Program: 045-S

Term: Date of Award to October 31, 2020

Title: Social Security Administration (SSA)

BASIS OF

ITEM NO. DESCRIPTION AWARD UNIT RATE COST UNIT RATE COST UNIT RATE COST UNIT RATE COST

I. COMPOSITION:

Envelopes...........................................per envelope 22 No Charge $0.00 $200.00 $4,400.00 No Charge $0.00 $25.00 $550.00

II. PROOFS: Booklets, Forms, Factsheets, Leaflets, and Envelopes

 (a) Color content proofs.........................per trim/page-size unit............ 320 No Charge $0.00 $100.00 $32,000.00 No Charge $0.00 $10.00 $3,200.00

 (b) Ink jet color proofs...........................per trim/page-size unit................. 320 No Charge $0.00 $100.00 $32,000.00 No Charge $0.00 $20.00 $6,400.00

 (c) PDF proofs.........................................per proof.............................. 42 No Charge $0.00 $100.00 $4,200.00 No Charge $0.00 No Charge $0.00

III. PROCESSING/FORMATTING FILES:

Processing/Formatting Files..................per/notice workload........... 10 No Charge $0.00 $500.00 $5,000.00 No Charge $0.00 No Charge $0.00

IV. PREPRODUCTION TESTS:

 (a) Transmission Test........................................................................... 1 No Charge $0.00 $500.00 $500.00 No Charge $0.00 No Charge $0.00

 (b) PreProduction Validation Test......................................................... 1 No Charge $0.00 $2,500.00 $2,500.00 No Charge $0.00 $250.00 $250.00

V. PRINTING/IMAGING, BINDING, AND CONSTRUCTION:

 (a) *Daily makeready/setup charge......................................................... 250 $215.00 $53,750.00 No Charge $0.00 $100.00 $25,000.00 $500.00 $125,000.00

 (b) Notices: Printing and imaging in black only, 

including binding..................................per 1,000 leaves......... 23400 $8.63 $201,942.00 $19.50 $456,300.00 $10.00 $234,000.00 $13.30 $311,220.00

 (c) Form CMS-2690:

Printing face and back in black ink, 

including binding..............................per 1,000 forms.............................. 92 $8.36 $769.12 $12.00 $1,104.00 $18.90 $1,738.80 $12.48 $1,148.16

 (d) Form SSA-3105:

Printing face and back in black ink, 

including binding..............................per 1,000 forms.............................. 160 $8.61 $1,377.60 $19.00 $3,040.00 $11.12 $1,779.20 $8.33 $1,332.80

 (e) Saddle-Stitched Booklet (3-1/2 x 8): 

Printing in two ink colors, 

including binding .............................per 1,000 complete booklets......... 28 $353.28 $9,891.84 $85.00 $2,380.00 $106.64 $2,985.92 $139.29 $3,900.12

 (f) Saddle-Stitched Booklet (5-1/4 x 8): 

Printing in two ink colors, 

including binding.............................per 1,000 complete booklets...... 5291 $69.02 $365,184.82 $120.00 $634,920.00 $42.69 $225,872.79 $49.64 $262,645.24

 (g) Factsheet (8-1/2 x 11):

Printing face and back in two ink colors, 

including binding..............................per 1,000 factsheets...... 29 $15.17 $439.93 $55.00 $1,595.00 $50.93 $1,476.97 $31.25 $906.25

 (h) Leaflet (10-1/2 x 8):

Printing face and back in two ink colors, 

including binding..............................per 1,000 leaflets........................... 30 $15.17 $455.10 $55.00 $1,650.00 $19.14 $574.20 $30.45 $913.50

 (i) Leaflet (14 x 8):

Printing face and back in two ink colors, 

including binding.............................per 1,000 leaflets.......................... 863 $20.69 $17,855.47 $51.00 $44,013.00 $9.48 $8,181.24 $9.40 $8,112.20

 (j) Leaflet (17-1/2 x 8):

Printing face and back in two ink colors, 

including binding..............................per 1,000 leaflets......... 108 $28.88 $3,119.04 $51.00 $5,508.00 $19.18 $2,071.44 $23.75 $2,565.00

 (k) Leaflets (21 x 8):

Printing face and back in two ink colors, 

including binding.............................per 1,000 leaflets............ 3 $306.95 $920.85 $51.00 $153.00 198.59 $595.77 198.59 $595.77

 (l) Green BRM Envelope (3-7/8 x 8-7/8):

Printing in black ink, 

including construction.....................per 1,000 envelopes...... 160 $10.43 $1,668.80 No Charge $0.00 $9.24 $1,478.40 $8.21 $1,313.60

 (m) White BRM Window Envelope (3-7/8 x 8-11/16):

Printing in black ink, 

including construction.....................per 1,000 envelopes...... 152 $19.12 $2,906.24 No Charge $0.00 $11.59 $1,761.68 $8.06 $1,225.12

NPC, INC.

CLAYSBURG, PA SUWANEE, GEORGIA GREENVILLE, SC SOURCELINK, LLC

PINNACLE DATA LLC SOURCELINK, LLC CURRENT CONTRACTOR

Page 1 of 2
Program: 045-S

Term: Date of Award to October 31, 2020

Title: Social Security Administration (SSA)

BASIS OF

ITEM NO. DESCRIPTION AWARD UNIT RATE COST UNIT RATE COST UNIT RATE COST UNIT RATE COST

NPC, INC.

