Program: 138-S

Term: September 1, 2020 to August 31, 2021

Title: SSA Third Party Draft Checks

BASIS OF

ITEM NO. DESCRIPTION AWARD UNIT RATE COST UNIT RATE COST

I. PRINTING, CONSTRUCTION, PACKING, AND DISTRIBUTION:

Laser-style checks.........................per 1,000 checks................................... 160 $355.54 $56,886.40 $299.86 $47,977.60

II. ADDITIONAL OPERATIONS

 (a) Paper samples..............................per order.............................................. 2 $200.00 $400.00 $200.00 $400.00

 (b) Proofs...........................................per order.......................................... 2 $5.00 $10.00 $5.00 $10.00

 (c) Prior to production samples......per order........................................ 2 $125.00 $250.00 $125.00 $250.00

CONTRACTOR TOTALS $57,546.40 $48,637.60

DISCOUNT 0.25% $143.87 0.25% $121.59

DISCOUNTED TOTALS $57,402.53 $48,516.01

AWARDED

CURRENT CONTRACTOR

Claysburg, PA NPC, INC.

NPC INC.

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Program 138-S Page 1 of 30 

Specifications by DLL 

Reviewed by MRN 

U.S. GOVERNMENT PUBLISHING OFFICE 

Washington, DC 

GENERAL TERMS, CONDITIONS, AND SPECIFICATIONS 

For the Procurement of 

SSA Third Party Draft Checks 

 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 September 1, 2020 and ending 

August 31, 2021 plus up to four (4) optional 12-month extension periods that may be added in accordance with the 

"OPTION TO EXTEND THE TERM OF THE CONTRACT" clause in Section 1 of this contract. 

Government processing of the security requirements, reviewing paper samples, and approval of Prior to 

Production test samples (SSA and/or Bank test checks) will take place from September 1, 2020 through 

February 28, 2021. Actual production begins March 1, 2021. 

BID OPENING: Bids shall be opened at 11:00 a.m., prevailing Eastern Standard Time (EST), on June 5, 2020 

at the U.S. Government Publishing Office, APSDC. Due to the COVID-19 pandemic, this will NOT be a public bid 

opening. 

BID SUBMISSION: Due to the COVID-19 pandemic, the 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 138-S and the 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. 

RESTRICTION ON LOCATION OF PRODUCTION FACILITIES: Due to the security requirements set forth 

in these specifications, all checks and security paper must be produced in the United States. 

BIDDERS, PLEASE NOTE: This program was formerly Program 693-S. These specifications have been 

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

specifications before bidding. 

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, call David Love at (202) 512-0307 or email apsdc@gpo.gov. 
SSA Third Party Draft Checks Page 2 of 30 

138-S (8/21) 

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. 1-18)) and GPO Contract Terms, Quality Assurance Through Attributes Program 

for Printing and Binding (GPO Publication 310.1, effective May 1979 (revised 9-19)). 

GPO Contract Terms (GPO Publication 310.2) – 

https://www.gpo.gov/docs/default-source/forms-and-standards-files-for-vendors/contractterms2018.pdf

GPO QATAP (GPO Publication 310.1) – 

https://www.gpo.gov/docs/default-source/forms-and-standards-files-for-vendors/qatap-rev-09-19.pdf

SUBCONTRACTING: Subcontracting will not be permitted. 

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

these specifications: 

Product Quality Levels: 

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

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

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

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

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

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

 Attribute Specified Standard 

P-7. Type Quality and Uniformity Approved Prior to Production samples / Approved 

Proofs / Electronic Media 

P-9. Solid and Screen Tint Color Match Pantone Matching System 

QUALITY CONTROL REQUIREMENTS: Prior to start-up, the contractor must put into effect, and maintain, 

within their own organization, an independent quality assurance organization of sufficient size and expertise to 

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 herein are met. The contractor must 

perform the process controls, inspections, and tests required to substantiate that the checks provided under this 

contract conform to the specifications and contract requirements. 

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

added under this clause. Further extension 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. 
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138-S (8/21) 

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. 

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

period will extend from the September 1, 2020 through August 31, 2021 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 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 May 31, 2020 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. 

If the Government exercises an option, the extended contract shall be considered to include this economic price 

adjustment clause. 

NOTE: Economic price adjustments are not cumulative and are to be applied to original bid prices only. 

SECURITY REQUIREMENTS: 

Protection of Confidential Information: 

(a) The contractor shall restrict access to all confidential information obtained from the SSA 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 must 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 must 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. 
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138-S (8/21) 

(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, 6401 Security 

Boulevard, 3-B-10-G Annex Building, Baltimore, MD 21235-6401. Attn: Kate Schmidt. 

 A copy must also be forwarded to: U.S. Government Publishing Office, 732 North Capitol Street, NW, 

Room C838, MS: CSAP Washington, DC 20401. Attn: David Love, APS DC, (202-512-0307). 

(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. 

 (g) 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. 

Restrictions on Movement: Government property shall not be transferred between plants except upon the formal 

authorization of responsible officials of the contractor and the Contracting Officer. Such transfer shall be at the 

contractor's expense unless other arrangements are mutually agreed to. 

Prohibition Against Similar Printing: The contractor shall not make or sell to any person, other than the 

Government, any documents which resemble the general appearance of the blank checks or which contain such 

features as may cause confusion in the processing. 

Defective Checks: Defective checks must be held in the check manufacturing area in a secure, lockable container 

which shall be constructed of any substance which deters easy access (i.e., cardboard is not acceptable). A 

department supervisor must hold the key to the container. The department supervisor will periodically transfer the 

defective checks to the vault for storage until they are delivered to the person charged with their destruction. Such 

checks shall be destroyed by shredding or hydro-pulping, after which the residue may be disposed of by the 

contractor as waste. The width of the shreds shall not be more than 3/8”. Waste/defective check destruction must 

be performed on site. 

Secure Production Area: The contractor must provide designated secure production area(s) for the manufacture of 

electronic media, plates, check print production, and the final packing into containers. The contractor must provide 

a designated secure storage room for the storage of the following: 

 Plates used for the production of checks 

 Old plates awaiting destruction 

 Printed checks 

 Check formats 

 Defective checks 

 Check production waste 
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138-S (8/21) 

At contractor’s discretion, the secure production area and the secure storage room(s) may be combined to 

accomplish both requirements. 

The contractor must provide security for the designated area to assure protection against theft. Security must 

include: 

 A secure room with controlled access and electronic security/intrusion detection devices. 

 Access Control: The contractor shall provide the means to prevent unauthorized personnel into the secure 

production area on a 24-hour hour basis. No personnel can access this area unless authorized by the Production 

Manager/Security Officer. 

 Exterior cameras that provide coverage of public and employee entrances and interior cameras that provide 

coverage of the entrance area and the secure room. Video data shall be stored for a minimum of 30 

calendar days. 

 A list of personnel authorized by the Production Manager/Security Officer must be forwarded to the Social 

Security Administration. A copy of this list must be retained by the contractor for future reference during 

regular security reviews by SSA. 

 Working Hours: A system shall be implemented to prohibit the entry of unauthorized personnel into the secure 

area. 

 Non-working Hours: The contractor shall provide approved intrusion alarms to detect any unauthorized entry 

into the secure area with a 3-minute response capability by company security personnel. The intrusion alarms 

must also sound in the nearest police facility. 

 Accountability: The contractor shall provide a record of accountability which includes all personnel, dates, and 

movement throughout all phases of production to include (1) the finished product, (2) the destruction of 

defective work, and (3) production materials. 

Unauthorized persons shall not be permitted within areas where these items are being manufactured and/or 

stored. Before authorizing any employee to enter such area, the employee must adhere to the PERSONNEL 

SECURITY AND SUITABILITY REQUIREMENTS and SECURITY AND SUITABILITY REQUIREMENTS 

FOR GOVERNMENT PRINTING as specified herein. 

The contractor will be held responsible for maintaining proper control and handling to prevent any information or 

materials required to produce the product ordered under these specifications from falling into unauthorized hands. 

Unless otherwise indicated herein, all extra copies, materials, waste, etc., must be destroyed. Paper documents 

containing confidential information must be destroyed by burning, pulping, shredding, macerating, or similar means 

that ensures the information cannot be recovered and used. Please note that hand tearing or lining through 

documents does not meet SSA guidelines for appropriate destruction of the product. Managers should remind their 

employees of their responsibilities to shred material containing confidential data. Managers should ensure that their 

facilities have adequate resources to shred the volume of sensitive material produced by their office, or securely 

store material pending shredding. Any theft or loss of items as defined in these specifications shall be reported 

immediately by the contractor to the nearest U.S. Secret Service Field Office, to the Social Security Administration, 

and to the Contracting Officer, U.S. Government Publishing Office, (202) 512-0307. 

When requested by the Government, the contractor must have the capability to provide a printed inventory list of 

all Government materials in their possession. 

GOVERNMENT ACCESS: 

The Government shall have the right to have representatives inspect the contractor's plant: 

(1) Prior to award; 

(2) Prior to the beginning of production; and 
SSA Third Party Draft Checks Page 6 of 30 

138-S (8/21) 

(3) At any time or times it may elect during the term of the contract, to ascertain whether the Third Party Draft 

Checks are being produced, stored, shipped, and delivered in accordance with these requirements, and that 

facilities are suitable, secure, and safe for storage of reproducibles, raw materials, and/or checks. Inspections of 

the contractor’s plant may be announced or unannounced. 

PERSONNEL SECURITY AND SUITABILITY REQUIREMENTS: 

The contractor must comply with the following Personnel Security and Suitability requirements: 

 Contractor personnel are considered Federal employees for purposes of applying provisions of the Privacy Act 

of 1974, Tax Reform Act of 1976, and SSA regulation 1 and Section 1106 of the Social Security Act on the 

confidentiality of and disclosure and protection of information entrusted to them. 

 Contractor personnel are subject to the same personnel security and suitability requirements as SSA employees. 

