (personnel transfer), requires the SSA Information Security Policy (ISP) to document 

specific exit interview security debrief policies and procedures and the defined time period in which these 

must be carried out. Please refer to Table 5 for specific details. The likelihood of these vulnerabilities being 

exploited combined with the potential system impact is considered an overall LOW risk to the system. It is 

recommended that the <system name> assigned representative from the Security Assessment and 

Authorization Branch (SAAB) work with the System Authorization Manager (SAM) to mitigate these risks. 

Due to the overall identified risk being LOW, it is recommended that this be considered an acceptable risk 

and the system be given an authority to operate (ATO) for the next three years. 

3 <system name> System Purpose 

The <system name> (<ACRONYM>) system, has a <system categorization> Security Categorization. The 

boundaries are designed to aid SSA in the accomplishment of its mission to provide cost-effective and 

reliable services to other Federal agencies, and the public at large. 

<Insert detailed information> 

Coalfire Federal Services’ objective is to provide IT Independent Verification and Validation (IV&V) Support 

Services for <SYSTEM ACRONYM>. 

3.1 System Name/Title/Unique Identifier 

System/Application Name: <system name> (<SYSTEM ACRONYM>)

Unique Identifier : <016-00-SSA/DCS-M-001> 
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3.2 Responsible Organization 

Table 1: <SYSTEM ACRONYM> Points of Contact 

Title II Batch 

POCs.xlsx

Title II Internet 

Applications POCs.xlsx

<Embed the applicable system’s POCs, EXAMPLE attached.>
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3.3 Security Categorization 

This authorization boundary has been categorized as <system categorization> risk according to FIPS 

199. Refer to Table 5 below for supporting documentation regarding the determination of the 

application’s security categorization. 

Table 2: <System Name> Security Categorization 

Information Type Confidentiality Integrity Availability 

Accounting 

Mission Area: Financial Management 

Explanation: Selected risk values derived from NIST SP-800-

60, and FIPS 199, considering SSA business case.

L M L

Payments 

Mission Area: Financial Management 

Explanation: Selected risk values derived from NIST SP-800-

60, and FIPS 199, considering SSA business case.

L M L

Reporting & Information 

Mission Area: Financial Management 

Explanation: Based on the protection requirements for 

confidentiality, integrity and availability, the overall system 

sensitivity is <SYSTEM CATEGORIZATION>. The loss, 

misuse or unauthorized access to Agency data can be 

expected to have a serious adverse effect on SSA operations 

and assets.

L M L

Entitlement Event Information 

Mission Area: General Government 

Explanation: Selected risk values derived from NIST SP-800-

60, and FIPS 199, considering SSA business case.

M M M

Personal Identity and Authentication 

Mission Area: General Government

M M M

Information Sharing 

Mission Area: Information and Technology Management 

Explanation: Selected risk values derived from NIST SP-800-

60, and FIPS 199, considering SSA business case.

N/A N/A N/A

Overall M M M 

4 Risk Assessment Approach 

4.1 Risk Assessment Purpose 

The purpose of this Risk Assessment Report (RAR) is to summarize the residual risk identified during the 

security assessment of <SYSTEM ACRONYM>. Risk is a factor derived from a vulnerability that can be 

exploited and the likelihood that it will be exploited. Please see Appendix A for the NIST 800-60 Volume II 

publication for the definition of risk. 

4.2 Risk Assessment Objective 

The objective of the risk assessment is to identify any controls that are not fully implemented as required 

by FISMA. Controls that are not implemented pose a measureable risk to SSA and that risk must be 

mitigated in a timely manner based on the level or risk the non-implemented control creates. For example, 

a low risk may only require an update to a policy or a POA&M that the system’s SAM must execute. Another 

example is a High risk that must have immediate action taken by the SAM and other stakeholders in order 

to prevent a threat actor(s) from exploiting the discovered risk. 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 9

4.3 Risk Assessment Scope 

The previous system specific risk assessment was conducted on <SYSTEM ACRONYM> in <date>. The 

residual risk was identified and submitted to the SSA’s CIO. This submission was in accordance with OMB 

and FISMA guidelines to present the risk level of <SYSTEM ACRONYM> and ask for the ATO <SYSTEM 

ACRONYM> for the next three years. The CIO granted the ATO on <Month DD, YYYY> and allowed 

<SYSTEM ACRONYM> to operate from <Month DD, YYYY> to <Month DD, YYYY>. 

A new risk assessment is required by OMB and FISMA in order to identify the current residual risk and any 

risks associated with controls that are not fully implemented. The assessed controls were selected based 

on the <SYSTEM ACRONYM> Security Assessment Plan (SAP) approved by the OIS Director and the 

<SYSTEM ACRONYM> SAM. 

In addition to the controls selected, SSA uses the Nessus scanner along with the McAfee ePolicy 

Orchestrator (EPO) deployed by the SOC to look for signature based vulnerabilities in accordance with the 

SSA ISP. Associated Windows Database servers that have the EPO agent deployed within the <SYSTEM 

ACRONYM> boundary were scanned. The other <SYSTEM ACRONYM> servers did not have any 

vulnerability scanning tools available that could scan mainframe or storage hardware, and therefore were 

not scanned. 

The risk assessment was performed in accordance with all applicable laws, regulations, rules and orders 

of all governmental agencies and authorities. A complete list of referenced publications and regulations can 

be found in Appendix A. All risks associated with <SYSTEM ACRONYM> that were identified during the 

assessment and the potential impact of those risks are documented in this RAR. 

The RAR complies with the following SSA guidance: 

 SSA ISP

4.4 Limitations 

The <SYSTEM ACRONYM> subsystems, which reside within the National Support Center (NSC), rely on 

the Office of Systems Operations and Hardware Engineering (OSOHE) for hardware, software, and 

maintenance support. Additionally, user access and user profile provisioning for <SYSTEM ACRONYM>

subsystems residing on the mainframe, are provided by CA Top Secret, and managed by the Office of 

Systems Operations and Hardware Engineering (OSOHE), not by <SYSTEM ACRONYM>. Therefore, 

some access controls specific to <SYSTEM ACRONYM> are tested during an enterprise level common 

control assessment, and not during the <SYSTEM ACRONYM> system specific assessment reported 

within this RAR. 

This assessment was limited to the 32 system specific controls as listed in the approved SAP. 

4.5 Risk Assessors 

The participants in this risk assessment included the following Coalfire Federal Services personnel: 

Table 3: Assessment Team Points of Contact 

Name Role Contact Information 

<TJ Crews> Program Manager <Tj.crews@ssa.gov> 

<Kenneth Free> Lead Assessor (Senior Analyst) <kenneth.free@ssa.gov> 

<Gregory Bonham> Junior Assessor <gregory.bonham@ssa.gov> 

<Thomas G. Volpe, Sr.> Lead Assessor (Surge Support) <Thomas.G.Volpe@ssa.gov> 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 10

The following techniques and NIST/FIPS publications were used to gather information relevant to the 

<SYSTEM ACRONYM>: 

 NIST SP 800-60 Volume II Revision 1/ and FIPS 199. The Risk Assessment (RA) Team utilized 

the <SYSTEM ACRONYM> Security Categorization, dated February 16, 2017 to determine 

associated system security categorization for the <SYSTEM ACRONYM>. System security 

categorization determines which recommended set of minimum (baseline) security controls from 

NIST SP 800-53 Revision 4 must be implemented. 

 NIST SP 800-53 Revision 4. The RA Team utilized NIST SP 800-53 Revision 4 to determine the 

recommended set of minimum-security controls. The security controls (management, operational, 

and technical safeguards or countermeasures) were reviewed to ensure they adequately protect 

the confidentiality, integrity, and availability of the <SYSTEM ACRONYM>, and that the selected 

security controls have been implemented, or there is a plan for future implementation. 

 Interviews. Interviews were conducted on-site with the SAM, System Administrator, and Database 

Administrator by the RA Team to collect useful information about the <SYSTEM ACRONYM>. 

Follow-up communications were conducted via email and by telephone to collect additional 

information about the <SYSTEM ACRONYM>. 

 Examination/Document Reviews. The RA Team reviewed documentation from the SSA for 

<SYSTEM ACRONYM>, such as policy and implementation guidance. POA&M, and the prior 

Security Assessment and Authorization (SA&A) Package, including the previous SSP, Risk 

Assessment, and the Security Control Assessment (SCA) Plan were reviewed. 

 Testing of Systems. Testing and Evaluation of security controls for <SYSTEM ACRONYM> was 

based on System Specific and Hybrid security controls defined by the OIS Rev4 SSA Control 

Inheritance Structure Worksheet with a <SYSTEM CATEGORIZATION> Baseline. Using the NIST 

Guidance from NIST SP 800-53A Revision 4, the RA Team tested and evaluated these controls for 

specified conditions that compare actual with expected behavior, the results of which are used to 

support the determination of security control existence, functionality, correctness, completeness, 

and potential for improvement over time. 

4.6 Results 

The overall risk level of the <SYSTEM ACRONYM> was determined to be Low, which is the combination 

of the likelihood of identified threats being able to exploit known system vulnerabilities and the potential the 

impact to <SYSTEM ACRONYM>. 

Low risk indicates that corrective actions are needed and a plan must be developed to incorporate these 

actions within a reasonable period of time. The preliminary review of security measures for the protection 

of the <SYSTEM ACRONYM> identified two low threat-vulnerability pairs (risks) in the overall risk 

assessment as summarized below in Table 2. 

Table 4: Overall Risk Level 

Risk Rating Control Category

Management Operational Technical Total 

Very High 0 0 0 0 

High 0 0 0 0 

Moderate 0 0 0 0 

Low 2 0 0 2 

Very Low 0 0 0 0 

Total 2 0 0 2 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 11

4.7 Recommendation 

It is the recommendation from the Office of Information Security that an issuance of an Authority to Operate 

(ATO) for <system name> (<ACRONYM>) be given. This recommendation comes from the assessment 

findings from the 3PAO that conducted a system specific security assessment. The overall security 

categorization of <SYSTEM ACRONYM> is <system categorization> and the findings have an overall risk 

of LOW. 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 12

5 Summary of Findings 

Table 5: <SYSTEM ACRONYM> Results Summary

Item 

No. 

Finding 

(In Order by Control 

Family) 

Threat Source Likelihood 

Level 

Impact 

Level 

Risk 

Level 

Recommended 

Corrective 

Action(s) 

V-1 PS-4.c.1 

PS-4.c.2 

Personnel 

Termination 

SSA ISP does not 

define the security 

debrief topics or policy 

to discuss with 

separating employees. 

In addition, the SSA 

ISP has no policy, 

guidelines for including 

the security debrief 

actions, or SSA specific 

information security 

topics during the exit 

interview as defined in 

PS-4.c.1 and PS-4.c.2. 

Insider Threat with 

Intent (e.g., Poorly 

Trained, 

Disgruntled, 

Malicious, 

Negligent, 

Dishonest, or 

Terminated 

Employees) 

Insider Threat 

without Intent or 

Knowledge 

Computer 

Crime/Hackers 

Espionage (e.g., 

Companies, 

Foreign 

Governments, or 

Other Government 

Interests) 

Low Low Low This is an agency 

requirement that 

must be reflected in 

the SSA ISP and is 

the responsibility of 

Division of Security 

Customer Service 

(DSCS). The 

Security 

Authorization 

Manager (SAM) is 

not responsible for 

updating policy. The 

SSA ISP should be 

updated to include a 

requirement that 

employees sign a 

Non-Disclosure 

Agreement (NDA), 

and have a security 

debrief to discuss 

the importance of 

not disclosing 

knowledge of 

specifics pertaining 

to the SSA 

information system 

environment. The 

ISP section 2.1.1.3 

should be updated 

to reflect this. In 

addition, section 

2.1.1.3 should be 

updated to reflect 

that a security 

debrief must be 

included as part of 

the exit interview. 

Exit interview 

guidance is currently 

located here: 

http://personnel.ba.s

sa.gov/OPE/cpps/exi

tprocedures.html 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 13

Item 

No. 

Finding 

(In Order by Control 

Family) 

Threat Source Likelihood 

Level 

Impact 

Level 

Risk 

Level 

Recommended 

Corrective 

Action(s) 

V-2 PS-5.b.1 

PS-5.b.2 

Personnel Transfer 

SSA ISP does not 

define what security 

actions are to be taken 

when an employee is 

transferred or 

reassigned. The SSA 

ISP also does not 

specify the time period 

in which security 

actions that are defined 

in must occur. 

Insider Threat with 

Intent (e.g., Poorly 

Trained, 

Disgruntled, 

Malicious, 

Negligent, 

Dishonest, or 

Terminated 

Employees) 

Insider Threat 

without Intent or 

Knowledge 

Low Low Low This is an agency 

requirement that 

must be reflected in 

the SSA ISP and is 

the responsibility of 

DSCS. The ISP 

section 2.4 should 

be updated to define 

what security actions 

need to occur, in 

what period of time 

and what personnel 

or role is to be 

identified to be 

notified when an 

employee is 

transferred or 

reassigned. 

Authority To Operate (ATO) 

Recommendation 

Acceptance and Signature 

As the Security Authorization Manager (SAM) for <system name>, I hereby certify that this Risk 

Assessment Report provides an accurate representation of the system and its subsystems that were 

assessed. I also certify that it is my recommendation based on the findings that the SSA Chief 

Information Officer (CIO) grant an Authority to Operate (ATO) for <system name> for the next three (3) 

years. 

Security Authorization Manager: 

<name> 

As the Acting Director of the Division of Compliance and Authorization (DCA) in the Office of Information 

Security (OIS), I hereby certify that this Risk Assessment Report provides an accurate representation of 

the system and its subsystems that were assessed. I also certify that it is my recommendation based on 

the findings that the SSA Chief Information Officer (CIO) grant an Authority to Operate (ATO) for <system 

name> for the next three (3) years. 

Division of Compliance and 

Assessments Director 

Steven Harkness 

(Acting)
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 14

Table 6: Acronym List 

Acronym Definition 

AO Authorizing Official 

BSM Boundary Scope Memorandum 

CET Customer Engagement Tool 

CICS Customer Information Control System 

CIO Chief Information Officer 

CSO Component Security Officer 

DCA Division of Compliance and Authorization 

DCS Deputy Commissioner for Systems 

EPO McAfee ePolicy Orchestrator 

FIPS Federal Information Processing Standard 

FISMA Federal Information Security Modernization Act 

FOUO For Official Use Only 

ISA Interconnection Security Agreement 

ISP Information Security Policy 

IT Information Technology 

IV&V Independent Verification and Validation 

L2TP Layer 2 Tunneling Protocol 

LAN Local Area Network 

LIS Low Income Subsidy 

MKS Mortise Kern Systems 

MOA Memorandum of Agreement 

MOU Memorandum of Understanding 

NDA Non-disclosure Agreement 

NSC National Support Center 

NIST National Institute of Standards and Technology 

OIS Office of Information Security 

OMB Office of Management and Budget 

OSOHE Office of Systems Operations and Hardware Engineering 

OTSO Office of Telecommunications and System Operations 

PII Personally Identifiable Information 

POA&M Plan of Action and Milestones 

PSC Program Service Centers 

RA Risk Assessment or Risk Assessor 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 15

Acronym Definition 

RAR Risk Assessment Report 

RSDI Retirement, Survivor, or Disability Insurance 

SA&A Security Assessment and Authorization 

SAM Security Authorization Manager 

SAP System Assessment Plan 

SBU Sensitive But Unclassified 

SCA Security Control Assessment 

SO System Owner

SP Special Publication

SSA Social Security Administration 

SSP System Security Plan 

VPN Virtual Private Network 

3PAO Third Party assessment Organization 

APPENDIX A. REFERENCE DOCUMENTS 

The following documents were reviewed during the risk assessment process of the SSA’s security 

controls: 

 Federal Information Processing Standard (FIPS) 199

 NIST Special Publication 800-30 Rev. 1, “Guide for Conducting Risk Assessments”

 Office of Management and Budget (OMB) Circular A-130.

 NIST Special Publication 800-39

 NIST Special Publication 800-60 Revision 1, Volumes 1&2

 NIST Special Publication 800-53 Revision 4

 SSA Information Security Policy (ISP)
EXHIBIT E
UNCLASSIFIED // FOR OFFICIAL USE ONLY 

UNCLASSIFIED // FOR OFFICIAL USE ONLY 

TEMPLATE VERSION (V2.2 FY17) 

Social Security Administration (SSA) 

Security Categorization: <Enter Categorization>

 NOTE: The Security Categorization for the system may not be available at the time of 

the development of this document if the system is a newly developed system or has 

undergone a major change which has augmented the data types processed by the 

system. Additional information on completing the security categorization of the 

information system can be found on the DSPP website at: 

http://sharepoint.ba.ssa.gov/DCS/OIS/DSPP/Veris%20TO14%20IVV%20and%20OA/

Forms/AllItems.aspx?RootFolder=%2fDCS%2fOIS%2fDSPP%2fVeris%20TO14%20I

VV%20and%20OA%2fIVV%2fTEMPLATES%2fOIS%20TEMPLATES%20FY16&Fol

derCTID=0x0120003BC3DC1169B0CE47BB662BC248F5B5EE. 

<Document Name> 

FOR 

<Externally Hosted Information System Name> 

<(Acronym)> 

<DRAFT/FINAL> Version <X.X> 

<Month DD, YYYY> 

Prepared by 

[COMPANY LOGO] 

[COMPANY STREET ADDRESS] 

[COMPANY CITY, STATE ZIP]
Social Security Administration 

<System Name><System Acronym> 

<Document Name> 

Version <X.X>

TMP V2.2 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY ii

Document Revision History 

Revision 

Number Revision Date Page Number Revision Summary Name of Reviewer 

V[X.X] MM/DD/YYYY All/Page 

No. [E.g. Initial Draft, Annual Review, etc.] 

[Company/Agency 

Name: Contact 

Name] 

 

 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V1.2 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iii 

PREFACE

To carry out its wide-ranging responsibilities, the Social Security Administration (SSA), and its employees 

and managers have access to diverse and complex automated information systems, which includes, file 

servers, local and wide area networks (LANs/WANs) running on various platforms, and 

telecommunications systems. The components and offices within the SSA depend on the confidentiality, 

integrity, and availability (as defined by the Federal Information Processing Standard (FIPS) 199) of these 

systems and their data in order to accomplish day-to-day operations. 

In accordance with Office of Management and Budget (OMB) Circular A-130, Appendix III, all federal 

systems have value and require some level of protection. The generic term “system” is used to mean 

either a general support system or a major application. (See NIST Special Publication 800-18, Guide for 

Developing Security Plans for Federal Information Systems for additional information). 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V1.2 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iv 

EXECUTIVE SUMMARY

The SSA relies on its information technology (IT) systems, including the [Enter SYSTEM NAME 

(Acronym)], to accomplish its undertaking of providing cost-effective and reliable services to the SSA, 

other Federal agencies, and the public at large. Since this externally hosted information system is part of 

an SSA security authorization boundary, it is subject to meet some or all of the SSA specific security 

requirements depending upon the information it processes and the services it provides for the SSA. 

[Provide an EXECUTIVE SUMMARY and overview of the information system. This summary should 

describe what the information system is, what its importance is to SSA, who is in the user audience, and 

any additional subsystems that is encompassed in the system.] 

The purpose of this system security plan is to provide an overview of the security requirements of the 

[ENTER SYSTEM NAME HERE] system and describe the controls in place or planned for meeting those 

requirements. The system security plan also delineates responsibilities and expected behavior of all 

individuals who access the system. 

The SSP documents the structured process of planning adequate, cost-effective security protection for a 

system. It shall reflect input from various managers/stakeholders with responsibilities concerning the 

system from the hosting company and from the SSA component for which the system provides services. 

 [Note: This SSP template shall be used to document an external hosted Information 

Systems that “IS” associated with one of the existing SSA Security Authorization 

Boundaries. 

As part of the development of this SSP document, the external system ISO or designee along with the 

SSA SAM and the Office of Information Security (OIS) will need to follow the instructions to determine 

which new application/system/sub-system should be included or associated with SSA. See section 1.1 

below for more details related to this process.]  DELETE THESE INSTRUCTIONS UPON 

COMPLETION 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V1.2 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY v 

SYSTEM SECURITY PLAN AGREEMENT SUMMARY

This SSP documents a formal agreement among the organizational officials approving the security 

controls designed to meet the security requirements for the [SYSTEM NAME]. These officials are the 

SSA System Owner (SO), (External Contractor) Information System Security Officer (ISSO), SSA 

Security Authorization Manager (SAM) and the SSA Authorizing Official (AO). 

Each organizational official has signed this agreement summary for the reasons identified below and has 

concurred with the security category of this Controlled Unclassified Information (CUI) system to be 

[LOW/MODERATE]. See Executive Order 13556 for more information on CUI. 

 [Check the box below that is applicable  DELETE] 

Initiation of the System Security Plan (including FIPS 199 security categorization)1

Annual Update of the System Security Plan (no significant changes) 

Acceptance and Signature 

As the Designated Representative(s) for <System Name>, I hereby certify that the <System 

Acronym> System Security Plan described in this document provides an accurate representation 

of the <System Acronym> and its subsystems. 

SSA Security Authorization Manager 

[ENTER NAME OF SAM  DELETE 

<Insert digital signature> 

SSA DSP Director 

[ENTER NAME OF DSP DIRECTOR] 

DELETE 

<Insert digital signature> 

 

1 When there are no significant changes, the System Owner, Information System Security Officer and SSA Security Authorization Manager must sign 

the agreement summary for an annual update. The Authorizing Official is not required to sign if there are no significant changes affecting the 

security posture of the system requiring reauthorization. Reauthorization is addressed via a formal memorandum approving the security plan and 

authorizing the system to operate for a specified period of time.
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V1.2 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY vi 

Table of Contents 

1 INFORMATION SYSTEM IDENTIFICATION ....................................................................... 1

1.1 DETERMINATION OF SYSTEM .......................................................................................................... 1

1.2 RESPONSIBLE ORGANIZATION ......................................................................................................... 1

1.3 INFORMATION SYSTEM CATEGORIZATION ........................................................................................ 1

1.4 GENERAL DESCRIPTION OF INFORMATION SENSITIVITY .................................................................... 2

1.5 IMPACT LEVEL FOR INFORMATION TYPES ......................................................................................... 2

1.6 SYSTEM POINTS OF CONTACT ........................................................................................................ 3

1.7 ASSIGNMENT OF SECURITY RESPONSIBILITY ................................................................................... 4

1.8 SYSTEM OPERATIONAL STATUS ...................................................................................................... 4

1.9 INFORMATION SYSTEM TYPE ........................................................................................................... 4

1.10 SECURITY STATUS ......................................................................................................................... 5

1.11 GENERAL DESCRIPTION AND PURPOSE ........................................................................................... 5

1.12 DATA TYPES .................................................................................................................................. 5

1.13 INFORMATION SYSTEM BOUNDARY .................................................................................................. 6

1.14 SYSTEM ARCHITECTURE/ENVIRONMENT .......................................................................................... 6

1.15 SECURITY AUTHORIZATION BOUNDARY ........................................................................................... 6

1.16 SYSTEM INVENTORY ....................................................................................................................... 6

1.17 SYSTEM INTERCONNECTIONS.......................................................................................................... 7

2 [SYSTEM ACRONYM] NIST SP 800-53 - REV 4 MINIMUM SECURITY CONTROLS ....... 8

2.1 SECURITY CONTROLS .................................................................................................................... 8

2.1.1 Access Control (AC) ................................................................................................................ 8

2.1.1.1 AC-1 Access Control Policy and Procedures .......................................................................... 8

2.1.1.2 AC-2 Account Management .................................................................................................... 9

2.1.1.3 AC-3 Access Enforcement .................................................................................................... 11

2.1.1.4 AC-4 Information Flow Enforcement ..................................................................................... 12

2.1.1.5 AC-5 Separation of Duties ..................................................................................................... 13

2.1.1.6 AC-6 Least Privilege .............................................................................................................. 13

2.1.1.7 AC-7 Unsuccessful Logon Attempts ..................................................................................... 16

2.1.1.8 AC-8 System Use Notification ............................................................................................... 16

2.1.1.9 AC-11 Session Lock .............................................................................................................. 17

2.1.1.10 AC-12 Session Termination .................................................................................................. 18

2.1.1.11 AC-14 Permitted Actions without Identification or Authentication ......................................... 19

2.1.1.12 AC-17 Remote Access .......................................................................................................... 20

2.1.1.13 AC-18 Wireless Access ......................................................................................................... 22

2.1.1.14 AC-19 Access Control for Mobile Devices ............................................................................ 23

2.1.1.15 AC-20 Use of External Information Systems ......................................................................... 24

2.1.1.16 AC-21 Information Sharing .................................................................................................... 26

2.1.1.17 AC-22 Publicly Accessible Content ....................................................................................... 26

2.1.2 Awareness and Training (AT) ................................................................................................ 27

2.1.2.1 AT-1 Security Awareness and Training Policy and Procedures ........................................... 27

2.1.2.2 AT-2 Security Awareness Training ........................................................................................ 28

2.1.2.3 AT-3 Role-Based Security Training ....................................................................................... 29

2.1.2.4 AT-4 Security Training Records ............................................................................................ 30

2.1.3 Audit and Accountability (AU) ................................................................................................ 30
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

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2.1.3.1 AU-1 Audit and Accountability Policy and Procedures.......................................................... 30

2.1.3.2 AU-2 Audit Events ................................................................................................................. 31

2.1.3.3 AU-3 Content of Audit Records ............................................................................................. 32

2.1.3.4 AU-4 Audit Storage ............................................................................................................... 33

2.1.3.5 AU-5 Response to Audit Processing Failures ....................................................................... 34

2.1.3.6 AU-6 Audit Review, Analysis, and Reporting ........................................................................ 34

2.1.3.7 AU-7 Audit Reduction and Report Generation ...................................................................... 36

2.1.3.8 AU-8 Time Stamps ................................................................................................................ 37

2.1.3.9 AU-9 Protection of Audit Information ..................................................................................... 38

2.1.3.10 AU-11 Audit Record Retention .............................................................................................. 39

2.1.3.11 AU-12 Audit Generation ........................................................................................................ 40

2.1.4 Security Assessment and Authorization (CA) ....................................................................... 40

2.1.4.1 CA-1 Security Assessment and Authorization Policies and Procedures .............................. 41

2.1.4.2 CA-2 Security Assessments .................................................................................................. 41

2.1.4.3 CA-3 System Interconnections .............................................................................................. 43

2.1.4.4 CA-5 Plan of Action and Milestones ...................................................................................... 44

2.1.4.5 CA-6 Security Authorization .................................................................................................. 44

2.1.4.6 CA-7 Continuous Monitoring ................................................................................................. 45

2.1.4.7 CA-9 Internal System Connections ....................................................................................... 46

2.1.5 Configuration Management (CM) .......................................................................................... 47

2.1.5.1 CM-1 Configuration Management Policy and Procedures .................................................... 47

2.1.5.2 CM-2 Baseline Configuration ................................................................................................ 48

2.1.5.3 CM-3 Configuration Change Control ..................................................................................... 50

2.1.5.4 CM-4 Security Impact Analysis ............................................................................................. 51

2.1.5.5 CM-5 Access Restrictions for Change .................................................................................. 52