CLAYSBURG, PA SUWANEE, GEORGIA GREENVILLE, SC SOURCELINK, LLC

PINNACLE DATA LLC SOURCELINK, LLC CURRENT CONTRACTOR

 (n) CRM Envelope (3-7/8 x 8-7/8):

Printing in black ink, 

including construction.....................per 1,000 envelopes...... 93 $22.40 $2,083.20 No Charge $0.00 $15.07 $1,401.51 $39.00 $3,627.00

 (o) Mailout Envelope (4-1/8 x 9-1/4):

Printing in black ink, 

including construction.....................per 1,000 envelopes...... 1100 $9.86 $10,846.00 No Charge $0.00 $6.26 $6,886.00 $8.21 $9,031.00

 (p) Mailout Envelope (4-1/8 x 9-1/2):

Printing in black ink, 

including construction.....................per 1,000 envelopes...... 1000 $9.33 $9,330.00 No Charge $0.00 $6.26 $6,260.00 $8.21 $8,210.00

 (q) Mailout Envelope (6-1/8 X 9-1/2):

Printing in black ink, 

including construction.....................per 1,000 envelopes............... 8700 $9.95 $86,565.00 No Charge $0.00 $7.12 $61,944.00 $8.80 $76,560.00

VI. PAPER: Per 1,000 leaves

 (a) Notice (8-1/2 x11): White Offset Book (50-lb) 23,400 $6.43 $150,462.00 $8.50 $198,900.00 $8.34 $195,156.00 $8.06 $188,604.00

 (b) Form CMS-2690 (8-1/2 x 3-1/2): Yellow Index (90-lb.) 92 $8.24 $758.08 $21.00 $1,932.00 $9.22 $848.24 $23.41 $2,153.72

 (c) Form SSA-3105 (10-1/2 x 8):White Writing (20-lb.) 160 $8.90 $1,424.00 $11.50 $1,840.00 $25.96 $4,153.60 $12.49 $1,998.40

 (d) Booklet (3-1/2 x 8): White Offset Book (60-lb.) 539 $4.90 $2,641.10 $5.50 $2,964.50 $12.41 $6,688.99 $5.76 $3,104.64

 (e) Booklet (5-1/4 x 8): White Offset Book (60-lb.) 81,943 $4.22 $345,799.46 $6.50 $532,629.50 $6.44 $527,712.92 $5.76 $471,991.68

 (f) Factsheet (8-1/2 x11): White Offset Book (60-lb.) 29 $12.09 $350.61 $7.50 $217.50 $118.84 $3,446.36 $46.37 $1,344.73

 (g) Leaflet (10-1/2 x 8): White Offset Book (60-lb.) 30 $12.09 $362.70 $9.00 $270.00 $44.65 $1,339.50 $14.10 $423.00

 (h) Leaflet (14 x 8): White Offset Book (60-lb.) 863 $22.13 $19,098.19 $11.50 $9,924.50 $22.11 $19,080.93 $14.10 $12,168.30

 (i) Leaflet (17-1/2 x 8): White Offset Book (60-lb.) 108 $24.56 $2,652.48 $14.50 $1,566.00 $44.76 $4,834.08 $34.99 $3,778.92

 (j) Leaflet (21 x 8): White Offset Book (60-lb.) 3 $64.45 $193.35 $26.00 $78.00 $463.37 $1,390.11 $488.51 $1,465.53

 (k) Green BRM Envelope (3-7/8 x 8-7/8):Green Writing (20-lb.) 160 $10.43 $1,668.80 $26.00 $4,160.00 $21.57 $3,451.20 $12.49 $1,998.40

 (l) White BRM Window Envelope (3-7/8 x 8-11/16):White Wove (24-lb.) 152 $19.12 $2,906.24 $13.50 $2,052.00 $27.05 $4,111.60 $27.05 $4,111.60

 (m) CRM Envelope (3-7/8 x 8-7/8): White Writing (20-lb.) 93 $22.40 $2,083.20 $13.50 $1,255.50 $35.17 $3,270.81 $58.50 $5,440.50

 (n) Mailout Envelope (4-1/8 x 9-1/4): White Wove (24-lb.) 1,100 $9.86 $10,846.00 $16.50 $18,150.00 $14.60 $16,060.00 $14.60 $16,060.00

 (o) Mailout Envelope (4-1/8 x 9-1/2): White Wove (24-lb.) 1,000 $9.33 $9,330.00 $16.50 $16,500.00 $14.60 $14,600.00 $12.28 $12,280.00

 (p) Mailout Envelope (6-1/8 x 9-1/2): White Wove (24-lb.) 8,700 $9.95 $86,565.00 $28.00 $243,600.00 $16.61 $144,507.00 $11.70 $101,790.00

VII. ADDITIONAL OPERATIONS

Destruction of outdated stock...................per 1,000 pieces......... 850 $1.00 $850.00 $1.00 $850.00 $1.00 $850.00 $2.75 $2,337.50

VIII. INSERTING AND MAILING:

 (a) Mailer 1.......................................per 1,000 complete mailers...... 1455 $25.10 $36,520.50 45.00 $65,475.00 37.00 $53,835.00 37.00 $53,835.00

 (b) Mailer 2.......................................per 1,000 complete mailers...... 45 $25.10 $1,129.50 45.00 $2,025.00 $210.00 $9,450.00 $210.00 $9,450.00

 (c) Mailer 3.......................................per 1,000 complete mailers...... 6,700 $25.10 $168,170.00 45.00 $301,500.00 $36.00 $241,200.00 $36.00 $241,200.00

 (d) Mailer 4.......................................per 1,000 complete mailers...... 300 $25.10 $7,530.00 45.00 $13,500.00 $125.00 $37,500.00 $125.00 $37,500.00

 (e) Mailer 5.......................................per 1,000 complete mailers...... 1,100 $23.43 $25,773.00 45.00 $49,500.00 $19.00 $20,900.00 $19.00 $20,900.00

 (f) Mailer 6.......................................per 1,000 complete mailers...... 40 $10.54 $421.60 45.00 $1,800.00 $19.00 $760.00 $19.00 $760.00

 (g) Mailer 7.......................................per 1,000 complete mailers...... 485 $17.57 $8,521.45 45.00 $21,825.00 $19.00 $9,215.00 $19.00 $9,215.00

 (h) Mailer 8.......................................per 1,000 complete mailers...... 475 $10.54 $5,006.50 45.00 $21,375.00 $15.00 $7,125.00 $15.00 $7,125.00