The provisions of Executive Order 10450, Executive Order 12968, and Title 5 of the Code of Federal 

Regulations (CFR), parts 731, 732, and 736 require that: "Every competitive, excepted and contractor position 

must be designated at a level of sensitivity that is commensurate with the responsibilities and other attributes, 

(such as policy making, fiduciary, public contact or public trust) of the position as they relate to the efficiency 

of the service, and; 

 All Federal service and contractor employees must be designated, in terms of their national security sensitivity, 

to assure appropriate screening. The required background investigation is conducted to provide a basis for 

ensuring that the employment of an individual is clearly consistent with the interests of the national security." 

 The contractor shall be required to provide the information required for such background checks and shall agree 

to abide by SSA personnel security and suitability determinations. 

 Before Government authorization is granted to any employee to enter the secured room and/or vault area(s) 

where the manufacture, storage, or shipment of items covered by this specification are being produced or held, 

the background security check must be conducted by the Government. The contractor shall not allow anyone 

into the secured area(s) until written security clearance has been furnished by the Government. 

 Personnel Screening: Before authorizing any employee to enter the secure room and/or vault area(s), or to 

participate in any way in the manufacture, storage, or shipment of any of the items covered by this contract, the 

contractor shall submit to the Government the name, address, date and place of birth, Social Security Number, 

race, sex, and finger prints of the employee for screening purposes. The Government will retain the prerogative 

for granting access to any of the secure areas. 

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 a SSA facility, site, information, or system, must complete and submit, through 

the COR-COTR, the documents listed in (a)(1) at least 30 work days 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. 

 
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138-S (8/21) 

(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 C; 

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

b. The e-QIP applicant listing must include the vendor’s name, the Social Security Administration 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. 

(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 

e-QIP 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 D. 

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-qip-background-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 E. 

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 
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138-S (8/21) 

(4) Status Check 

a. 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. 

(3) If personnel has 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 F. CSPS will notify the CPOC, COR, and Contract 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 was previously cleared under another Federal contract and does 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; vendors 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 

 
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138-S (8/21) 

(e) Vendor Notification to Government 

The vendor shall notify the COR and CSPS within one (1) business day if any vendor personnel is 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 recommend 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” 

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. The file has been successfully encrypted, 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
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CONTRACTOR LIABILITY: The contractor shall be responsible for all electronic media, printed checks, plates, 

SSA Logo, blank proofs or photocopies thereof, and all other materials necessary to produce this product, while in 

their custody and control. The contractor agrees to pay the Government the amount of loss(es) sustained by 

misappropriation or improper use of the electronic media, paper, printed checks, plates, or proofs in the custody and 

control of the contractor. 

The contractor shall guarantee that the imprinted checks: 

 Will have no missing numbers. 

 Will have the correct Common Accounting Number (CAN) numbers on them. 

 Are sequential and shipped to the correct address. 

 That duplicate numbers or blank checks will not be included in shipments. 

NOTE: The contractor shall reimburse the Government for any costs incurred from the use of checks furnished by 

the contractor which do not conform to the specifications. 

The contractor may be held responsible and/or liable to reimburse SSA and/or the bank for any misprinted, incorrect, 

and/or duplicate stock, blank stock, and/or incorrectly delivered stock resulting in fraudulent or counterfeit activity. 

Such activity will be determined by SSA and/or the bank and reimbursement will be required by the contractor 

within 30 workdays upon notification. 

Upon notification from SSA of any incorrect printing or incorrect shipment, the contractor will replace order(s) 

with a new shipment of stock within two workdays and shall deliver to the office(s) in question by overnight, 

traceable delivery at no additional cost to the Government. 

PREAWARD SURVEY: In order to determine the responsibility of the contractor, the Government reserves the 

right to conduct an on-site preaward survey at the contractor's facility and 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 (1) or more of the following 

financial documents: 

1) Most recent profit and loss statement 

2) Most recent balance sheet 

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) 

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. Failure to provide the required information within five workdays after requested by the 

Government may result in the Contracting Officer not having adequate information to reach an affirmative 

determination of responsibility. 

The preaward survey will include a review of the contractor’s mail, material, personnel, production, quality 

control/recovery program, security, and backup facility 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 at least 120 calendar days prior to the start of live 

production, on or about March 1, 2021.

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 Government reserves the right to deem the contractor nonresponsive 

and will proceed to the next responsive bidder, if applicable. 
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PRODUCTION PLANS: The contractor shall present, in writing, to the Contracting Officer within five workdays 

of being notified to do so by the Contracting Officer or his/her representative, detailed plans for each of the 

following activities. The workday after notification to submit will be the first day of the schedule. These proposed 

plans are subject to review and approval by the Government, and award will not be made prior to approval of same. 

NOTE: THE GOVERNMENT RESERVES THE RIGHT TO WAIVE SOME OR ALL OF THESE PLANS. 

Backup Facility/Contingency Plan – Failure to deliver checks in a timely manner would have a major negative 

impact on the Government. Therefore, if for any reason(s) (Act of God, labor disagreements, etc.) the contractor is 

unable to perform at the said location for a period longer than 48 hours, the contractor must have a backup facility 

with the capability of producing the checks. This backup facility must be operated by the contractor and must meet 

the requirements of this contract. 

Plans for this 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 that facility, and a timetable for the start of production at that facility. Part of this plan must also 

include the transportation of Government materials from one (1) facility to the other. 

NOTE: All terms and conditions of this contract will apply to the backup facility. 

Distribution Plan – This plan must include sufficient detail as to how the contractor will comply with all applicable 

shipping requirements. 

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

handled: incoming raw materials, work-in-progress materials, and quality control inspection materials. 

Personnel Plan – This plan must include a listing of all personnel who will be involved with this contract. For any 

new employees, the plan must include the source of these employees, and a description of the training programs the 

employees will be given to familiarize them with the requirements of this program. 

Production Plan – This plan must include items such as a detailed listing of all production equipment and equipment 

capacities to be utilized on this contract. If new equipment is to be utilized, documentation of the source, delivery 

schedule, and installation dates are required. 

Security Control Plan – This plan must provide the details of the contractor’s entire production facility and 

surrounding areas. Part of the Security Control 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. This plan must also address 

all topics noted in the section detailing the Security Requirements. 

Quality Control Plan – The contractor must describe in detail their quality control/quality assurance plan including 

how, when, where, and by whom the items in the plan will be performed. This plan must also address all topics 

noted in the section detailing the Quality Control Requirements. 

The Quality Control Plan must include, as a minimum, the following elements: 

1. Quality assurance of all materials (e.g., check paper and inks). Each homogeneous lot of check paper and inks 

shall be tested for compliance with specification requirements. Records of all materials tests and inspections 

shall be maintained and made available to the Government upon request. 

These records include tests and inspections performed by the contractor and/or by third party laboratories. If 

the contractor is receiving test and inspection data from material suppliers, these records shall also be 

maintained and made available to the Government upon request. 

2. Process controls inspections and tests during all phases of production. 

3. Targets for control and measurement of color register. 
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4. Use of standard specimens for color and printing matching purposes when printing checks. 

5. Independent inspections during the printing process of printed checks for conformance to the standard. 

6. Use of equipment in the manufacture of checks which will reject, or identify for rejection, those with defects 

which cause incorrect operation of high speed print equipment, high speed MICR Reader/Sorter, or other 

equipment used in the issuance and payment of checks. 

7. Examination of each delivery order to assure that pre-printed serial numbers are not duplicated from previous 

orders. If this is the case, the contractor must immediately notify the Contracting Officer or designee. 

8. Independent verification of the machine set-up as to disbursing check serial number at the beginning of the 

numerical printing operations and prior to resuming such operations after each machine stoppage. 

9. Audit of each batch of checks involved in a machine jam or malfunction during numerical printing or MICR 

encoding to verify the accuracy of such printing and MICR encoding. 

10. Independent inspection and approval of checks made up specifically to replace defective checks and of their 

insertion in numerical sequence within the related batches. 

11. All records covering the manufacturing, packaging, and shipping of the checks must be identified by the serial 

numbers of the checks when applicable. They must also contain the following information: 

(a) Employee(s) handling the checks 

(b) Description of any difficulties encountered 

(c) Date 

(d) Time 

(e) Machine identification 

12. Records of all tests and inspections. When quantitative results are available, they shall be recorded. Results of 

non-quantitative inspections (e.g., visual matches) shall also be recorded. 

13. Records of process controls sufficient to validate their effectiveness. 

14. All quality system records shall be maintained throughout production and be made available to the Government 

upon request. 

15. Appointment of an official who shall be responsible for the operation of the quality control system and for 

investigating and ascertaining the causes of deficiencies found in checks shipped. 

NOTE: A Certificate of Inspection of each shipment, certifying that the checks were tested and inspected and 

found to comply with all requirements and giving the number of the final inspection, may be required by the 

Contracting Officer. 

16. Inspection for conformance to color standards and integrity of numbers. 

17. Performance of Finished Product: Checks produced under these specifications must be guaranteed to function 

properly when processed. Checks require precision spacing, printing, perforating, and trimming. 

Recovery Plan – A recovery system will be required to ensure that all defective, missing, or mutilated pieces 

detected are identified, reprinted, and replaced. 

Material Plan – The contractor must describe in detail how all accountable materials will be handled throughout 

all phases of production. This plan must also include the method of disposal of all production waste materials. 

 
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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, 6401 Security Boulevard, Baltimore, MD, 21235, 

immediately after award. 

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 Government Publishing Office jacket 

number will be assigned and a purchase order issued to the contractor to cover work performed. The purchase order 

will be supplemented by an individu“l "Print Or”er" 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 particular order. 

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

Government. Orders may be issued under the contract from September 1, 2020 through August 31, 2021, 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 “e "iss”ed" 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 Governm’nt'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. 

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 shall 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 t“e "ORDER”NG" clause of this contract. 

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. 
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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 all 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 invoicing. Information for using 

this method can be found at the following web address: 

https://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: https://www.gpo.gov/how-to-work-with-us/vendors/how-to-get-paid. 

Contractor’s billing must be itemized in accordance with line items in the “SCHEDULE OF PRICES.” 