2.1.5.6 CM-6 Configuration Settings ................................................................................................. 52

2.1.5.7 CM-7 Least Functionality ....................................................................................................... 53

2.1.5.8 CM-8 Information System Component Inventory .................................................................. 55

2.1.5.9 CM-9 Configuration Management Plan ................................................................................. 57

2.1.5.10 CM-10 Software Usage Restrictions ..................................................................................... 58

2.1.5.11 CM-11 User-Installed Software ............................................................................................. 58

2.1.6 Contingency Planning (CP) ................................................................................................... 59

2.1.6.1 CP-1 Contingency Planning Policy and Procedures ............................................................. 59

2.1.6.2 CP-2 Contingency Plan ......................................................................................................... 60

2.1.6.3 CP-3 Contingency Training ................................................................................................... 62

2.1.6.4 CP-4 Contingency Plan Testing ............................................................................................ 63

2.1.6.5 CP-6 Alternate Storage Site .................................................................................................. 64

2.1.6.6 CP-7 Alternate Processing Site ............................................................................................. 65

2.1.6.7 CP-8 Telecommunications Services ..................................................................................... 67

2.1.6.8 CP-9 Information System Backup ......................................................................................... 69

2.1.6.9 CP-10 Information System Recovery and Reconstitution ..................................................... 70

2.1.7 Identification and Authentication (IA) .................................................................................... 71

2.1.7.1 IA-1 Identification and Authentication Policy and Procedures .............................................. 71

2.1.7.2 IA-2 Identification and Authentication .................................................................................... 72

2.1.7.3 IA-3 Device Identification and Authentication ........................................................................ 75

2.1.7.4 IA-4 Identifier Management ................................................................................................... 76

2.1.7.5 IA-5 Authenticator Management............................................................................................ 76

2.1.7.6 IA-6 Authenticator Feedback ................................................................................................. 79

2.1.7.7 IA-7 Cryptographic Module Authentication ............................................................................ 80

2.1.7.8 IA-8 Identification and Authentication (Non-Organizational Users) ....................................... 80

2.1.8 Incident Response (IR) .......................................................................................................... 82

2.1.8.1 IR-1 Incident Response Policy and Procedures .................................................................... 83

2.1.8.2 IR-2 Incident Response Training ........................................................................................... 83

2.1.8.3 IR-3 Incident Response Testing ............................................................................................ 84
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

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2.1.8.4 IR-4 Incident Handling ........................................................................................................... 85

2.1.8.5 IR-5 Incident Monitoring ........................................................................................................ 86

2.1.8.6 IR-6 Incident Reporting ......................................................................................................... 87

2.1.8.7 IR-7 Incident Response Assistance ...................................................................................... 88

2.1.8.8 IR-8 Incident Response Plan ................................................................................................. 89

2.1.9 Maintenance (MA) ................................................................................................................. 89

2.1.9.1 MA-1 System Maintenance Policy and Procedures .............................................................. 90

2.1.9.2 MA-2 Controlled Maintenance ............................................................................................... 90

2.1.9.3 MA-3 Maintenance Tools ...................................................................................................... 91

2.1.9.4 MA-4 Nonlocal Maintenance ................................................................................................. 92

2.1.9.5 MA-5 Maintenance Personnel ............................................................................................... 93

2.1.9.6 MA-6 Timely Maintenance ..................................................................................................... 94

2.1.10 Media Protection (MP) ........................................................................................................... 95

2.1.10.1 MP-1 Media Protection Policy and Procedures ..................................................................... 95

2.1.10.2 MP-2 Media Access .............................................................................................................. 95

2.1.10.3 MP-3 Media Marking ............................................................................................................. 96

2.1.10.4 MP-4 Media Storage ............................................................................................................. 97

2.1.10.5 MP-5 Media Transport ........................................................................................................... 97

2.1.10.6 MP-6 Media Sanitization ....................................................................................................... 98

2.1.10.7 MP-7 Media Use .................................................................................................................... 99

2.1.11 Physical and Environmental Protection (PE) ...................................................................... 100

2.1.11.1 PE-1 Physical and Environmental Protection Policy and Procedures ................................ 100

2.1.11.2 PE-2 Physical Access Authorizations ................................................................................. 101

2.1.11.3 PE-3 Physical Access Control ............................................................................................. 102

2.1.11.4 PE-4 Access Control for Transmission Medium .................................................................. 102

2.1.11.5 PE-5 Access Control for Output Devices ............................................................................ 103

2.1.11.6 PE-6 Monitoring Physical Access........................................................................................ 104

2.1.11.7 PE-8 Visitor Access Records .............................................................................................. 105

2.1.11.8 PE-9 Power Equipment and Cabling ................................................................................... 105

2.1.11.9 PE-10 Emergency Shutoff ................................................................................................... 106

2.1.11.10 PE-11 Emergency Power .................................................................................................... 107

2.1.11.11 PE-12 Emergency Lighting .................................................................................................. 107

2.1.11.12 PE-13 Fire Protection .......................................................................................................... 108

2.1.11.13 PE-14 Temperature and Humidity Controls ........................................................................ 109

2.1.11.14 PE-15 Water Damage Protection ........................................................................................ 110

2.1.11.15 PE-16 Delivery and Removal .............................................................................................. 110

2.1.11.16 PE-17 Alternate Work Site .................................................................................................. 111

2.1.12 Planning (PL) ....................................................................................................................... 112

2.1.12.1 PL-1 Security Planning Policy and Procedures ................................................................... 112

2.1.12.2 PL-2 System Security Plan .................................................................................................. 113

2.1.12.3 PL-4 Rules of Behavior ....................................................................................................... 114

2.1.12.4 PL-8 Information Security Architecture ............................................................................... 115

2.1.13 Personnel Security (PS) ...................................................................................................... 116

2.1.13.1 PS-1 Personnel Security Policy and Procedures ................................................................ 116

2.1.13.2 PS-2 Position Risk Designation ........................................................................................... 117

2.1.13.3 PS-3 Personnel Screening .................................................................................................. 117

2.1.13.4 PS-4 Personnel Termination ............................................................................................... 118

2.1.13.5 PS-5 Personnel Transfer ..................................................................................................... 119

2.1.13.6 PS-6 Access Agreements ................................................................................................... 119

2.1.13.7 PS-7 Third-Party Personnel Security .................................................................................. 120

2.1.13.8 PS-8 Personnel Sanctions .................................................................................................. 121

2.1.14 Risk Assessment (RA) ........................................................................................................ 121

2.1.14.1 RA-1 Risk Assessment Policy and Procedures .................................................................. 122

2.1.14.2 RA-2 Security Categorization .............................................................................................. 122
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2.1.14.3 RA-3 Risk Assessment ........................................................................................................ 123

2.1.14.4 RA-5 Vulnerability Scanning ................................................................................................ 124

2.1.15 System and Services Acquisition ........................................................................................ 126

2.1.15.1 SA-1 System and Services Acquisition Policy and Procedures .......................................... 126

2.1.15.2 SA-2 Allocation of Resources .............................................................................................. 127

2.1.15.3 SA-3 System Development Life Cycle ................................................................................ 127

2.1.15.4 SA-4 Acquisition Process .................................................................................................... 128

2.1.15.5 SA-5 Information System Documentation ........................................................................... 130

2.1.15.6 SA-8 Security Engineering Principles ................................................................................. 131

2.1.15.7 SA-9 External Information System Services ....................................................................... 132

2.1.15.8 SA-10 Developer Configuration Management .................................................................... 133

2.1.15.9 SA-11 Developer Security Testing and Evaluation ............................................................. 134

2.1.16 System and Communications Protection ............................................................................ 135

2.1.16.1 SC-1 System and Communications Protection Policy and Procedures .............................. 135

2.1.16.2 SC-2 Application Partitioning ............................................................................................... 136

2.1.16.3 SC-4 Information in Shared Resources .............................................................................. 136

2.1.16.4 SC-5 Denial of Service Protection ....................................................................................... 137

2.1.16.5 SC-7 Boundary Protection ................................................................................................... 137

2.1.16.6 SC-8 Transmission Confidentiality and Integrity ................................................................. 140

2.1.16.7 SC-10 Network Disconnect ................................................................................................. 141

2.1.16.8 SC-12 Cryptographic Key Establishment and Management ............................................... 142

2.1.16.9 SC-13 Cryptographic Protection .......................................................................................... 142

2.1.16.10 SC-15 Collaborative Computing Devices ............................................................................ 143

2.1.16.11 SC-17 Public Key Infrastructure Certificates ....................................................................... 144

2.1.16.12 SC-18 Mobile Code ............................................................................................................. 144

2.1.16.13 SC-19 Voice Over Internet Protocol .................................................................................... 145

2.1.16.14 SC-20 Secure Name / Address Resolution Service (Authoritative Source) ........................ 146

2.1.16.15 SC-21 Secure Name / Address Resolution Service (Recursive or Caching Resolver) ...... 146

2.1.16.16 SC-22 Architecture and Provisioning for Name / Address Resolution Service ................... 147

2.1.16.17 SC-23 Session Authenticity ................................................................................................. 148

2.1.16.18 SC-28 Protection of Information at Rest ............................................................................. 148

2.1.16.19 SC-39 Process Isolation ...................................................................................................... 149

2.1.17 System and Information Integrity......................................................................................... 149

2.1.17.1 SI-1 System and Information Integrity Policy and Procedures ............................................ 149

2.1.17.2 SI-2 Flaw Remediation ........................................................................................................ 150

2.1.17.3 SI-3 Malicious Code Protection ........................................................................................... 151

2.1.17.4 SI-4 Information System Monitoring .................................................................................... 153

2.1.17.5 SI-5 Security Alerts, Advisories, and Directives .................................................................. 155

2.1.17.6 SI-7 Software, Firmware, and Information Integrity ............................................................. 156

2.1.17.7 SI-8 Spam Protection .......................................................................................................... 157

2.1.17.8 SI-10 Information Input Validation ....................................................................................... 159

2.1.17.9 SI-11 Error Handling ............................................................................................................ 159

2.1.17.10 SI-12 Information Handling and Retention .......................................................................... 160

2.1.17.11 SI-16 Memory Protection ..................................................................................................... 161

3 APPENDIX LISTING ......................................................................................................... 162

3.1 REQUIRED APPENDICES ............................................................................................................. 162

3.2 SYSTEM SPECIFIC APPENDICES .................................................................................................. 162

3.3 ACRONYM LIST .......................................................................................................................... 163

3.4 DEFINITIONS/GLOSSARY ............................................................................................................. 165

3.5 APPLICABLE LAWS AND REFERENCES ......................................................................................... 169
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LIST OF FIGURES 

Figure 1: [System Acronym] Architecture Diagram ....................................................................................... 6

Figure 2: [System Acronym] Accreditation Boundary ................................................................................... 6

LIST OF TABLES 

Table 1: System Name/Identifier ................................................................................................................... 1

Table 2: Responsible Organization ............................................................................................................... 1

Table 3: Security Categorization ................................................................................................................... 1

Table 4: Impact Level for Information Types ................................................................................................. 3

Table 5: <System Name> Points of Contact ................................................................................................. 3

Table 6: [System Acronym] (Contractor) Information System Security Officer (ISSO) ................................. 4

Table 7: SSA Security Authorization Manager (SAM) ................................................................................. 4

Table 8: Information System Operational Status .......................................................................................... 4

Table 9: Information System Type ................................................................................................................ 5

Table 10: NIST SP 800-60 Vol 2. Information Data Types ........................................................................... 5

Table 11: Inventory: List of Technologies ..................................................................................................... 6

Table 12: [System Acronym] System Interconnections ................................................................................ 7
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1 Information System Identification 

1.1 Determination of System 

Table 1: System Name/Identifier 

System Name/Title: System ID No: 

<System name: external information system 

name> ( short name-subsystem short name)

1.2 Responsible Organization 

Table 2: Responsible Organization 

Organization Address 

 

1.3 Information System Categorization 

Security categorizations are to be performed as the first step in the security authorization process as 

required by Federal Information Processing Standard (FIPS) 199 in order to select appropriate system 

security controls to be addressed throughout the rest of the security authorization. FIPS 199 categories 

are derived according to the potential impact on the agency that would occur if its Confidentiality, 

Integrity, or Availability were compromised. FIPS 199 category definitions are as follows: 

 High Impact: The loss of confidentiality, integrity, or availability could be expected to have a 

severe or catastrophic adverse effect on organizational operations, organizational assets, or 

individuals. 

 Moderate Impact: The loss of confidentiality, integrity, or availability could be expected to have 

a serious adverse effect on organizational operations, organizational assets, or individuals. (At 

SSA, the highest security categorization is currently Moderate) 

 Low Impact: The loss of confidentiality, integrity, or availability could be expected to have a 

limited adverse effect on organizational operations, organizational assets, or individuals. 

Based on the system categorization of this externally hosted system the [SYSTEM ACRONYM] system 

has been categorized as a [LOW/MODERATE] system according to FIPS 199. 

 [Enter an “X” in the applicable section]  DELETE 

Table 3: Security Categorization 

Low 

Moderate 
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1.4 General Description of Information Sensitivity 

Sensitive information is defined by the Computer Security Act (section 552a of Title 5, United States 

Code) as any information, the loss, misuse, or unauthorized access to or modification of which could 

adversely affect the national interest or the conduct of federal programs, or the privacy to which 

individuals are entitled. The National Institute of Standards and Technology (NIST) Special Publication 

800-122 Guide to Protecting the Confidentiality of Personally Identifiable Information (PII) further defines 

the requirements for Personal Identity Information (PII) which SSA follows with regard to protecting its 

sensitive PII. 

FIPS 199 defines security categories for information systems based on potential impact on organizations, 

assets, or individuals should there be a breach of security—that is, a loss of confidentiality, integrity, or 

availability. FIPS 199 security categories play an important part in defining information system security 

boundaries by partitioning the agency's information systems according to the criticality or sensitivity of the 

information and information systems and the importance of those systems in accomplishing the agency's 

mission. This is particularly important when there are various FIPS 199 impact levels contained in one 

information system. The FIPS 199 requirement to secure an information system to the high watermark or 

highest impact level must be applied when grouping minor applications/subsystems with varying FIPS 

199 impact levels into a single general support system or major application unless there is adequate 

boundary protection, e.g., firewalls and encryption, around those subsystems or applications with the 

highest impact level. Additionally, there must be assurance that the shared resources, i.e., networks, 

communications, and physical access within the whole general support system or major application, are 

protected adequately for the highest impact level. Having the ability to isolate the high impact systems will 

not only result in more secure systems, but will also reduce the amount of resources required to secure 

many applications/systems that do not require that level of security. NIST SP 800-53 provides three 

security control baselines, i.e., low, moderate, and high (high is not addressed by this SSP), that are 

associated with the three FIPS 199 impact levels; as the impact level increases, so do the minimum 

assurance requirements. For reporting purposes, i.e., FISMA annual report, when an information system 

has varying FIPS 199 impact levels, that system is categorized at the highest impact level on that 

information system. 

1.5 Impact Level for Information Types 

The following tables identify the information types that are input, stored, processed, and/or output from 

[System Acronym]. The selection of the information types is based on guidance provided by OMB 

Federal Enterprise Architecture Program Management Office Business Reference Model 2.0 

(http://www.whitehouse.gov/omb/e-gov/fea), and the FIPS 199, Standards for Security Categorization of 

Federal Information and Information Systems, and NIST Special Publication (SP) 800-60, Guide for 

Mapping Types of Information and Information Systems to Security Categories. SP 800-60 includes two 

volumes: Volume I is a basic guideline and Volume II contains appendices. Users should review the 

guidelines provided in Volume I, then refer to only the material from the appendices that is applicable. 

NIST SP 800-60 is available for download at http://csrc.nist.gov/publications/. 

The potential impact is LOW if— 

The loss of confidentiality, integrity, or availability could be expected to have a limited adverse 

effect on organizational operations, organizational assets, or individuals. 

A limited adverse effect means that, for example, the loss of confidentiality, integrity, or availability 

might: (i) cause a degradation in mission capability to an extent and duration that the organization 

is able to perform its primary functions, but the effectiveness of the functions is noticeably 

reduced; (ii) result in minor damage to organizational assets; (iii) result in minor financial loss; or 

(iv) result in minor harm to individuals. 

The potential impact is MODERATE if— 
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The loss of confidentiality, integrity, or availability could be expected to have a serious adverse 

effect on organizational operations, organizational assets, or individuals. 

A serious adverse effect means that, for example, the loss of confidentiality, integrity, or 

availability might: (i) cause a significant degradation in mission capability to an extent and 

duration that the organization is able to perform its primary functions, but the effectiveness of the 

functions is significantly reduced; (ii) result in significant damage to organizational assets; (iii) 

result in significant financial loss; or (iv) result in significant harm to individuals that does not 

involve loss of life or serious life threatening injuries. 

The potential impact is HIGH if— 

The loss of confidentiality, integrity, or availability could be expected to have a severe or 

catastrophic adverse effect on organizational operations, organizational assets, or individuals. 

A severe or catastrophic adverse effect means that, for example, the loss of confidentiality, 

integrity, or availability might: (i) cause a severe degradation in or loss of mission capability to an 

extent and duration that the organization is not able to perform one or more of its primary 

functions; (ii) result in major damage to organizational assets; (iii) result in major financial loss; or 

(iv) result in severe or catastrophic harm to individuals involving loss of life or serious life 

threatening injuries. 

 [List the different information types per NIST SP 800-60 and indicate provisional impact level. Add or 

modify information types if necessary]. This information can be copy/pasted from the SSA Parent 

System FIPS199 Security Categorization Review documentation, Section 4.  DELETE THESE 

INSTRUCTIONS UPON COMPLETION 

Table 4: Impact Level for Information Types 

NIST Information 

Type 

NIST 

SP 800-60, 

Volume II 

Reference 

NIST Recommended Provisional Impact Levels 

System Owner 

Selected Impact Levels Comments 

Confidentiality Integrity Availability Confidentiality Integrity Availability 

EXAMPLE: 

Personal 

Identity and 

Authentication 

Information 

Type

C.2.8.9 M M M M M M None

 

1.6 System Points of Contact 

<Complete the attached spreadsheet with system specific information.> 

Table 5: <System Name> Points of Contact 

SSP-Point of 

Contacts.xlsx
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1.7 Assignment of Security Responsibility 

Table 6: [System Acronym] (Contractor) Information System Security Officer (ISSO) 

Name: 

Title: 

Agency: 

Address: 

Telephone: 

Email: 

Responsibility: Individual with assigned responsibility for maintaining the appropriate operational 

security posture for an information system or program. Information System Security 

Officer (ISSO). 

Table 7: SSA Security Authorization Manager (SAM) 

Name: 

Title: 

Agency: 

Address: 

Telephone: 

Email: 

Responsibility: SSA Security Authorization Manager 

1.8 System Operational Status 

The [SYSTEM ACRONYM] and its component systems are in the [INITIATION, 

ACQUISITION/DEVELOPMENT, IMPLEMENATION, OPERATIONAL/MAINTENANCE] phase of their 

System Development Life Cycles (SDLC). 

 [Enter an “X” in the applicable section]  DELETE 

Table 8: Information System Operational Status 

Initiation Development Implementation Operational 

 

1.9 Information system Type 

 [Enter an “X” in the applicable section below]  DELETE 
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Table 9: Information System Type 

Subsystem/Application Major Application General Support System 

 

1.10 Security Status 

[SECURTIY AUTHORIZATION ACRONYM/ EXTERNAL INFORMATION SYSTEM ACRONYM] received 

a full Authority to Operate (ATO) on [Enter DATE of ATO]. 

1.11 General Description and Purpose 

 [This section should contain a detailed general description and overall purpose for the information 

system. It should identify the system's purpose, capabilities, users, arrangements for hosting, 

connection and/or interface to SSA, and information data flow; discuss the hardware, software and 

firmware implemented in support of the information system]  DELETE 

1.12 Data Types 

Table 10: NIST SP 800-60 Vol 2. Information Data Types 

NIST 

Information 

Type 

NIST SP 800-60, Volume II 

Reference Data Type Description 

EXAMPLE: 

Personal 

Identity 

Information 

Type

C.2.8.9 Personal identity and authentication information includes that 

information necessary to ensure that all persons who are 

potentially entitled to receive any federal benefit are 

enumerated and identified so that Federal agencies can 

have reasonable assurance that they are paying or 

communicating with the right individuals. This information 

include individual citizen’s Social Security Numbers, names, 

dates of birth, places of birth, parents’ names, etc. 

 

 

 
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1.13 Information System Boundary 

The [SYSTEM ACRONYM] system architecture, environment and agreement boundary is described 

below. 

1.14 System Architecture/Environment 

[Provide a description of the information system architecture/environment, explaining where and by whom 

it is hosted, whether it is a web-based (or cloud, etc.) application, what Software (SW) it is utilizing, what 

SW sits on the front end, back end, OS, how many users access the system, describe user interfaces, 

and designate whether connectivity to SSA and/or the outside is through VPN or WAN, etc.]  DELETE 

 [INSERT a diagram of the information system architecture, including its connections/interfaces/other 

relationships to SSA].  DELETE 

Figure 1: [System Acronym] Architecture Diagram 

1.15 Security Authorization Boundary 

[Provide information of where the information system is located; where backups and restores are 

conducted, and specifically where databases are housed. Provide an explanation of where the servers 

are located (company facility, datacenter, etc.), personnel, public access or not, how the systems are 

connected, how remote users can connect and how in and outbound internet connections are secured 

and maintained].  DELETE 

 [INSERT a diagram of the information security authorization boundary showing its 

connections/interfaces/other relationships to SSA.] DELETE

Figure 2: [System Acronym] Accreditation Boundary

1.16 System Inventory 

The hardware (HW) and software (SW) components included in the externally hosted, non-SSA [System 

Acronym] boundary are listed in the tables below. <System acronym> consists of multiple technologies. 

Table 11 contains a listing of technologies (hardware, software, technologies and platforms) that reside 

within the <system acronym> authorization boundary. Technology is listed per system and subsystem: 

<Complete the embedded spreadsheet with system specific information.> 

Table 11: Inventory: List of Technologies 
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Table 6_Inventory - 

List of Technologies - 

 NOTE: Any changes to the scope of the Authorization Boundary after the Boundary 

Scope Meeting and finalization of the BSM may impact the overall IV&V schedule. 

1.17 System Interconnections 

The externally hosted [SYSTEM ACRONYM] requires that written agreements (e.g., Memorandums of 

Understanding (MOUs), Memorandums of Agreement (MOAs), Interconnection Security Agreements 

(ISAs), etc., on the security controls to be enforced on interconnecting systems and must be obtained 

prior to connecting and/or sharing sensitive data/information. Table 18 shows the status of these 

agreements between [SYSTEM ACRONYM] and the external systems that share its information. 

[SYSTEM ACRONYM] [Has /does not have] external communications requiring MOUs or ISAs. 

Table 12: [System Acronym] System Interconnections 

Information 

System 

Organization Type 

(GSS/MA) 

Agreement 

(ISA/MOU/MOA) 

Date FIPS 199 

Category 

C&A 

Status 

DAA 

N/A N/A N/A N/A N/A N/A N/A N/A 

 
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2 [System Acronym] NIST SP 800-53 - Rev 4 

MINIMUM SECURITY CONTROLS 

The minimum security control baseline for [LOW/MODERATE]-impact systems from NIST SP 800-53 

Revision 4 is documented below. Specifically, this section provides a description of how all the minimumsecurity controls in the baseline are being implemented, planned, and compensated or how they will be 

implemented in the future. The table contains: (1) the NIST SP Publication and revision number (2) the 

security control family and specific control with applicable enhancements; (3) if the security control is a 

common control, hybrid or system specific (4) the implementation statement; how the security control is 

being implemented or how it will be implemented (5) the implementation status to determine whether the 

control is in place, not in place, compensated or not applicable and (6) comments to capture specific 

notes about the control’s implementation. (Note: if not in place, an explanation will need to be provided 

under this section). Implementation statements of controls identified as common will reference the system 

and/or SSP that the control is inherited from.

2.1 Security Controls 

Organizations employ security controls in federal information systems and the environments in which 

those systems operate in accordance with FIPS Publication 199, FIPS Publication 200, and NIST Special 

Publications 800-37 and 800-39. Security categorization of federal information and information systems, 

as required by FIPS Publication 199, is the first step in the risk management process. Next, organizations 

select an appropriate set of security controls for their information systems by satisfying the minimumsecurity requirements set forth in FIPS Publication 200. Appendix D includes three security control 

baselines that are associated with the designated impact levels of information systems as determined 

during the security categorization process. After baseline selection, organizations tailor the baselines by: 

(i) identifying/designating common controls; (ii) applying scoping considerations; (iii) selecting 

compensating controls, if needed; (iv) assigning control parameter values in selection and assignment 

statements; (v) supplementing the baseline controls with additional controls and control enhancements 

from the security control catalog; and (vi) providing additional information for control implementation. 

2.1.1 Access Control (AC) 

2.1.1.1 AC-1 Access Control Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

b. An access control policy that addresses purpose, scope, roles, responsibilities, management 

commitment, coordination among organizational entities, and compliance; and 

c. Procedures to facilitate the implementation of the access control policy and associated 

access controls; and 

d. Reviews and updates the current: 

e. Access control policy [Assignment: organization-defined frequency]; and 

f. Access control procedures [Assignment: organization-defined frequency]. 
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NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-1] 

Implementation Statement: 

AC-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.2 AC-2 Account Management 

The organization: 

a. Identifies and selects the following types of information system accounts to support 

organizational missions/business functions: [Assignment: organization-defined information 

system account types]; 

b. Assigns account managers for information system accounts; 

c. Establishes conditions for group and role membership; 

d. Specifies authorized users of the information system, group and role membership, and 

access authorizations (i.e., privileges) and other attributes (as required) for each account; 

e. Requires approvals by [Assignment: organization-defined personnel or roles] for requests to 

create information system accounts; 

f. Creates, enables, modifies, disables, and removes information system accounts in 

accordance with [Assignment: organization-defined procedures or conditions]; 

g. Monitors the use of, information system accounts; 

h. Notifies account managers: 

1. When accounts are no longer required; 

2. When users are terminated or transferred; and 

3. When individual information system usage or need-to-know changes; 

i. Authorizes access to the information system based on: 

1. A valid access authorization; 

2. Intended system usage; and 

3. Other attributes as required by the organization or associated missions/business 

functions; 

j. Reviews accounts for compliance with account management requirements [Assignment: 

organization-defined frequency]; and 

k. Establishes a process for reissuing shared/group account credentials (if deployed) when 

individuals are removed from the group. 
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(1) ACCOUNT MANAGEMENT | AUTOMATED SYSTEM ACCOUNT MANAGEMENT 

The organization employs automated mechanisms to support the management of information 

system accounts. 

(2) ACCOUNT MANAGEMENT | REMOVAL OF TEMPORARY / EMERGENCY ACCOUNTS 

The information system automatically [Selection: removes; disables] temporary and 

emergency accounts after [Assignment: organization-defined time period for each type of 

account]. 

(3) ACCOUNT MANAGEMENT | DISABLE INACTIVE ACCOUNTS 

The information system automatically disables inactive accounts after [Assignment: 

organization-defined time period]. 

(4) ACCOUNT MANAGEMENT | AUTOMATED AUDIT ACTIONS 

The information system automatically audits account creation, modification, enabling, 

disabling, and removal actions, and notifies [Assignment: organization-defined personnel or 

roles]. 