 (i) Mailer 9.......................................per 1,000 complete mailers...... 155 $131.80 $20,429.00 45.00 $6,975.00 $35.00 $5,425.00 $35.00 $5,425.00

 (j) Mailer 10....................................per 1,000 complete mailers...... 45 $131.80 $5,931.00 45.00 $2,025.00 $210.00 $9,450.00 $210.00 $9,450.00

CONTRACTOR SUBTOTALS $1,686,528.77 $2,754,152.50 $1,930,369.26 $2,054,616.68

DISCOUNT 0.25% $4,216.32 1.00% $27,541.53 0.00% $0.00 0.00% $0.00

DISCOUNTED TOTALS $1,682,312.45 $2,726,610.97 $1,930,369.26 $2,054,616.68

AWARDED

Page 2 of 2
Program 45-S Page 1 of 63

Specifications by MRN

U.S. GOVERNMENT PUBLISHING OFFICE

Washington, DC

GENERAL TERMS, CONDITIONS, AND SPECIFICATIONS

For the Procurement of

MADCAP, MCS, SSA-L991, TASTE (Age Attainments), and TATTER Notices

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

Social Security Administration (SSA)

Single Award

TERM OF CONTRACT: The base term of this contract is for approximately 16 months beginning Date of Award 

and ending October 31, 2020, plus up to four (4) optional 12-month extension period(s) that may be added in 

accordance with the “OPTION TO EXTEND THE TERM OF THE CONTRACT” clause in SECTION 1 of this 

contract. 

The period from Date of Award until October 31, 2019 will be used by the contractor for testing and 

interfacing with SSA’s National File Transfer Management System (FTMS) for electronic transmission of 

files from SSA to the production facility. Actual live production begins November 1, 2019.

BID OPENING: Bids shall be publicly opened at 11:00 a.m., prevailing Washington, DC time March 22, 2019.

BID SUBMISSION: Submit bid in pre-addressed envelope furnished with solicitation or send to: U.S. Government 

Publishing Office, Bid Section, Room C-848, Stop: CSPS, 732 North Capitol Street, NW, Washington, DC 20401. 

Facsimile bids in response to this solicitation are permitted. Facsimile bids may be submitted directly to the GPO 

Bid Section, Fax No. (202) 512-1782. The program number and bid opening date must be specified with the bid. 

Refer to Facsimile Bids in Solicitation Provisions of GPO Contract Terms, GPO Publication 310.2, as revised 

January 2018. Hand delivered bids are to be taken to: GPO Bookstore, 710 North Capitol Street, NW, Washington, 

DC, between the hours of 8:00 a.m. and 4:00 p.m., prevailing Washington, DC, time, Monday through Friday. The 

contractor is to follow the submission instructions posted in the Bid Submission/Opening area. If further instruction 

or assistance is required, call (202) 512-0526. NOTE: The GPO 910 “BID” Form is no longer required. Bidders 

are to fill out, sign/initial, as applicable, all pages of SECTION 4. – SCHEDULE OF PRICES.

BID RESTRICTIONS: Due to time constraints, bidders must possess an SSA installed/active data connection 

between the exact location specified by the bidder and SSA’s National Computer Center (NCC). SSA must have 

security-cleared the bidder’s physical location(s) used for production of materials for this contract, and all 

employees passed Final Suitability (for same locations) completed prior to bid submission in order to be eligible 

for award of this contract. NOTE: If bidder does not have these requirements completed prior to bid submission, 

then the bidder will be declared non-responsible.

BIDDERS, PLEASE NOTE: This Program was formerly Program 430-S. These specifications have been 

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

specifications before bidding, with particular attention to the following: GPO has issued a new GPO Publication 

310.2, GPO Contract Terms - Solicitation Provisions, Supplemental Specifications, and Contract Clauses (Rev 1-

18). Prospective bidders should carefully read this publication as the applicable terms within become an integral 

part of this contract. The document is posted at: https://www.gpo.gov/how-to-work-with-us/vendors/forms-andstandards along with a list of major revisions.

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 (202) 512-0310 or email aps-team1@gpo.gov.
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 2 of 62

45-S (10/20)

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 (Rev. August 2002)).

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.pdf 

SUBCONTRACTING: The predominant production functions are the laser/ion deposition imaging of data for the 

printing/imaging of notices, the inserting of items into mailout envelopes, and disposal/destruction of waste 

materials. Any bidder who cannot perform the predominant production functions will be declared non-responsible. 

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

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

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

then the contractor must submit a new subcontractor’s information to the Government for approval 15 calendar days 

prior to the start of production at that facility. 

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

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

(GPO Publication 305.3; Rev. 2-11).

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

these specifications:

Product Quality Levels:

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

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

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

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

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

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

test with a rejection rate of less than 1/4% when run through a United States Postal Service (USPS) OCR 

Scanner.

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

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

which shall apply.

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

10.8.3M unless otherwise specified.

(f) The payment portion below the micro-perforation on the “payment stub,” once detached, will be scanned 

and must function properly when processed through the current high speed scanning equipment at SSA. A 

form is a reject and will be considered a major defect when its OCR print cannot be correctly deciphered 

on the first pass through the scanning equipment (See “PRINTING/IMAGING” for additional information 

regarding perforated payment stub.)
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 3 of 62

45-S (10/20)

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

be allowed.

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

New York, NY 10036.

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

Attribute Specified Standard

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

P-9. Solid and Screen Tint Color Match O.K. Press sheets

Special Instructions - In the event that inspection of press sheets is waived by the Government, the following listed 

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

P-7. Type Quality and Uniformity Average Type Dimension in Publication

Electronic Media/Camera Copy/Manuscript Copy

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

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 no 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.

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 Date of Award to October 31, 2020, 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.