PRIVACY ACT NOTIFICATION: This procurement action requires the contractor to do one (1) 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 l974 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. 

 
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SECTION 2 – SPECIFICATIONS

SCOPE: These specifications cover the production of paper SSA checks requiring such operations as composition, 

proofing, printing including MICR numbering, construction, packing, and distribution. 

TITLE: SSA Third Party Draft Checks. 

FREQUENCY OF ORDERS: 

Approximately four (4) orders will be placed each year (12 months) of live production. 

A separate print order will be issued for paper samples, proofs, and prior to production samples 

It is possible that additional special re-stocking requests for approximately 1,000 to 10,000 printed checks may be 

required on occasion. The contractor will meet the delivery requirements for restocking within 48 hours by overnight delivery at a premium rate. Contractor will be reimbursed for all shipping of special stocking requests by 

submitting the overnight shipping receipts with the invoice for billing. See “ACCELERATED SCHEDULE – 

SPECIAL RESTOCKING REQUESTS” under “SCHEDULE” 

QUANTITY: Approximately 15,000 to 40,000 checks per order. 

NOTE: A special order as high as 250,000 checks may be required if a change in banks becomes necessary as a 

result of changes to the separate bank contract or in the 5th year of this contract if a new bank is awarded the bank 

contract. 

QUANTITY VARIATION ALLOWED: None. 

TRIM SIZE: 8-1/2 x 11” 

GOVERNMENT TO FURNISH: 

 Artwork for artificial (SSA logo) watermark to be supplied electronically by email 

 Distribution lists with delivery quantities to be provided via email with the print order 

 Name and address of financial institution (for contractor to forward test checks for approval) 

 Check numbering sequence and Common Accounting Numbers (CAN) - to be provided after award 

 Exhibit A: Form SSA-301, Contractor Personnel Security Certification 

 Exhibit B: Security and Suitability Requirements 

 Exhibit C: Declaration for Federal Employment Optional Form 306 

 Exhibit D: Questionnaire for Public Trust Positions - Sample Form SF85P 

 Exhibit E: Sample Finger Print Card FD-258 

 Exhibit F: Contractor Personnel Rollover Request Form 

 Exhibit G: Check Testing Specifications 

NOTE: Check testing specifications are subject to change at any time. 

 Exhibit H: Check Sample – not available as an exhibit, a voided digital copy is available upon request. The 

awarded contractor will be supplied voided hard copies for review. 

Identification markings such as register marks, ring folios, rubber stamped jacket numbers, commercial 

identification marks of any kind, etc., must not print on finished product. 
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138-S (8/21) 

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. 

All technology necessary to produce signature security line (micro printing).

COMPOSITION: 

The entirety of all composition must be identical throughout the products ordered under these specifications. 

Typefaces and Sizes: The contractor is required to match the Government furnished samples. 

Text Matter: Imprint lines. 

Base stock is personalized to include a static 10-digit MICR number (the first four (4) digits represent the static 

CAN and the last six (6) digits represent the consecutive check/draft number), a static 9-digit bank routing transit 

number, and one (1) of the approximately 15 different static 8-digit SSA Account numbers (no spaces, dashes, or 

alpha characters may be used in this number). 

The design of the SSA Third Party draft checks shall be subject to approval by SSA and consist of, at a minimum, 

the following items: 

 Pre-numbered check number 

 Social Security Administration, Office of Travel and Administrative Payment Services address. 

 Payee line. 

 Date line. 

 Amount line (for spelling the money amount) 

 Amount block (for numeric amount). 

 Three (3) accounting/management information memo lines. 

 Authorized signature line.

 Include the statement “Void After 60 Days” 

2D Barcode: The contractor will generate a 2D barcode that will be a unique identifier for each check form. The 

2D barcode will have a unique identifier which will allow the contractor to verify each check is accounted for in 

the required quantity. 

CHECK SECURITY FEATURES: The contractor must provide the Government with the following security 

features built into the checks ordered during the course of this contract: 

 Chain-link Design Watermark – Created by the Fourdrinier (dandy-roll) papermaking process, this 

overall design is pressed into the wet paper, displacing some fibers thereby achieving various levels of light 

transmission which allow easy recognition from either side as a two-dimensional watermark which cannot 

be photocopied or scanned, removed, corrupted, or faithfully replicated. The watermark design must be 

Conservator or SSA approved, functional, and aesthetic equivalent. 

 Invisible Fluorescent Security Fibers – Paper must contain two (2) different colors of fibers (blue and 

yellow-green) that are embedded into the paper, invisible to the naked eye, and viewable only with a UV 

light. This feature therefore cannot be photocopied or scanned and is valuable as an additional tool in 

determining document authenticity. 

 Toner Retention Treatment – At least the front of the paper must be fully treated with a security level 

toner retention purposed to facilitate the bonding of laser printed toner characters to the paper surface to 

deter mechanical alteration through removal of toner data via tape-lift, scraping, or other abrasive 

techniques so that attack results in either the inability to effectively remove laser printed data, or a 

perceptible disruption of the surface print and/or fibers. 
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138-S (8/21) 

The toner retention treatment must be either TA4 or SSA approved functional equivalent to TA4 which is 

a full-face toner retention treatment developed for high-speed laser printers such as the Xerox 4635 series 

and Xerox DP180 as well as for general laser-printers. 

 Full Chemical Sensitization – The paper pulp must contain chemical reagents to the five families of known 

chemical alteration agents. If chemicals from the families of oxidants, polar solvents, non-polar solvents, 

acids, or alkalis are applied to attempt localized chemical alteration, noticeable colored stains will appear 

through the paper and be visible from either side. 

 Warning Band on top of check 

 Logo line of the words “SECURE DOCUMENT” document for the signature line 

 “VOID” pantograph if check is copied. The “VOID” pantograph should not appear in amount box and 

signature line. 

NOTE: ANY “VOID” FEATURE USED BY THE CONTRACTOR CANNOT VIOLATE ANY 

COPYRIGHTS OR PATENTS. 

 Padlock icon on the face. Exact location to be determined. 

The contractor may also suggest or notify the Government of additional industry standard security features and 

technologies when possible to improve the security of the checks during the course of this contract. Acceptance of 

new technologies or altering of the checks is at the Government’s discretion. In the event any new technology is 

approved by SSA, the cost will be negotiated between the contractor and the Government. 

PAPER SAMPLES: As indicated on Print Order

Contractor to supply 40 sheets of blank production stock, each 8-1/2 x 11” in size, containing all security features 

and meeting all required paper specifications. The contractor shall submit paper samples to each of the following: 

30 sheets deliver to: U.S. Government Publishing Office, 732 North Capitol Street, NW, Room C838, MS: CSAP 

Washington, DC 20401. Attn: David Love, APS DC, (202-512-0307) 

10 sheets deliver to: Social Security Administration, 6401 Security Boulevard, 3-B-10-G Annex Building, 

Baltimore, MD 21235-6401. Attn: Kate Schmidt. 

The container and accompanying documentation shall be marked PREPRODUCTION SAMPLES and shall include 

the GPO jacket, purchase order, and program numbers. 

The samples must be submitted, in accordance with the schedule for “PROOFS AND PAPER SAMPLES.”

Samples will be reviewed and must comply with the specifications as to kind and quality of materials. If paper 

samples are disapproved by the Government, the Government, at its option, may require the contractor to submit 

additional samples for inspection and test, in the time and under the terms and conditions specified in the notice of 

rejection. 

In the event the revised test samples are disapproved by the Government, the contractor shall be deemed to have 

failed to comply with the applicable requirements of these specifications and will be found non-responsible 

regarding these requirements. 

Samples will not be returned to the contractor. 

PROOFS: As indicated on Print Order

Contractor must supply two (2) sets of digital color content proofs. Proofs must be created using the same Raster 

Image Processor (RIP) that will be used to produce the product. Proofs shall be imaged face and back with all 

elements in proper position (not pasted up) and trimmed to the finished size of the product. 
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The contractor will be required to furnish an overlay (film positive) of the black image of the check to show the 

exact position of the MICR line and the Check number. 

 All proofs must be uniform in size and must contain a single imprint to a sheet. 

 The imprint information contained on each proof will be overprinted. 

 Contractor will produce generic stock for overprinting the information, as well as the numbering sequence. 

At agency’s option, contractor to submit ink drawdowns on actual production stock with Pantone colors to be used 

in job. 

The Government may require one (1) or more sets of revised proofs before rendering an “O.K. to Print.” 

If any contractor’s errors are serious enough in the opinion of the GPO to require revised proofs, the revised proofs 

are to be provided at no expense to the Government. No extra time can be allowed for this reproofing; 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”.

PRIOR TO PRODUCTION SAMPLES: As indicated on Print Order

Prior to the commencement of production on the first order and any time there is a bank change, the sample 

requirement for this contract is as follows: 

1. Bank Test Checks: The contractor must submit 15 test checks (of the first part of the actual check) for each of 

SSA’s approximately 15 accounts for bank testing of MICR printing specifications. 

Samples are to be printed on the actual security paper to be used in this contract. Samples will be tested for 

conformance of material(s) and construction 

Samples deliver directly to the financial institution by the contractor. The container and accompanying 

documentation shall be marked PREPRODUCTION SAMPLES and shall include the GPO jacket, purchase 

order, and program numbers. 

The samples must be submitted, in accordance with the schedule for PRIOR TO PRODUCTION SAMPLES. 

SSA will notify Contractor of bank approval of test checks. 

The Government may exercise the option to waive Bank Test Checks. 

2. SSA Test Checks: The contractor must submit 100 laser style test checks for SSA testing. 

For the SSA test check samples the full 8-1/2 x 11” sheet is required. Samples are to be printed on the actual 

security paper to be used in this contract, but do not have to contain the MICR printing. Samples will be tested 

for conformance of material(s) and construction 

For testing purposes only, contractor is to ensure the top portion of the check is voided and the middle and 

bottom portions contain a “Non Negotiable” pantograph (location to be determined at postaward conference). 