NIST SP 800-53 Access Controls Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-2] 

Implementation Statement: 

AC-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments: 

Control Enhancement AC-2(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-2(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-2(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.3 AC-3 Access Enforcement 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 12 

The information system enforces approved authorizations for logical access to information and system 

resources in accordance with applicable access control policies. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-3] 

Implementation Statement: 

AC-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.4 AC-4 Information Flow Enforcement 

The information system enforces approved authorizations for controlling the flow of information within the 

system and between interconnected systems based on [Assignment: organization-defined information 

flow control policies]. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-4] 

Implementation Statement: 

AC-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 13 

Comments:

2.1.1.5 AC-5 Separation of Duties 

The organization: 

a. Separates [Assignment: organization-defined duties of individuals]; 

b. Documents separation of duties of individuals; and 

c. Defines information system access authorizations to support separation of duties. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-5] 

Implementation Statement: 

AC-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.6 AC-6 Least Privilege 

The organization employs the principle of least privilege, allowing only authorized accesses for users (or 

processes acting on behalf of users) which are necessary to accomplish assigned tasks in accordance 

with organizational missions and business functions. 

Control Enhancements: 

(1) LEAST PRIVILEGE | AUTHORIZE ACCESS TO SECURITY FUNCTIONS 

The organization explicitly authorizes access to [Assignment: organization-defined security functions 

(deployed in hardware, software, and firmware) and security-relevant information]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 14 

(2) LEAST PRIVILEGE | NON-PRIVILEGED ACCESS FOR NONSECURITY FUNCTIONS 

The organization requires that users of information system accounts, or roles, with access to 

[Assignment: organization-defined security functions or security-relevant information], use non-privileged 

accounts or roles, when accessing nonsecurity functions. 

(5) LEAST PRIVILEGE | PRIVILEGED ACCOUNTS 

The organization restricts privileged accounts on the information system to [Assignment: organizationdefined personnel or roles]. 

(9) LEAST PRIVILEGE | AUDITING USE OF PRIVILEGED FUNCTIONS 

The information system audits the execution of privileged functions. 

(10) LEAST PRIVILEGE | PROHIBIT NON-PRIVILEGED USERS FROM EXECUTING PRIVILEGED 

FUNCTIONS 

The information system prevents non-privileged users from executing privileged functions to include 

disabling, circumventing, or altering implemented security safeguards/countermeasures. 

NIST SP 800-53 Access Controls Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-6] 

Implementation Statement: 

AC-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-6(1) 

Implementation Statement: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 15 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-6(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-6(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-6(9) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 16 

Control Enhancement AC-6(10) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.7 AC-7 Unsuccessful Logon Attempts 

The information system: 

a. Enforces a limit of [Assignment: organization-defined number] consecutive invalid logon 

attempts by a user during a [Assignment: organization-defined time period]; and 

b. Automatically [Selection: locks the account/node for an [Assignment: organization-defined 

time period]; locks the account/node until released by an administrator; delays next logon 

prompt according to [Assignment: organization-defined delay algorithm]] when the maximum 

number of unsuccessful attempts is exceeded. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-7] 

Implementation Statement: 

AC-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.8 AC-8 System Use Notification 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 17 

The information system: 

a. Displays to users [Assignment: organization-defined system use notification message or 

banner] before granting access to the system that provides privacy and security notices 

consistent with applicable federal laws, Executive Orders, directives, policies, regulations, 

standards, and guidance and states that: 

1. Users are accessing a U.S. Government information system; 

2. Information system usage may be monitored, recorded, and subject to audit; 

3. Unauthorized use of the information system is prohibited and subject to criminal and civil 

penalties; and 

4. Use of the information system indicates consent to monitoring and recording; 

b. Retains the notification message or banner on the screen until users acknowledge the usage 

conditions and take explicit actions to log on to or further access the information system; and 

c. For publicly accessible systems: 

1. Displays system use information [Assignment: organization-defined conditions], before 

granting further access; 

2. Displays references, if any, to monitoring, recording, or auditing that are consistent with 

privacy accommodations for such systems that generally prohibit those activities; and 

3. Includes a description of the authorized uses of the system. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-8] 

Implementation Statement: 

AC-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.9 AC-11 Session Lock 

The information system: 

a. Prevents further access to the system by initiating a session lock after [Assignment: 

organization-defined time period] of inactivity or upon receiving a request from a user; and 

b. Retains the session lock until the user reestablishes access using established identification 

and authentication procedures. 

Control Enhancements: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 18 

(1) SESSION LOCK | PATTERN-HIDING DISPLAYS 

The information system conceals, via the session lock, information previously visible on the display with a 

publicly viewable image. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-11] 

Implementation Statement: 

AC-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Implementation Statement: 

AC-11(1) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.10 AC-12 Session Termination 

The information system automatically terminates a user session after [Assignment: organization-defined 

conditions or trigger events requiring session disconnect].
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 19 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-12] 

Implementation Statement: 

AC-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.11 AC-14 Permitted Actions without Identification or Authentication 

The organization: 

a. Identifies [Assignment: organization-defined user actions] that can be performed on the 

information system without identification or authentication consistent with organizational 

missions/business functions; and 

b. Documents and provides supporting rationale in the security plan for the information system, 

user actions not requiring identification or authentication. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-14] 

Implementation Statement: 

AC-14 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 20 

Comments:

2.1.1.12 AC-17 Remote Access 

The organization: 

a. Establishes and documents usage restrictions, configuration/connection requirements, and 

implementation guidance for each type of remote access allowed; and 

b. Authorizes remote access to the information system prior to allowing such connections. 

Control Enhancements: 

(1) REMOTE ACCESS | AUTOMATED MONITORING / CONTROL 

The information system monitors and controls remote access methods. 

(2) REMOTE ACCESS | PROTECTION OF CONFIDENTIALITY / INTEGRITY USING ENCRYPTION 

The information system implements cryptographic mechanisms to protect the confidentiality and integrity 

of remote access sessions. 

 

(3) REMOTE ACCESS | MANAGED ACCESS CONTROL POINTS 

The information system routes all remote accesses through [Assignment: organization-defined number] 

managed network access control points. 

(4) REMOTE ACCESS | PRIVILEGED COMMANDS / ACCESS 

The organization: 

(a) Authorizes the execution of privileged commands and access to security-relevant 

information via remote access only for [Assignment: organization-defined needs]; and 

(b) Documents the rationale for such access in the security plan for the information system. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-17] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 21 

Implementation Statement: 

AC-17 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-17(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-17(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-17(3) 

Implementation Statement: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 22 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-17(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.13 AC-18 Wireless Access 

The organization: 

a. Establishes usage restrictions, configuration/connection requirements, and implementation 

guidance for wireless access; and 

b. Authorizes wireless access to the information system prior to allowing such connections. 

Control Enhancements: 

(1) WIRELESS ACCESS | AUTHENTICATION AND ENCRYPTION 

The information system protects wireless access to the system using authentication of [Selection (one or 

more): users; devices] and encryption. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-18] 

Implementation Statement: 

AC-18 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 23 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-18(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.14 AC-19 Access Control for Mobile Devices 

The organization: 

a. Establishes usage restrictions, configuration requirements, connection requirements, and 

implementation guidance for organization-controlled mobile devices; and 

b. Authorizes the connection of mobile devices to organizational information systems. 

(5) ACCESS CONTROL FOR MOBILE DEVICES | FULL DEVICE / CONTAINER-BASED 

ENCRYPTION 

The organization employs [Selection: full-device encryption; container encryption] to protect the 

confidentiality and integrity of information on [Assignment: organization-defined mobile devices]. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-19] 

Implementation Statement: 

AC-19 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 24 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-19(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.15 AC-20 Use of External Information Systems 

The organization establishes terms and conditions, consistent with any trust relationships established with 

other organizations owning, operating, and/or maintaining external information systems, allowing 

authorized individuals to: 

a. Access the information system from external information systems; and 

b. Process, store, or transmit organization-controlled information using external information 

systems. 

Control Enhancements: 

(1) USE OF EXTERNAL INFORMATION SYSTEMS | LIMITS ON AUTHORIZED USE 

The organization permits authorized individuals to use an external information system to access the 

information system or to process, store, or transmit organization-controlled information only when the 

organization: 

(a) Verifies the implementation of required security controls on the external system as 

specified in the organization’s information security policy and security plan; or 

(b) Retains approved information system connection or processing agreements with the 

organizational entity hosting the external information system. 

(2) USE OF EXTERNAL INFORMATION SYSTEMS | PORTABLE STORAGE DEVICES 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 25 

The organization [Selection: restricts; prohibits] the use of organization-controlled portable storage 

devices by authorized individuals on external information systems. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-20] 

Implementation Statement: 

AC-20 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-20(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-20(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 26 

Comments: 

2.1.1.16 AC-21 Information Sharing 

The organization: 

a. Facilitates information sharing by enabling authorized users to determine whether access 

authorizations assigned to the sharing partner match the access restrictions on the 

information for [Assignment: organization-defined information sharing circumstances where 

user discretion is required]; and 

b. Employs [Assignment: organization-defined automated mechanisms or manual processes] to 

assist users in making information sharing/collaboration decisions. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-21] 

Implementation Statement: 

AC-21 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.17 AC-22 Publicly Accessible Content 

The organization: 

a. Designates individuals authorized to post information onto a publicly accessible information 

system; 

b. Trains authorized individuals to ensure that publicly accessible information does not contain 

nonpublic information; 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 27 

c. Reviews the proposed content of information prior to posting onto the publicly accessible 

information system to ensure that nonpublic information is not included; and 

d. Reviews the content on the publicly accessible information system for nonpublic information 

[Assignment: organization-defined frequency] and removes such information, if discovered. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-22] 

Implementation Statement: 

AC-22 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.2 Awareness and Training (AT) 

2.1.2.1 AT-1 Security Awareness and Training Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A security awareness and training policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the security awareness and training policy 

and associated security awareness and training controls; and 

b. Reviews and updates the current: 

1. Security awareness and training policy [Assignment: organization-defined frequency]; 

and 

2. Security awareness and training procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 Awareness and 

Training 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 28 

Revision 4 [AT-1] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

AT-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.2.2 AT-2 Security Awareness Training 

The organization provides basic security awareness training to information system users (including 

managers, senior executives, and contractors): 

a. As part of initial training for new users; 

b. When required by information system changes; and 

c. [Assignment: organization-defined frequency] thereafter. 

Control Enhancements: 

(2) SECURITY AWARENESS | INSIDER THREAT 

The organization includes security awareness training on recognizing and reporting potential indicators of 

insider threat. 

NIST SP 800-53 Awareness and 

Training 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AT-2] 

Implementation Statement: 

AT-2 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 29 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AT-2(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.2.3 AT-3 Role-Based Security Training 

The organization provides role-based security training to personnel with assigned security roles and 

responsibilities: 

a. Before authorizing access to the information system or performing assigned duties; 

b. When required by information system changes; and 

c. [Assignment: organization-defined frequency] thereafter. 

NIST SP 800-53 Awareness and 

Training 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AT-3] 

Implementation Statement: 

AT-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 30 

Comments:

2.1.2.4 AT-4 Security Training Records 

The organization: 

a. Documents and monitors individual information system security training activities including 

basic security awareness training and specific information system security training; and 

b. Retains individual training records for [Assignment: organization-defined time period]. 

NIST SP 800-53 Awareness and 

Training 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AT-4] 

Implementation Statement: 

AT-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3 Audit and Accountability (AU) 

2.1.3.1 AU-1 Audit and Accountability Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. An audit and accountability policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 31 

2. Procedures to facilitate the implementation of the audit and accountability policy and 

associated audit and accountability controls; and 

b. Reviews and updates the current: 

1. Audit and accountability policy [Assignment: organization-defined frequency]; and 

2. Audit and accountability procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-1] 

Implementation Statement: 

AU-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.2 AU-2 Audit Events 

The organization: 

a. Determines that the information system is capable of auditing the following events: 

[Assignment: organization-defined auditable events]; 

b. Coordinates the security audit function with other organizational entities requiring auditrelated information to enhance mutual support and to help guide the selection of auditable 

events; 

c. Provides a rationale for why the auditable events are deemed to be adequate to support 

after-the-fact investigations of security incidents; and 

d. Determines that the following events are to be audited within the information system: 

[Assignment: organization-defined audited events (the subset of the auditable events defined 

in AU-2 a.) along with the frequency of (or situation requiring) auditing for each identified 

event]. 

Control Enhancements: 

(3) AUDIT EVENTS | REVIEWS AND UPDATES 

The organization reviews and updates the audited events [Assignment: organization-defined frequency]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 32 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-2] 

Implementation Statement: 

AU-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-2(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.3 AU-3 Content of Audit Records 

The information system generates audit records containing information that establishes what type of 

event occurred, when the event occurred, where the event occurred, the source of the event, the outcome 

of the event, and the identity of any individuals or subjects associated with the event. 

Control Enhancements: 

(1) CONTENT OF AUDIT RECORDS | ADDITIONAL AUDIT INFORMATION 

The information system generates audit records containing the following additional information: 

[Assignment: organization-defined additional, more detailed information]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 33 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-3] 

Implementation Statement: 

AU-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-3(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.4 AU-4 Audit Storage 

The organization allocates audit record storage capacity in accordance with [Assignment: organizationdefined audit record storage requirements]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-4] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 34 

Implementation Statement: 

AU-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.5 AU-5 Response to Audit Processing Failures 

The information system: 

a. Alerts [Assignment: organization-defined personnel or roles] in the event of an audit 

processing failure; and 

b. Takes the following additional actions: [Assignment: organization-defined actions to be taken 

(e.g., shut down information system, overwrite oldest audit records, stop generating audit 

records)]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-5] 

Implementation Statement: 

AU-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.6 AU-6 Audit Review, Analysis, and Reporting 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 35 

The organization: 

a. Reviews and analyzes information system audit records [Assignment: organization-defined 

frequency] for indications of [Assignment: organization-defined inappropriate or unusual 

activity]; and 

b. Reports findings to [Assignment: organization-defined personnel or roles]. 

Control Enhancements: 

(1) AUDIT REVIEW, ANALYSIS, AND REPORTING | PROCESS INTEGRATION 

The organization employs automated mechanisms to integrate audit review, analysis, and reporting 

processes to support organizational processes for investigation and response to suspicious activities. 

(3) AUDIT REVIEW, ANALYSIS, AND REPORTING | CORRELATE AUDIT REPOSITORIES 

The organization analyzes and correlates audit records across different repositories to gain organizationwide situational awareness. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-6] 

Implementation Statement: 

AU-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-6(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 36 

Scoped 

Comments: 

Control Enhancement AU-6(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.7 AU-7 Audit Reduction and Report Generation 

The information system provides an audit reduction and report generation capability that: 

a. Supports on-demand audit review, analysis, and reporting requirements and after-the-fact 

investigations of security incidents; and 

b. Does not alter the original content or time ordering of audit records. 

Control Enhancements: 

(1) AUDIT REDUCTION AND REPORT GENERATION | AUTOMATIC PROCESSING 

The information system provides the capability to process audit records for events of interest based on 

[Assignment: organization-defined audit fields within audit records]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-7] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

AU-7 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Implementation Statement: 

AU-7(1) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.8 AU-8 Time Stamps 

The information system: 

a. Uses internal system clocks to generate time stamps for audit records; and 

b. Records time stamps for audit records that can be mapped to Coordinated Universal Time 

(UTC) or Greenwich Mean Time (GMT) and meets [Assignment: organization-defined 

granularity of time measurement]. 

Control Enhancements: 

(1) TIME STAMPS | SYNCHRONIZATION WITH AUTHORITATIVE TIME SOURCE 

The information system: 

(a) Compares the internal information system clocks [Assignment: organization-defined 

frequency] with [Assignment: organization-defined authoritative time source]; and 

(b) Synchronizes the internal system clocks to the authoritative time source when the time difference 

is greater than [Assignment: organization-defined time period]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 [AU-8] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 38 

 System Specific Control

Implementation Statement: 

AU-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.9 AU-9 Protection of Audit Information 

The information system protects audit information and audit tools from unauthorized access, modification, 

and deletion. 

Control Enhancements: 

(4) PROTECTION OF AUDIT INFORMATION | ACCESS BY SUBSET OF PRIVILEGED USERS 

The organization authorizes access to management of audit functionality to only [Assignment: 

organization-defined subset of privileged users]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 39 

Revision 4 [AU-9] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

AU-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-9(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.10 AU-11 Audit Record Retention 

The organization retains audit records for [Assignment: organization-defined time period consistent with 

records retention policy] to provide support for after-the-fact investigations of security incidents and to 

meet regulatory and organizational information retention requirements. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-11] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 40 

Implementation Statement: 

AU-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.11 AU-12 Audit Generation 

The information system: 

a. Provides audit record generation capability for the auditable events defined in AU-2 a. at 

[Assignment: organization-defined information system components]; 

b. Allows [Assignment: organization-defined personnel or roles] to select which auditable events 

are to be audited by specific components of the information system; and 

c. Generates audit records for the events defined in AU-2 d. with the content defined in AU-3. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-12] 

Implementation Statement: 

AU-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.4 Security Assessment and Authorization (CA) 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 41 

2.1.4.1 CA-1 Security Assessment and Authorization Policies and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A security assessment and authorization policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the security assessment and authorization 

policy and associated security assessment and authorization controls; and 

b. Reviews and updates the current: 

1. Security assessment and authorization policy [Assignment: organization-defined 

frequency]; and 

2. Security assessment and authorization procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-1] 

Implementation Statement: 

CA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.4.2 CA-2 Security Assessments 

The organization: 

a. Develops a security assessment plan that describes the scope of the assessment including: 

1. Security controls and control enhancements under assessment; 

2. Assessment procedures to be used to determine security control effectiveness; and 

3. Assessment environment, assessment team, and assessment roles and responsibilities; 

b. Assesses the security controls in the information system and its environment of operation 

[Assignment: organization-defined frequency] to determine the extent to which the controls 
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Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 42 

are implemented correctly, operating as intended, and producing the desired outcome with 

respect to meeting established security requirements; 

c. Produces a security assessment report that documents the results of the assessment; and 

d. Provides the results of the security control assessment to [Assignment: organization-defined 

individuals or roles]. 

Control Enhancements: 

(1) SECURITY ASSESSMENTS | INDEPENDENT ASSESSORS 

The organization employs assessors or assessment teams with [Assignment: organization-defined level 

of independence] to conduct security control assessments. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-2] 

Implementation Statement: 

CA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CA-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 43 

2.1.4.3 CA-3 System Interconnections 

The organization: 

a. Authorizes connections from the information system to other information systems through the 

use of Interconnection Security Agreements; 

b. Documents, for each interconnection, the interface characteristics, security requirements, and 

the nature of the information communicated; and 

c. Reviews and updates Interconnection Security Agreements [Assignment: organizationdefined frequency]. 

Control Enhancements: 

(5) SYSTEM INTERCONNECTIONS | RESTRICTIONS ON EXTERNAL SYSTEM CONNECTIONS 

The organization employs [Selection: allow-all, deny-by-exception; deny-all, permit-by-exception] policy 

for allowing [Assignment: organization-defined information systems] to connect to external information 

systems. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-3] 

Implementation Statement: 

CA-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CA-3(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 44 

Scoped 

Comments: 

2.1.4.4 CA-5 Plan of Action and Milestones 

The organization: 

a. Develops a plan of action and milestones for the information system to document the 

organization’s planned remedial actions to correct weaknesses or deficiencies noted during 

the assessment of the security controls and to reduce or eliminate known vulnerabilities in 

the system; and 

b. Updates existing plan of action and milestones [Assignment: organization-defined frequency] 

based on the findings from security controls assessments, security impact analyses, and 

continuous monitoring activities. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-5] 

Implementation Statement: 

CA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.4.5 CA-6 Security Authorization 

The organization: 

a. Assigns a senior-level executive or manager as the authorizing official for the information 

system; 

b. Ensures that the authorizing official authorizes the information system for processing before 

commencing operations; and 

c. Updates the security authorization [Assignment: organization-defined frequency]. 
Social Security Administration 

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<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 45 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-6] 

Implementation Statement: 

CA-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.4.6 CA-7 Continuous Monitoring 

The organization develops a continuous monitoring strategy and implements a continuous monitoring 

program that includes: 

a. Establishment of [Assignment: organization-defined metrics] to be monitored; 

b. Establishment of [Assignment: organization-defined frequencies] for monitoring and 

[Assignment: organization-defined frequencies] for assessments supporting such monitoring; 

c. Ongoing security control assessments in accordance with the organizational continuous 

monitoring strategy; 

d. Ongoing security status monitoring of organization-defined metrics in accordance with the 

organizational continuous monitoring strategy; 

e. Correlation and analysis of security-related information generated by assessments and 

monitoring; 

f. Response actions to address results of the analysis of security-related information; and 

g. Reporting the security status of organization and the information system to [Assignment: 

organization-defined personnel or roles] [Assignment: organization-defined frequency]. 

Control Enhancements: 

(1) CONTINUOUS MONITORING | INDEPENDENT ASSESSMENT 

The organization employs assessors or assessment teams with [Assignment: organization-defined level 

of independence] to monitor the security controls in the information system on an ongoing basis. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 46 

Revision 4 [CA-7] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

CA-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CA-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.4.7 CA-9 Internal System Connections 

The organization: 

a. Authorizes internal connections of [Assignment: organization-defined information system 

components or classes of components] to the information system; and 

b. Documents, for each internal connection, the interface characteristics, security requirements, 

and the nature of the information communicated. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-9] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 47 

Implementation Statement: 

CA-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.5 Configuration Management (CM) 

2.1.5.1 CM-1 Configuration Management Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A configuration management policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the configuration management policy and 

associated configuration management controls; and 

b. Reviews and updates the current: 

1. Configuration management policy [Assignment: organization-defined frequency]; and 

2. Configuration management procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-1] 

Implementation Statement: 

CM-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 48 

Comments:

2.1.5.2 CM-2 Baseline Configuration 

The organization develops, documents, and maintains under configuration control, a current baseline 

configuration of the information system. 

Control Enhancements: 

(1) BASELINE CONFIGURATION | REVIEWS AND UPDATES 

The organization reviews and updates the baseline configuration of the information system: 

(a) [Assignment: organization-defined frequency]; 

(b) When required due to [Assignment organization-defined circumstances]; and 

(c) As an integral part of information system component installations and upgrades. 

(3) BASELINE CONFIGURATION | RETENTION OF PREVIOUS CONFIGURATIONS 

The organization retains [Assignment: organization-defined previous versions of baseline configurations 

of the information system] to support rollback. 

(7) BASELINE CONFIGURATION | CONFIGURE SYSTEMS, COMPONENTS, OR DEVICES FOR 

HIGH-RISK AREAS 

The organization: 

(a) Issues [Assignment: organization-defined information systems, system components, or 

devices] with [Assignment: organization-defined configurations] to individuals traveling to 

locations that the organization deems to be of significant risk; and 

(b) Applies [Assignment: organization-defined security safeguards] to the devices when the 

individuals return. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-2] 
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Version <X.X> 

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Implementation Statement: 

CM-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CM-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-2(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-2(7) 

Implementation Statement: 
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<Document Name> 

Version <X.X> 

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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.5.3 CM-3 Configuration Change Control 

The organization: 

a. Determines the types of changes to the information system that are configuration-controlled; 

b. Reviews proposed configuration-controlled changes to the information system and approves 

or disapproves such changes with explicit consideration for security impact analyses; 

c. Documents configuration change decisions associated with the information system; 

d. Implements approved configuration-controlled changes to the information system; 

e. Retains records of configuration-controlled changes to the information system for 

[Assignment: organization-defined time period]; 

f. Audits and reviews activities associated with configuration-controlled changes to the 

information system; and 

g. Coordinates and provides oversight for configuration change control activities through 

[Assignment: organization-defined configuration change control element (e.g., committee, 

board] that convenes [Selection (one or more): [Assignment: organization-defined frequency]; 

[Assignment: organization-defined configuration change conditions]]. 

Control Enhancements: 

(2) CONFIGURATION CHANGE CONTROL | TEST / VALIDATE / DOCUMENT CHANGES 

The organization tests, validates, and documents changes to the information system before implementing 

the changes on the operational system. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-3] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

CM-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

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Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 51 

Scoped 

Comments:

Control Enhancement CM-3(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.5.4 CM-4 Security Impact Analysis 

The organization analyzes changes to the information system to determine potential security impacts 

prior to change implementation. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-4] 

Implementation Statement: 

CM-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 52 

2.1.5.5 CM-5 Access Restrictions for Change 

The organization defines documents, approves, and enforces physical and logical access restrictions 

associated with changes to the information system. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-5] 

Implementation Statement: 

CM-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.5.6 CM-6 Configuration Settings 

The organization: 

a. Establishes and documents configuration settings for information technology products 

employed within the information system using [Assignment: organization-defined security 

configuration checklists] that reflect the most restrictive mode consistent with operational 

requirements; 

b. Implements the configuration settings; 

c. Identifies, documents, and approves any deviations from established configuration settings 

for [Assignment: organization-defined information system components] based on 

[Assignment: organization-defined operational requirements]; and 

d. Monitors and controls changes to the configuration settings in accordance with organizational 

policies and procedures. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-6] 
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Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 53 

Implementation Statement: 

CM-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.5.7 CM-7 Least Functionality 

The organization: 

a. Configures the information system to provide only essential capabilities; and 

b. Prohibits or restricts the use of the following functions, ports, protocols, and/or services: 

[Assignment: organization-defined prohibited or restricted functions, ports, protocols, 

and/or services]. 

Control Enhancements: 

(1) LEAST FUNCTIONALITY | PERIODIC REVIEW 

The organization: 

(a) Reviews the information system [Assignment: organization-defined frequency] to identify 

unnecessary and/or nonsecure functions, ports, protocols, and services; and 

(b) Disables [Assignment: organization-defined functions, ports, protocols, and services 

within the information system deemed to be unnecessary and/or nonsecure]. 

(2) LEAST FUNCTIONALITY | PREVENT PROGRAM EXECUTION 

The information system prevents program execution in accordance with [Selection (one or more): 

[Assignment: organization-defined policies regarding software program usage and restrictions]; rules 

authorizing the terms and conditions of software program usage]. 

(4) LEAST FUNCTIONALITY | UNAUTHORIZED SOFTWARE / BLACKLISTING 

The organization: 

(a) Identifies [Assignment: organization-defined software programs not authorized to execute 

on the information system]; 
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TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 54 

(b) Employs an allow-all, deny-by-exception policy to prohibit the execution of unauthorized 

software programs on the information system; and 

(c) Reviews and updates the list of unauthorized software programs [Assignment: organizationdefined frequency]. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-7] 

Implementation Statement: 

CM-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CM-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-7(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 55 

Comments: 

Control Enhancement CM-7(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.5.8 CM-8 Information System Component Inventory 

The organization: 

a. Develops and documents an inventory of information system components that: 

1. Accurately reflects the current information system; 

2. Includes all components within the authorization boundary of the information system; 

3. Is at the level of granularity deemed necessary for tracking and reporting; and 

4. Includes [Assignment: organization-defined information deemed necessary to achieve 

effective information system component accountability]; and 

b. Reviews and updates the information system component inventory [Assignment: 

organization-defined frequency]. 