NOTE: The term of the first contract year (base year) is expected to be approximately 18 months; however, the 

Economic Price Adjustment will be based on the date of actual live production. Actual live production begins 

November 1, 2019.
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 4 of 62

45-S (10/20)

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

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

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

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

paragraph. An index called the variable index will be calculated by averaging the monthly Indexes from the 12-

month interval ending three (3) months prior to the beginning of the period being considered for adjustment. This 

average is then compared to the average of the monthly Indexes for the 12-month interval ending July 31, 2019 

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

economic price adjustment for the period being considered for adjustment.

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

decrease to be applied to invoices for orders placed during the period indicated. The contractor shall apply the 

percentage increase or decrease against the total price of the invoice less reimbursable postage or transportation 

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

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

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

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

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

production. Actual live production begins November 1, 2019.

1. BLS code 0913-01 for “Offset and Text” will apply to all paper required under this contract.

2. The applicable index figures for the month of October 2019 will establish the Base Index.

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

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

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

month being considered for adjustment.

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

the following formula:

X - Base Index

_____________________ x 100 = ___ %

Base Index

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

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

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

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

adjusted.

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

orders placed during months affected by this clause. In no event, however, will any price adjustment be made which 

would exceed the maximum permissible under any law in effect at the time of the adjustment. The adjustment, if 

any, shall not be based upon the actual change in cost to the contractor, but shall be computed as provided above.
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 5 of 62

45-S (10/20)

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

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

adjustment clause.

All requirements, starting with Security Requirements below, through page 13 must be completed and approved at 

time of solicitation of this contract, if not the bidder will be declared non-responsive.

SECURITY REQUIREMENTS - Protection of Confidential Information

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

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

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

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

representative.

(b) The contractor 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.

(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 must ensure 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 are required to sign Form SSA 301-

Contractor Personal Security Certification. (See Exhibit A.)

A copy of this signed certification must be forwarded to: Social Security Administration, Division of Printing 

Management, Attn: Kate Schmidt, 1369 Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-

6401.

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

be stored in an area that is physically safe from unauthorized access.

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

6103(b) of the Internal Revenue Code (IRC). All such information must be handled as confidential and may not 

be disclosed without the written permission of SSA. For willingly disclosing confidential tax return information 

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

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

(h) The Government reserves the rights to conduct on-site visits to review the contractor’s documentation and inhouse procedures for protection of confidential information.
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(i) If a subcontractor is used for the sorting and/or mailing of the notices of this contract, the subcontractor must 

conform to all security requirements of the contract.

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

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

externally to SSA’s Network. 

See Exhibit B: SSA External Service Provider Security Requirements.

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

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

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

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

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

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

country (29 CFR 4.112).

b) Upon request from the SSA Printing Management Branch, the contractor shall provide access to the hosting 

facility to the U.S. Government or authorized agents for inspection and facilitate an on-site security risk 

and vulnerability assessment. 

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

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

Information Security Management Act (FISMA) to develop security standards for federal information 

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

d) Solutions classified as Cloud Service Providers (CSP) must adhere to additional FedRAMP security control 

requirements. Further information may be found at: http://www.gsa.gov/portal/category/102371. As part 

of these requirements, CSPs must have a security control assessment performed by a Third Party 

Assessment Organization.

NOTE: A Third Party Assessment Organization (3PAO) is an organization that has been certified to help 

cloud service providers and Government agencies meet FedRAMP compliance regulations. Accredited 

3PAOs can be found at https://marketplace.fedramp.gov/#/assessors?sort=assessorName.

e) Before SSA provides data to the contractor, the contractor shall submit a System Security Plan (SSP), which 

documents how the solution implements security controls in accordance with the designated FIPS 199 

security categorization and the Minimum Security Requirements for Federal Information and Information 

Systems. This SSP requires the use of NIST SP 800-53, or the contractor shall provide a Security 

Assessment Package (SAP) completed by either an independent assessor or another Federal agency.

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

of security controls employed within or inherited by an information system.

f) SSA will consider a self-assessment of security controls for solutions that do not involve sensitive 

information or Personally Identifiable Information (PII).

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

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

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

linked or linkable to an individual, such as medical, educational, financial, and employment information.
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References (Refer to the most up to date revision):

 Federal Information Security Management Act (FISMA) of 2002.

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

 Privacy Act of 1974 (5 U.S.C. § 552a).

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

Federal Employees and Contractors,” August 27, 2004.

 Office of Management and Budget (OMB) Circular A‐130, “Management of Federal Information 

Resources,” and Appendix III, “Security of Federal Automated Information Systems,” as amended.

 OMB Memorandum M‐04‐04, “E‐Authentication Guidance for Federal Agencies.”

 FIPS PUB 199, “Standards for Security Categorization of Federal Information and Information Systems.”

 FIPS PUB 200, “Minimum Security Requirements for Federal Information and Information Systems.”

 FIPS PUB 140‐2, “Security Requirements for Cryptographic Modules.”

 NIST Special Publication 800-18, “Guide for Developing Security Plans for Federal Information Systems.”

 NIST Special Publication 800-30, “Risk Management Guide for Information Technology Security Risk 

Assessment Procedures for Information Technology Systems.”

 NIST Special Publication 800-34, “Contingency Planning Guide for Information Technology Systems.”

 NIST SP 800‐37 “Guide for the Security Certification and Accreditation of Federal Information Systems.”

 NIST Special Publication 800-47, “Security Guide for Interconnecting Information Technology Systems.”

 NIST Special Publication 800-53, “Recommended Security Controls for Federal Information Systems.”

 NIST Special Publication 800-53A, “Guide for Assessing the Security Controls in Federal Information 

Systems, “CIO Council’s Federal Identity, Credential, and Access Management (FICAM) Roadmap and 

Implementation Guidance.”

 NIST Special Publication 800-60.

 OMB M-07-16, AIMS Chapter 15: Personally Identifiable Information Loss and Remediation.