The contractor shall submit samples to: Social Security Administration, 6401 Security Boulevard., 3-B-10-G 

Annex Building, Baltimore, MD 21235-6401. Attn: Kate Schmidt. 

The container and accompanying documentation shall be marked PREPRODUCTION SAMPLES and shall 

include the GPO jacket, purchase order, and program numbers. 

The samples must be submitted, in accordance with the schedule for PRIOR TO PRODUCTION SAMPLES. 
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138-S (8/21) 

The Government will approve, conditionally approve, or disapprove the samples. 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. A 

notice of disapproval shall state the reasons therefor. 

If the samples are disapproved by the Government, the Government, at its option, may require the contractor to 

submit additional samples for inspection and test, in the time and under the terms and conditions specified in 

the notice of rejection. Such additional samples shall be furnished, and necessary changes made, at no 

additional cost to the Government and with no extension in the shipping schedule. 

In the event the additional samples are disapproved by the Government, the contractor shall 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, provided however, that the failure of the Government to terminate the contract for 

default in such event shall not relieve the contractor of the responsibility to deliver the contract quantities in 

accordance with the shipping schedule. 

In the event the Government fails to approve, conditionally approve, or disapprove the samples within the time 

specified, the Contracting Officer shall automatically extend the shipping schedule in accordance with Contract 

Clause 12, "Notice of Compliance With Schedules," of GPO Contract Terms (GPO Publication 310.2, effective 

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

 The Government may exercise the option to waive SSA Test Checks. 

All samples shall be manufactured at the facility and on the equipment in which the contract production quantities 

are to be manufactured. 

Samples will not be returned to the contractor. 

Manufacture of the final product prior to the approval of the samples submitted is not permitted. Violation of this 

restriction shall be considered a breach of security, and contractor shall be subject to default. 

STOCK/PAPER: The specifications of all paper furnished must be in accordance with those listed herein. 

Color of paper furnished shall be of a uniform shade and a close match to samples provided after award. 

The Contracting Officer reserves the right to reject shipments of any order printed on paper the color of which, in 

his opinion, materially differs from that of the color sample(s). 

White Safety Check Paper for laser printers with the following characteristics:

Basis Weight: 17 x 22 inches, 500 sheets ........................................................................ pounds ......... 25 

A tolerance of -4 and +1.3 percent shall be allowed. 

Caliper (in mils= 0.001”) Target ................................................................................................ 5.0 (0.005”) 

A tolerance of 0.0004 inches shall be allowed. 

Paper shall be uniform and shall not vary more than 0.0004 inch from one (1) edge to the other. 

Tearing strength: Elmendorf Tester 

Target Machine Direction (MD) ...................................................................................... grams ......... 70 

Target Cross Machine Direction (CD) ............................................................................. grams ......... 75 

Stiffness: Gurley Tester 

Target MD ................................................................................................................. milligrams ....... 200 

Target CD .................................................................................................................. milligrams ....... 130 

Smoothness: Sheffield Tester 

Target, Felt side and Wire side ............................................................................................ units ........ 160 
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138-S (8/21) 

Porosity: Sheffield Tester 

Target ................................................................................................................................... units .......... 11 

Opacity: Target ............................................................................................................... percent .......... 91 

A tolerance of -6 percent shall be allowed. 

Brightness: Target ........................................................................................................... percent .......... 84 

A tolerance of -4 and +3 percent shall be allowed. 

Shade L: Target .................................................................................................................... UV ....... 93.5 

Shade a: Target ..................................................................................................................... UV ......... 0.2 

Shade b: Target ..................................................................................................................... UV ......... 1.6 

UV Fluorescent Component: Target................................................................................... units ......... 0.2 

A maximum tolerance of +0.6 units shall be allowed. 

Tensile strength: CD Target ................................................................................................ units .......... 17 

Bursting strength: Mullen 

Target ................................................................................................................................... units .......... 45 

Moisture content: Target .............................................................................................. percent. ......... 5.5 

A tolerance of -5 and +3 percent shall be allowed. 

Pulp components: ................................................................................................ no post-consumer waste 

The paper must be a true security paper with fully integrated security features. Print-based features such as an 

artificial watermark are not acceptable. Paper must be UV Dull and contain a Fourdrinier process two-dimensional 

chain link design mill-formed into the fibers of the security paper which is the first line of defense containing 

features that provide deterrence to counterfeiting, chemical alteration, and mechanical alteration. 

PRINTING: (LIVE CHECK STOCK) - Contractor is to meet the industry standards for Third Party Draft checks 

for all the ink, OCR, MICR and Check Numbering requirements. 

Face of Check 

Prints in Pantone 185 Red, blue (to match sample), and black plus MICR. The warning band and SSA logo is 

reversed out of blue at the top of the check. The “NON-NEGOTIABLE” text prints in Pantone 185 Red (or match 

sample) in the middle and bottom portions of the check. All other text prints in black. All colors are subject to 

Government approval. 

Micro printing is required on the signature line and dollar amount box. Contractor to print the following on stub (at 

top of page): “PLEASE REMOVE THIS STUB BEFORE CASHING.” 

Only the top and middle check portions need to reflect the SSA emblem printed in the background in a phantom 

manner so as not to interfere with other information printed or written on the check. Only the original check shall 

be imprinted with the MICR encoded account number line. 

Check stock is to be printed on appropriate quality security paper. Printed checks must be imprinted on the front 

with a legend limiting negotiability to 60 calendar days after issuance. 

Checks must have a “VOID” pantograph (incorporated into the background) intended for use on products produced 

on this program. The proposed “VOID” pantograph is subject to Government approval and must be created by the 

contractor. The word “VOID” will print on the face of the check. The word “VOID” must not be visible on the 

printed check, but must appear when the check is reproduced by use of a single or multi-color laser copier or other 

similar duplicating processes on the market today. The “VOID” pantograph should not appear in amount box and 

signature line. 
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No additional time will be given in the contract schedule for creating the “VOID” pantograph and/or performing 

any testing of the “VOID” pantograph. Any void feature used by the contractor cannot violate any copyrights or 

patents. 

Base stock is personalized to include a static 10-digit MICR number (the first four (4) digits represent the static 

CAN and the last six (6) digits represent the consecutive check/draft number), a static 9-digit bank routing transit 

number, and one (1) of the approximately 15 different static 8-digit SSA Account numbers (no spaces, dashes, or 

alpha characters may be used in this number). 

2D Barcode 

The 2D Barcode is required to print in the bottom portion of the check on the right corner approximately 3/4” from 

right edge and 3/4” from bottom edge or foot of the 8-1/2 x 11” check form. 

After printing, the operator will scan the 2D code on each check form to verify each check is accounted for in the 

required quantity. 

Back of Check 

Prints black only with custom check endorsement copy. 

Location and dimensions of the endorsement copy will be provided at the postaward conference. 

All inks, screens, and pantographs must be image-friendly as the checks will be processed through the IBM 

image capture deposit and check payment processing system. 

The Government reserves the right to alter base stock requirements or make format/text changes to the checks at 

any time during the term of the contract. Notification of a proposed change will be given with sufficient time for 

the contractor to allow for the change and submit stock samples, proofs, and test checks to the Government and test 

checks to the bank. Therefore, the contractor is not to preprint or maintain an inventory of base stock greater than 

as is necessary to meet restocking requirements. 

The Government shall not be obligated to purchase from the contractor any inventory of unused paper or base stock 

remaining on hand beyond this requirement when a stock or format/text change is implemented OR at the end of 

the term of the contract. 

MARGINS: Follow sample and check testing specifications provided. See Exhibit G and Exhibit H. 

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 QA TAP tolerances 

when applicable) and with discarding all makeready sheets that preceded approval. When a press sheet inspection 

is required, it will be specified on the individual print order. See GPO Publication 315.3 (Guidelines for Contractors 

Holding Press Sheet Inspections) issued January 2015. 

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. 

 
SSA Third Party Draft Checks Page 23 of 30 

138-S (8/21) 

CONSTRUCTION: Finished checks must be suitable for continuous operation on laser compatible printers.

The document is 8-1/2 x 11” with three (3) horizontal perforations. The first perforation is 3/8” from the top of the 

check page. This is the top stub portion of the check. The second and third perforations are every 3-9/16” from the 

first perforation. This document must be cut exactly to specifications in order to properly be used with SSA’s 

software that is required for issuing checks. No magnetic ink, other than the encoded MICR, may appear on the 

lower 5/8” of the document. This includes additional printing, signature, or printing on the reverse of the document. 

The check is comprised of three (3) parts: one original check at the top, the middle portion a blank section containing 

only the “NON NEGOTIABLE” marking. The bottom portion shall be a contrasting color to the top (check) portion. 

DEFECTIVES: A single check is defective if it fails to conform to any applicable requirements of this 

specification. 

The contractor shall examine finished checks, to the extent necessary, to eliminate imperfect work prior to delivery. 

Defective work includes, but is not limited to, the following defects: 

Not color specified; scuffs or tears; broken corners; split, ragged, or crushed edges; wrinkles; encoding quality not 

equal to the standard; slime spots, dirt spots, knots, lumps, or blisters in excess of standard; improper registration; 

incorrect printing; defective tinting; printing quality not equal to the standard; checks not in number sequence; 

missing checks; and duplicate checks. The Contracting Officer reserves the right to require the contractor to replace 

any defective checks and any related copies or stubs found in any order or to replace all checks within a continuous 

series if, in his/her opinion, segregation of the defective items would not be feasible. The determination by the 

Contracting Officer as to defective workmanship in a particular check or lots of checks shall be final and conclusive, 

subject to normal appeal procedures as outlined in the Disputes Clause as indicated in GPO Contract Terms. 

Testing and Inspection by the Contracting Officer: Occasionally, the Contracting Officer will, at his/her option, 

perform tests to determine that the checks being manufactured adhere to the specifications and standards prescribed 

herein. He/she may use either or both of the following methods for obtaining samples: 

 a. An authorized representative may periodically visit the contractor’s manufacturing plant to inspect quality 

of printing, shade of tint, the methods of packing, etc., and will select or require the contractor to furnish 

samples of blank stock, printed work, ink, packing material, etc., for laboratory testing. 

 b. The Contracting Officer may request the contractor to take samples of the security paper, checks, ink, 

packing material, etc., and promptly forward them by registered mail or by hand delivery with appropriate 

receipt to the GPO. All photo prints or specimens of checks shall be voided in an approved manner before 

being permitted to leave the contractor's plant. 