Control Enhancements: 

(1) INFORMATION SYSTEM COMPONENT INVENTORY | UPDATES DURING INSTALLATIONS / 

REMOVALS 

The organization updates the inventory of information system components as an integral part of 

component installations, removals, and information system updates. 

(3) INFORMATION SYSTEM COMPONENT INVENTORY | AUTOMATED UNAUTHORIZED 

COMPONENT DETECTION 

The organization: 

(a) Employs automated mechanisms [Assignment: organization-defined frequency] to detect 

the presence of unauthorized hardware, software, and firmware components within the 

information system; and 
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(b) Takes the following actions when unauthorized components are detected: [Selection (one 

or more): disables network access by such components; isolates the components; notifies 

[Assignment: organization-defined personnel or roles]]. 

(5) INFORMATION SYSTEM COMPONENT INVENTORY | NO DUPLICATE ACCOUNTING OF 

COMPONENTS 

The organization verifies that all components within the authorization boundary of the information system 

are not duplicated in other information system inventories. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-8] 

Implementation Statement: 

CM-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CM-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-8(3) 

Implementation Statement: 
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Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 57 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-8(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.5.9 CM-9 Configuration Management Plan 

The organization develops, documents, and implements a configuration management plan for the 

information system that: 

a. Addresses roles, responsibilities, and configuration management processes and procedures; 

b. Establishes a process for identifying configuration items throughout the system development 

life cycle and for managing the configuration of the configuration items; 

c. Defines the configuration items for the information system and places the configuration items 

under configuration management; and 

d. Protects the configuration management plan from unauthorized disclosure and modification. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-9] 

Implementation Statement: 

CM-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Scoped 

Comments:

2.1.5.10 CM-10 Software Usage Restrictions 

The organization: 

a. Uses software and associated documentation in accordance with contract agreements and 

copyright laws; 

b. Tracks the use of software and associated documentation protected by quantity licenses to 

control copying and distribution; and 

c. Controls and documents the use of peer-to-peer file sharing technology to ensure that this 

capability is not used for the unauthorized distribution, display, performance, or reproduction 

of copyrighted work. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-10] 

Implementation Statement: 

CM-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.5.11 CM-11 User-Installed Software 

The organization: 

a. Establishes [Assignment: organization-defined policies] governing the installation of 

software by users; 

b. Enforces software installation policies through [Assignment: organization-defined 

methods]; and 
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c. Monitors policy compliance at [Assignment: organization-defined frequency]. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-11] 

Implementation Statement: 

CM-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.6 Contingency Planning (CP) 

2.1.6.1 CP-1 Contingency Planning Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A contingency planning policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the contingency planning policy and 

associated contingency planning controls; and 

b. Reviews and updates the current: 

1. Contingency planning policy [Assignment: organization-defined frequency]; and 

2. Contingency planning procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-1] 
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Implementation Statement: 

CP-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.6.2 CP-2 Contingency Plan 

The organization: 

a. Develops a contingency plan for the information system that: 

1. Identifies essential missions and business functions and associated contingency 

requirements; 

2. Provides recovery objectives, restoration priorities, and metrics; 

3. Addresses contingency roles, responsibilities, assigned individuals with contact 

information; 

4. Addresses maintaining essential missions and business functions despite an information 

system disruption, compromise, or failure; 

5. Addresses eventual, full information system restoration without deterioration of the 

security safeguards originally planned and implemented; and 

6. Is reviewed and approved by [Assignment: organization-defined personnel or roles]; 

b. Distributes copies of the contingency plan to [Assignment: organization-defined key 

contingency personnel (identified by name and/or by role) and organizational elements]; 

c. Coordinates contingency planning activities with incident handling activities; 

d. Reviews the contingency plan for the information system [Assignment: organization-defined 

frequency]; 

e. Updates the contingency plan to address changes to the organization, information system, or 

environment of operation and problems encountered during contingency plan 

implementation, execution, or testing; 

f. Communicates contingency plan changes to [Assignment: organization-defined key 

contingency personnel (identified by name and/or by role) and organizational elements]; and 

g. Protects the contingency plan from unauthorized disclosure and modification. 

Control Enhancements: 

(1) CONTINGENCY PLAN | COORDINATE WITH RELATED PLANS 

The organization coordinates contingency plan development with organizational elements responsible for 

related plans. 
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(3) CONTINGENCY PLAN | RESUME ESSENTIAL MISSIONS / BUSINESS FUNCTIONS 

The organization plans for the resumption of essential missions and business functions within 

[Assignment: organization-defined time period] of contingency plan activation. 

(8) CONTINGENCY PLAN | IDENTIFY CRITICAL ASSETS 

The organization identifies critical information system assets supporting essential missions and business 

functions. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-2] 

Implementation Statement: 

CP-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CP-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CP-2(3) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

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Scoped 

Comments: 

Control Enhancement CP-2(8) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.3 CP-3 Contingency Training 

The organization provides contingency training to information system users consistent with assigned roles 

and responsibilities: 

a. Within [Assignment: organization-defined time period] of assuming a contingency role or 

responsibility; 

b. When required by information system changes; and 

c. [Assignment: organization-defined frequency] thereafter. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-3] 

Implementation Statement: 

CP-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments:

2.1.6.4 CP-4 Contingency Plan Testing 

The organization: 

a. Tests the contingency plan for the information system [Assignment: organization-defined 

frequency] using [Assignment: organization-defined tests] to determine the effectiveness of 

the plan and the organizational readiness to execute the plan; 

b. Reviews the contingency plan test results; and 

c. Initiates corrective actions, if needed. 

Control Enhancements: 

(1) CONTINGENCY PLAN TESTING | COORDINATE WITH RELATED PLANS 

The organization coordinates contingency plan testing with organizational elements responsible for 

related plans. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-4] 

Implementation Statement: 

CP-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CP-4(1) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

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Scoped 

Comments: 

2.1.6.5 CP-6 Alternate Storage Site 

The organization: 

a. Establishes an alternate storage site including necessary agreements to permit the storage 

and retrieval of information system backup information; and 

b. Ensures that the alternate storage site provides information security safeguards equivalent to 

that of the primary site. 

Control Enhancements: 

(1) ALTERNATE STORAGE SITE | SEPARATION FROM PRIMARY SITE 

The organization identifies an alternate storage site that is separated from the primary storage site to 

reduce susceptibility to the same threats. 

. 

(3) ALTERNATE STORAGE SITE | ACCESSIBILITY 

The organization identifies potential accessibility problems to the alternate storage site in the event of an 

area-wide disruption or disaster and outlines explicit mitigation actions. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-6] 

Implementation Statement: 

CP-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments:

Control Enhancement CP-6(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CP-6(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.6 CP-7 Alternate Processing Site 

The organization: 

a. Establishes an alternate processing site including necessary agreements to permit the 

transfer and resumption of [Assignment: organization-defined information system operations] 

for essential missions/business functions within [Assignment: organization-defined time 

period consistent with recovery time and recovery point objectives] when the primary 

processing capabilities are unavailable; 

b. Ensures that equipment and supplies required to transfer and resume operations are 

available at the alternate processing site or contracts are in place to support delivery to the 

site within the organization-defined time period for transfer/resumption; and 

c. Ensures that the alternate processing site provides information security safeguards 

equivalent to that of the primary site. 
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Control Enhancements: 

(1) ALTERNATE PROCESSING SITE | SEPARATION FROM PRIMARY SITE 

The organization identifies an alternate processing site that is separated from the primary processing site 

to reduce susceptibility to the same threats. 

(2) ALTERNATE PROCESSING SITE | ACCESSIBILITY 

The organization identifies potential accessibility problems to the alternate processing site in the event of 

an area-wide disruption or disaster and outlines explicit mitigation actions. 

(3) ALTERNATE PROCESSING SITE | PRIORITY OF SERVICE 

The organization develops alternate processing site agreements that contain priority-of-service provisions 

in accordance with organizational availability requirements (including recovery time objectives). 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-7] 

Implementation Statement: 

CP-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CP-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments: 

Control Enhancement CP-7(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CP-7(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.7 CP-8 Telecommunications Services 

The organization establishes alternate telecommunications services including necessary agreements to 

permit the resumption of [Assignment: organization-defined information system operations] for essential 

missions and business functions within [Assignment: organization-defined time period] when the primary 

telecommunications capabilities are unavailable at either the primary or alternate processing or storage 

sites. 

Control Enhancements: 

(1) TELECOMMUNICATIONS SERVICES | PRIORITY OF SERVICE PROVISIONS 

The organization: 
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(a) Develops primary and alternate telecommunications service agreements that contain priorityof-service provisions in accordance with organizational availability requirements (including 

recovery time objectives); and 

(b) Requests Telecommunications Service Priority for all telecommunications services used for 

national security emergency preparedness in the event that the primary and/or alternate 

telecommunications services are provided by a common carrier. 

(2) TELECOMMUNICATIONS SERVICES | SINGLE POINTS OF FAILURE 

The organization obtains alternate telecommunications services to reduce the likelihood of sharing a 

single point of failure with primary telecommunications services. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-8] 

Implementation Statement: 

CP-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Implementation Statement: 

CP-8(1) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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Implementation Statement: 

CP-8(2) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.6.8 CP-9 Information System Backup 

The organization: 

a. Conducts backups of user-level information contained in the information system [Assignment: 

organization-defined frequency consistent with recovery time and recovery point objectives]; 

b. Conducts backups of system-level information contained in the information system 

[Assignment: organization-defined frequency consistent with recovery time and recovery 

point objectives]; 

c. Conducts backups of information system documentation including security-related 

documentation [Assignment: organization-defined frequency consistent with recovery time 

and recovery point objectives]; and 

d. Protects the confidentiality, integrity, and availability of backup information at storage 

locations. 

Control Enhancements: 

(1) INFORMATION SYSTEM BACKUP | TESTING FOR RELIABILITY / INTEGRITY 

The organization tests backup information [Assignment: organization-defined frequency] to verify media 

reliability and information integrity. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-9] 
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Implementation Statement: 

CP-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CP-9(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.9 CP-10 Information System Recovery and Reconstitution 

The organization provides for the recovery and reconstitution of the information system to a known state 

after a disruption, compromise, or failure. 

Control Enhancements: 

(2) INFORMATION SYSTEM RECOVERY AND RECONSTITUTION | TRANSACTION RECOVERY 

The information system implements transaction recovery for systems that are transaction-based. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-10] 
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Implementation Statement: 

CP-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Implementation Statement: 

CP-10(2) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.7 Identification and Authentication (IA) 

2.1.7.1 IA-1 Identification and Authentication Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. An identification and authentication policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the identification and authentication policy 

and associated identification and authentication controls; and 

b. Reviews and updates the current: 

1. Identification and authentication policy [Assignment: organization-defined frequency]; and 

2. Identification and authentication procedures [Assignment: organization-defined 

frequency]. 
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NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-1] 

Implementation Statement: 

IA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.7.2 IA-2 Identification and Authentication 

The information system uniquely identifies and authenticates organizational users (or processes acting on 

behalf of organizational users). 

Control Enhancements: 

(1) IDENTIFICATION AND AUTHENTICATION | NETWORK ACCESS TO PRIVILEGED ACCOUNTS 

The information system implements multifactor authentication for network access to privileged accounts. 

(2) IDENTIFICATION AND AUTHENTICATION | NETWORK ACCESS TO NON-PRIVILEGED 

ACCOUNTS 

The information system implements multifactor authentication for network access to non-privileged 

accounts. 

(3) IDENTIFICATION AND AUTHENTICATION | LOCAL ACCESS TO PRIVILEGED ACCOUNTS 

The information system implements multifactor authentication for local access to privileged accounts. 

(8) IDENTIFICATION AND AUTHENTICATION | NETWORK ACCESS TO PRIVILEGED ACCOUNTS - 

REPLAY RESISTANT 

The information system implements replay-resistant authentication mechanisms for network access to 

privileged accounts. 
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(11) IDENTIFICATION AND AUTHENTICATION | REMOTE ACCESS - SEPARATE DEVICE 

The information system implements multifactor authentication for remote access to privileged and nonprivileged accounts such that one of the factors is provided by a device separate from the system gaining 

access and the device meets [Assignment: organization-defined strength of mechanism requirements]. 

(12) IDENTIFICATION AND AUTHENTICATION | ACCEPTANCE OF PIV CREDENTIALS 

The information system accepts and electronically verifies Personal Identity Verification (PIV) credentials. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-2] 

Implementation Statement: 

IA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IA-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-2(2) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-2(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-2(8) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-2(11) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments: 

Control Enhancement IA-2(12) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.7.3 IA-3 Device Identification and Authentication 

The information system uniquely identifies and authenticates [Assignment: organization-defined specific 

and/or types of devices] before establishing a [Selection (one or more): local; remote; network] 

connection. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-3] 

Implementation Statement: 

IA-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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2.1.7.4 IA-4 Identifier Management 

The organization manages information system identifiers by: 

a. Receiving authorization from [Assignment: organization-defined personnel or roles] to assign 

an individual, group, role, or device identifier; 

b. Selecting an identifier that identifies an individual, group, role, or device; 

c. Assigning the identifier to the intended individual, group, role, or device; 

d. Preventing reuse of identifiers for [Assignment: organization-defined time period]; and 

e. Disabling the identifier after [Assignment: organization-defined time period of inactivity]. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-4] 

Implementation Statement: 

IA-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.7.5 IA-5 Authenticator Management 

The organization manages information system authenticators by: 

a. Verifying, as part of the initial authenticator distribution, the identity of the individual, group, 

role, or device receiving the authenticator; 

b. Establishing initial authenticator content for authenticators defined by the organization; 

c. Ensuring that authenticators have sufficient strength of mechanism for their intended use; 

d. Establishing and implementing administrative procedures for initial authenticator distribution, 

for lost/compromised or damaged authenticators, and for revoking authenticators; 

e. Changing default content of authenticators prior to information system installation; 

f. Establishing minimum and maximum lifetime restrictions and reuse conditions for 

authenticators; 

g. Changing/refreshing authenticators [Assignment: organization-defined time period by 

authenticator type]; 

h. Protecting authenticator content from unauthorized disclosure and modification; 

i. Requiring individuals to take, and having devices implement, specific security safeguards to 

protect authenticators; and 
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j. Changing authenticators for group/role accounts when membership to those accounts 

changes. 

Control Enhancements: 

 

(1) AUTHENTICATOR MANAGEMENT | PASSWORD-BASED AUTHENTICATION 

The information system, for password-based authentication: 

a. Enforces minimum password complexity of [Assignment: organization-defined requirements 

for case sensitivity, number of characters, mix of upper-case letters, lower-case letters, 

numbers, and special characters, including minimum requirements for each type]; 

b. Enforces at least the following number of changed characters when new passwords are 

created: [Assignment: organization-defined number]; 

c. Stores and transmits only encrypted representations of passwords; 

d. Enforces password minimum and maximum lifetime restrictions of [Assignment: organizationdefined numbers for lifetime minimum, lifetime maximum]; 

e. Prohibits password reuse for [Assignment: organization-defined number] generations; and 

f. Allows the use of a temporary password for system logons with an immediate change to a 

permanent password. 

(2) AUTHENTICATOR MANAGEMENT | PKI-BASED AUTHENTICATION 

The information system, for PKI-based authentication: 

a. Validates certifications by constructing and verifying a certification path to an accepted trust 

anchor including checking certificate status information; 

b. Enforces authorized access to the corresponding private key; 

c. Maps the authenticated identity to the account of the individual or group; and 

d. Implements a local cache of revocation data to support path discovery and validation in case 

of inability to access revocation information via the network. 

(3) AUTHENTICATOR MANAGEMENT | IN-PERSON OR TRUSTED THIRD-PARTY REGISTRATION 

The organization requires that the registration process to receive [Assignment: organization-defined types 

of and/or specific authenticators] be conducted [Selection: in person; by a trusted third party] before 

[Assignment: organization-defined registration authority] with authorization by [Assignment: organizationdefined personnel or roles]. 

(11) AUTHENTICATOR MANAGEMENT | HARDWARE TOKEN-BASED AUTHENTICATION 

The information system, for hardware token-based authentication, employs mechanisms that satisfy 

[Assignment: organization-defined token quality requirements]. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 
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Revision 4 [IA-5] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

IA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IA-5(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-5(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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Control Enhancement IA-5(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-5(11) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.7.6 IA-6 Authenticator Feedback 

The information system obscures feedback of authentication information during the authentication 

process to protect the information from possible exploitation/use by unauthorized individuals. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-6] 

Implementation Statement: 

IA-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Scoped 

Comments:

2.1.7.7 IA-7 Cryptographic Module Authentication 

The information system implements mechanisms for authentication to a cryptographic module that meet 

the requirements of applicable federal laws, Executive Orders, directives, policies, regulations, standards, 

and guidance for such authentication. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-7] 

Implementation Statement: 

IA-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.7.8 IA-8 Identification and Authentication (Non-Organizational Users) 

The information system uniquely identifies and authenticates non-organizational users (or processes 

acting on behalf of non-organizational users). 

Control Enhancements: 

(1) IDENTIFICATION AND AUTHENTICATION | ACCEPTANCE OF PIV CREDENTIALS FROM 

OTHER AGENCIES 
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The information system accepts and electronically verifies Personal Identity Verification (PIV) credentials 

from other federal agencies. 

(2) IDENTIFICATION AND AUTHENTICATION | ACCEPTANCE OF THIRD-PARTY 

CREDENTIALS 

The information system accepts only FICAM-approved third-party credentials. 

(3) IDENTIFICATION AND AUTHENTICATION | USE OF FICAM-APPROVED PRODUCTS 

The organization employs only FICAM-approved information system components in [Assignment: 

organization-defined information systems] to accept third-party credentials. 

(4) IDENTIFICATION AND AUTHENTICATION | USE OF FICAM-ISSUED PROFILES 

The information system conforms to FICAM-issued profiles. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-8] 

Implementation Statement: 

IA-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IA-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments: 

Control Enhancement IA-8(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-8(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-8(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.8 Incident Response (IR) 
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2.1.8.1 IR-1 Incident Response Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. An incident response policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the incident response policy and 

associated incident response controls; and 

b. Reviews and updates the current: 

1. Incident response policy [Assignment: organization-defined frequency]; and 

2. Incident response procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-1] 

Implementation Statement: 

IR-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.8.2 IR-2 Incident Response Training 

The organization provides incident response training to information system users consistent with 

assigned roles and responsibilities: 

a. Within [Assignment: organization-defined time period] of assuming an incident response role 

or responsibility; 

b. When required by information system changes; and 

c. [Assignment: organization-defined frequency] thereafter. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-2] 
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Implementation Statement: 

IR-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.8.3 IR-3 Incident Response Testing 

The organization tests the incident response capability for the information system [Assignment: 

organization-defined frequency] using [Assignment: organization-defined tests] to determine the incident 

response effectiveness and documents the results. 

Control Enhancements: 

(2) INCIDENT RESPONSE TESTING | COORDINATION WITH RELATED PLANS 

The organization coordinates incident response testing with organizational elements responsible for 

related plans. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-3] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

IR-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments:

Control Enhancement IR-3(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.8.4 IR-4 Incident Handling 

The organization: 

a. Implements an incident handling capability for security incidents that includes preparation, 

detection and analysis, containment, eradication, and recovery; 

b. Coordinates incident handling activities with contingency planning activities; and 

c. Incorporates lessons learned from ongoing incident handling activities into incident response 

procedures, training, and testing/exercises, and implements the resulting changes 

accordingly. 

Control Enhancements: 

(1) INCIDENT HANDLING | AUTOMATED INCIDENT HANDLING PROCESSES 

The organization employs automated mechanisms to support the incident handling process. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-4] 

Implementation Statement: 

IR-4 

Implementation Status: Status (check all that apply): 
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 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IR-4(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.8.5 IR-5 Incident Monitoring 

The organization tracks and documents information system security incidents. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-5] 

Implementation Statement: 

IR-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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2.1.8.6 IR-6 Incident Reporting 

The organization: 

a. Requires personnel to report suspected security incidents to the organizational incident 

response capability within [Assignment: organization-defined time period]; and 

b. Reports security incident information to [Assignment: organization-defined authorities]. 

Control Enhancements: 

(1) INCIDENT REPORTING | AUTOMATED REPORTING 

The organization employs automated mechanisms to assist in the reporting of security incidents. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-6] 

Implementation Statement: 

IR-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IR-6(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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<System Name><(System Acronym)> 

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2.1.8.7 IR-7 Incident Response Assistance 

The organization provides an incident response support resource, integral to the organizational incident 

response capability that offers advice and assistance to users of the information system for the handling 

and reporting of security incidents. 

Control Enhancements: 

(1) INCIDENT RESPONSE ASSISTANCE | AUTOMATION SUPPORT FOR AVAILABILITY OF 

INFORMATION / SUPPORT 

The organization employs automated mechanisms to increase the availability of incident response-related 

information and support. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-7] 

Implementation Statement: 

IR-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IR-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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<System Name><(System Acronym)> 

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2.1.8.8 IR-8 Incident Response Plan 

The organization: 

a. Develops an incident response plan that: 

1. Provides the organization with a roadmap for implementing its incident response 

capability; 

2. Describes the structure and organization of the incident response capability; 

3. Provides a high-level approach for how the incident response capability fits into the 

overall organization; 

4. Meets the unique requirements of the organization, which relate to mission, size, 

structure, and functions; 

5. Defines reportable incidents; 

6. Provides metrics for measuring the incident response capability within the 

organization; 

7. Defines the resources and management support needed to effectively maintain and 

mature an incident response capability; and 

8. Is reviewed and approved by [Assignment: organization-defined personnel or roles]; 

b. Distributes copies of the incident response plan to [Assignment: organization-defined incident 

response personnel (identified by name and/or by role) and organizational elements]; 

c. Reviews the incident response plan [Assignment: organization-defined frequency]; 

d. Updates the incident response plan to address system/organizational changes or problems 

encountered during plan implementation, execution, or testing; 

e. Communicates incident response plan changes to [Assignment: organization-defined incident 

response personnel (identified by name and/or by role) and organizational elements]; and 

f. Protects the incident response plan from unauthorized disclosure and modification. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-8] 

Implementation Statement: 

IR-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.9 Maintenance (MA) 
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2.1.9.1 MA-1 System Maintenance Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A system maintenance policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the system maintenance policy and 

associated system maintenance controls; and 

b. Reviews and updates the current: 

1. System maintenance policy [Assignment: organization-defined frequency]; and 

2. System maintenance procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-1] 

Implementation Statement: 

MA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.9.2 MA-2 Controlled Maintenance 

The organization: 

a. Schedules, performs, documents, and reviews records of maintenance and repairs on 

information system components in accordance with manufacturer or vendor specifications 

and/or organizational requirements; 

b. Approves and monitors all maintenance activities, whether performed on site or remotely and 

whether the equipment is serviced on site or removed to another location; 

c. Requires that [Assignment: organization-defined personnel or roles] explicitly approve the 

removal of the information system or system components from organizational facilities for offsite maintenance or repairs; 
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d. Sanitizes equipment to remove all information from associated media prior to removal from 

organizational facilities for off-site maintenance or repairs; 

e. Checks all potentially impacted security controls to verify that the controls are still functioning 

properly following maintenance or repair actions; and 

f. Includes [Assignment: organization-defined maintenance-related information] in 

organizational maintenance records. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-2] 

Implementation Statement: 

MA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.9.3 MA-3 Maintenance Tools 

The organization approves, controls, and monitors information system maintenance tools. 

Control Enhancements: 

(1) MAINTENANCE TOOLS | INSPECT TOOLS 

The organization inspects the maintenance tools carried into a facility by maintenance personnel for 

improper or unauthorized modifications. 

(2) MAINTENANCE TOOLS | INSPECT MEDIA 

The organization checks media containing diagnostic and test programs for malicious code before the 

media are used in the information system. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

Revision 4 Hybrid (Partially Inherited Control) [MA-3] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 System Specific Control

Implementation Statement: 

MA-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement MA-3(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.9.4 MA-4 Nonlocal Maintenance 

The organization: 

a. Approves and monitors nonlocal maintenance and diagnostic activities; 

b. Allows the use of nonlocal maintenance and diagnostic tools only as consistent with 

organizational policy and documented in the security plan for the information system; 

Employs strong authenticators in the establishment of nonlocal maintenance and diagnostic sessions; 

Maintains records for nonlocal maintenance and diagnostic activities; and terminates session and network 

connections when nonlocal maintenance is completed. 

Control Enhancements: 

(2) NONLOCAL MAINTENANCE | DOCUMENT NONLOCAL MAINTENANCE 
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The organization documents in the security plan for the information system, the policies and procedures 

for the establishment and use of nonlocal maintenance and diagnostic connections. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-4] 

Implementation Statement: 

MA-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement MA-4(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.9.5 MA-5 Maintenance Personnel 

The organization: 

a. Establishes a process for maintenance personnel authorization and maintains a list of 

authorized maintenance organizations or personnel; 

b. Ensures that non-escorted personnel performing maintenance on the information system 

have required access authorizations; and 

c. Designates organizational personnel with required access authorizations and technical 

competence to supervise the maintenance activities of personnel who do not possess the 

required access authorizations. 
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NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-5] 

Implementation Statement: 

MA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.9.6 MA-6 Timely Maintenance 

The organization obtains maintenance support and/or spare parts for [Assignment: organization-defined 

information system components] within [Assignment: organization-defined time period] of failure. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-6] 

Implementation Statement: 

MA-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<System Name><(System Acronym)> 

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2.1.10 Media Protection (MP) 

2.1.10.1 MP-1 Media Protection Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A media protection policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the media protection policy and associated 

media protection controls; and 

b. Reviews and updates the current: 

1. Media protection policy [Assignment: organization-defined frequency]; and 

2. Media protection procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-1] 

Implementation Statement: 

MP-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.10.2 MP-2 Media Access 

The organization restricts access to [Assignment: organization-defined types of digital and/or non-digital 

media] to [Assignment: organization-defined personnel or roles 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

Revision 4 Hybrid (Partially Inherited Control) [MP-2] 
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Version <X.X> 

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 System Specific Control

Implementation Statement: 

MP-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.10.3 MP-3 Media Marking 

The organization: 

a. Marks information system media indicating the distribution limitations, handling caveats, and 

applicable security markings (if any) of the information; and 

b. Exempts [Assignment: organization-defined types of information system media] from marking 

as long as the media remain within [Assignment: organization-defined controlled areas]. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-3] 

Implementation Statement: 

MP-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<System Name><(System Acronym)> 

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2.1.10.4 MP-4 Media Storage 

The organization: 

a. Physically controls and securely stores [Assignment: organization-defined types of digital 

and/or non-digital media] within [Assignment: organization-defined controlled areas]; and 

b. Protects information system media until the media are destroyed or sanitized using approved 

equipment, techniques, and procedures. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-4] 

Implementation Statement: 

MP-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.10.5 MP-5 Media Transport 

The organization: 

a. Protects and controls [Assignment: organization-defined types of information system media] 

during transport outside of controlled areas using [Assignment: organization-defined security 

safeguards]; 

b. Maintains accountability for information system media during transport outside of controlled 

areas; 

c. Documents activities associated with the transport of information system media; and 

d. Restricts the activities associated with the transport of information system media to 

authorized personnel. 