All External Service Providers (ESP) are subject to the following security requirements:

 All ESPs are subjected to SSA’s Security Authorization Process, which will entail security testing and 

evaluation of the in-place security controls. For more information see NIST SP 800-37, Revision 1.

 ESPs must follow NIST SP 800-53 Revision 4 Recommended Security Controls for Federal Information 

Systems and Organizations for protecting Low or Moderate impact level information as categorized by 

FIPS 199 for the information system. 

NOTE: Systems that contain Personally Identifiable Information (PII) are considered “Moderate.” 

 ESPs must document all deployed (applicable) and planned controls for an information system in a System 

Security Plan that is in NIST-compliant format. Refer to NIST SP 800-18.

 ESPs classified as Cloud Service Providers (CSP) must adhere to additional FedRAMP security control 

requirements. Further information may be found at: http://www.gsa.gov/portal/category/102371. As part 

of these requirements, CSPs must have a security control assessment performed by a Third Party 

Assessment Organization.

 Upon request from SSA, the ESP shall provide the following network security information and 

documentation for review and audit purposes: 

 All information security control artifacts required to support the Security Assessment and Authorization 

(SA&A) process.

 Intrusion Detection Systems (IDS) configuration. 

 Network firewall configuration. 
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 Server and network device patching schedules and compliance. 

 Server, network device, and security logs. 

 Detailed hardware inventory including servers, network devices, and storage. 

ESPs are required to adhere to NIST 800-53 Rev. 4 security control framework based on their assigned 

categorization. The following sections outline additional security controls and SSA organizational defined 

parameters for NIST 800-53, Rev. 4. Security requirements below are applicable to low and moderately categorized 

systems unless otherwise designated. For additional information or supplement guidance for these controls, refer 

Appendix F of NIST 800-53, Rev. 4.

See Exhibit B: SSA External Service Provider Security Requirements for complete details regarding this 

requirement.

Templates for Required Security Documents:

 Exhibit C: Security Assessment Report (SAR) Template

 Exhibit D: Risk Assessment Report (RAR) Template

 Exhibit E: External Hosted Information System Plan (ESP) Template

PHYSICAL SECURITY: Contractor’s facilities storing SSA assets and information are required to meet the 

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

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

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

contractor must implement corrective actions within 60 calendar days of notification. Requirements can include 

but not be limited to, the physical security countermeasures, such as access control systems, closed circuit television 

systems, intrusion detection systems, and barriers.

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

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

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

declared non-responsible.

SECURITY WARNING: It is the contractor’s responsibility to properly safeguard personally identifiable 

information from loss, theft, or inadvertent disclosure and to immediately notify the Government of any loss of 

personally identifiable information. Personally identifiable information is “any information which can be used to 

distinguish or trace an individual’s identity, such as their name, social security number, biometric records, etc., 

alone or when combined with other personal or identifying information which is linked or linkable to a specific 

individual, such as date and place of birth, mother’s maiden name, etc.”

NOTE: These requirements apply to all contractor’s facilities (i.e., multiple plants) used for production of the 

notices.

All employees working on this contract must –

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

requirements of this contract.

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

determination as applicable to the specifications.

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

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

 Protect sensitive electronic records.

 Be alert to threats and vulnerabilities to their systems.
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 Be prohibited from having any mobile devices or cameras in sensitive areas that contain any confidential 

materials. This includes areas where shredding and waste management occurs.

Contractor’s managers working on this contract must –

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

local policies, as well as the Privacy Act statement.

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

individual being authorized access to sensitive or critical applications.

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

as outlined by the contractor.

 Contact the SSA, Division of Printing Management, within 24 hours, whenever a systems security violation 

is discovered or suspected.

Applicability -

The responsibility to protect personally identifiable information applies during the entire term of this contract and 

all option year terms if exercised. All contractors must secure and retain written acknowledgement from their 

employees stating they understand these policy provisions and their duty to safeguard personally identifiable 

information. 

These policy provisions include, but are not limited to, the following:

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

if applicable.

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

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

transported to and from contractor’s facility.

The following list provides examples of situations where personally identifiable information is not properly 

safeguarded –

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

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

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

in a breakroom or on an employee’s desk).

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

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

This list does not encompass all failures to safeguard personally identifiable information but is intended to act as an 

alert to the contractor’s employees of situations that must be avoided. Misfeasance occurs when an employee is 

authorized to access Government information that contains sensitive or personally identifiable information and, due 

to the employee’s failure to exercise due care, the information is lost, stolen, or inadvertently released.

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

safeguarding personally identifiable information, they should consult the GPO and/or SSA.
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SECURITY AND SUITABILITY REQUIREMENTS FOR GOVERNMENT PRINTING (NOV 2018):

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

Officers 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 workdays prior to the date vendor personnel are to 

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

complete documents.

(1) Suitability Document Submission

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

Suitability and Personnel Security (CSPS) and a copy to the Contracting Officers 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 G); 

(iii) Fair Credit Reporting Act (FCRA) Authorization Form (see Exhibit H);

(iv) Additional Questions for Public Trust Positions Branching (see Exhibit I); and,

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

b. The e-QIP applicant listing must include the vendors 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. 

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. (See Exhibit J.)

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 eQIP Hotline at 

1-844-874-9940. 
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(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. 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. (See Exhibit K.)

 

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

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

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

Security Boulevard, 2246 Annex Building, Baltimore, MD 21235.

(4) Status Check 

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. 

CSPS will notify the CPOC, COR, and Contract Officer (CO) of suitability to work under the new vendor.

(See Exhibit L.)

(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 OF306. 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.
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(d) Unsuitable Determinations

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

receipt of such a determination.

 

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

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

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

dchr.ope.suitclarify@ssa.gov

OR

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

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

(e) Vendor Notification to Government 

The vendor shall notify the COR and CSPS within one business day if any vendor personnel 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)

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.
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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

SUITABILITY DETERMINATION: A Federal Bureau of Investigation fingerprint check is part of the basis 

used 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 contactor personnel unsuitable to continue performing under this contract. CPSPM will notify 

the CPOC, COTR, and Contracting Officer of the result of these determinations. 