PACKING: 

Checks must be bagged in lots of 100 (because of bending, no shrink wrap will be permitted). 

Pack into shipping containers in multiples of 100. Shipping containers must be white or brown and approved by 

SSA. 

Contractor is required to use a sealing tape on the outer shipping container that will detect if the tape has been 

tampered with or broken. 

All shipments must be packaged with materials of sufficient strength and durability and in such a manner which 

will guarantee that the product will not be damaged, and the package will not open nor split during shipment. 

LABELING AND MARKING: 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. 
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DISTRIBUTION: 

Deliver f.o.b. contractor’s city by small package common carrier to approximately 50 to 200 addresses nationwide 

(including U.S. Territories) per order. If a bank change occurs, then this quantity could increase for a onetime 

delivery of up to 1,500 different addresses. Contractor will be reimbursed for all shipping costs by submitting 

shipping receipts with billing invoice for payment. 

Complete addresses and quantities will be furnished with each print order. 

Printed checks must be shipped by a 2 or 3-day delivery service (pre-approved by SSA) with a required signature 

of the receiving office. Contractor must begin shipping to destinations with the furthest delivery point (specific 

CANs/addresses may require shipping first as directed on the print order). 

NOTE: No orders are to be shipped by U.S. Postal Service. 

The contractor shall provide hardcopy or electronic confirmation of deliveries to SSA no later than three (3) calendar 

days following complete distribution. The Government reserves the right to request from the contractor and obtain 

the tracking numbers, CANs, and delivery dates for all offices not receiving their deliveries by the required due 

date. 

Contractor is required to notify SSA immediately of any undeliverable addresses. Contractor CANNOT make any 

address corrections. If an address discrepancy is identified, the contractor must ask SSA for clarification. 

Shipping Documentation 

Upon completion of each order the contractor must notify the ordering agency (on the same day the order ships) via 

email to Kate Schmidt at Kathryn.Schmidt@ssa.gov. The subject line of the email shall be “Distribution Notice for 

Program 138-S, Print Order XXXXX, Jacket Number XXX-XXX.” The notice must provide all applicable tracking 

numbers, shipping/mailing method, and title of publication. 

Within five (5) workdays of completion of each order, contractor must email all supporting delivery documentation 

(i.e., delivery/mailing receipts, and mailing documentation) and one (1) copy of the contractor’s billing invoice. 

Contractor to email as a PDF file to Kate Schmidt at Kathryn.Schmidt@ssa.gov. Contractor must identify the 

contract number and print order number in the subject line of all emails. 

All expenses incidental to picking up and returning materials (if applicable), submitting proofs, paper samples, and 

prior to production samples, and furnished sample copies must be borne by the contractor. 

Upon completion of the contract, all furnished material must be returned to: Social Security Administration, 6401 

Security Boulevard., 3-B-10-G Annex Building, Baltimore, MD 21235-6401. Attn: Kate Schmidt. 

SCHEDULE: Adherence to this schedule must be maintained. Contractor must not start production of any job 

prior to receipt of the individual print order. 

Most Government furnished materials and print orders will be supplied by e-mail. All other Government furnished 

materials must be picked up from SSA in Baltimore MD at the contractor’s expense. 

Submit proofs to: Social Security Administration, 6401 Security Boulevard, 3-B-10-G Annex Building, Baltimore, 

MD 21235-6401. Attn: Kate Schmidt. The container and accompanying documentation must be marked 

“PROOFS”, and must include the GPO jacket, purchase, and program numbers. The contractor must provide their 

UPS number for SSA to use to return signed-off proofs. 

No definite schedule for release of print orders and Government Furnished Materials can be predetermined. 

The following schedules begin the workday (WD) after notification of the availability of print order and furnished 

material; the workday after notification will be the first workday of the schedule. 
SSA Third Party Draft Checks Page 25 of 30 

138-S (8/21) 

PROOFS AND PAPER SAMPLES 

No specific date is set for submission of proofs and paper samples. Proofs and paper samples must be submitted as 

soon as possible to allow for revised proofs and/or paper samples, if contractor’s errors are judged serious enough 

to require them. 

Proofs will be withheld no more than two (2) workdays from their receipt at the ordering agency until they are made 

available for pickup. The first workday after receipt of proofs at the ordering agency is day one (1) of the hold time. 

The Government will approve, conditionally approve or disapprove the paper samples within seven (7) workdays 

of the receipt thereof. 

PRIOR TO PRODUCTION SAMPLES

The Bank Test checks and/or SSA test checks samples must be submitted within seven (7) workdays after approval 

of proofs. 

The Government will approve, conditionally approve or disapprove the samples with in seven (7) workdays of the 

receipt thereof. 

REGULAR SCHEDULE 

Contractor must complete production and distribution within 15 workdays upon receipt of “O.K. to print” on proofs 

and priors or after notification of the availability of print order and furnished material, as applicable. 

NOTE: With notification provided to SSA, the contractor is authorized to deliver any completed Print Order prior 

to the contracted delivery date. 

ACCELERATED SCHEDULE – SPECIAL RESTOCKING REQUESTS 

If an accelerated schedule is required, orders must be completed and delivered (by over-night delivery*) within 48 

hours after notification of the availability of print order and furnished material. 

Approximately 1,000 to 10,000 printed checks may be required under an accelerated schedule. 

* Contractor to utilize overnight shipping for all special restocking requests in order to meet accelerated schedule 

requirements. Reimbursement will be made by submitting the receipts with the invoice for billing. 

Orders requiring this accelerated schedule will not require proofs or priors.

Orders requiring this accelerated schedule will be paid at the premium rate of an additional 25% of the total invoice, 

(minus shipping) as determined in the SCHEDULE OF PRICES. 

All other orders will be placed with the REGULAR SCHEDULE and paid for at the basic prices offered. 

Press Sheet Inspection 

The contractor must notify the U.S. GPO of the date and time the press sheet inspection can be performed. In order 

for proper arrangements to be made, notification must be given at least two (2) workdays prior to the inspection. 

Notify the U.S. Government Publishing Office, Quality Control for Procured Printing, Washington, DC 20401 at 

(202) 512-0542. Telephone calls 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 of 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 
SSA Third Party Draft Checks Page 26 of 30 

138-S (8/21) 

The ship/deliver date indicated on the print order is the date products ordered for delivery f.o.b. contractor’s city 

must be delivered to the destinations specified. 

Unscheduled material such as shipping documents, receipts or instructions, delivery lists, labels, etc., will be 

furnished with each 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. 

For compliance reporting purposes, contractors are to report information regarding each order with date of shipment 

or delivery, as applicable, in accordance with the contract requirements by contacting 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. 
SSA Third Party Draft Checks Page 27 of 30 

138-S (8/21) 

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 during a like period of time. 

NOTE: The Determination of Award estimates specified below are based on historical data; however, due to the 

current global pandemic, the contractor is put on notice that the estimated amounts of work anticipated on this 

contract may be significantly impacted during the first period of performance. 

Although the base year will allow only six (6) months of live production, the determination below was estimated 

on a full years’ production 

Premium Payments: Orders requiring the “ACCELERATED SCHEDULE” will be paid for at the premium rate. 

All other orders will be placed with the REGULAR SCHEDULE and paid for at the basic prices offered. 

Failure of the contractor to deliver work at the time specified will result in disallowance of premium payments that 

were anticipated, and the contractor will not list such items on his voucher. 

The following item designations correspond to those listed in the “Schedule of Prices”. 

I. 160 

II. (a) 2 

(b) 2 

(c) 2 

 
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THIS PAGE IS INTENTIONALLY BLANK. 

 
SSA Third Party Draft Checks Page 29 of 30 

138-S (8/21) 

SECTION 4 – SCHEDULE OF PRICES 

Bids offered are f.o.b. contractor’s city. 

Prices must include the cost of all required materials and operations for each item listed in accordance with these 

specifications. 

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 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. 

I. PRINTING, CONSTRUCTION, PACKING, AND DISTRIBUTION: Prices offered shall include the cost of all 

required materials and operations (including all composition and paper) necessary for the printing, construction, 

packing and distribution of the product listed in accordance with these specifications. Cost of makeready must 

be included. 

 Laser-style checks ................................................................... per 1,000 checks ......................... $ ___________ 

II. ADDITIONAL OPERATIONS 

(a) Paper samples ................................................................... per order ..................................... $ ___________ 

(b) Proofs ............................................................................... per order ..................................... $ ___________ 

(c) Prior to production samples ............................................. per order ..................................... $ ___________ 

 ____________ 

(Initials) 
SSA Third Party Draft Checks Page 30 of 30 

138-S (8/21)

SHIPMENT(S): 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 Solicitation 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 

points(s), in exact accordance with specifications. 

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 (1) 

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 Name) (GPO Contractor’s Code) 

 ___________________________________________________________________________________________ 

(Street Address) 

 ___________________________________________________________________________________________ 

(City – State – Zip Code) 

By _________________________________________________________________________________________ 

(Printed Name, Signature, and Title of Person Authorized to Sign this Bid) (Date) 

 ___________________________________________________________________________________________ 

(Person to be Contacted) (Telephone Number) (Email) 

******************************************************************************************* 

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. 

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

Contractor Date 

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Contractor Employee Date 

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Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

Form SSA-301 (2-98) 
EXHIBIT A – Page 2 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

Form SSA-301 (2-98) 
EXHIBIT A – Page 3 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

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Contractor Employee Date 

Form SSA-301 (2-98) 

1 

EXHIBIT B

0401 – Security and Suitability Requirements (JUNE 2011)

a. Acronyms and Definitions

 Access to a facility, site, system, or information means physical access to

any Social Security Administration (SSA) facility or site, logical access to any

SSA information system, or access to programmatic or sensitive information.