Control Enhancements: 

(4) MEDIA TRANSPORT | CRYPTOGRAPHIC PROTECTION 

The information system implements cryptographic mechanisms to protect the confidentiality and integrity 

of information stored on digital media during transport outside of controlled areas. 
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NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-5] 

Implementation Statement: 

MP-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement MA-5(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.10.6 MP-6 Media Sanitization 

The organization: 

a. Sanitizes [Assignment: organization-defined information system media] prior to disposal, 

release out of organizational control, or release for reuse using [Assignment: organizationdefined sanitization techniques and procedures] in accordance with applicable federal and 

organizational standards and policies; and 

b. Employs sanitization mechanisms with the strength and integrity commensurate with the 

security category or classification of the information. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Revision 4 [MP-6] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

MP-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.10.7 MP-7 Media Use 

The organization [Selection: restricts; prohibits] the use of [Assignment: organization-defined types of 

information system media] on [Assignment: organization-defined information systems or system 

components] using [Assignment: organization-defined security safeguards]. 

Control Enhancements: 

(1) MEDIA USE | PROHIBIT USE WITHOUT OWNER 

The organization prohibits the use of portable storage devices in organizational information systems when 

such devices have no identifiable owner. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-7] 

Implementation Statement: 

MP-7 

Implementation Status: Status (check all that apply): 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

MP-7(1) Control Enhancement 

Implementation Statement: 

Implementation Status: Status (check all that apply 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.11 Physical and Environmental Protection (PE) 

2.1.11.1 PE-1 Physical and Environmental Protection Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A physical and environmental protection policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the physical and environmental protection 

policy and associated physical and environmental protection controls; and 

b. Reviews and updates the current: 

1. Physical and environmental protection policy [Assignment: organization-defined 

frequency]; and 

2. Physical and environmental protection procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-1] 
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Implementation Statement: 

PE-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.2 PE-2 Physical Access Authorizations 

The organization: 

a. Develops, approves, and maintains a list of individuals with authorized access to the facility 

where the information system resides; 

b. Issues authorization credentials for facility access; 

c. Reviews the access list detailing authorized facility access by individuals [Assignment: 

organization-defined frequency]; and 

d. Removes individuals from the facility access list when access is no longer required. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-2] 

Implementation Statement: 

PE-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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2.1.11.3 PE-3 Physical Access Control 

The organization: 

a. Enforces physical access authorizations at [Assignment: organization-defined entry/exit 

points to the facility where the information system resides] by; 

1. Verifying individual access authorizations before granting access to the facility; and 

2. Controlling ingress/egress to the facility using [Selection (one or more): [Assignment: 

organization-defined physical access control systems/devices]; guards]; 

b. Maintains physical access audit logs for [Assignment: organization-defined entry/exit points]; 

c. Provides [Assignment: organization-defined security safeguards] to control access to areas 

within the facility officially designated as publicly accessible; 

d. Escorts visitors and monitors visitor activity [Assignment: organization-defined circumstances 

requiring visitor escorts and monitoring]; 

e. Secures keys, combinations, and other physical access devices; 

f. Inventories [Assignment: organization-defined physical access devices] every [Assignment: 

organization-defined frequency]; and 

g. Changes combinations and keys [Assignment: organization-defined frequency] and/or when 

keys are lost, combinations are compromised, or individuals are transferred or terminated. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-3] 

Implementation Statement: 

PE-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.4 PE-4 Access Control for Transmission Medium 

The organization controls physical access to [Assignment: organization-defined information system 

distribution and transmission lines] within organizational facilities using [Assignment: organization-defined 

security safeguards]. 
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NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-4] 

Implementation Statement: 

PE-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.5 PE-5 Access Control for Output Devices 

The organization controls physical access to information system output devices to prevent unauthorized 

individuals from obtaining the output. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-5] 

Implementation Statement: 

PE-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.11.6 PE-6 Monitoring Physical Access 

The organization: 

a. Monitors physical access to the facility where the information system resides to detect and 

respond to physical security incidents; 

b. Reviews physical access logs [Assignment: organization-defined frequency] and upon 

occurrence of [Assignment: organization-defined events or potential indications of events]; 

and 

c. Coordinates results of reviews and investigations with the organizational incident response 

capability. 

Control Enhancements: 

(1) MONITORING PHYSICAL ACCESS | INTRUSION ALARMS / SURVEILLANCE EQUIPMENT 

The organization monitors physical intrusion alarms and surveillance equipment. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-6] 

Implementation Statement: 

PE-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement PE-6(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.11.7 PE-8 Visitor Access Records 

The organization: 

a. Maintains visitor access records to the facility where the information system resides for 

[Assignment: organization-defined time period]; and 

b. Reviews visitor access records [Assignment: organization-defined frequency]. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-8] 

Implementation Statement: 

PE-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.8 PE-9 Power Equipment and Cabling 

The organization protects power equipment and power cabling for the information system from damage 

and destruction. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-9] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Statement: 

PE-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.9 PE-10 Emergency Shutoff 

The organization: 

a. Provides the capability of shutting off power to the information system or individual system 

components in emergency situations; 

b. Places emergency shutoff switches or devices in [Assignment: organization-defined location 

by information system or system component] to facilitate safe and easy access for personnel; 

and 

c. Protects emergency power shutoff capability from unauthorized activation. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-10] 

Implementation Statement: 

PE-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.11.10 PE-11 Emergency Power 

The organization provides a short-term uninterruptible power supply to facilitate [Selection (one or more): 

an orderly shutdown of the information system; transition of the information system to long-term alternate 

power] in the event of a primary power source loss. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-11] 

Implementation Statement: 

PE-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.11 PE-12 Emergency Lighting 

The organization employs and maintains automatic emergency lighting for the information system that 

activates in the event of a power outage or disruption and that covers emergency exits and evacuation 

routes within the facility. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-12] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Statement: 

PE-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.12 PE-13 Fire Protection 

The organization employs and maintains fire suppression and detection devices/systems for the 

information system that are supported by an independent energy source. 

Control Enhancements: 

(3) FIRE PROTECTION | AUTOMATIC FIRE SUPPRESSION 

The organization employs an automatic fire suppression capability for the information system when the 

facility is not staffed on a continuous basis. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-13] 

Implementation Statement: 

PE-13 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Comments:

Control Enhancement PE-13(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.11.13 PE-14 Temperature and Humidity Controls 

The organization: 

a. Maintains temperature and humidity levels within the facility where the information system 

resides at [Assignment: organization-defined acceptable levels]; and 

b. Monitors temperature and humidity levels [Assignment: organization-defined frequency]. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-14] 

Implementation Statement: 

PE-14 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Comments:

2.1.11.14 PE-15 Water Damage Protection 

The organization protects the information system from damage resulting from water leakage by providing 

master shutoff or isolation valves that are accessible, working properly, and known to key personnel. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-15] 

Implementation Statement: 

PE-15 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.15 PE-16 Delivery and Removal 

The organization authorizes, monitors, and controls [Assignment: organization-defined types of 

information system components] entering and exiting the facility and maintains records of those items. 

NIST SP 800-53 Physical and 

Environmental 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 111 

Protection Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-16] 

Implementation Statement: 

PE-16 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.16 PE-17 Alternate Work Site 

The organization: 

a. Employs [Assignment: organization-defined security controls] at alternate work sites; 

b. Assesses as feasible, the effectiveness of security controls at alternate work sites; and 

c. Provides a means for employees to communicate with information security personnel in case 

of security incidents or problems. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-17] 

Implementation Statement: 

PE-17 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.12 Planning (PL) 

2.1.12.1 PL-1 Security Planning Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A security planning policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the security planning policy and associated 

security planning controls; and 

b. Reviews and updates the current: 

1. Security planning policy [Assignment: organization-defined frequency]; and 

2. Security planning procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PL-1] 

Implementation Statement: 

PL-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.12.2 PL-2 System Security Plan 

The organization: 

a. Develops a security plan for the information system that: 

1. Is consistent with the organization’s enterprise architecture; 

2. Explicitly defines the authorization boundary for the system; 

3. Describes the operational context of the information system in terms of missions and 

business processes; 

4. Provides the security categorization of the information system including supporting 

rationale; 

5. Describes the operational environment for the information system and relationships with 

or connections to other information systems; 

6. Provides an overview of the security requirements for the system; 

7. Identifies any relevant overlays, if applicable; 

8. Describes the security controls in place or planned for meeting those requirements 

including a rationale for the tailoring and supplementation decisions; and 

9. Is reviewed and approved by the authorizing official or designated representative prior to 

plan implementation; 

b. Distributes copies of the security plan and communicates subsequent changes to the plan to 

[Assignment: organization-defined personnel or roles]; 

c. Reviews the security plan for the information system [Assignment: organization-defined 

frequency]; 

d. Updates the plan to address changes to the information system/environment of operation or 

problems identified during plan implementation or security control assessments; and 

e. Protects the security plan from unauthorized disclosure and modification. 

Control Enhancements: 

(1) SYSTEM SECURITY PLAN | PLAN / COORDINATE WITH OTHER ORGANIZATIONAL ENTITIES 

The organization plans and coordinates security-related activities affecting the information system with 

[Assignment: organization-defined individuals or groups] before conducting such activities in order to 

reduce the impact on other organizational entities. 

NIST SP 800-53 Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PL-2] 

Implementation Statement: 

PL-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Scoped 

Comments:

Control Enhancement PL-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.12.3 PL-4 Rules of Behavior 

The organization: 

a. Establishes and makes readily available to individuals requiring access to the information 

system, the rules that describe their responsibilities and expected behavior with regard to 

information and information system usage; 

b. Receives a signed acknowledgment from such individuals, indicating that they have read, 

understand, and agree to abide by the rules of behavior, before authorizing access to 

information and the information system; 

c. Reviews and updates the rules of behavior [Assignment: organization-defined frequency]; 

and 

d. Requires individuals who have signed a previous version of the rules of behavior to read and 

resign when the rules of behavior are revised/updated. 

Control Enhancements: 

(1) RULES OF BEHAVIOR | SOCIAL MEDIA AND NETWORKING RESTRICTIONS 

The organization includes in the rules of behavior, explicit restrictions on the use of social 

media/networking sites and posting organizational information on public websites. 

NIST SP 800-53 Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PL-4] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Statement: 

PL-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement PL-4(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.12.4 PL-8 Information Security Architecture 

The organization: 

a. Develops an information security architecture for the information system that: 

1. Describes the overall philosophy, requirements, and approach to be taken with regard to 

protecting the confidentiality, integrity, and availability of organizational information; 

2. Describes how the information security architecture is integrated into and supports the 

enterprise architecture; and 

3. Describes any information security assumptions about, and dependencies on, external 

services; 

b. Reviews and updates the information security architecture [Assignment: organization-defined 

frequency] to reflect updates in the enterprise architecture; and 

c. Ensures that planned information security architecture changes are reflected in the security 

plan, the security Concept of Operations (CONOPS), and organizational 

procurements/acquisitions. 

NIST SP 800-53 Planning Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 116 

Revision 4 [PL-8] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

PL-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13 Personnel Security (PS) 

2.1.13.1 PS-1 Personnel Security Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A personnel security policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the personnel security policy and 

associated personnel security controls; and 

b. Reviews and updates the current: 

1. Personnel security policy [Assignment: organization-defined frequency]; and 

2. Personnel security procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-1] 

Implementation Statement: 

PS-1 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.2 PS-2 Position Risk Designation 

The organization: 

a. Assigns a risk designation to all organizational positions; 

b. Establishes screening criteria for individuals filling those positions; and 

c. Reviews and updates position risk designations [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-2] 

Implementation Statement: 

PS-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.3 PS-3 Personnel Screening 

The organization: 

a. Screens individuals prior to authorizing access to the information system; and 

b. Rescreens individuals according to [Assignment: organization-defined conditions requiring 

rescreening and, where rescreening is so indicated, the frequency of such rescreening]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 118 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-3] 

Implementation Statement: 

PS-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.4 PS-4 Personnel Termination 

The organization, upon termination of individual employment: 

a. Disables information system access within [Assignment: organization-defined time period]; 

b. Terminates/revokes any authenticators/credentials associated with the individual; 

c. Conducts exit interviews that include a discussion of [Assignment: organization-defined 

information security topics]; 

d. Retrieves all security-related organizational information system-related property; 

e. Retains access to organizational information and information systems formerly controlled by 

terminated individual; and 

f. Notifies [Assignment: organization-defined personnel or roles] within [Assignment: 

organization-defined time period]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-4] 

Implementation Statement: 

PS-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 119 

Scoped 

Comments:

2.1.13.5 PS-5 Personnel Transfer 

The organization: 

a. Reviews and confirms ongoing operational need for current logical and physical access 

authorizations to information systems/facilities when individuals are reassigned or transferred 

to other positions within the organization; 

b. Initiates [Assignment: organization-defined transfer or reassignment actions] within 

[Assignment: organization-defined time period following the formal transfer action]; 

c. Modifies access authorization as needed to correspond with any changes in operational need 

due to reassignment or transfer; and 

d. Notifies [Assignment: organization-defined personnel or roles] within [Assignment: 

organization-defined time period]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-5] 

Implementation Statement: 

PS-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.6 PS-6 Access Agreements 

The organization: 

a. Develops and documents access agreements for organizational information systems; 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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b. Reviews and updates the access agreements [Assignment: organization-defined frequency]; 

and 

c. Ensures that individuals requiring access to organizational information and information 

systems: 

1. Sign appropriate access agreements prior to being granted access; and 

2. Re-sign access agreements to maintain access to organizational information systems 

when access agreements have been updated or [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-6] 

Implementation Statement: 

PS-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.7 PS-7 Third-Party Personnel Security 

The organization: 

a. Establishes personnel security requirements including security roles and responsibilities for 

third-party providers; 

b. Requires third-party providers to comply with personnel security policies and procedures 

established by the organization; 

c. Documents personnel security requirements; 

d. Requires third-party providers to notify [Assignment: organization-defined personnel or roles] 

of any personnel transfers or terminations of third-party personnel who possess 

organizational credentials and/or badges, or who have information system privileges within 

[Assignment: organization-defined time period]; and 

e. Monitors provider compliance. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-7] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 121 

Implementation Statement: 

PS-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.8 PS-8 Personnel Sanctions 

The organization: 

a. Employs a formal sanctions process for individuals failing to comply with established information 

security policies and procedures; and 

b. Notifies [Assignment: organization-defined personnel or roles] within [Assignment: organizationdefined time period] when a formal employee sanctions process is initiated, identifying the 

individual sanctioned and the reason for the sanction. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-8] 

Implementation Statement: 

PS-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.14 Risk Assessment (RA) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 122 

2.1.14.1 RA-1 Risk Assessment Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A risk assessment policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the risk assessment policy and associated 

risk assessment controls; and 

b. Reviews and updates the current: 

1. Risk assessment policy [Assignment: organization-defined frequency]; and 

2. Risk assessment procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Risk Assessment Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [RA-1] 

Implementation Statement: 

RA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.14.2 RA-2 Security Categorization 

The organization: 

a. Categorizes information and the information system in accordance with applicable federal 

laws, Executive Orders, directives, policies, regulations, standards, and guidance; 

b. Documents the security categorization results (including supporting rationale) in the security 

plan for the information system; and 

c. Ensures that the security categorization decision is reviewed and approved by the authorizing 

official or authorizing official designated representative. 

NIST SP 800-53 Risk Assessment Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 123 

Revision 4 [RA-2] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

RA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.14.3 RA-3 Risk Assessment 

The organization: 

a. Conducts an assessment of risk, including the likelihood and magnitude of harm, from the 

unauthorized access, use, disclosure, disruption, modification, or destruction of the 

information system and the information it processes, stores, or transmits; 

b. Documents risk assessment results in [Selection: security plan; risk assessment report;

[Assignment: organization-defined document]]; 

c. Reviews risk assessment results [Assignment: organization-defined frequency]; 

d. Disseminates risk assessment results to [Assignment: organization-defined personnel or 

roles]; and 

e. Updates the risk assessment [Assignment: organization-defined frequency] or whenever 

there are significant changes to the information system or environment of operation (including 

the identification of new threats and vulnerabilities), or other conditions that may impact the 

security state of the system. 

NIST SP 800-53 Risk Assessment Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [RA-3] 

Implementation Statement: 

RA-3 

Implementation Status: Status (check all that apply): 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.14.4 RA-5 Vulnerability Scanning 

The organization: 

a. Scans for vulnerabilities in the information system and hosted applications [Assignment: 

organization-defined frequency and/or randomly in accordance with organization-defined 

process] and when new vulnerabilities potentially affecting the system/applications are 

identified and reported; 

b. Employs vulnerability scanning tools and techniques that facilitate interoperability among 

tools and automate parts of the vulnerability management process by using standards for: 

1. Enumerating platforms, software flaws, and improper configurations; 

2. Formatting checklists and test procedures; and 

3. Measuring vulnerability impact; 

c. Analyzes vulnerability scan reports and results from security control assessments; 

d. Remediates legitimate vulnerabilities [Assignment: organization-defined response times] in 

accordance with an organizational assessment of risk; and 

e. Shares information obtained from the vulnerability scanning process and security control 

assessments with [Assignment: organization-defined personnel or roles] to help eliminate 

similar vulnerabilities in other information systems (i.e., systemic weaknesses or 

deficiencies). 

Control Enhancements: 

(1) VULNERABILITY SCANNING | UPDATE TOOL CAPABILITY 

The organization employs vulnerability scanning tools that include the capability to readily update the 

information system vulnerabilities to be scanned. 

(2) VULNERABILITY SCANNING | UPDATE BY FREQUENCY / PRIOR TO NEW SCAN / WHEN 

IDENTIFIED 

The organization updates the information system vulnerabilities scanned [Selection (one or more): 

[Assignment: organization-defined frequency]; prior to a new scan; when new vulnerabilities are identified 

and reported]. 

(5) VULNERABILITY SCANNING | PRIVILEGED ACCESS 

The information system implements privileged access authorization to [Assignment: organizationidentified information system components] for selected [Assignment: organization-defined vulnerability 

scanning activities]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [RA-5] 

Implementation Statement: 

RA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement RA-5(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement RA-5(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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Control Enhancement RA-5(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.15 System and Services Acquisition 

2.1.15.1 SA-1 System and Services Acquisition Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A system and services acquisition policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the system and services acquisition policy 

and associated system and services acquisition controls; and 

b. Reviews and updates the current: 

1. System and services acquisition policy [Assignment: organization-defined frequency]; 

and 

2. System and services acquisition procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-1] 

Implementation Statement: 

SA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Version <X.X> 

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Scoped 

Comments:

2.1.15.2 SA-2 Allocation of Resources 

The organization: 

a. Determines information security requirements for the information system or information 

system service in mission/business process planning; 

b. Determines, documents, and allocates the resources required to protect the information 

system or information system service as part of its capital planning and investment control 

process; and 

c. Establishes a discrete line item for information security in organizational programming and 

budgeting documentation. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-2] 

Implementation Statement: 

SA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.3 SA-3 System Development Life Cycle 

The organization: 

a. Manages the information system using [Assignment: organization-defined system 

development life cycle] that incorporates information security considerations; 

b. Defines and documents information security roles and responsibilities throughout the system 

development life cycle; 
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c. Identifies individuals having information security roles and responsibilities; and 

d. Integrates the organizational information security risk management process into system 

development life cycle activities. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-3] 

Implementation Statement: 

SA-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.4 SA-4 Acquisition Process 

The organization includes the following requirements, descriptions, and criteria, explicitly or by reference, 

in the acquisition contract for the information system, system component, or information system service in 

accordance with applicable federal laws, Executive Orders, directives, policies, regulations, standards, 

guidelines, and organizational mission/business needs: 

a. Security functional requirements; 

b. Security strength requirements; 

c. Security assurance requirements; 

d. Security-related documentation requirements; 

e. Requirements for protecting security-related documentation; 

f. Description of the information system development environment and environment in which 

the system is intended to operate; and 

g. Acceptance criteria. 

Control Enhancements: 

(1) ACQUISITION PROCESS | FUNCTIONAL PROPERTIES OF SECURITY CONTROLS 

The organization requires the developer of the information system, system component, or information 

system service to provide a description of the functional properties of the security controls to be 

employed. 
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(2) ACQUISITION PROCESS | DESIGN / IMPLEMENTATION INFORMATION FOR SECURITY 

CONTROLS 

The organization requires the developer of the information system, system component, or information 

system service to provide design and implementation information for the security controls to be employed 

that includes: [Selection (one or more): security-relevant external system interfaces; high-level design; 

low-level design; source code or hardware schematics; [Assignment: organization-defined 

design/implementation information]] at [Assignment: organization-defined level of detail]. 

(9) ACQUISITION PROCESS | FUNCTIONS / PORTS / PROTOCOLS / SERVICES IN USE 

The organization requires the developer of the information system, system component, or information 

system service to identify early in the system development life cycle, the functions, ports, protocols, and 

services intended for organizational use. 

(10) ACQUISITION PROCESS | USE OF APPROVED PIV PRODUCTS 

The organization employs only information technology products on the FIPS 201-approved products list 

for Personal Identity Verification (PIV) capability implemented within organizational information systems. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-4] 

Implementation Statement: 

SA-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SA-4(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Version <X.X> 

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Scoped 

Comments: 

Control Enhancement SA-4(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SA-4(9) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SA-4(10) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.15.5 SA-5 Information System Documentation 
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The organization: 

a. Obtains administrator documentation for the information system, system component, or 

information system service that describes: 

1. Secure configuration, installation, and operation of the system, component, or service; 

2. Effective use and maintenance of security functions/mechanisms; and 

3. Known vulnerabilities regarding configuration and use of administrative (i.e., privileged) 

functions; 

b. Obtains user documentation for the information system, system component, or information 

system service that describes: 

1. User-accessible security functions/mechanisms and how to effectively use those security 

functions/mechanisms; 

2. Methods for user interaction, which enables individuals to use the system, component, or 

service in a more secure manner; and 

3. User responsibilities in maintaining the security of the system, component, or service; 

c. Documents attempts to obtain information system, system component, or information system 

service documentation when such documentation is either unavailable or nonexistent and 

[Assignment: organization-defined actions] in response; 

d. Protects documentation as required, in accordance with the risk management strategy; and 

e. Distributes documentation to [Assignment: organization-defined personnel or roles]. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-5] 

Implementation Statement: 

SA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.6 SA-8 Security Engineering Principles 

The organization applies information system security engineering principles in the specification, design, 

development, implementation, and modification of the information system. 
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NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-8] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SA-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.7 SA-9 External Information System Services 

The organization: 

a. Requires that providers of external information system services comply with organizational 

information security requirements and employ [Assignment: organization-defined security 

controls] in accordance with applicable federal laws, Executive Orders, directives, policies, 

regulations, standards, and guidance; 

b. Defines and documents government oversight and user roles and responsibilities with regard 

to external information system services; and 

c. Employs [Assignment: organization-defined processes, methods, and techniques] to monitor 

security control compliance by external service providers on an ongoing basis. 

Control Enhancements: 

(2) EXTERNAL INFORMATION SYSTEMS | IDENTIFICATION OF FUNCTIONS / PORTS / 

PROTOCOLS / SERVICES 

The organization requires providers of [Assignment: organization-defined external information system 

services] to identify the functions, ports, protocols, and other services required for the use of such 

services. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 [SA-9] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 System Specific Control

Implementation Statement: 

SA-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SA-9(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.15.8 SA-10 Developer Configuration Management 

The organization requires the developer of the information system, system component, or information 

system service to: 

a. Perform configuration management during system, component, or service [Selection (one or 

more): design; development; implementation; operation]; 

b. Document, manage, and control the integrity of changes to [Assignment: organization-defined 

configuration items under configuration management]; 

c. Implement only organization-approved changes to the system, component, or service; 

d. Document approved changes to the system, component, or service and the potential security 

impacts of such changes; and 

e. Track security flaws and flaw resolution within the system, component, or service and report 

findings to [Assignment: organization-defined personnel]. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 
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<Document Name> 

Version <X.X> 

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Revision 4 [SA-10] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SA-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.9 SA-11 Developer Security Testing and Evaluation 

The organization requires the developer of the information system, system component, or information 

system service to: 

a. Create and implement a security assessment plan; 

b. Perform [Selection (one or more): unit; integration; system; regression] testing/evaluation at 

[Assignment: organization-defined depth and coverage]; 

c. Produce evidence of the execution of the security assessment plan and the results of the 

security testing/evaluation; 

d. Implement a verifiable flaw remediation process; and 

e. Correct flaws identified during security testing/evaluation. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-11] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SA-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Comments:

2.1.16 System and Communications Protection 

2.1.16.1 SC-1 System and Communications Protection Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A system and communications protection policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the system and communications protection 

policy and associated system and communications protection controls; and 

b. Reviews and updates the current: 

1. System and communications protection policy [Assignment: organization-defined 

frequency]; and 

2. System and communications protection procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-1] 

Implementation Statement: 

SC-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.16.2 SC-2 Application Partitioning 

The information system separates user functionality (including user interface services) from information 

system management functionality. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-2] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SC-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.3 SC-4 Information in Shared Resources 

The information system prevents unauthorized and unintended information transfer via shared system 

resources. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-3] 

Implementation Statement: 

SC-4 

Implementation Status: Status (check all that apply): 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.4 SC-5 Denial of Service Protection 

The information system protects against or limits the effects of the following types of denial of service 

attacks: [Assignment: organization-defined types of denial of service attacks or reference to source for 

such information] by employing [Assignment: organization-defined security safeguards]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-5] 

Implementation Statement: 

SC-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.5 SC-7 Boundary Protection 

The information system: 

a. Monitors and controls communications at the external boundary of the system and at key 

internal boundaries within the system; 

b. Implements subnetworks for publicly accessible system components that are [Selection: 

physically; logically] separated from internal organizational networks; and 
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c. Connects to external networks or information systems only through managed interfaces 

consisting of boundary protection devices arranged in accordance with organizational 

security architecture. 

Control Enhancements: 

(3) BOUNDARY PROTECTION | ACCESS POINTS 

The organization limits the number of external network connections to the information system. 

Supplemental Guidance: Limiting the number of external network connections facilitates more 

comprehensive monitoring of inbound and outbound communications traffic. The Trusted Internet 

Connection (TIC) initiative is an example of limiting the number of external network connections. 

(4) BOUNDARY PROTECTION | EXTERNAL TELECOMMUNICATIONS SERVICES 

The organization: 

(a) Implements a managed interface for each external telecommunication service; 

(b) Establishes a traffic flow policy for each managed interface; 

(c) Protects the confidentiality and integrity of the information being transmitted across each 

interface; 

(d) Documents each exception to the traffic flow policy with a supporting mission/business 

need and duration of that need; and 

(e) Reviews exceptions to the traffic flow policy [Assignment: organization-defined frequency] 

and removes exceptions that are no longer supported by an explicit mission/business 

need. 

(5) BOUNDARY PROTECTION | DENY BY DEFAULT / ALLOW BY EXCEPTION 

The information system at managed interfaces denies network communications traffic by default and 

allows network communications traffic by exception (i.e., deny all, permit by exception). 