NOTE: Due to PII issues, the Government cannot provide production test files to the contractor until all Public 

Trust Security Requirements and Suitability Determination requirements, as specified herein, are met. If the 

contractor fails to meet these requirements within 90 calendar days of award, the contractor will be declared nonresponsive.

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

Government reserves the right to conduct an on-site pre-award survey of all of the contractor’s and any 

subcontractor’s computer, printing, inserting, and mailing equipment which will be used on this contract or to 

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

award of a contract.

The preaward survey will include a review of all subcontractors involved, along with their specific functions; and 

the contractor’s/subcontractor’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, be installed, and be fully functional at least 90 

calendar days prior to the start of live production.

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

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

Preaward Production Plans – The contractor must present, in writing, to the Contracting Officer within five (5) 

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

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

Government requests additional information after review of plans, the contractor must submit updated plans within 

two (2) workdays of request.
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If the contractor intends to use multiple plants, the production plans must indicate which plants will be used and the 

quantity to be produced in each plant. This requirement applies to all security requirements, tests, and live 

production. If the contractor intends to change processes described in the production plans during the term of the 

contract, they must provide updated plans to SSA/GPO for review and approval prior to implementing any changes.

Option Years - For each option year that may be exercised, the contractor will be required to review their production 

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

revised plans are subject to Government approval. The revised plans must be submitted to the Contracting Officer 

or his/her representative within five (5) workdays of notification of the option year being exercised. 

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

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

THESE PROPOSED PLANS ARE SUBJECT TO REVIEW AND APPROVAL BY THE GOVERNMENT, 

AND AWARD WILL NOT BE MADE PRIOR TO APPROVAL OF SAME. THE GOVERNMENT 

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

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

operations of SSA. Therefore, if for any reason(s) (Act of God, labor disagreements, etc.) the contractor is unable 

to perform at said locations for a period longer than two (2) workdays, the contractor must have a backup facility 

with the capability of producing the products required under this specification.

Plans for their contingency production must be prepared and submitted to the Contracting Officer as part of the preaward survey. These plans must include the location of the facility to be used, equipment available at the facility, 

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

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

SSA has the option to install a VPN into the contractor’s backup facility.

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

notices produced on this contract, the contractor must maintain the original schedule set forth in this contract.

Quality Control Plan – The contractor must provide and maintain, within their 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 specified herein are met. 

The contractor must perform, or have performed, the process controls, inspections, and tests required to substantiate 

that the products provided under this contract conform to the specifications and contract requirements. The 

contractor must describe in detail their quality control/quality assurance and recovery plans describing how, when, 

and by whom the plans will be performed.

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

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

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

their duties in relationship to the quality control plan.

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

the postage meters, as well as the controls for the setting of the meters (if meters will be used).
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Quality Control Sample Plan – The plan must provide a description of how the contractor will create quality control 

samples for periodic samplings to be taken during the production run, provide for backup and rerunning in the event 

of an unsatisfactory sample, and contain control systems that will detect defective, missing, or mutilated pieces. 

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

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

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

time: 

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

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

from each print order and shipped to Social Security Administration, Division of Printing Management, 

Attn: Kate Schmidt, 1369 Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401. 

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

control samples for a particular print order within two (2) workdays of the last mailing date of that print 

order.

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

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

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

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

delivery of these notices meet specifications and Government requirements. 

This includes maintaining 100% accountability in the accuracy of imaging and mailing of all pieces throughout 

each run. The contractor must ensure that there are no missing or duplicate pieces.

Contractor must submit samples of the automated 100% Accountability Audit and Summary Reports.

The contractor must maintain quality control samples, inspection reports, and records for a period of no less than 

210 calendar days subsequent to the date of the check tendered for final payment by the Government Publishing 

Office. The Government will periodically verify that the contractor is complying with the approved quality control 

plan through on-site examinations and/or requesting copies of the contractor’s quality assurance records and quality 

assurance random copies.

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

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

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

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

production facility.

 

This plan must demonstrate the contractor’s ability to provide complete hardware and software compatibility with 

SSA’s existing network (see “FILE TRANSFER MANAGEMENT SYSTEM (FTMS) REQUIRMENTS” and 

“TRANSMISSION TESTS” for additional information). 

The contractor must complete a System Plan. (See Exhibit M.)

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

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

consultant for either task, a resume must still be included. This plan must show that the programmer(s) is skilled 

in the handling and programming of Advanced Function Presentation (Mixed Mode or Fully Composed) resources 

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

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

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

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

contract.

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

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

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

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

REQUIREMENTS FOR GOVERNMENT PRINTING”), this plan should include a listing of all personnel who 

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

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

this program.

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

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

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

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

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

installation dates are required. 

The contractor must disclose in their production plan their intentions for the use of any subcontractors for any 

materials necessary under this contract. If a subcontractor will be handling SSA notices, the plan must include the 

same information required from the contractor for all items contained under “SECURITY REQUIREMENTS” and 

“PREAWARD SURVEY.” If a subcontractor for any operation is added at any time after award, the contractor 

must submit the subcontractor’s proposed plans which are subject to review and approval by the Government. 

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

subcontractor is not approved by the Government, then the contractor has 15 calendar days prior to production to 

submit to the Government the new subcontractor’s information. 

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

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

the product ordered falling into unauthorized hands.

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

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

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

The plan must contain at a minimum:

 How Government files (data) will be secured to prevent disclosure to a third party.

 How the disposal of waste materials will be handled.

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

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

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

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

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

http://www.gsa.gov/portal/category/102371.
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 The contractor shall submit a System Security Plan (SSP), which documents how the solution implements 

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

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

SP 800-53, or the contractor shall provide a Security Assessment Package (SAP) completed by either an 

independent assessor or another Federal agency.

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

phases of production. 