 CO - Contracting Officer

 Contractor – In this clause, this term means any entity that has a relationship

with SSA because of this contract. This term includes, but is not limited to,

corporations, limited liability partnerships, and individuals.

 CPOC – Company Point of Contact as specified by the contract

 CPSPM – Center for Personnel Security and Project Management

 COTR – Contracting Officer’s Technical Representative

 Contractor Employee – In this clause, this term means a person hired by an

SSA contractor to provide services in exchange for compensation.

 PIV – Personal Identity Verification

 Subcontractor – In this clause, this term means any entity that has a

relationship with SSA’s contractor because of this contract. This term

includes, but is not limited to, corporations, limited liability partnerships, and

individuals.

 Subcontractor Employee - In this clause, this term means a person hired by a

subcontractor to provide services in exchange for compensation.

 eQIP - Electronic Questionnaire for Investigations Processing

b. Purpose

This clause provides SSA’s policies and procedures concerning the conduct of

background investigations (i.e. suitability determinations). The purpose of these

investigations is to determine the suitability of contractors, contractor employees,

subcontractors, and subcontractor employees who need access to an SSA facility,

site, system, or information. If applicable, the clause also describes the process to

obtain a PIV credential.

c. PIV Credentials

A PIV credential will be required for:
2 

o Any contractor, contractor employee, subcontractor, or subcontractor 

employee requiring access to a SSA information system or routine, 

unescorted access to a SSA facility or site for a period of six months or 

more. (See Paragraph k. for more information.) 

A PIV credential will not be required for: 

o Any contractor, contractor employee, subcontractor, or subcontractor 

employee requiring escorted access to a SSA facility or site for less than 

six months. 

o Any contractor, contractor employee, subcontractor, or subcontractor 

employee requiring infrequent escorted access to a SSA facility or site, 

even if the access may be longer than six months. For example,

contractors or contractor employees who provide infrequent 

facilities/equipment maintenance or repair, conduct onsite shredding, etc. 

Please Note: A background investigation is required any time a contractor, 

contractor employee, subcontractor, or subcontractor employee requires any type 

of access to a facility, site, system, or information regardless of whether a 

credential is required or not. 

The contractor is required to include the substance of this clause in any 

subcontract where subcontractors and subcontractor employees will have similar 

access as described in the preceding paragraphs. However, the contractor is 

responsible for obtaining all of the required forms (see paragraphs g-i) from its 

subcontractors and the subcontractors’ employees, reviewing these forms, and 

submitting them to SSA. Subcontractors and subcontractors’ employees shall not 

submit forms directly to SSA. 

d. Authorities 

 Homeland Security Presidential Directive 12

 Office of Management and Budget Memorandum M-05-24

 The Crime Control Act of 1990, Public Law 101-647, subtitle E, as 

amended by Public Law 102-190 (for childcare center security 

requirements) 

 Executive Orders 10450 and 12968 and Title 5, Code of Federal 

Regulations (CFR), Parts 731, 732 and 736 (for positions assigned a 

“National Security” designation) 

e. Background Investigation and Adjudication Process 

The background investigation and adjudication processes are compliant with 5 

CFR 731. 

f. Listing of Applicants 
3 

Upon award, the CPOC will provide to SSA an applicant listing of all individuals 

for whom the contractor is requesting a suitability determination (i.e., background 

investigation). This listing should include the contractor’s name, the contract 

number, the CPOC’s name, the CPOC’s contact information, each applicant’s full 

name, each applicant’s Social Security number (SSN), each applicant’s date of 

birth, and each applicant’s place of birth (must show city and state if born in the 

United States (U.S.) OR city and country if born outside of the U.S.). The 

background investigation process does not start until the CPOC submits this 

applicant listing; therefore, the CPOC should submit the listing as soon as 

practical after award. 

Submit the applicant listing via U.S. Mail to the address located in paragraph i. 

OR via fax to 410-966-0640. 

g. Required Forms 

1) eQIP 

SSA will initiate the eQIP process using the applicant listing provided by the 

CPOC. SSA will email notification to the CPOC that each applicant has been 

invited into the eQIP website to electronically complete their background 

investigation form. The CPOC will provide the website to the applicants to 

complete their eQIP form. The applicant will have up to seven (7) calendar days 

to complete the eQIP form. The seven-day timeframe begins once SSA notifies 

the CPOC of the eQIP invitation(s). The applicant must print the signature pages 

of the form (pages 5 and 6 for Standard Form (SF) 85; pages 7-9 for SF 85P), sign 

the signature pages, and then provide the signed originals to the CPOC. 

2) Paper Forms 

 Two (2) Field Division-258 charts, Applicant Fingerprint Chart (The 

CO will provide the FD-258 charts at the time of contract award.) 

NOTE: The contractor will be responsible for obtaining and providing 

acceptable fingerprints for use by SSA. Regardless of the method used to 

fingerprint contractors, contractor employees, subcontractors, or 

subcontractor employees, (electronic capture or ink) the only acceptable 

fingerprint chart is the FD-258.

 Optional Form 306, Declaration for Federal Employment

 http://www.opm.gov/forms/html/of.asp 

 Fair Credit Reporting Act Authorization Form 

 Federal Investigations Notice: 98-02 

 Original signed and dated eQIP Signature Pages (See paragraph g.1 

above) 

 If the contractor, contractor employee, subcontractor or 

subcontractor employee is not a U.S. Citizen, the individual must 
4 

provide SSA with a legible photocopy of his or her work authorization 

permit and Social Security card. 

h. Forms Completion 

The CPOC must ensure all paper forms are fully completed and signed prior 

to submission to SSA. The fingerprint charts and all paper forms must be legible 

or typed in black ink and all signatures must be in black ink. There must be no 

“breaks” in residences or employment. SSA requires complete addresses, 

including zip codes and phone numbers. SSA must receive forms within 30 days 

of signature and date. 

SSA will return forms not fully completed to the CPOC. To ensure the forms are 

completed correctly, obtain a sample of a properly completed form at the 

following website: 

http://www.ssa.gov/oag/acq/Sample_Security_Requirement_Docs%20.pdf. 

Access information related to the eQIP process at: e-QIP - Quick Reference Guide 

for the Applicant. 

i. Forms Submission 

The CPOC shall submit one cover sheet to SSA containing the names of all of 

the individuals for whom the contractor is submitting completed paperwork. This 

cover sheet should include the contract number, each applicant’s full name, each 

applicant’s SSN, each applicant’s date of birth, and each applicant’s place of 

birth. Submit this cover sheet along with the completed paper forms and two FD258 fingerprint charts for each applicant to: 

SSA 

CPSPM Suitability Team 

6401 Security Boulevard 

Room 1260 Dunleavy Building 

Baltimore, MD 21235 

Simultaneously, the CPOC must submit a copy of the cover sheet ONLY to 

the COTR. 

The CPOC must submit the paper forms at least 15 days prior to the date work 

is to begin. For new contract employees, subcontractors, or subcontract 

employees (i.e., those who had not previously received a suitability determination 

under this contract) who will need access to a SSA facility, site, information, or 

system, the contractor must submit these forms at least 15 days prior to beginning 

work under the contract. 

j. Suitability Determination 

A Federal Bureau of Investigation fingerprint check will be used 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, 
5 

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

the individual unsuitable to continue performing under this contract. CPSPM will 

notify the CPOC, COTR, and CO of the results of these determinations. 

No contractor, contractor employee, subcontractor, or subcontractor employee 

will be allowed access to a SSA facility, site, information, or system until CPSPM 

has issued a favorable suitability determination for that contractor, contractor 

employee, subcontractor, or subcontractor employee. 

A contractor is not entitled to an equitable adjustment of the contract because of 

an unfavorable suitability determination(s). Additionally, if SSA determines that 

the number or percentage of unfavorable determinations make successful contract 

performance unlikely, SSA may terminate the contract for cause or default. 

The contractor must notify the contractor employee, subcontractor, or 

subcontractor employee of any unsuitable determinations as soon as possible after 

receipt of such a determination (see paragraph p., below, for an explanation of the 

appeals process). 

k. Obtaining a Credential 

Note: This section applies only if the contractor, contractor employee, 

subcontractor, or subcontractor employee will have access to a facility, site, 

system, or information as described in the first bullet of paragraph c. 

Once the contractor, contractor employee, subcontractor, or subcontract employee 

receives notification of an acceptable suitability determination, but prior to 

beginning work under the contract, the contractor, contractor employee, 

subcontractor, or subcontract employee must appear at the respective Regional 

Security Office or at SSA Headquarters Parking and Credentialing Office to begin 

the credentialing process. The contractor, contractor employee, subcontractor, or 

subcontract employee must present the suitability determination letter and two 

forms of identification at this meeting. At least one of the forms of identification 

must be a Government-issued photo identification (ID) (please see Employment 

Eligibility Verification, I-9, for acceptable forms of ID). For SSA Headquarters 

access, a completed Form SSA-4395, Application for Access to SSA Facilities, 

signed by the contractor, contractor employee, subcontractor, or subcontract 

employee and the COTR is also required. The COTR will provide the SSA-4395 

Form to the contractor, contractor employee, subcontractor, or subcontract 

employee when applicable. 

The contractor must contact the COTR to arrange for credentialing. The COTR is 

responsible for scheduling an appointment for contractors, contractor employees, 

subcontractors, or subcontract employees to meet with the appropriate SSA 

Parking and Credentialing Office or Regional Security Office and obtain a 

credential. Once the COTR makes the appointment, the COTR must contact the 

contractor to inform the contractor of the credentialing appointment(s). The 
6 

COTR must also arrange for the contractor, contractor employees, subcontractors, 

or subcontract employees to be escorted (by either the COTR or a COTR’s 

representative) to the appropriate credentialing office at the time of this 

appointment. 

Credentialing appointments last approximately 15 minutes. Depending on a 

contractor’s scheduling needs and availabilities, contractor employees, 

subcontractors, or subcontract employees may be scheduled for credentialing all 

in one day (this process may take a few hours to complete, depending on the 

number of employees that need to be credentialed) or contractor employees, 

subcontractors, or subcontract employees may come in at separate times 

convenient to the individuals’ and the COTR’s schedules. 