(7) BOUNDARY PROTECTION | PREVENT SPLIT TUNNELING FOR REMOTE DEVICES 

The information system, in conjunction with a remote device, prevents the device from simultaneously 

establishing non-remote connections with the system and communicating via some other connection to 

resources in external networks. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-7] 
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Version <X.X> 

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Implementation Statement: 

SC-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SC-7(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SC-7(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SC-7(5) 

Implementation Statement: 
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<Document Name> 

Version <X.X> 

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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SC-7(7) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.16.6 SC-8 Transmission Confidentiality and Integrity 

The information system protects the [Selection (one or more): confidentiality; integrity] of transmitted 

information. 

Control Enhancements: 

(1) TRANSMISSION CONFIDENTIALITY AND INTEGRITY | CRYPTOGRAPHIC OR ALTERNATE 

PHYSICAL PROTECTION 

The information system implements cryptographic mechanisms to [Selection (one or more): prevent 

unauthorized disclosure of information; detect changes to information] during transmission unless 

otherwise protected by [Assignment: organization-defined alternative physical safeguards]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-8] 
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<Document Name> 

Version <X.X> 

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Implementation Statement: 

SC-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SC-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.16.7 SC-10 Network Disconnect 

The information system terminates the network connection associated with a communications session at 

the end of the session or after [Assignment: organization-defined time period] of inactivity.

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-10] 

Implementation Statement: 

SC-10 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.8 SC-12 Cryptographic Key Establishment and Management 

The organization establishes and manages cryptographic keys for required cryptography employed within 

the information system in accordance with [Assignment: organization-defined requirements for key 

generation, distribution, storage, access, and destruction]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-12] 

Implementation Statement: 

SC-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.9 SC-13 Cryptographic Protection 

The information system implements [Assignment: organization-defined cryptographic uses and type of 

cryptography required for each use] in accordance with applicable federal laws, Executive Orders, 

directives, policies, regulations, and standards. 
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Version <X.X> 

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NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-13] 

Implementation Statement: 

SC-13 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.10 SC-15 Collaborative Computing Devices 

The information system: 

a. Prohibits remote activation of collaborative computing devices with the following exceptions: 

[Assignment: organization-defined exceptions where remote activation is to be allowed]; and 

b. Provides an explicit indication of use to users physically present at the devices. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-15] 

Implementation Statement: 

SC-15 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.16.11 SC-17 Public Key Infrastructure Certificates 

The organization issues public key certificates under an [Assignment: organization-defined certificate 

policy] or obtains public key certificates from an approved service provider 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-17] 

Implementation Statement: 

SC-17 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.12 SC-18 Mobile Code 

The organization: 

a. Defines acceptable and inacceptable mobile code and mobile code technologies; 

b. Establishes usage restrictions and implementation guidance for acceptable mobile code and 

mobile code technologies; and 

c. Authorizes, monitors, and controls the use of mobile code within the information system. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Revision 4 [SC-18] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

SC-18 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.13 SC-19 Voice Over Internet Protocol 

The organization: 

a. Establishes usage restrictions and implementation guidance for Voice over Internet Protocol 

(VoIP) technologies based on the potential to cause damage to the information system if 

used maliciously; and 

b. Authorizes, monitors, and controls the use of VoIP within the information system. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-19] 

Implementation Statement: 

SC-19 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.16.14 SC-20 Secure Name / Address Resolution Service (Authoritative Source) 

The information system: 

a. Provides additional data origin and integrity artifacts along with the authoritative name 

resolution data the system returns in response to external name/address resolution queries; 

and 

Provides the means to indicate the security status of child zones and (if the child supports secure 

resolution services) to enable verification of a chain of trust among parent and child domains, when 

operating as part of a distributed, hierarchical namespace. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-20] 

Implementation Statement: 

SC-20 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.15 SC-21 Secure Name / Address Resolution Service (Recursive or Caching 

Resolver) 

The information system requests and performs data origin authentication and data integrity verification on 

the name/address resolution responses the system receives from authoritative sources. 
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NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-21] 

Implementation Statement: 

SC-21 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.16 SC-22 Architecture and Provisioning for Name / Address Resolution 

Service 

The information systems that collectively provide name/address resolution service for an organization are 

fault-tolerant and implement internal/external role separation 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-22] 

Implementation Statement: 

SC-22 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Comments:

2.1.16.17 SC-23 Session Authenticity 

The information system protects the authenticity of communications sessions. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-23] 

Implementation Statement: 

SC-23 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.18 SC-28 Protection of Information at Rest 

The information system protects the [Selection (one or more): confidentiality; integrity] of [Assignment: 

organization-defined information at rest]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-28] 
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Implementation Statement: 

SC-28 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.19 SC-39 Process Isolation 

The information system maintains a separate execution domain for each executing process. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-39] 

Implementation Statement: 

SC-39 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17 System and Information Integrity 

2.1.17.1 SI-1 System and Information Integrity Policy and Procedures 
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The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A system and information integrity policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the system and information integrity policy 

and associated system and information integrity controls; and 

b. Reviews and updates the current: 

1. System and information integrity policy [Assignment: organization-defined frequency]; 

and 

2. System and information integrity procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-1] 

Implementation Statement: 

SI-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17.2 SI-2 Flaw Remediation 

The organization: 

a. Identifies, reports, and corrects information system flaws; 

b. Tests software and firmware updates related to flaw remediation for effectiveness and 

potential side effects before installation; 

c. Installs security-relevant software and firmware updates within [Assignment: organizationdefined time period] of the release of the updates; and 

d. Incorporates flaw remediation into the organizational configuration management process. 

Control Enhancements: 
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(2) FLAW REMEDIATION | AUTOMATED FLAW REMEDIATION STATUS 

The organization employs automated mechanisms [Assignment: organization-defined frequency] to 

determine the state of information system components with regard to flaw remediation. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-2] 

Implementation Statement: 

SI-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-2(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.3 SI-3 Malicious Code Protection 

The organization: 

a. Employs malicious code protection mechanisms at information system entry and exit points 

to detect and eradicate malicious code; 

b. Updates malicious code protection mechanisms whenever new releases are available in 

accordance with organizational configuration management policy and procedures; 
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c. Configures malicious code protection mechanisms to: 

1. Perform periodic scans of the information system [Assignment: organization-defined 

frequency] and real-time scans of files from external sources at [Selection (one or more); 

endpoint; network entry/exit points] as the files are downloaded, opened, or executed in 

accordance with organizational security policy; and 

2. [Selection (one or more): block malicious code; quarantine malicious code; send alert to 

administrator; [Assignment: organization-defined action]] in response to malicious code 

detection; and 

d. Addresses the receipt of false positives during malicious code detection and eradication and 

the resulting potential impact on the availability of the information system. 

Control Enhancements: 

(1) MALICIOUS CODE PROTECTION | CENTRAL MANAGEMENT 

The organization centrally manages malicious code protection mechanisms. 

(2) MALICIOUS CODE PROTECTION | AUTOMATIC UPDATES 

The information system automatically updates malicious code protection mechanisms. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-3] 

Implementation Statement: 

SI-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-3(1) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SI-3(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.4 SI-4 Information System Monitoring 

The organization: 

a. Monitors the information system to detect: 

1. Attacks and indicators of potential attacks in accordance with [Assignment: 

organization-defined monitoring objectives]; and 

2. Unauthorized local, network, and remote connections; 

b. Identifies unauthorized use of the information system through [Assignment: organizationdefined techniques and methods]; 

c. Deploys monitoring devices: (i) strategically within the information system to collect 

organization-determined essential information; and (ii) at ad hoc locations within the system 

to track specific types of transactions of interest to the organization; 

d. Protects information obtained from intrusion-monitoring tools from unauthorized access, 

modification, and deletion; 

e. Heightens the level of information system monitoring activity whenever there is an indication 

of increased risk to organizational operations and assets, individuals, other organizations, or 

the Nation based on law enforcement information, intelligence information, or other credible 

sources of information; 

f. Obtains legal opinion with regard to information system monitoring activities in accordance 

with applicable federal laws, Executive Orders, directives, policies, or regulations; and 

g. Provides [Assignment: organization-defined information system monitoring information] to 

[Assignment: organization-defined personnel or roles] [Selection (one or more): as needed;

[Assignment: organization-defined frequency]]. 

Control Enhancements: 
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(2) INFORMATION SYSTEM MONITORING | AUTOMATED TOOLS FOR REAL-TIME ANALYSIS 

The organization employs automated tools to support near real-time analysis of events. 

(4) INFORMATION SYSTEM MONITORING | INBOUND AND OUTBOUND COMMUNICATIONS 

TRAFFIC 

The information system monitors inbound and outbound communications traffic [Assignment: 

organization-defined frequency] for unusual or unauthorized activities or conditions. 

(5) INFORMATION SYSTEM MONITORING | SYSTEM-GENERATED ALERTS 

The information system alerts [Assignment: organization-defined personnel or roles] when the following 

indications of compromise or potential compromise occur: [Assignment: organization-defined compromise 

indicators]. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-4] 

Implementation Statement: 

SI-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-4(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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Control Enhancement SI-4(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SI-4(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.5 SI-5 Security Alerts, Advisories, and Directives 

The organization: 

a. Receives information system security alerts, advisories, and directives from [Assignment: 

organization-defined external organizations] on an ongoing basis; 

b. Generates internal security alerts, advisories, and directives as deemed necessary; 

c. Disseminates security alerts, advisories, and directives to: [Selection (one or more):

[Assignment: organization-defined personnel or roles]; [Assignment: organization-defined 

elements within the organization]; [Assignment: organization-defined external organizations]]; 

and 

d. Implements security directives in accordance with established time frames, or notifies the 

issuing organization of the degree of noncompliance. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-5] 
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Implementation Statement: 

SI-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17.6 SI-7 Software, Firmware, and Information Integrity 

The organization employs integrity verification tools to detect unauthorized changes to [Assignment: 

organization-defined software, firmware, and information]. 

Control Enhancements: 

(1) SOFTWARE, FIRMWARE, AND INFORMATION INTEGRITY | INTEGRITY CHECKS 

The information system performs an integrity check of [Assignment: organization-defined software, 

firmware, and information] [Selection (one or more): at startup; at [Assignment: organization-defined 

transitional states or security-relevant events]; [Assignment: organization-defined frequency]]. 

(7) SOFTWARE, FIRMWARE, AND INFORMATION INTEGRITY | INTEGRATION OF DETECTION 

AND RESPONSE 

The organization incorporates the detection of unauthorized [Assignment: organization-defined securityrelevant changes to the information system] into the organizational incident response capability. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-7] 
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Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SI-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SI-7(7) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.7 SI-8 Spam Protection 

The organization: 
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a. Employs spam protection mechanisms at information system entry and exit points to detect 

and take action on unsolicited messages; and 

b. Updates spam protection mechanisms when new releases are available in accordance with 

organizational configuration management policy and procedures. 

Control Enhancements: 

(1) SPAM PROTECTION | CENTRAL MANAGEMENT 

The organization centrally manages spam protection mechanisms. 

(2) SPAM PROTECTION | AUTOMATIC UPDATES 

The information system automatically updates spam protection mechanisms. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-8] 

Implementation Statement: 

SI-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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Control Enhancement SI-8(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.8 SI-10 Information Input Validation 

The information system checks the validity of [Assignment: organization-defined information inputs]. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-10] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SI-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17.9 SI-11 Error Handling 

The information system: 
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a. Generates error messages that provide information necessary for corrective actions without 

revealing information that could be exploited by adversaries; and 

b. Reveals error messages only to [Assignment: organization-defined personnel or roles]. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-11] 

Implementation Statement: 

SI-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17.10 SI-12 Information Handling and Retention 

The organization handles and retains information within the information system and information output 

from the system in accordance with applicable federal laws, Executive Orders, directives, policies, 

regulations, standards, and operational requirements. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-12] 

Implementation Statement: 

SI-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Scoped 

Comments:

2.1.17.11 SI-16 Memory Protection 

The information system implements [Assignment: organization-defined security safeguards] to protect its 

memory from unauthorized code execution. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-16] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SI-16 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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3 APPENDIX LISTING 

3.1 Required Appendices 

APPENDIX DESCRIPTION STATUS 

A Acronym List Refer to Appendix 3.2 below 

B Definitions Refer to Appendix 3.3 below 

C Applicable Laws and References Refer to Appendix 3.4 below 

D Agency IT Master Inventory System Security Plan Appendices.doc 

E Security Assessment Report Matrix SecurityAssessmentReport.pdf 

G System Documentation [ENTER NAME OF SSP]

H System Rules of Behavior System Security Plan Appendices.doc 

I Security Awareness and Training 

Plan 

System Security Plan Appendices.doc 

J Incident Response Plan System Security Plan Appendices.doc 

K Configuration Management Plan System Security Plan Appendices.doc 

3.2 System Specific Appendices 

APPENDIX DESCRIPTION STATUS 

E2 Prior Security Assessment Report 

Matrix 

[System Name] SAR Matrix.doc 
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3.3 Acronym List 

TERM DEFINITION 

AO Authorizing Official 

ASSERT Automated Security Self-Evaluation and Remediation Tracking 

ATO Authorization to Operate 

BSM Boundary Scope Memo 

CIO Chief Information Officer 

CISO Chief Information Security Officer 

CONOPS Concept of Operations 

COTS Commercial off the Shelf 

CSAM Cyber Security and Asset Management 

CSO Component Security Officer 

FICAM Federal Identity, Credential, and Access Management 

FIPS Federal Information Processing Standard(s) 

FISMA Federal Information Security Management Act 

GMT Greenwich Mean Time 

HW Hardware 

ISA Interconnection Security Agreement 

ISSH Information System Security Handbook 

IT Information Technology 

MD Maryland 

MOA Memorandum of Agreement 

MOU Memorandum of Understanding 

NCC National Coordinating Center for Communications 

NIST National Institute of Standards and Technology 

OIG Office of Inspector General 

OIS Office of Information Security 

OMB Office of Management and Budget 

OS Operating System 

PIV Personal Identity Verification 

POA&M Plan of Action and Milestones 

POC Point of Contact 
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TERM DEFINITION 

PRIDE Project Resource Guide 

PSC Program Support Center 

RBD Risk-Based Decision 

SAM Security Authorization Manager 

SAR Security Assessment Report 

SBU Sensitive But Unclassified 

SDLC Systems Development Life Cycle 

SDLCM Systems Development Life Cycle Methodology 

SME Subject Matter Expert 

SO System Owner 

SP Special Publication 

SPM System Project Manager 

SRA Security Risk Assessment 

SSA Social Security Administration 

SSC Secure Standards Council 

SSP System Security Plan 

SW Software 

TIC Trusted Internet Connection 

TSL Transport Layer Security 

U.S.C. United States Code 

UTC Coordinated Universal Time 

VoIP Voice Over Internet Protocol 

VPN Virtual Private Network 

WAN Wide Area Network 
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3.4 Definitions/Glossary 

Term Definition 

Accreditation The official management decision given by a senior agency official to 

authorize operation of an information system and to explicitly accept the risk 

to agency operations (including mission, functions, image, or reputation), 

agency assets, or individuals, based on the implementation of an agreedupon set of security controls. 

Accreditation 

Boundary 

All components of an information system to be accredited by an authorizing 

official and excludes separately accredited systems, to which the information 

system is connected. 

Accreditation Package The evidence provided to the authorizing official to be used in the security 

accreditation decision process. Evidence includes, but is not limited to: (i) the 

system security plan; (ii) the assessment results from the security 

certification; and (iii) the plan of action and milestones. 

Assessment 

Procedure 

A set of activities or actions employed by an assessor to determine the extent 

to which a security control is implemented correctly, operating as intended, 

and producing the desired outcome with respect to meeting the security 

requirements for the system. 

Automated Information 

System (AIS) 

An assembly of computer hardware, software and/or firmware configured to 

collect, create, communicate, compute, disseminate, process, store, and/or 

control data or information. 

Certification The comprehensive evaluation of the technical and non-technical security 

features of an AIS and other safeguards, made in support of the accreditation 

process that establishes the extent to which a particular design and 

implementation meet a specified set of security requirements. 

Common Security 

Control 

Security control that can be applied to one or more agency information 

systems and has the following properties: (i) the development, 

implementation, and assessment of the control can be assigned to a 

responsible official or organizational element (other than the information 

system owner); and (ii) the results from the assessment of the control can be 

used to support the C&A processes of an agency information system where 

that control has been applied. 

Confidentiality Preserving authorized restrictions on information access and disclosure, 

including means for protecting personal privacy and proprietary information. 

[44 U.S.C., Sec. 3542] 

Configuration Control Process for controlling modifications to hardware, firmware, software, and 

documentation to ensure the information system is protected against 

improper modifications prior to, during, and after system implementation. 

[CNSS Inst. 4009] 
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Term Definition 

General Support 

System 

An interconnected set of information resources under the same direct 

management control that shares common functionality. It normally includes 

hardware, software, information, data, applications, communications, and 

people. [OMB Circular A-130, Appendix III] 

Information Owner Official with statutory or operational authority for specified information and 

responsibility for establishing the controls for its generation, collection, 

processing, dissemination, and disposal. [CNSS Inst. 4009] 

Information Security The protection of information and information systems from unauthorized 

access, use, disclosure, disruption, modification, or destruction in order to 

provide confidentiality, integrity, and availability. [44 U.S.C., Sec. 3542] 

Information Security 

Policy 

Aggregate of directives, regulations, rules, and practices that prescribe how 

an organization manages, protects, and distributes information. [CNSS Inst. 

4009] 

Information System A discrete set of information resources organized for the collection, 

processing, maintenance, use, sharing, dissemination, or disposition of 

information. [44 U.S.C., Sec. 3502] [OMB Circular A-130, Appendix III] 

Information Type A specific category of information (e.g., privacy, medical, proprietary, 

financial, investigative, contractor sensitive, security management), defined 

by an organization or in some instances, by a specific law, Executive Order, 

directive, policy, or regulation. [FIPS 199] 

Integrity Guarding against improper information modification or destruction, and 

includes ensuring information non-repudiation and authenticity. [44 U.S.C., 

Sec. 3542] 

Major Application An application that requires special attention to security due to the risk and 

magnitude of harm resulting from the loss, misuse, or unauthorized access to 

or modification of the information in the application. [OMB Circular A-130, 

Appendix III] 

Management Controls The security controls (i.e., safeguards or countermeasures) for an information 

system that focus on the management of risk and the management of 

information system security. [NIST SP 800-18] 

Minor Application An application, other than a major application, that requires attention to 

security due to the risk and magnitude of harm resulting from the loss, 

misuse, or unauthorized access to or modification of the information in the 

application. Minor applications are typically included as part of a general 

support system. 

Operational Controls The security controls (i.e., safeguards or countermeasures) for an information 

system that primarily are implemented and executed by people (as opposed 

to systems). [NIST SP 800-18] 

Plan of Action and 

Milestones 

A document that identifies tasks needing to be accomplished. It details 

resources required to accomplish the elements of the plan, any milestones in 

meeting the tasks, and scheduled completion dates for the milestones. [OMB 

Memorandum M-02-09] 
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Term Definition 

Risk The level of impact on agency operations, (including mission, functions, 

image, or reputation), agency assets, or individuals, resulting from the 

operation of an information system given the potential impact of a threat and 

the likelihood of that threat occurring. [NIST SP 800-30] 

Risk Assessment The process of identifying risks to agency operations (including mission, 

functions, image, or reputation), agency assets, or individuals by determining 

the probability of occurrence, the resulting impact, and additional security 

controls that would mitigate this impact. Part of risk management, 

synonymous with risk analysis, and incorporates threat and vulnerability 

analyses. [NIST SP 800-30] 

Risk Management The process of managing risks to agency operations (including mission, 

functions, image, or reputation), agency assets, or individuals resulting from 

the operation of an information system. It includes risk assessment; costbenefit analysis; the selection, implementation, and assessment of security 

controls; and the formal authorization to operate the system. The process 

considers effectiveness, efficiency, and constraints due to laws, directives, 

policies, or regulations. [NIST SP 800-30] 

Security Category The characterization of information or an information system based on an 

assessment of the potential impact that a loss of confidentiality, integrity, or 

availability of such information or information system would have on 

organizational operations, organizational assets, or individuals. [FIPS 199] 

Security Controls The management, operational, and technical controls (i.e., safeguards or 

countermeasures) prescribed for an information system to protect the 

confidentiality, integrity, and availability of the system and its information. 

[FIPS 199] 

Subsystem A major subdivision or component of an information system consisting of 

information, information technology, and personnel that performs one or more 

specific functions. 

System Security Plan Formal document that provides an overview of the security requirements for 

the information system and describes the security controls in place or planned 

for meeting those requirements. [NIST SP 800-18] 

System-specific 

Security Control 

A security control for an information system that has not been designated as 

a common security control. 

Technical Controls The security controls (i.e., safeguards or countermeasures) for an information 

system that are primarily implemented and executed by the information 

system through mechanisms contained in the hardware, software, or firmware 

components of the system. [NIST SP 800-18] 

Threat Any circumstance or event with the potential to adversely impact agency 

operations (including mission, functions, image, or reputation), agency assets, 

or individuals through an information system via unauthorized access, 

destruction, disclosure, modification of information, and/or denial of service. 

[CNSS Inst. 4009, Adapted] 
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Term Definition 

User Person or process accessing an AIS either by direct connections (e.g., via 

terminals), or indirect connections (e.g., prepare input data or receive output 

that is not reviewed for content or classification by a responsible individual). 

Vulnerability Weakness in an information system, system security procedures, internal 

controls, or implementation that could be exploited or triggered by a threat 

source. [CNSS Inst. 4009, Adapted] 

Vulnerability 

Assessment 

Formal description and evaluation of the vulnerabilities in an information 

system. [CNSS Inst. 4009] 
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3.5 Applicable Laws and References 

Applicable Laws or Regulations Affecting the System 

Federal Policies/Directives/Guidance 

Committee on National Security Systems (CNSS) Instruction 4009, National Information Assurance 

Glossary, June 2006 

Committee on National Security Systems (CNSS) Instruction 1253, Security Categorization and Control 

Selection for National Security Systems, October 2009 

Freedom of Information Act (FOIA) 

Federal Information Security Management Act (FISMA) of 2002 

Federal Information Security Modernization Act (FISMA) of 2014 

Federal Managers’ Financial Integrity Act (FMFIA) 

Federal Information Processing Standards (FIPS) 199, Standards for Security Categorization of 

Federal Information and Information Systems, February 2004 

FIPS 200, Minimum Security Requirements for Federal Information and Information Systems, March 

2006 

Homeland Security Presidential Directive (HSPD)-7, Critical Infrastructure Identification, Prioritization, 

and Protection 

Homeland Security Presidential Directive/HSPD-12, Policy for a Common Identification Standard for 

Federal Employees and Contractors 

Homeland Security Presidential Directive/HSPD-20, National Continuity Policy 

National Archives & Records Administration (NARA) 

National Institute of Standards and Technology (NIST) Special Publications (SP) 800-18, Revision 1, 

Guide for Developing Security Plans for Federal Information Systems, February 2006 

NIST SP 800-27, Revision A, Engineering Principles for Information Technology Security (A Baseline 

for Achieving Security), June 2004 

NIST SP 800-30, Revision 1, Guide for Conducting Risk Assessments, September 2012 

NIST SP 800-34, Revision 1, Contingency Planning Guide for Federal Information Systems, May 2010 

NIST SP 800-37, Revision 1, Guide for Applying the Risk Management Framework to Federal 

Information Systems: A Security Life Cycle Approach, February 2010 

NIST SP 800-39, Managing Information Security Risk: Organization, Mission, and Information System 

View, March 2011 

NIST SP 800-50, Building an Information Technology Security Awareness and Training Program, 

October 2003 

NIST SP 800-52, Guidelines for Selecting and Use of Transport Layer Security (TSL) Implementations, 

April 2014 

NIST SP 800-53, Revision 4, Security and Privacy Controls for Federal Information Systems and 

Organizations, April 2013 

NIST SP 800-53A, Revision 4, Assessing Security and Privacy Controls in Federal Information 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 170 

Applicable Laws or Regulations Affecting the System 

Systems and Organizations: Building Effective Assessment Plans, December 2014 

NIST SP 800-59, Guideline for Identifying an Information System as a National Security System, 

August 2003. 

NIST SP 800-60, Revision 1, Guide for Mapping Types of Information and Information Systems to 

Security Categories, August 2008. 

NIST SP 800-64, Rev 2, Security Consideration in the Information System Development Life Cycle, 

October 2008 

NIST SP 800-70, Revision 3, National Checklist Program for IT Products: Guidelines for Checklist 

Users and Developers, March 2015 

NIST SP 800-122, Guide to Protecting the Confidentiality of Personally Identifiable Information (PII), 

April 2010 

NIST SP 800-126, Revision 1, The Technical Specification for the Security Content Automation 

Protocol (SCAP): SCAP Version 1.2, February 2011. 

Office of Management and Budget (OMB) Circular A-123 Management Accountability and Control, 

1995 

OMB Circular A-127 Financial Management Systems, 1993 

OMB Circular A-130 Management of Federal Information Resources, 2000 

NIST SP 800-144, Guidelines on Security and Privacy in Public Cloud Computing, December 2011 

NIST SP 800-145, The NIST Definition of Cloud Computing, September 2011 

NIST SP 800-146, Cloud Computing Synopsis and Recommendations, May 2012 

OMB Circular M-02-01, Guidance for Preparing and Submitting Security Plans of Action and 

Milestones, October 2001. 

Paperwork Reduction Act, May 1995 

Privacy Act of 1974, as amended 

Social Security Act of 2013 

SSA Departmental Guidance 

ISSH, Information System Security Handbook - http://eis.ba.ssa.gov/ssasso/issh/tableofcontents.htm

OIS Guidance, http://ois.ssahost.ba.ssa.gov/dspp/fisma/security_assessment_authorization.htm 

PRIDE, http://pride.ssahost.ba.ssa.gov/ 

CSAM, https://csamssa.justapps.doj.gov/CSAM/login.aspx?ReturnUrl=%2fCSAM%2fDefault.aspx 

ISAHB, Information Security Authorization Handbook (dated June 2014) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 171 

Appendix A. <Appendix Name>Appendix body 

 NOTE: Automatic section numbering (Heading 1, Heading 2, etc.) should not be 

applied to the appendix body. The numbering will be a continuation of the numbering 

from the body of the document, and will not accurately reflect the appendix location. 

 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 172 

Appendix B. Acronym List 

 Make sure all acronyms within this document are included in the acronym list. Delete 

any that are not used. 

Acronym Definition 

AO Authorizing Official 

APM Application Portfolio Management 

APP Application 

BRM Business Reference Model 

BSM Boundary Scope Memorandum 

CSAM Cybersecurity Assessment and Management 

CSO Component Security Officer 

DB Database 

DBMS Database Management System 

DCS Deputy Commissioner for Systems 

FIPS Federal Information Processing Standard 

FISMA Federal Information Security Modernization Act 

FOUO For Official Use Only 

FTP File Transfer Protocol 

HW Hardware 

ID Identification 

IPSEC Internet Protocol Security 

ISA Interconnection Security Agreement 

IT Information Technology 

IV&V Independent Verification and Validation 

L2TP Layer 2 Tunneling Protocol 

MA Major Application 

MOA Memorandum of Agreement 

MOU Memorandum of Understanding 

NCC National Computer Center 

NIST National Institute of Standards and Technology 

NMS Network Management System 

OIS Office of Information Security 

OS Operating System 

PDA Personal Digital Assistant 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 173 

Acronym Definition 

SAM Security Authorization Manager 

SBU Sensitive But Unclassified 

SCQ Significant Change Questionnaire 

SO System Owner 

SP Special Publication 

SSA Social Security Administration 

SSC Secondary Support Center 

SSP System Security Plan 

V-HW Virtual Hardware 

VPN Virtual Private Network 
EXHIBIT F
Declaration for Federal Employment*

(*This form may also be used to assess fitness for federal contract employment)

Form Approved:

OMB No. 3206-0182

U.S. Office of Personnel Management

5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306

Revised October 2011 Previous editions obsolete and unusable

Instructions

The information collected on this form is used to determine your acceptability for Federal and Federal contract employment and your

enrollment status in the Government's Life Insurance program. You may be asked to complete this form at any time during the hiring

process. Follow instructions that the agency provides. If you are selected, before you are appointed you will be asked to update

your responses on this form and on other materials submitted during the application process and then to recertify that your answers

are true.