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

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

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

production of notices.

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

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

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

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

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

approved personnel. Contractor must present this information, in detail, in the production area plan. 

Disposal of Waste Materials – The contractor is required to demonstrate how all waste materials used in the 

production of sensitive SSA records will be definitively destroyed (e.g., burning, pulping, shredding, macerating, 

or other suitable similar means). Electronic records must be definitively destroyed in a manner that prevents 

reconstruction. Definitively destroying the records means the material cannot be reassembled and used in an 

inappropriate manner in violation of law and regulations. Sensitive records are records that are national security 

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

The contractor, at a minimum, must crosscut shred all documents into squares not to exceed 1/4”. All documents 

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

contractor must specify the method planned to dispose of the material. Subcontracting is not allowed.

UNIQUE IDENTIFICATION NUMBER: Unique identification numbers will be used to track each individual 

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

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

minimum of one (1) test sample. This sample must have a unique number and must be produced on each notice. 

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

unique numbers will be marked off the list. This enables the contractor to track which samples have been produced 

and pulled and what records have been produced. The contractor may create their own sequence number and run 

date to facilitate their presorting and inserting process but must maintain the original SSA identification number.

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

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

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

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

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

facility. An explanation of the contractor’s sequential numbering system is required to understand the audit trail 

required for each and every piece.
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100% ACCOUNTABILITY OF PRODUCTION AND MAILING: Contractor must have a closed loop 

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

pages and inserts. Notices requiring print regeneration must be reprinted from their original print image with the 

original job ID and piece ID remaining unchanged as each mail piece continues through the inserting life cycle. 

This process will repeat itself (since subsequent reprint runs may yield damages) until all mail pieces from the 

original print run have been inserted and accounted for.

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

reprinting capabilities. The method provides a mail handling process which tracks processing errors with the use 

of a first and second scan code which obtain information regarding each mail piece, diverts mail pieces in response 

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

initiate reprints for the diverted mail pieces.

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

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

phases of printing, inserting, and mailing and to ensure all notices received from SSA were correctly entered into 

the U.S. postal system. 

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

The equipment must arrive at least 90 calendar days prior to the start of live production, on July 1, 2019. Contractor 

must submit a sample of their proposed Audit and Summary reports with the required preaward production plans 

for approval. The Government considers grounds for the immediate default of this contract if the contractor, at any 

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

Notice integrity must be defined as follows:

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

in the print files received from SSA.

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

printing when detected, and identify, remove, and reprint all effected notices.

Mailing integrity must be defined as follows:

 All notices received from SSA for each file date were printed, inserted, and entered correctly into the United 

States postal system.

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

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

correct inserts are accounted for, inserted, and mailed correctly.

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

technology capable of:

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

number and file date.

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

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

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

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

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

of variance must be logged.

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

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

regenerated in a new print file for reprint. Exception – Intentionally diverted pieces due to a requirement 

for a product, which cannot be intelligently inserted and requires manual insertion such as a publication, 

can be sealed, re-scanned and placed back into production. These must be programmed diverts and sent to 

a separate bin for processing to ensure they are not mixed with other problem diverts and logged into the 

Audit system as such. 

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

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

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

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

mail piece. The equipment must check the mail pieces, after insertion, verify that all leaves are accounted 

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

to and immediately after must be diverted. The equipment must divert all products that exhibit missing or 

out of order sequence numbers and any other processing errors. All diverted pieces are to be automatically 

recorded and regenerated in a new print file for reprint.

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

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

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

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

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

of the inserting process. Therefore, all finished mail for that sequence run must be held in an accessible 

area until this reconciliation is complete.

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

(h) Contractor must generate an automated audit report from the information gathered from scanning for each 

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

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

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

(i) Audit report must contain the following information:

1. Job name

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

3. Machine ID

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

5. Start and end sequence numbers in each run

6. Status of all sequence numbers in a run

7. Total volume in run

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

for divert such as missing sequence number, missing leaves, mutilated, duplicate, pulled for inspection, 

etc.)

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

of duplicates, duplicates verified and pulled, total completed.
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10. Audit report must contain the same information for all the reprints married with this report as listed 

above showing that all pieces for each mailer number and file date are accounted for. 

See Exhibit N: 100% Accountability Audit and Summary Report

(j) Contractor must generate a final automated 100% accountability summary report for each individual 

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

(manual inputs are not allowed). The summary report must contain the following (See Exhibit N: 100% 

Accountability Audit and Summary Report):

1. Job information - Job name, file date, Mailer number, piece quantity, sequence start and end number, 

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

etc.).

2. Job Start Time and Job End Time

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

were inserted and date completed

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

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

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

712 form(s) must be submitted to Kate Schmidt at Kathryn.Schmidt@ssa.gov for each file date within two (2) 

workdays of mailing.

Contractor must submit a sample of their Audit and Summary reports (see Exhibit N) with the required preaward

production plans for Government review and approval. The audit team must approve the audit and summary reports 

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

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

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

approval.

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

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

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

request via email in an MS Word, MS Excel, or PDF file to Jamey Cunningham at Jamey.Cunningham@ssa.gov.

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

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

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

summary reports, and postal documentation for during the audit. The contractor must provide the required audit 

reports within one (1) hour of request. The audit team will grant one (1) hour for each report to be pulled. The audit 

team may request a full tour and demonstration of the accountability process at the time of the audit. A wrap-up 

meeting will occur at the conclusion of the audit. The audit team will review their findings with the contractor at 

this time. The contractor will need to provide, in writing, responses to all findings, questions, and concerns within 

one (1) week of the wrap-up meeting. The Government considers grounds for the immediate default of this contract

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

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

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

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

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

ability to comply with this type of request if and when the need arises.
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REQUEST FOR NOTICE PULLS FROM PRODUCTION: Due to the sensitivity of notices in this contract, 

the Government may request that the contractor remove individual notices from the production stream. When this 

occurs, the Government will supply the contractor with a list of notices to be pulled. The list will contain the name 

and address that appears in the Mail Run Data (MRD) file to identify the notices. The contractor must be able to 

run a sort to find and eliminate the notice from the production run. If the list is provided after the notice had been 

produced, the contractor must be capable of identifying the notice and pulling it from the production floor. 