SSA Headquarters’ Parking and Credentialing Office representatives can be 

reached by emailing Parking.and.Credentialing@ssa.gov or calling 410/965-5910. 

Regional Security Office contact information can be found in the Appendix at the 

end of this clause. 

l. Contractors, Contractor Employees, Subcontractors, or Subcontract Employees 

Previously Cleared by SSA or Another Federal Agency 

If a contractor, contractor employee, subcontractor, or subcontract employee 

previously received a suitability determination from SSA or another Federal 

agency, the CPOC should include this information next to the individual’s name 

on the initial applicant listing (see paragraph f.). CPSPM will review the 

information. If CPSPM determines another suitability determination is not 

required, it will provide a letter to the CPOC and COTR indicating the contractor, 

contractor employee, subcontractor, or subcontract employee was previously 

cleared under another Federal contract and does not need to go through the 

suitability determination process again. 

m. Contractor Notification to Government 

The contractor shall notify the COTR and CPSPM within one business day if the 

contractor, contractor employee, subcontractor, or subcontract employee is 

arrested or charged with a crime during the term of this contract, or if there is any 

other change in the status of the contractor, contractor employee, subcontractor, or 

subcontract employee (e.g., the contractor employee leaves the company; the 

contractor employee no longer works under the contract; the alien status of the 

contractor, contractor employee, subcontractor, or subcontract employee changes) 

that could affect the suitability determination for that individual. The contractor 

must provide in that notification as much detail as possible, including, but not 

limited to: name(s) of individual whose status has changed, contract number, the 

type of charge(s), if applicable, the court date, and, if available, the disposition of 

the charge(s). 

n. Contractor Return of PIV Credential 
7 

The contractor must account for and ensure that all forms of Governmentprovided identification (PIV credential) issued to a contractor, contractor 

employee, subcontractor, or subcontract employee under this contract are returned 

to SSA’s Headquarters’ Parking and Credentialing Office or Regional Security 

Office, as appropriate, as soon as any of the following occur: when no longer 

needed for contract performance; upon completion of a contractor’s, contractor 

employee’s, subcontractor’s, or subcontract employee’s employment; or upon 

contract completion or termination. 

o. Government Control 

The Government has full control over and may grant, deny, or withhold access to 

a facility, site, system, or information and may remove contractors, or require the 

contractor to remove contractor employees, subcontractors, or require the 

subcontractor to remove subcontractor employees from performing under the 

contract for reasons related to conduct even after the individual has been found 

suitable to work on the contract (see paragraph q. below). 

p. Appeals Process for Unsuitable Determinations 

If a contractor, contractor employee, subcontractor, or subcontract employee 

would like clarification or wishes to appeal an unsuitable determination, his/her 

request must be in writing and submitted within 30 days of the date of the 

unsuitable determination. The contractor may not file appeals on behalf of its 

employees, subcontractors, or subcontract employees; rather, contractor 

employees, subcontractors, or subcontract employees must file their own 

individual appeals. 

 The request for clarification and/or the appeal can be emailed to SSA at 

dchr.ope.hspd12appeals@ssa.gov, or mailed to:

 Social Security Administration 

Attn: CPSPM Suitability Program Officer 

6401 Security Boulevard 

Room 1260 Dunleavy Building 

Baltimore, MD 21235 

q. Removal From Duty 

SSA may remove a contractor, or request that the contractor immediately remove 

or cause to be removed any contractor employee, subcontractor, or subcontract 

employee from working under the contract based on conduct that occurs after a 

favorable suitability determination. This includes temporarily removing a 

contract employee, subcontractor, or subcontract employee should the individual 

be arrested for a violation of law pending the outcome of any judicial 

proceedings. The contractor must comply with these requests to remove or cause 

to have removed any contractor employee, subcontractor, or subcontract 
8 

employee. The Government's determination may be made based on, but not 

limited to, incidents involving the misconduct or delinquency as set forth below: 

i. Violation of the Rules and Regulations Governing Public Buildings and 

Grounds, 41 CFR 101-20.3. This includes any local badging requirements. 

ii. Neglect of duty, including sleeping while on duty; unreasonable delays or 

failure to carry out assigned tasks; conducting personal affairs while on duty; 

and refusing to cooperate in upholding the integrity of SSA's security 

program. 

iii. Falsification or unlawful concealment, removal, mutilation, or destruction of 

any official documents or records, or concealment of material facts by 

willful omissions from official documents or records. 

iv. Disorderly conduct, use of abusive or offensive language, quarreling, 

intimidation by words or actions, or fighting. Also, participating in 

disruptive activities that interfere with the normal and efficient operations of 

the Government. 

v. Theft, vandalism, or any other criminal actions. 

vi. Selling, consuming, possessing, or being under the influence of intoxicants, 

drugs, or substances that produce similar effects. 

vii. Improper use of official authority or credentials. 

viii. Unauthorized use of communications equipment or Government property. 

ix. Misuse of weapon(s) or tools used in the performance of the contract. 

x. Unauthorized access to areas not required for the performance of the 

contract. 

xi. Unauthorized access to employees' personal property. 

xii. Violation of security procedures or regulations. 

xiii. Prior determination by SSA or other Federal agency that a contractor, 

contractor employee, subcontractor, or subcontract employee was unsuitable. 

xiv. Unauthorized access to, or disclosure of, agency programmatic or sensitive 

information, or Internal Revenue Service Tax Return information. 

xv. Unauthorized access to an agency Automated Information System. 
9 

xvi. Unauthorized access of information for personal gain (including, but not 

limited to, monetary gain), or with malicious intent. 

xvii. Not providing for the confidentiality of and protection from disclosure of 

information entrusted to them. Certain provisions of the following statutes 

and regulations that apply to Federal employees also apply equally to 

contractors, contractor employees, subcontractors, and subcontract 

employees: 

The Privacy Act of 1974 

The Tax Reform Act of 1976 and the Taxpayer Browsing Protection Act 

of 1997 

SSA regulation 1 

The Computer Fraud and Abuse Act of 1986 

Section 1106 of the Social Security Act 

xviii.Being under investigation by an appropriate authority for violating any of 

the above. 
10 

Appendix: Regional Security Offices 

Regional Credentialing Contacts for Contractor Employees 

Region 1 – Boston 

Management and Operations Support, Lenny Nyren – 617-565-2840 

Region 2 – New York 

Center for Materiel Resources, Field Services Team, General Office – 212-264-2603 

Region 3 – Philadelphia 

Center for Materiel Resources, Building Management Team, 

General Office - 215-597-8201 

Region 4 – Atlanta 

Center for Security and Integrity, Coleman Wicks – 404-562-1252 

Region 5 – Chicago 

Management and Operations Support, Building Services Unit 

Sharon Young – 312 575-4150 

Evelyn Principe – 312 575-6342 

Sofia Luna – 312 575-5762 

Carlon Brown – 312 575-5957 

Cassandra Murphy - 312 575-5067 

Region 6 – Dallas 

Center for Materiel Resources, Employee Relations, Veronica Drake – 214-767-2221 

Region 7 – Kansas City 

Center for Security Integrity, General Office Line – 816-936-5555 

Region 8 – Denver 

Center for Security and Integrity, Phil Mocon – 303-844-4016 

Region 9 - San Francisco 

Center for Security and Integrity, Cassandra Mapp - 510-970-4124 

Region 10 - Seattle 

 Center for Security and Integrity 

Lisa Steepleton - 206-615-2186 

D’ette Day - 206-615-2149 


















FD-258 (Rev. 5-15-17) 1110-0046

LEAVE BLANK

APPLICANT

TYPE OR PRINT ALL INFORMATION IN BLACK FBI LEAVE BLANK

LAST NAME FIRST NAME MIDDLE NAME NAM

ALIASES AKA

DATE OF BIRTH DOB

Month Day Year

SEX RACE HGT. WGT. EYES HAIR PLACE OF BIRTH POB

LEAVE BLANK

CITIZENSHIP CTZ

YOUR NO. OCA

O

R

I

CLASS

REF.

UNIVERSAL CONTROL NO. UCN

ARMED FORCES NO. MNU

SOCIAL SECURITY NO. SOC

MISCELLANEOUS NO. MNU

SIGNATURE OF PERSON FINGERPRINTED

RESIDENCE OF PERSON FINGERPRINTED

DATE

EMPLOYER AND ADDRESS

REASON FINGERPRINTED

SIGNATURE OF OFFICIAL TAKING FINGERPRINTS

 1. R. THUMB 2. R. INDEX 3. R. MIDDLE 4. R. RING 5. R. LITTLE

6. L. THUMB 7. L. INDEX 8. L. MIDDLE 9. L. RING 10. L. LITTLE

LEFT FOUR FINGERS TAKEN SIMULTANEOUSLY L. THUMB R. THUMB RIGHT FOUR FINGERS TAKEN SIMULTANEOUSLY

* See Privacy Act Notice on Back
FEDERAL BUREAU OF INVESTIGATION

UNITED STATES DEPARTMENT OF JUSTICE

CJIS DIVISION/CLARKSBURG, WV 26306

APPLICANT

THIS CARD FOR USE BY:

1. LAW ENFORCEMENT AGENCIES IN FINGERPRINTING APPLICANTS FOR LAW ENFORCEMENT POSITIONS.*

2. OFFICIALS OF STATE AND LOCAL GOVERNMENTS FOR PURPOSES OF EMPLOYMENT, LICENSING, AND

PERMITS, AS AUTHORIZED BY STATE STATUTES AND APPROVED BY THE ATTORNEY GENERAL OF THE

UNITED STATES. LOCAL AND COUNTY ORDINANCES, UNLESS SPECIFICALLY BASED ON APPLICABLE 

STATE STATUTES DO NOT SATISFY THIS REQUIREMENT.*

3. U.S. GOVERNMENT AGENCIES AND OTHER ENTITIES REQUIRED BY FEDERAL LAW.**

4. OFFICIALS OF FEDERALLY CHARTERED OR INSURED BANKING INSTITUTIONS TO PROMOTE OR MAINTAIN

THE SECURITY OF THOSE INSTITUTIONS.