All your answers must be truthful and complete. A false statement on any part of this declaration or attached forms or sheets

may be grounds for not hiring you, or for firing you after you begin work. Also, you may be punished by a fine or

imprisonment (U.S. Code, title 18, section 1001).

Either type your responses on this form or print clearly in dark ink. If you need additional space, attach letter-size sheets (8.5" X 11").

Include your name, Social Security Number, and item number on each sheet. We recommend that you keep a photocopy of your

completed form for your records.

Privacy Act Statement

The Office of Personnel Management is authorized to request this information under sections 1302, 3301, 3304, 3328, and 8716 of

title 5, U. S. Code. Section 1104 of title 5 allows the Office of Personnel Management to delegate personnel management functions

to other Federal agencies. If necessary, and usually in conjunction with another form or forms, this form may be used in conducting

an investigation to determine your suitability or your ability to hold a security clearance, and it may be disclosed to authorized officials

making similar, subsequent determinations.

Your Social Security Number (SSN) is needed to keep our records accurate, because other people may have the same name and

birth date. Public Law 104-134 (April 26, 1996) asks Federal agencies to use this number to help identify individuals in agency

records. Giving us your SSN or any other information is voluntary. However, if you do not give us your SSN or any other information

requested, we cannot process your application. Incomplete addresses and ZIP Codes may also slow processing.

ROUTINE USES: Any disclosure of this record or information in this record is in accordance with routine uses found in System

Notice OPM/GOVT-1, General Personnel Records. This system allows disclosure of information to: training facilities; organizations

deciding claims for retirement, insurance, unemployment, or health benefits; officials in litigation or administrative proceedings where

the Government is a party; law enforcement agencies concerning a violation of law or regulation; Federal agencies for statistical

reports and studies; officials of labor organizations recognized by law in connection with representation of employees; Federal

agencies or other sources requesting information for Federal agencies in connection with hiring or retaining, security clearance,

security or suitability investigations, classifying jobs, contracting, or issuing licenses, grants, or other benefits; public and private

organizations, including news media, which grant or publicize employee recognitions and awards; the Merit Systems Protection

Board, the Office of Special Counsel, the Equal Employment Opportunity Commission, the Federal Labor Relations Authority, the

National Archives and Records Administration, and Congressional offices in connection with their official functions; prospective

non-Federal employers concerning tenure of employment, civil service status, length of service, and the date and nature of action for

separation as shown on the SF 50 (or authorized exception) of a specifically identified individual; requesting organizations or

individuals concerning the home address and other relevant information on those who might have contracted an illness or been

exposed to a health hazard; authorized Federal and non-Federal agencies for use in computer matching; spouses or dependent

children asking whether the employee has changed from a self-and-family to a self-only health benefits enrollment; individuals

working on a contract, service, grant, cooperative agreement, or job for the Federal government; non-agency members of an

agency's performance or other panel; and agency-appointed representatives of employees concerning information issued to the

employees about fitness-for-duty or agency-filed disability retirement procedures.

Public Burden Statement

Public burden reporting for this collection of information is estimated to vary from 5 to 30 minutes with an average of 15

minutes per response, including time for reviewing instructions, searching existing data sources, gathering the data needed, and

completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of the

collection of information, including suggestions for reducing this burden, to the U.S. Office of Personnel Management, Reports and

Forms Manager (3206-0182), Washington, DC 20415-7900. The OMB number, 3206-0182, is valid. OPM may not collect this

information, and you are not required to respond, unless this number is displayed.
Declaration for Federal Employment*

(*This form may also be used to assess fitness for federal contract employment)

Form Approved:

OMB No. 3206-0182

U.S. Office of Personnel Management

5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306

Revised October 2011 Previous editions obsolete and unusable

GENERAL INFORMATION

1. FULL NAME (Provide your full name. If you have only initials in your name, provide them and indicate "Initial only". If you do not have a middle name,

indicate "No Middle Name". If you are a "Jr.," "Sr.," etc. enter this under Suffix. First, Middle, Last, Suffix)

2. SOCIAL SECURITY NUMBER 3a. PLACE OF BIRTH (Include city and state or country)

3b. ARE YOU A U.S. CITIZEN?

YES NO (If "NO", provide country of citizenship)

4. DATE OF BIRTH (MM / DD / YYYY)

5. OTHER NAMES EVER USED (For example, maiden name, nickname, etc) 6. PHONE NUMBERS (Include area codes)

Day

Night

Selective Service Registration

If you are a male born after December 31, 1959, and are at least 18 years of age, civil service employment law (5 U.S.C. 3328) requires that you

must register with the Selective Service System, unless you meet certain exemptions.

7a. Are you a male born after December 31, 1959? YES NO (If "NO", proceed to 8.)

7b. Have you registered with the Selective Service System? YES (If "YES", proceed to 8.) NO (If "NO", proceed to 7c.)

7c. If "NO," describe your reason(s) in item 16.

Military Service

8. Have you ever served in the United States military? YES (If "YES", provide information below) NO

If you answered "YES," list the branch, dates, and type of discharge for all active duty.

If your only active duty was training in the Reserves or National Guard, answer "NO."

Branch From (MM/DD/YYYY) To (MM/DD/YYYY) Type of Discharge

Background Information

For all questions, provide all additional requested information under item 16 or on attached sheets. The circumstances of each event

you list will be considered. However, in most cases you can still be considered for Federal jobs.

For questions 9,10, and 11, your answers should include convictions resulting from a plea of nolo contendere (no contest), but omit (1) traffic

fines of $300 or less, (2) any violation of law committed before your 16th birthday, (3) any violation of law committed before your 18th birthday if

finally decided in juvenile court or under a Youth Offender law, (4) any conviction set aside under the Federal Youth Corrections Act or similar

state law, and (5) any conviction for which the record was expunged under Federal or state law . 9. During the last 7 years, have you been convicted, been imprisoned, been on probation, or been on parole?

(Includes felonies, firearms or explosives violations, misdemeanors, and all other offenses.) If "YES," use item 16

to provide the date, explanation of the violation, place of occurrence, and the name and address of the police

department or court involved.

YES NO

10. Have you been convicted by a military court-martial in the past 7 years? (If no military service, answer "NO.") If

"YES," use item 16 to provide the date, explanation of the violation, place of occurrence, and the name and

address of the military authority or court involved.

YES NO

11. Are you currently under charges for any violation of law? If "YES," use item 16 to provide the date, explanation of

the violation, place of occurrence, and the name and address of the police department or court involved.

YES NO

12. During the last 5 years, have you been fired from any job for any reason, did you quit after being told that you

would be fired, did you leave any job by mutual agreement because of specific problems, or were you debarred

from Federal employment by the Office of Personnel Management or any other Federal agency? If "YES," use item

16 to provide the date, an explanation of the problem, reason for leaving, and the employer's name and address.

YES NO

13. Are you delinquent on any Federal debt? (Includes delinquencies arising from Federal taxes, loans, overpayment

of benefits, and other debts to the U.S. Government, plus defaults of Federally guaranteed or insured loans such

as student and home mortgage loans.) If "YES," use item 16 to provide the type, length, and amount of the

delinquency or default, and steps that you are taking to correct the error or repay the debt.

YES NO
Declaration for Federal Employment*

(*This form may also be used to assess fitness for federal contract employment)

Form Approved:

OMB No. 3206-0182

U.S. Office of Personnel Management

5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306

Revised October 2011 Previous editions obsolete and unusable

Additional Questions

14. Do any of your relatives work for the agency or government organization to which you are submitting this form?

(Include: father, mother, husband, wife, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece,

father-in-law,mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in-law, stepfather, stepmother,

stepson, stepdaughter, stepbrother, stepsister, half brother, and half sister.) If "YES," use item 16 to provide the

relative's name,relationship, and the department, agency, or branch of the Armed Forces for which your relative

works.

YES NO

15. Do you receive, or have you ever applied for, retirement pay, pension, or other retired pay based on military,

Federal civilian, or District of Columbia Government service?

YES NO

Continuation Space / Agency Optional Questions

16. Provide details requested in items 7 through 15 and 18c in the space below or on attached sheets. Be sure to identify attached sheets with

your name, Social Security Number, and item number, and to include ZIP Codes in all addresses. If any questions are printed below, please

answer as instructed (these questions are specific to your position and your agency is authorized to ask them).

Certifications / Additional Questions

APPLICANT: If you are applying for a position and have not yet been selected, carefully review your answers on this form and any

attached sheets. When this form and all attached materials are accurate, read item 17, and complete 17a.

APPOINTEE: If you are being appointed, carefully review your answers on this form and any attached sheets, including any other application

materials that your agency has attached to this form. If any information requires correction to be accurate as of the date you are signing, make

changes on this form or the attachments and/or provide updated information on additional sheets, initialing and dating all changes and additions.

When this form and all attached materials are accurate, read item 17, complete 17b, read 18, and answer 18a, 18b, and 18c as appropriate.

17. I certify that, to the best of my knowledge and belief, all of the information on and attached to this Declaration for Federal Employment,

including any attached application materials, is true, correct, complete, and made in good faith . I understand that a false or fraudulent

answer to any question or item on any part of this declaration or its attachments may be grounds for not hiring me, or for firing

me after I begin work, and may be punishable by fine or imprisonment. I understand that any information I give may be investigated

for purposes of determining eligibility for Federal employment as allowed by law or Presidential order. I consent to the release of

information about my ability and fitness for Federal employment by employers, schools, law enforcement agencies, and other individuals

and organizations to investigators, personnel specialists, and other authorized employees or representatives of the Federal Government. I

understand that for financial or lending institutions, medical institutions, hospitals, health care professionals, and some other sources of

information, a separate specific release may be needed, and I may be contacted for such a release at a later date.

17a. Applicant's Signature: Date

(Sign in ink)

17b. Appointee's Signature: Date

(Sign in ink)

Appointing Officer:

Enter Date of Appointment or Conversion

MM / DD / YYYY

18. Appointee (Only respond if you have been employed by the Federal Government before): Your elections of life insurance during

previous Federal employment may affect your eligibility for life insurance during your new appointment. These questions are asked to help

your personnel office make a correct determination.

18a. When did you leave your last Federal job? DATE:

MM / DD / YYYY

18b. When you worked for the Federal Government the last time, did you waive Basic Life

Insurance or any type of optional life insurance?

YES NO DO NOT KNOW

18c. If you answered "YES" to item 18b, did you later cancel the waiver(s)? If your answer to item

18c is "NO," use item 16 to identify the type(s) of insurance for which waivers were not

canceled.

YES NO DO NOT KNOW

Standard Form 85P 

Revised September 1995 

U.S. Office of Personnel Management 

5 CFR Parts 731, 732, and 736 

Questionnaire for Public Trust Positions 

Form approved: 

OMB No. 3206-0191 

NSN 7540-01-317- 7372 

85-1602 

Follow instructions fully or we cannot process your form. Be sure to sign and date the certification statement on Page 7 and the release on 

Page 8. If you have any questions, call the office that gave you the form. 

Purpose of this Form 

The U.S. Government conducts background investigations and 

reinvestigations to establish that applicants or incumbents either 

employed by the Government or working for the Government under 

contract, are suitable for the job and/or eligible for a public trust or 

sensitive position. Information from this form is used primarily as the 

basis for this investigation. Complete this form only after a conditional 

offer of employment has been made. 

Giving us the information we ask for is voluntary. However, we may 

not be able to complete your investigation, or complete it in a timely 

manner, if you don't give us each item of information we request. This 

may affect your placement or employment prospects. 

Authority to Request this Information 

The U.S. Government is authorized to ask for this information under 

Executive Orders 10450 and 10577, sections 3301 and 3302 of title 5, 

U.S. Code; and parts 5, 731, 732, and 736 of Title 5, Code of Federal 

Regulations. 

Your Social Security number is needed to keep records accurate, 

because other people may have the same name and birth date. Executive 

Order 9397 also asks Federal agencies to use this number to help 

identify individuals in agency records. 

The Investigative Process 

Background investigations are conducted using your responses on this 

form and on your Declaration for Federal Employment (OF 306) to 

develop information to show whether you are reliable, trustworthy, of 

good conduct and character, and loyal to the United States. The 

information that you provide on this form is confirmed during the 

investigation. Your current employer must be contacted as part of the 

investigation, even if you have previously indicated on applications or 

other forms that you do not want this. 

In addition to the questions on this form, inquiry also is made about a 

person's adherence to security requirements, honesty and integrity, 

vulnerability to exploitation or coercion, falsification, misrepresentation, and any other behavior, activities, or associations that 

tend to show the person is not reliable, trustworthy, or loyal. 

Your Personal Interview 

Some investigations will include an interview with you as a normal part 

of the investigative process. This provides you the opportunity to 

update, clarify, and explain information on your form more completely, 

which often helps to complete your investigation faster. It is important 

that the interview be conducted as soon as possible after you are 

contacted. Postponements will delay the processing of your 

investigation, and declining to be interviewed may result in your 

investigation being delayed or canceled. 

You will be asked to bring identification with your picture on it, such as 

a valid State driver's license, to the interview. There are other 

documents you may be asked to bring to verify your identity as well. 

These include documentation of any legal name change, Social Security 

card, and/or birth certificate. 

You may also be asked to bring documents about information you 

provided on the form or other matters requiring specific attention. 

These matters include alien registration, delinquent loans or taxes, 

bankruptcy, judgments, liens, or other financial obligations, agreements 

involving child custody or support, alimony or property settlements, 

arrests, convictions, probation, and/or parole. 

Instructions for Completing this Form 

1. Follow the instructions given to you by the person who gave you the 

form and any other clarifying instructions furnished by that person to 

assist you in completion of the form. Find out how many copies of the 

form you are to tum in. You must sign and date, in black ink, the 

original and each copy you submit. 

2. Type or legibly print your answers in black ink (if your form is not 

legible, it will not be accepted). You may also be asked to submit your 

form in an approved electronic format. 

3. All questions on this form must be answered. If no response is 

necessary or applicable, indicate this on the form (for example, enter 

"None" or "N/A"). If you find that you cannot report an exact date, 

approximate or estimate the date to the best of your ability and indicate 

this by marking "APPROX." or "EST." 

4. Any changes that you make to this form after you sign it must be 

initialed and dated by you. Under certain limited circumstances, 

agencies may modify the form consistent with your intent. 

5. You must use the State codes (abbreviations) listed on the back of 

this page when you fill out this form. Do not abbreviate the names of 

cities or foreign countries. 

6. The 5-digit postal ZIP codes are needed to speed the processing of 

your investigation. The office that provided the form will assist you in 

completing the ZIP codes. 

7. All telephone numbers must include area codes. 

8. All dates provided on this form must be in Month/Day/Year or 

Month/Year format. Use numbers (1-12) to indicate months. For 

example, June 10, 1978, should be shown as 6/10/78. 

9. Whenever "City (Country)" is shown in an address block, also 

provide in that block the name of the country when the address is 

outside the United States. 

10. If you need additional space to list your residences or 

employments/self-employments/unemployments or education, you 

should use a continuation sheet, SF 86A. If additional space is needed 

to answer other items, use a blank piece of paper. Each blank piece of 

paper you use must contain your name and Social Security Number 

at the top of the page. 
Final Determination on Your Eligibility 

Final determination on your eligibility for a public trust or sensitive 

position and your being granted a security clearance is the responsibility 

of the Office of Personnel Management or the Federal agency that 

requested your investigation. You may be provided the opportunity 

personally to explain, refute, or clarify any information before a final 

decision is made. 

Penalties for Inaccurate or False Statements 

The U.S. Criminal Code (title 18, section 1001) provides that knowingly 

falsifying or concealing a material fact is a felony which may result in 

fines of up to $10,000, and/or 5 years imprisonment, or both. In 

addition, Federal agencies generally fire, do not grant a security 

clearance, or disqualify individuals who have materially and 

deliberately falsified these forms, and this remains a part of the 

permanent record for future placements. Because the position for which 

you are being considered is one of public trust or is sensitive, your 

trustworthiness is a very important consideration in deciding your 

suitability for placement or retention in the position. 

Your prospects of placement are better if you answer all questions 

truthfully and completely. You will have adequate opportunity to 

explain any information you give us on the form and to make your 

comments part of the record. 

Disclosure of Information 

The information you give us is for the purpose of investigating you for a 

position; we will protect it from unauthorized disclosure. The 

collection, maintenance, and disclosure of background investigative 

information is governed by the Privacy Act. The agency which 

requested the investigation and the agency which conducted the 

investigation have published notices in the Federal Register describing 

the system of records in which your records will be maintained. You 

may obtain copies of the relevant notices from the person who gave you 

this form. The information on this form, and information we collect 

during an investigation may be disclosed without your consent as 

permitted by the Privacy Act (5 USC 552a(b)) and as follows: 

PRIVACY ACT ROUTINE USES 

1. To the Department of Justice when: (a) the agency or any component thereof; or 

(b) any employee of the agency in his or her official capacity; or (c) any employee of 

the agency in his or her individual capacity where the Department of Justice has 

agreed to represent the employee; or (d) the United States Government, is a party to 

litigation or has interest in such litigation, and by careful review, the agency 

determines that the records are both relevant and necessary to the litigation and the 

use of such records by the Department of Justice is therefore deemed by the agency 

to be for a purpose that is compatible with the purpose for which the agency 

collected the records. 

2. To a court or adjudicative body in a proceeding when: (a) the agency or any 

component thereof; or (b) any employee of the agency in his or her official capacity; 

or (c) any employee of the agency in his or her individual capacity where the 

Department of Justice has agreed to represent the employee; or (d) the United 

States Government is a party to litigation or has interest in such litigation, and by 

careful review, the agency determines that the records are both relevant and 

necessary to the litigation and the use of such records is therefore deemed by the 

agency to be for a purpose that is compatible with the purpose for which the agency 

collected the records. 

3. Except as noted in Question 21, when a record on its face, or in conjunction with 

other records, indicates a violation or potential violation of law, whether civil, criminal, 

or regulatory in nature, and whether arising by general statute, particular program 

statute, regulation, rule, or order issued pursuant thereto, the relevant records may 

be disclosed to the appropriate Federal, foreign, State, local, tribal, or other public 

authority responsible for enforcing, investigating or prosecuting such violation or 

charged with enforcing or implementing the statute, rule, regulation, or order. 

4. To any source or potential source from which information is requested in the 

course of an investigation concerning the hiring or retention of an employee or other 

personnel action, or the issuing or retention of a security clearance, contract, grant, 

license, or other benefit, to the extent necessary to identify the individual, inform the 

source of the nature and purpose of the investigation, and to identify the type of 

information requested. 

5. To a Federal, State, local, foreign, tribal, or other public authority the fact that this 

system of records contains information relevant to the retention of an employee, or 

the retention of a security clearance, contract, license, grant, or other benefit. The 

other agency or licensing organization may then make a request supported by 

written consent of the individual for the entire record if it so chooses. No disclosure 

will be made unless the information has been determined to be sufficiently reliable to 

support a referral to another office within the agency or to another Federal agency for 

criminal, civil, administrative, personnel, or regulatory action. 

6. To contractors, grantees, experts, consultants, or volunteers when necessary to 

perform a function or service related to this record for which they have been 

engaged. Such recipients shall be required to comply with the Privacy Act of 1974, 

as amended. 

7. To the news media or the general public, factual information the disclosure of 

which would be in the public interest and which would not constitute an unwarranted 

invasion of personal privacy. 

8. To a Federal, State, or local agency, or other appropriate entities or individuals, or 

through established liaison channels to selected foreign governments, in order to 

enable an intelligence agency to carry out its responsibilities under the National 

Security Act of 1947 as amended, the CIA Act of 1949 as amended, Executive Order 

12333 or any successor order, applicable national security directives, or classified 

implementing procedures approved by the Attorney General and promulgated 

pursuant to such statutes, orders or directives. 

9. To a Member of Congress or to a Congressional staff member in response to an 

inquiry of the Congressional office made at the written request of the constituent 

about whom the record is maintained. 

10. To the National Archives and Records Administration for records management 

inspections conducted under 44 USC 2904 and 2906. 

11. To the Office of Management and Budget when necessary to the review of 

private relief legislation. 

STATE CODES (ABBREVIATIONS) 

Alabama AL Hawaii HI Massachusetts MA New Mexico NM South Dakota SD 

Alaska AK Idaho ID Michigan Ml New York NY Tennessee TN 

Arizona AZ Illinois IL Minnesota MN North Carolina NC Texas TX 

Arkansas AR Indiana IN Mississippi MS North Dakota ND Utah UT 

California CA Iowa IA Missouri MO Ohio OH Vermont VT 

Colorado co Kansas KS Montana MT Oklahoma OK Virginia VA 

Connecticut CT Kentucky KY Nebraska NE Oregon OR Washington WA 

Delaware DE Louisiana LA Nevada NV Pennsylvania PA West Virginia WV 

Florida FL Maine ME New Hampshire NH Rhode Island RI Wisconsin WI 

Georgia GA Maryland MD New Jersey NJ South Carolina SC Wyoming WY 

American Samoa AS District of Columbia DC Guam GU Northern Marianas CM Puerto Rico PR 

Trust Territory TT Virgin Islands VI 

PUBLIC BURDEN INFORMATION 

Public burden reporting for this collection of information is estimated to average 60 minutes per response, including 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 the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Reports 

and Forms Management Officer, U.S. Office of Personnel Management, 1900 E Street, N.W., Room CHP-500, Washington, D.C. 20415. Do not send 

your completed form to this address. 
Standard Form 85P (EG) 

Revised September 1995 

U.S. Office of Personnel Management 

5 CFR Parts 731, 732, and 736 

QUESTIONNAIRE FOR 

PUBLIC TRUST POSITIONS 

Form approved: 

OMB No. 3206-0191 

NSN 7540-01-317- 7372 

85-1602 

f)DATEOF 

BIRTH 

Case Number 

Telephone Number 

- If you are a "Jr.," "Sr.," "II," etc., enter this in the 

box after your middle name. 

Codes 

Coverage 

• It you have only initials in your name, use them and state (10). 

• If you have no middle name, enter "NMN". 

OPM 

USE 

ONLY 

H Position Position 

Code Title 

J K ocatton None Other Address ZIP Code 

SON of Official 

Pe NPRC rsonnel 

Folder At SON 

L MLocation None Other Address ZIP Code 

SOI of Security At SOI 

Folder 

NPI 

NOPAC-ALC 0 Accounting Data and/or 

Number Agency Case Number 

QFULL 

NAME 

8PLACE OF BIRTH - Use the two letter code for the State. 

City County 

Last Name First Name Middle Name 

State Country (if not in the United States) 

Month Day Year 

• OTHER NAMES USED 

Name Month/Year Month/Year Name Month/Year Month/Year 

#1 To #3 To 

Name Month/Year Month/Year Name Month/Year Month/Year 

#2 To #4 To 

. Height (feet and inches) Weight (pounds) Hair Color Eye Color S (M k b 

I I 

ex er. one ox 

I

I

D

NF

E

O

NT

R

I

M

FY

A

I

T

N

I

G 

ON n Female n Male 

@TELEPHONE Work (include Area Code and extension) Home (include Area Code) Fl Day Fl Day NUMBERS Night ( ) Night ( ) 

.CITIZENSHIP I am a U.S. citizen or national by birth in the U.S. or U.S. territory/possession. Answer G) Your Mother's Maiden Name 

0 items b and d. Mark the box at the right that 

reflects your current citizenship I am a U.S. citizen, but I was NOT born in the U.S. Answer items b, c and d. 

status, and follow its instructions. I am not a U.S. citizen. Answer items band e. 

eoTHER 

9 UNITED STATES CITIZENSHIP If you are a U.S. Citizen, but were not born in the U.S., provide information about one or more of the following proofs of your citizenship. 

Naturalization Certificate (Where were you naturalized?) 

Court City State Certificate Number Month/Day/Year Issued 

Citizenship Certificate (Where was the certificate issued?) 

City State Certificate Number Month/Day/Year Issued 

State Department Form 240 - Report of Birth Abroad of a Citizen of the United States 

Give the date the form was Month/Day/Year 

prepared and give an explanation 

if needed. 

Explanation 

U.S. Passport 

This may be either a current or previous U.S. Passport 

Passport Number Month/Day/Year Issued 

m DUAL CITIZENSHIP If you are (or were) a dual citizen of the United States and another country, Country 

provide the name of that country in the space to the right. 

Q ALIEN If you are an alien, provide the following information: 

������---.-�C�t-i�y ������������---,S�at _t___, e D�a-t-�e Y�o-u�E�n-et _r_e��d U�S. .,,.-��. �A�ie-ln--=-ge �-ts-ar -t�o-in�N�u-m�b-e-r��-C�o-u-n-rt-y�ie(-s�-o��f C�t�zi-i-sn �h�pi���- 

Place You Month I Day I Year 

Entered the 

United States: 

Exception to SF85, SF85P, SF85P-S, SF86, and SF86A approved by GSA September, 1995. 

Designed using Perform Pro, WHS/DIOR, Sep 95 

Page 1 
OwHERE You HAVE uvsn 

List the places where you have lived, beginning with the most recent (#1) and working back 7 years. All periods must be accounted for in your list. Be sure to indicate the 

actual physical location of your residence: do not use a post office box as an address, do not list a permanent address when you were actually living at a school address, 

etc. Be sure to specify your location as closely as possible: for example, do not list only your base or ship, list your barracks number or home port. You may omit 

temporary military duty locations under 90 days (list your permanent address instead), and you should use your APO/FPO address if you lived overseas. 

For any address in the last 5 years, list a person who knew you at that address, and who preferably still lives in that area (do not list people for residences completely 

outside this 5-year period, and do not list your spouse, former spouses, or other relatives). Also for addresses in the last 5 years, if the address is "General Delivery," a 

Rural or Star Route, or may be difficult to locate, provide directions for locating the residence on an attached continuation sheet. 

Month/Year Month/Year Street Address Apt. # I City (Country) State I ZIP Code 

#1 To Present 

Name of Person Who Knows You Street Address Apt.# I City (Country) I State I ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Street Address Apt. # I City (Country) State I ZIP Code 

#2 To 

Name of Person Who Knew You Street Address Apt.# I City (Country) I State I ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Street Address Apt. # I City (Country) State I ZIP Code 

#3 To 

Name of Person Who Knew You Street Address Apt.# I City (Country) I State I ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Street Address Apt. # I City (Country) State I ZIP Code 

#4 To 

Name of Person Who Knew You Street Address Apt.# I City (Country) I State I ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Street Address Apt. # I City (Country) State I ZIP Code 

#5 To 

Name of Person Who Knew You Street Address Apt.# I City (Country) I State I ZIP Code Telephone Number 

( ) 

G) WHERE YOU WENT TO SCHOOL 

List the schools you have attended, beyond Junior High School, beginning with the most recent (#1) and working back 7 years. List all College or University degrees 

and the dates they were received. If all of your education occurred more than 7 years ago, list your most recent education beyond high school, no matter when that 

education occurred. 