1. PRINTS MUST GENERALLY BE CHECKED THROUGH THE APPROPRIATE STATE IDENTIFICATION BUREAU, AND ONLY THOSE

FINGERPRINTS FOR WHICH NO DISQUALIFYING RECORD HAS BEEN FOUND LOCALLY SHOULD BE SUBMITTED FOR FBI SEARCH.

2. IDENTITY OF PRIVATE CONTRACTORS SHOULD BE SHOWN IN SPACE “EMPLOYER AND ADDRESS”. THE

CONTRIBUTOR IS THE NAME OF THE AGENCY SUBMITTING THE FINGERPRINT CARD TO THE FBI.

UNIVERSAL CONTROL NUMBER, IF KNOWN, SHOULD ALWAYS BE FURNISHED IN THE APPROPRIATE SPACE.

3. MISCELLANEOUS NO. - RECORD: OTHER ARMED FORCES NO. PASSPORT NO. [FP], ALIEN REGISTRATION NO.

(AR), PORT SECURITY CARD NO. (PS), SELECTIVE SERVICE NO. (SS) VETERANS’ ADMINISTRATION CLAIM NO. (VA).

**

*

INSTRUCTIONS:

ARCHES HAVE NO DELTAS

FD-258 (REV. 5-15-17)

3. ARCH

THESE LINES RUNNING BETWEEN

DELTAS MUST BE CLEAR

CENTER

OF LOOP

2. WHORL

DELTAS

THE LINES BETWEEN CENTER OF

LOOP AND DELTA MUST SHOW

DELTA

1. LOOP

Please review this helpful information to aid in the successful processing of hard copy civil fingerprint submissions in order to prevent delays or 

rejections. Hard copy fingerprint submissions must meet specific criteria for processing by the Federal Bureau of Investigation.

Ensure all information is typed or legibly printed using blue or black ink.

Enter data within the boundaries of the designated field or block.

Complete all required fields. (If a required field is left blank, the fingerprint card may be immediately rejected without further processing.)

• The required fields for hard copy civil fingerprint cards are: ORI, Date of Birth, Place of Birth, NAM, Sex, Date 

fingerprinted, Reason Fingerprinted, and proper completion of fingerprint impression boxes.

Do not use highlighters on fingerprint cards. 

Do not enter data or labels within ‘Leave Blank’ areas.

Ensure fingerprint impressions are rolled completely from nail to nail.

Ensure fingerprint impressions are in the correct sequence.

Ensure notations are made for any missing fingerprint impression (i.e. amputation).

Do not use more than two retabs per fingerprint impression block.

Ensure no stray marks are within the fingerprint impression blocks.

Training aids can be ordered online via the Internet by accessing the FBI’s website at: fbi.gov, click on ‘Fingerprints’, then click on 

‘Ordering Fingerprint Cards & Training Aids’. Direct questions to the Biometric Services Section’s Customer Service Group at (304) 625-5590 or by email at <identity@fbi.gov>.

PRIVACY ACT STATEMENT

Authority: The FBI's acquisition, preservation, and exchange of fingerprints and associated information is generally authorized under 

28 U.S.C. 534. Depending on the nature of your application, supplemental authorities include Federal statutes, State statutes pursuant to

Pub.L. 92-544, Presidential Executive Orders, and federal regulations. Providing your fingerprints and associated information is voluntary; 

however, failure to do so may affect completion or approval of your application.

Principal Purpose: Certain determinations, such as employment, licensing, and security clearances, may be predicated on fingerprintbased background checks. Your fingerprints and associated information/biometrics may be provided to the employing, investigating, or

otherwise responsible agency, and/or the FBI for the purpose of comparing your fingerprints to other fingerprints in the FBI's Next Generation 

Identification (NGI) system or its successor systems (including civil, criminal, and latent fingerprints repositories) or other available records of 

the employing, investigating, or otherwise responsible agency. The FBI may retain your fingerprints and associated information/biometrics in 

NGI after the completion of this application and, while retained, your fingerprints may continue to be compared against other fingerprints 

submitted to or retained by NGI.

Routine Uses:

 

During the processing of this application and for as long thereafter as your fingerprints and associated information/

biometrics are retained in NGI, your information may be disclosed pursuant to your consent, and may be disclosed without your consent as

permitted by the Privacy Act of 1974 and all applicable Routine Uses as may be published at any time in the Federal Register, including the 

Routine Uses for the NGI system and the FBI's Blanket Routine Uses. Routine uses include, but are not limited to, disclosures to:

employing, governmental or authorized non-governmental agencies responsible for employment, contracting, licensing, security clearances, 

and other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice agencies; and agencies

responsible for national security or public safety.

1110-0046

Social Security Account Number (SSAN): Pursuant to the Privacy Act of 1974, any Federal, state, or local government agency that 

requests an individual to disclose his or her SSAN, is responsible for informing the person whether disclosure is mandatory or voluntary, by 

what statutory or other authority the SSAN is solicited, and what uses will be made of it. In this instance, the SSAN is solicited pursuant to 

28 U.S.C 534 and will be used as a unique identifier to confirm your identity because many people have the same name and date of birth. 

Disclosure of your SSAN is voluntary; however, failure to disclose your SSAN may affect completion or approval of your application.

PAPERWORK REDUCTION ACT NOTICE

According to the Paperwork Reduction Act of 1995, no persons are required to provide the information requested unless a valid OMB 

control number is displayed. The valid OMB control number for this information collected is 1110-0046. The time required to complete this 

information collected is estimated to be 10 minutes, including time reviewing instructions, gathering, completing, reviewing and submitting 

the information collection. If you have any comments concerning the accuracy of this time estimate or suggestions for reducing this 

burden, please send to: Department Clearance Officer, United States Department of Justice, Justice Management Division, Policy and 

Planning Staff, Washington, DC 20530.


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: _____________________________________

CHECK TESTING SPECIFICATIONS

Delaware Accounts

Page 1 of 2 

©2009 Citibank, N.A. All rights reserved. Citi and Arc Design is a service mark of Citigroup Inc., used and registered throughout the world. 

GENERAL INFORMATION Height of the document must be between 2-3/4 and 3-5/8 inches. Length of the document must be between 6-1/2 and 8-3/4 inches. Citi recommends choosing a stock between 6-3/4 and 8-1/2 inches.The company name must appear at the top of the check. “Citibank, N.A. - One Penn’s Way - New Castle DE 19720” must appear on the face of the document.The Fractional Transit Routing Code ( 62-20/311) must appear on the face of the document. Citi recommends the Routing Code be located in the top right corner of the check. The serial number must be printed in the upper right-hand corner of the document. The entire serial number must be printed in the same size font and color. The number must match the serial number encoded in the MICR line. Serial number must be 4-10 digits. No spaces, dashes or alpha characters may be used in the serial number. Check stock must be 24 lb. paper or better. Safety paper is recommended. IMAGING The minimum background paper reflectance is 60%. The printed background pattern of the check in the payee area must be light enough to not interfere with the imaging. GREEN or RED backgrounds are NOT recommended as these colors are not as image friendly as BLUE or YELLOW.Check Printing: Dot Matrix printers are NOT recommended when printing checks. Laser printing quality is preferred. 

MICR LINE No magnetic ink, other than the encoded MICR may appear on the lower 5/8” of the document. This includes additional printing, signature, or printing on the reverse of the document. Please ensure signatures DO NOT cross into the 5/8” MICR band area. Characters must be black MICR ink, printed in E13-B font. Signal strength must be between 50% and 200 % of nominal strength. There must be at least 1/4” margin between trailing edge of check and the left-most MICR character. On-Us Field: Opening On-us symbol must be within positions 14 to 23. Citi recommends position 19. No blanks or dashes are permitted between the On-Us symbol and the account number. (Reference check #) Account number must be within positions 15 to 31. - Citi recommends positions 20 to 27 - Account numbers must NOT have blanks or dashes. Transit Number field: Positions 32 and 44 must be blank Transit symbols must be in positions 33 and 43 Citi Transit #: 031100209 Auxiliary On-Us field: Opening symbol must be in position 45 or 46; closing symbol must be immediately to the left of the serial number. No blanks or dashes are permitted between the On-Us symbols. Serial number must be 4 to 10 digits. The maximum number is 10 digits. No pre-filled zeros required. Check Printing: Dot Matrix printers are NOT permitted when printing the MICR line on checks.Laser printing quality is preferred. 

PAYEE NAME The payee name inEXACTLY MATCof the payee name file. The first two matched on the cheprinted per line. CPayee details will bimplementation pro(and address, if preusing fixed pitch (wwidth). During imbe tested to see if following font typeSerifs and DecoratVariations to this sbased on font typeHelvetica and AriaNO HANDWRITTEN PNA PROCESSING. Citi recommends 1

Print with default fa clear separation bbetween lines of teCheck Printing: Dwhen printing chec

The payee name mfrom the bottom of which the payee naextending at least .white (clear band), print contrast signainformation, lines, region. This will pinterfering with the The location of the payee font type maimmediately of any 
SAMPLE CHECK AND GRID NOT TO SCALE

Page 2 of 2 

©2009 Citibank, N.A. All rights reserved. Citi and Arc Design is a service mark of Citigroup Inc., used and registered throughout the world. 

1 2

3

4

5

6

Company Name 62-20

311

1/4"

Payee Name 1

Pay to the order of: Payee Name 2 (Typically A ddress line 1 )

1/4" Address Line 2 1/4"

Address Line 3

1/4"

 Citibank, N.A. One Penn's Way New Castle, DE 19720

3/16"

1 2 3 4 5 6 7 8 9 0 0 3 1 1 0 0 2 0 9 

3/16"

65 60 55 50 45 40 35 30 25 20 15 10 

ALIGNING 

TR

A

I

L

I

N

G

ED

G

E

OUTBOARD EDGE

Auxiliary On-Us Field Transit Field On-Us Field Am