-Use one of the following codes in the "Code" block: 

1 - High School 2 - College/University/Military College 3 - Vocational/Technical/Trade School 

et=or schools you attended in the past 3 years, list a person who knew you at school (an instructor, student, etc.). Do not list people for education 

completely outside this 3-year period. 

9For correspondence schools and extension classes, provide the address where the records are maintained. 

Month/Year Month/Year Code I Name of School I Degree/Diploma/Other Month/Year Awarded 

#1 To 

Street Address and City (Country) of School I State ZIP Code 

Name of Person Who Knew You Street Address Apt.# I City (Country) I State I ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Code I Name of School I Degree/Diploma/Other Month/Year Awarded 

#2 To 

Street Address and City (Country) of School I State ZIP Code 

Name of Person Who Knew You Street Address Apt.# I City (Country) I State I ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Code I Name of School I Degree/Diploma/Other Month/Year Awarded 

#3 To 

Street Address and City (Country) of School I State ZIP Code 

Name of Person Who Knew You Street Address Apt.# I City (Country) I State I ZIP Code Telephone Number 

( ) 

Enter your Social Security Number before going to the next page--------------• 

Page 2 
• YOUR EMPLOYMENT ACTIVITIES 

List your employment activities, beginning with the present (#1) and working back 7 years. You should list all full-time work, part-time work, military service, 

temporary military duty locations over 90 days, self-employment, other paid work, and all periods of unemployment. The entire ?-year period must be accounted for 

without breaks, but you need not list employments before your 16th birthday. 

• Code. Use one of the codes listed below to identify the type of employment: 

1 - Active military duty stations 

2 - National Guard/Reserve 

3 - U.S.P.H.S. Commissioned Corps 

4 - Other Federal employment 

5 - State Government (Non-Federal 

employment) 

6 - Self-employment (Include business 

and/or name of person who can verify) 

7 - Unemployment (Include name of 

person who can verify) 

8 - Federal Contractor (List Contractor, 

not Federal agency) 

9 - Other 

• Employer/Verifier Name. List the business name of your employer or the name of the person who can verify your self-employment or unemployment in this block. If 

military service is being listed, include your duty location or home port here as well as your branch of service. You should provide separate listings to reflect changes in 

your military duty locations or home ports. 

• Previous Periods of Activity. Complete these lines if you worked for an employer on more than one occasion at the same location. After entering the most recent 

period of employment in the initial numbered block, provide previous periods of employment at the same location on the additional lines provided. For example, if you 

worked at XY Plumbing in Denver, CO, during 3 separate periods of time, you would enter dates and information concerning the most recent period of employment first, 

and provide dates, position titles, and supervisors for the two previous periods of employment on the lines below that information. 

Month/Year Month/Year I Code Employer/Verifier Name/Military Duty Location Your Position Title/Military Rank 

#1 To Present 

Employer's/Verifier's Street Address City (Country) State ZIP Code Telephone Number 

( ) 

Street Address of Job Location (if different than Employer's Address) City (Country) State ZIP Code Telephone Number 

( ) 

Supervisor's Name & Street Address (if different than Job Location) City (Country) State ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Position Title Supervisor 

PREVIOUS To 

PERIODS Month/Year Month/Year Position Title Supervisor 

OF 

ACTIVITY To 

(Block #1) Month/Year Month/Year Position Title Supervisor 

To 

Month/Year Month/Year I Code Employer/Verifier Name/Military Duty Location Your Position Title/Military Rank 

#2 To 

Employer's/Verifier's Street Address City (Country) State ZIP Code Telephone Number 

( ) 

Street Address of Job Location (if different than Employer's Address) City (Country) State ZIP Code Telephone Number 

( ) 

Supervisor's Name & Street Address (if different than Job Location) City (Country) State ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Position Title Supervisor 

PREVIOUS To 

PERIODS Month/Year Month/Year Position Title Supervisor 

OF 

ACTIVITY To 

(Block#2) Month/Year Month/Year Position Title Supervisor 

To 

Month/Year Month/Year I Code Employer/Verifier Name/Military Duty Location Your Position Title/Military Rank 

#3 To 

Employer's/Verifier's Street Address City (Country) State ZIP Code Telephone Number 

( ) 

Street Address of Job Location (if different than Employer's Address) City (Country) State ZIP Code Telephone Number 

( ) 

Supervisor's Name & Street Address (if different than Job Location) City (Country) State ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Position Title Supervisor 

PREVIOUS To 

PERIODS Month/Year Month/Year Position Title Supervisor 

OF 

ACTIVITY To 

(Block#3) Month/Year Month/Year Position Title Supervisor 

To 

Enter your Social Security Number before going to the next page------------• 

Page 3 
YOUR EMPLOYMENT ACTIVITIES (CONTINUED) 

Month/Year Month/Year I Code Employer/Verifier Name/Military Duty Location Your Position Title/Military Rank 

#4 To 

Employer's/Verifier's Street Address City (Country) State ZIP Code Telephone Number 

( ) 

Street Address of Job Location (if different than Employer's Address) City (Country) State ZIP Code Telephone Number 

( ) 

Supervisor's Name & Street Address (if different than Job Location) City (Country) State ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Position Title Supervisor 

PREVIOUS To 

PERIODS Month/Year Month/Year Position Title Supervisor 

OF 

ACTIVITY To 

(Block #4) Month/Year Month/Year Position Title Supervisor 

To 

Month/Year Month/Year I Code Employer/Verifier Name/Military Duty Location Your Position Title/Military Rank 

#5 To 

Employer's/Verifier's Street Address City (Country) State ZIP Code Telephone Number 

( ) 

Street Address of Job Location (if different than Employer's Address) City (Country) State ZIP Code Telephone Number 

( ) 

Supervisor's Name & Street Address (if different than Job Location) City (Country) State ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Position Title Supervisor 

PREVIOUS To 

PERIODS Month/Year Month/Year Position Title Supervisor 

OF 

ACTIVITY To 

(Block#5) Month/Year Month/Year Position Title Supervisor 

To 

Month/Year Month/Year I Code Employer/Verifier Name/Military Duty Location Your Position Title/Military Rank 

#6 To 

Employer's/Verifier's Street Address City (Country) State ZIP Code Telephone Number 

( ) 

Street Address of Job Location (if different than Employer's Address) City (Country) State ZIP Code Telephone Number 

( ) 

Supervisor's Name & Street Address (if different than Job Location) City (Country) State ZIP Code Telephone Number 

( ) 

Month/Year Month/Year Position Title Supervisor 

PREVIOUS To 

PERIODS Month/Year Month/Year Position Title Supervisor 

OF 

ACTIVITY To 

(Block#6) Month/Year Month/Year Position Title Supervisor 

To 

0 YOUR EMPLOYMENT RECORD 

Yes No 

Has any of the following happened to you in the last 7 years? If "Yes," begin with the most recent occurrence and go backward, providing date 

fired, quit, or left, and other information requested. 

Use the following codes and explain the reason your employment was ended: 

1 - Fired from a job 

2 - Quit a job after being told 

you'd be fired 

3 - Left a job by mutual agreement following allegations of misconduct 

4 - Left a job by mutual agreement following allegations of 

unsatisfactory performance 

5 - Left a job for other reasons 

under unfavorable circumstances 

Month/Year Code Specify Reason Employer's Name and Address (Include city/Country if outside U.S.) State ZIP Code 

Enter your Social Security Number before going to the next page------------ .... 

Page4 
Cl) PEOPLE WHO KNOW YOU WELL 

List three people who know you well and live in the United States. They should be good friends, peers, colleagues, college roommates, etc., whose combined 

association with you covers as well as possible the last 7 years. Do not list your spouse, former spouses, or other relatives, and try not to list anyone who is listed 

elsewhere on this form. 

Name Dates Known hone Number 

#1 MonthNear MonthNear Day ( To Night 

Home or Work Address City (Country) 

Name Dates Known hone Number 

#2 MonthNear MonthNear Day ( To Night 

Home or Work Address City (Country) 

Name Dates Known hone Number 

#3 MonthNear MonthNear Day ( To Night 

Home or Work Address City (Country) 

State ZIP Code 

State ZIP Code 

State ZIP Code 

• YOUR MARITAL STATUS 

Mark one of the following boxes to show your current marital status: 

1 - Never married (go to question 15) 3 - Separated 

2 - Married 4 - Legally Separated 

Current Spouse Complete the following about your current spouse. 

Full Name Date of Birth (Mo.!Day/Yr.) 

5 - Divorced 

6-Widowed 

Place of Birth (Include country if outside the U.S.) Social Security Number 

Other Names Used (Specify maiden name, names by other marriages, etc., and show dates used for each name) 

Country of Citizenship 

If Separated, Date of Separation (Mo./Day!Yr.) 

Date Married (Mo.!Day!Yr.) I Place Married (Include country if outside the U.S.) 

If Legally Separated, Where is the Record Located? City (Country) 

State 

State 

Address of Current Spouse (Street, city, and country if outside the U.S.) 

CD YOUR RELATIVES 

Give the full name, correct code, and other requested information for each of your relatives, living or dead, specified below. 

1 - Mother (first) 3 - Stepmother 5 - Foster Parent 

2 - Father (second) 4 - Stepfather 6 - Child (adopted also) 

I State I ZIP Code 

7 - Stepchild 

Full Name (If deceased, check box on the Code Date of Birth Country of Birth Country(ies) of Current Street Address and City (country) of State left before entering name) Month/Day Near Citizenship Living Relatives 

1 

2 

Enter your Social Security Number before going to the next page------------• 

Page 5 
e YOUR MILITARY HISTORY Yes No 

0 Have you served in the United States military? 

0) Have you served in the United States Merchant Marine? 

List all of your military service below, including service in Reserve, National Guard, and U.S. Merchant Marine. Start with the most recent period of service (#1) and work 

backward. If you had a break in service, each separate period should be listed. 

•Code. Use one of the codes listed below to identify your branch of service: 

1 -Air Force 2-Army 3 - Navy 4 - Marine Corps 5 - Coast Guard 6 - Merchant Marine 7 - National Guard 

•OIE. Mark "O" block for Officer or "E" block for Enlisted. 

•status. "X" the appropriate block for the status of your service during the time that you served. If your service was in the National Guard, do not use 

an "X": use the two-letter code for the state to mark the block. 

•Country. If your service was with other than the U.S. Armed Forces, identify the country for which you served. 

Month/Year Month/Year Code Service/Certificate No. 0 E Status Country 

Active Active Inactive National 

Reserve Reserve Guard 

(State) 

To 

To 

� YOUR SELECTIVE SERVICE RECORD Yes No 

0 Are you a male born after December 31, 1959? If "No," go to 18. If "Yes," go to b. 

0) Have you registered with the Selective Service System? If "Yes," provide your registration number. If "No," show the reason for your legal 

exemption below. 

Heqtstratlon Number Legal Exemption Explanation 

I G, YOUR INVESTIGATIONS RECORD Yes No 

0 Has the United States Government ever investigated your background and/or granted you a security clearance? If "Yes," use the codes that 

follow to provide the requested information below. If "Yes," but you can't recall the investigating agency and/or the security clearance 

received, enter "Other" agency code or clearance code, as appropriate, and "Don't know" or "Don't recall" under the "Other Agency" 

heading, below. If your response is "No," or you don't know or can't recall if you were investigated and cleared, check the "No" box. 

Codes for Investigating Agency Codes for Security Clearance Received 

1 - Defense Department 4- FBI 0 - Not Required 3 - Top Secret 6-L 

2 - State Department 5 - Treasury Department 1 - Confidential 4 - Sensitive Compartmented Information 7-0ther 

3 - Office of Personnel Management 6 - Other (Specify) 2 - Secret 5-Q 

Month/Year Agency Other Agency Clearance Month/Year Agency Other Agency Clearance 

Code Code Code Code 

0) To your knowledge, have you ever had a clearance or access authorization denied, suspended, or revoked, or have you ever been debarred Yes No 

from government employment? If "Yes," give date of action and agency. Note: An administrative downgrade or termination of a security 

clearance is not a revocation. 

Month/Year Department or Agency Taking Action Month/Year Department or Agency Taking Action 

G) FOREIGN COUNTRIES YOU HAVE VISITED 

List foreign countries you have visited, except on travel under official Government orders, beginning with the most current (#1) and working back 7 years. (Travel as a 

dependent or contractor must be listed.) 

•Use one of these codes to indicate the purpose of your visit: 1 - Business 2 - Pleasure 3 - Education 4-0ther 

•Include short trips to Canada or Mexico. If you have lived near a border and have made short (one day or less) trips to the neighboring country, you do 

not need to list each trip. Instead, provide the time period, the code, the country, and a note ("Many Short Trips"). 

•Do not repeat travel covered in items 9, 10, or 11. 

Month/Year Month/Year Code Country Month/Year Month/Year Code Country 

#1 To #5 To 

#2 To #6 To 

#3 To #7 To 

#4 To #8 To 

Enter your Social Security Number before going to the next page 

Page 6 
@) YOUR POLICE RECORD (Do not include anything that happened before your 16th birthday.) Yes No 

In the last 7 years, have you been arrested for, charged with, or convicted of any offense(s)? (Leave out traffic fines of less than $150.) 

If you answered "Yes," explain your answer(s) in the space provided. 

Month/Year Offense Action Taken Law Enforcement Authority or Court (City and county/country it outside the U.S.) State ZIP Code 

� ILLEGAL DRUGS 

Yes No 

The following questions pertain to the illegal use of drugs or drug activity. You are required to answer the questions fully and truthfully, and your 

failure to do so could be grounds for an adverse employment decision or action against you, but neither your truthful responses nor information 

derived from your responses will be used as evidence against you in any subsequent criminal proceeding. 

E) In the last year, have you�used any controlled substance, for example, marijuana, cocaine, crack cocaine, hashish, narcotics (opium, 

morphine, codeine, heroin, etc.), amphetamines, depressants (barbiturates, methaqualone, tranquilizers, etc.), hallucinogenics (LSD, PCP, etc.), or 

prescription drugs? 

0, In the last 7 years, have you been involved in the illegal purchase, manufacture, trafficking, production, transfer, shipping, receiving, or sale of any 

narcotic, depressant, stimulant, hallucinogen, or cannabis, for your own intended profit or that of another? 

If you answered "Yes" to "a" above, provide information relating to the types of substance(s), the nature of the activity, and any other details relating 

to your involvement with illegal drugs. Include any treatment or counseling received. 

Month/Year Month/Year Controlled Substance/Prescription Drug Used Number of Times Used 

To 

To 

To 

fl) YOUR FINANCIAL RECORD Yes No 

E) In the last 7 years, have you, or a company over which you exercised some control, filed for bankruptcy, been declared bankrupt, been subject to a 

tax lien, or had legal judgment rendered against you for a debt? If you answered "Yes," provide date of initial action and other information requested 

below. 

Month/Year Type of Action Name Action Occurred Under Name/Address of Court or Agency Handling Case State ZIP Code 

0, Are you now over 180 days delinquent on any loan or financial obligation? Include loans or obligations funded or guaranteed by the Federal Yes No 

Government. 

If you answered "Yes," provide the information requested below: 

Month/Year Type of Loan or Obligation Name/Address of Creditor or Obligee State ZIP Code 

and Account # 

After completing this form and any attachments, you should review your answers to all questions to make sure the form is complete and accurate, and then sign and date the 

following certification and sign and date the release on Page 8. 

Certification That My Answers Are True 

My statements on this form, and any attachments to it, are true, complete, and correct to the best of my knowledge and belief and are 

made in good faith. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or 

both. (See section 1001 of title 18, United States Code). 

Signature (Sign in ink) 

Enter your Social Security Number before going to the next page 

Date 

Page 7 
Standard Form 85P 

Revised September 1995 

U.S. Office of Personnel Management 

5 CFR Parts 731, 732, and 736 

UNITED STATES OF AMERICA 

AUTHORIZATION FOR RELEASE OF INFORMATION 

Carefully read this authorization to release information about you, then sign and date it in ink. 

Form approved: 

OMB No. 3206-0191 

NSN 7540-01-317- 7372 

85-1602 

I Authorize any investigator, special agent, or other duly accredited representative of the authorized Federal agency conducting my 

background investigation, to obtain any information relating to my activities from individuals, schools, residential management 

agents, employers, criminal justice agencies, credit bureaus, consumer reporting agencies, collection agencies, retail business 

establishments, or other sources of information. This information may include, but is not limited to, my academic, residential, 

achievement, performance, attendance, disciplinary, employment history, criminal history record information, and financial and 

credit information. I authorize the Federal agency conducting my investigation to disclose the record of my background 

investigation to the requesting agency for the purpose of making a determination of suitability or eligibility for a security clearance. 

I Understand that, for financial or lending institutions, medical institutions, hospitals, health care professionals, and other sources of 

information, a separate specific release will be needed, and I may be contacted for such a release at a later date. Where a separate 

release is requested for information relating to mental health treatment or counseling, the release will contain a list of the specific 

questions, relevant to the job description, which the doctor or therapist will be asked. 

I Further Authorize any investigator, special agent, or other duly accredited representative of the U.S. Office of Personnel 

Management, the Federal Bureau of Investigation, the Department of Defense, the Defense Investigative Service, and any other 

authorized Federal agency, to request criminal record information about me from criminal justice agencies for the purpose of 

determining my eligibility for assignment to, or retention in a sensitive National Security position, in accordance with 5 U.S.C. 9101. 

I understand that I may request a copy of such records as may be available to me under the law. 

I Authorize custodians of records and other sources of information pertaining to me to release such information upon request of the 

investigator, special agent, or other duly accredited representative of any Federal agency authorized above regardless of any previous 

agreement to the contrary. 

I Understand that the information released by records custodians and sources of information is for official use by the Federal 

Government only for the purposes provided in this Standard Form 85P, and that it may be redisclosed by the Government only as 

authorized by law. 

Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for 

five (5) years from the date signed or upon the termination of my affiliation with the Federal Government, whichever is sooner. 

Signature (Sign in ink) Full Name (Type or Print Legibly) Date Signed 

Other Names Used Social Security Number 

Current Address (Street, City) State ZIP Code Home Telephone Number 

(Include Area Code) 

( ) 

Pages 
Standard Form 85P 

Revised September 1995 

U.S. Office of Personnel Management 

5 CFR Parts 731, 732, and 736 

UNITED STATES OF AMERICA 

AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION 

Carefully read this authorization to release information about you, then sign and date it in black ink. 

Instructions for Completing this Release 

Form approved: 

OMB No. 3206-0191 

NSN 7540-01-317- 7372 

85-1602 

This is a release for the investigator to ask your health practitioner(s) the three questions below concerning your mental health 

consultations. Your signature will allow the practitioner(s) to answer only these questions. 

I am seeking assignment to or retention in a position of public trust with the Federal Government as a(n) 

(Investigator instructed to write in position title.) 

As part of the investigative process, I hereby authorize the investigator, special agent, or duly accredited representative of the 

authorized Federal agency conducting my background investigation, to obtain the following information relating to my mental health 

consultations: 

Does the person under investigation have a condition or treatment that could impair his/her judgment or reliability? 

If so, please describe the nature of the condition and the extent and duration of the impairment or treatment. 

What is the prognosis? 

I understand that the information released pursuant to this release is for use by the Federal Government only for purposes provided in 

the Standard Form 85P and that it may be redisclosed by the Government only as authorized by law. 

Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for 1 

year from the date signed or upon termination of my affiliation with the Federal Government, whichever is sooner. 

Signature (Sign in ink) Full Name (Type or Print Legibly) Date Signed 

Other Names Used Social Security Number 

Current Address (Street, City) State ZIP Code Home Telephone Number 

(Include Area Code) 

( ) 

EXHIBIT I
CONTRACTOR PERSONNEL ROLLOVER REQUEST FORM

Social Security Administration (SSA) Center for Suitability and Personnel Security (CSPS)

March 2018 

Submit this document to your designated contracting officer’s representative-contracting officer’s technical 

representative (COR-COTR) via secure email. The COR-COTR must ensure the information is complete and 

accurate (all fields are required) and then submit to ^DCHR OPE Suitability. 

 

Only use this form when contractor personnel already working on an SSA contract need to move to another SSA 

contract. The information on this form must be typed, complete, and accurate. Failure to do so may result in a 

delay in receiving a suitability letter. The company point of contact (CPOC) and COR-COTR will receive suitability 

letters from the Center for Suitability and Personnel Security (CSPS) once the rollover is complete.

FULL NAME

SOCIAL 

SECURITY 

NUMBER

DATE OF BIRTH FROM TO ACTIVE ON BOTH 

CONTRACTS?

 LAST FIRST MIDDLE 000-00-0000 MM/DD/YYYY CONTRACT NUMBER CONTRACT NUMBER YES NO

CPOC INFORMATION:

NAME: ______________________________________ EMAIL ADDRESS: _________________________________

PHONE: _____________________________________ DATE OF SUBMISSION:_____________________________

COR-COTR INFORMATION:

NAME: ______________________________________ EMAIL ADDRESS: _________________________________

PHONE: _____________________________________
EXHIBIT J 
SYSTEM PLAN

TYPE OF PROPOSED MAINFRAME PLATFORM_____________________________ 

TYPE OF PERSONAL COMPUTER_________________________________________ 

MEDIA TO BE USED FOR RECEIPT OF FILE TRANSMISSION_________________ 

FILE STORAGE MEDIUM_________________________________________________ 

MANAGED FILE TRANSFER PLATFORM SERVER INSTALLED? ____________________ 

AMOUNT OF AVAILABLE FILE STORAGE SPACE___________________________ 

TYPE OF PRINT STREAM MAIL RUN CONTROL SYSTEM____________________ 

TYPE OF NETWORK PLATFORM (i.e., NOVELL/NT/UNIX)____________________ 
EXHIBIT K
100% Accountability and Summary Reports 

Full Audit report must include the following information (reprints must have the same information): 

1. Program Number/Job Name/Print Order/File Date

2. PC#/Sequence numbers/Total Volume 

3. Inserter ID and Operator

4. Date of insertion

5. Start and End time 

6. Start and End Range (sequence numbers) 

7. Total for each Start and End Range 

8. Event (i.e. Processed, Spoiled, Diverted and reason: Missing Piece, Unverified, Misread etc.)

9. Status (i.e. Inserted, Routed to Reprint Area, etc.) 

10. Totals 

a. Machine inserted

b. Sent to Reprint 

c. Reprints Recovered

d. Records Accounted For 

e. Duplicates

f. Duplicated Verified

g. Records less duplicates

h. Reported Output 

i. Variances

Example: 

Inserter ID Date Start Time End Time Start Range End Range Total EVENT STATUS

Inserter 1 05/10/12 10:31:04 AM 11:12:45 AM 19386 21567 2182 Standard Processing Inserted

Operator Joe 05/10/12 11:12:50 AM 11:12:50 AM 21568 1 Diverted Routed to Reprint

05/10/12 11:13:10 AM 11:28:06 AM 21569 22516 948 Standard Processing Inserted

05/10/12 11:28:07 AM 11:28:10 AM 22517 22518 2 Diverted/ leave count unverified Routed to Reprint

05/10/12 11:29:30 AM 11:29:35 AM 22519 22521 3 Diverted/missing piece Routed to Reprint

05/10/12 11:29:45 AM 11:30:15 AM 22522 1 Diverted/manual insertion of pub Manual Scan

05/10/12 11:30:34 AM 11:40:35 AM 22523 1 Diverted/misread Manual Scan

Inserter 2 05/11/12 8:12:50 AM 8:12:50 AM 21568 1 Standard Processing Inserted

(REPRINTS) 05/11/12 8:28:07 AM 8:28:10 AM 22517 22518 2 Standard Processing Inserted

Operator Sue 05/11/12 8:29:30 AM 8:29:35 AM 22519 22521 3 Standard Processing Inserted

26604

582

Reprints Recovered: 582

27186

16

16

27170

27170

0

TOTALS

Records Accounted for:

Duplicates:

Duplicates Verified:

Records Less Duplicates:

Reported Output:

Variance:

Audit Report

Program 123-S/SSA Notices Name/PO#54001/File Date

PC # and Sequence Numbers and Volume

Machine Inserted:

Sent to Reprints:
100% Accountability and Summary Reports - Continued

The Summary Report must include the following; Reprints must also have all of the same information: 

1. Job Name/Print Order 

2. Piece Quantity 

3. Sequence number range (Start and End Range) 

4. Start date and time

5. End date and time 

6. Total Processed Pieces

7. Total Reprints

8. Total Pieces Inserted

9. Total Variances

10. Job Complete or Incomplete 

Summary Report

Job Information Operation Information

Job Name: XYZ Notice 

PO # 54001 Start Range: 1 

Piece Quantity: 35862 End Range 35862 

Job Status: Completed 

Start Date &Time: 05/10/12 10:29:54 

End Date & Time: 05/11/12 14:22:34 

 

Statistical Summary

35537 Processed Pieces - Completed 05/10/12 

10:29:54 

325 Processed Reprints - Completed 05/11/12

14:22:34 

35862 Total Pieces Inserted - 

0 Variances - 

Completed 05/11/12

14:22:34

Job Complete 

YOUR LETTERHEAD

DATE: 

TO: Business Mailer Support 

RE: USPS Minimum Volume Reduction Program 

To Whom It May Concern: 

I am writing to request approval to use USPS Minimum Volume Reduction Program as shown in 

Publication 401 - Guide to the Manifest Mailing System. The exception is for the “200 piece or 

50 pound” rule for permit imprint mailings (including certified and foreign mail). 

If approved, we would submit the paperwork electronically and include piece level barcode 

information. 

A large portion of our business is government mailings and the use of this exception would 

greatly expedite our mail processing. 

Please let me know if any additional information is required. My contact information is below. 

Thank you for your time and consideration. 

NAME AND PHONE NUMBER OF YOUR CONTACT

 
EXHIBIT M
Detailed Meter Usage Report

Account Name

Meter 

Serial 

Number Job ID 1 Operator

Transaction 

Start Time

Transaction 

End Time Date Location

Meter 

Model

Class 

of Mail Pieces Postage

SSA Contract 

Program # 

####### SSA

Mailer # 

and File 

Date

Grand Total

SSA POSTAGE METER ACTIVITY LOG

CONTRACT NUMBER:

METER MANUFACTURER:

METER SERIAL NUMBER:

TODAY'S

DATE

METER

DATE

WORKLOAD

MAILER

NUMBER / 

NAME

SSA PRINT 

ORDER # / 

CONTRACTOR 

ORDER #

FILE

DATE

BEGINNING 

METER

BALANCE 

AMOUNT

METER

REPLENISHMENT 

AMOUNT 

(if applicable)

METER

RATE

CERT. BULK 

MAILING 

CHARGES 

(if applicable)

TOTAL

NUMBER

OF PIECES

METERED

SPOILED

POSTAGE / 

POSTAGE

ERRORS 

(actual cost