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

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

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

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

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

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

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

selections, and inspections; and monitor the packing and staging of the mail. 

These representatives will not have contractual authority, and cannot make changes in the specifications or in 

contract terms, but will bring any and all defects detected to the attention of the company Quality Control Officer. 

The representatives must have full and unrestricted access to all production areas where work on this program is 

being performed.

POSTAWARD CONFERENCE: 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, 

Baltimore, MD, immediately after award. At the Government’s option, the postaward conference may be held via 

teleconference.

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

attendance. 

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

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

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

Government Publishing Office, Social Security Administration, and the U.S. Postal Service. The contractor must 

present and explain their final plan for printing, imaging, folding, inserting, and mailing. 

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

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

facility, where the contractor is to furnish specific mail flow information. 

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

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

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

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

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

assurance, projected commencement dates, equipment loading, pallet needs, etc. 

The contractor is to provide the name of the representative responsible for the mailing operation and that 

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

attendance. 

THE GOVERNMENT RESERVES THE RIGHT TO WAIVE THE PREPRODUCTION MEETING.

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

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

supplemented by an individual daily electronic “Task Order” for each job placed with the contractor. A print order 

will be issued weekly and will indicate the quantity to be produced and any other information pertinent to the order. 

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

supplemented by daily electronic task orders. Orders may be issued under the contract from Date of Award through 

October 31, 2020 plus for such additional periods as the contract is extended. All print orders and task 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 or task order. 

Task orders will be “issued” daily for purposes of the contract and will detail the daily volume of notices required. 

A print order (GPO Form 2511) to be used for billing purposes will be issued weekly and will cover all daily task

orders issued that week. A print order or task order shall be “issued” upon notification by the Government for 

purposes of the contract when it is electronically transmitted or otherwise physically furnished to the contractor in 

conformance with the schedule. 

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

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

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

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

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

constitute the basis for an equitable price adjustment under this contract.

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

which are required to be purchased by the Government activity identified on page 1.

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 must 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 the “ORDERING” clause of this contract.
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PRIVACY ACT NOTIFICATION: This procurement action requires the contractor to do one or more of the 

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

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

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

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

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

(i)(1) CRIMINAL PENALTIES and m(1) GOVERNMENT CONTRACTORS.

PRIVACY ACT

(a) The contractor agrees:

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

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

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

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

development, or (C) operation;

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

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

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

to accomplish an agency function; and

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

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

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

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

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

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

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

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

employee of the agency.

(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.

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

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

using this method can be found at the following web address: 

http://winapps.access.gpo.gov/fms/vouchers/barcode/instructions.html.
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Invoices may also be mailed to: U.S. Government Publishing Office, Office of Financial Management, Attn: 

Comptroller, Stop: FMCE, Washington, DC 20401.

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

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

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

SCOPE: These specifications cover the production of mailing packages from five (5) workloads, consisting of 

English and Spanish/English personalized notices; English form inserts; English and Spanish publication inserts; 

mailout envelopes; Business Reply Mail (BRM) envelopes and Courtesy Reply Mail (CRM) envelopes; requiring 

such operations as: the receipt and processing of electronically transmitted data; re-development of Advanced 

Function Presentation (Mixed Mode or Fully Composed) resources; composition; printing/imaging; dating of form 

inserts; binding; construction; inserting; presorting; and distribution.

*The five workloads identified thus far are as follows:

1. MADCAP

2. MCS

3. SSA-L991

4. TASTE 

5. TATTER

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

developing new notice workloads with the same requirements as the notice workload described by these 

specifications. All terms and conditions in this specification will apply to these future notice workloads. It is 

estimated that approximately one (1) to three (3) new notice workloads may be added during the term of this 

contract. The file names for each new notice workload will be supplied to the contractor as they are developed.

FREQUENCY OF ORDERS AND QUANTITY: An electronic task order will be issued daily, Tuesday through 

Saturday. A print order will be issued weekly.

Separate print orders will be issued for the composition and proofs (after award), and for the preproduction 

validation tests (after award).

Combined yearly total for all mailers will be approximately 10,800,000 notices per year. 

The estimated annual quantity for the daily MADCAP notices is 1,500,000, MCS notices is 7,000,000, SSA-L991 

notices is 1,100,000, TASTE notices is 1,000,000, and TATTER notices is 200,000. 

The Government reserves the right to increase or decrease by up to and including 25% of the total number of notices 

ordered annually.

NUMBER OF PAGES AND TRIM SIZES:

Item No. of Pages Trim Size

Notice 1 to 24 8-1/2 x 11”

Form CMS-2690 Face and back 8-1/2 x 3-1/2”

Form SSA-3105 Face and back 10-1/2 x 8” flat size

Booklet:

SSA Publication No. 05-10137 40 pages 3-1/2 x 8”

SSA Publication No. 05-10138 40 pages 3-1/2 x 8”

SSA Publication No. 05-10095 24 pages 3-1/2 x 8”

SSA Publication No. 05-10076 24 pages 5-1/4 x 8”

SSA Publication No. 05-10077 32 pages 5-1/4 x 8”

SSA Publication No. 05-10153 28 pages 5-1/4 x 8”

SSA Publication No. 05-10903 28 pages 5-1/4 x 8”

SSA Publication No. 05-10976 24 pages 5-1/4 x 8”

SSA Publication No. 05-10977 36 pages 5-1/4 x 8”
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Item No. of Pages Trim Size

Factsheet:

SSA Publication No. 05-10007 Face and back 8-1/2 x 11” flat size

SSA Publication No. 05-10075 Face and back 8-1/2 x 11” flat size

SSA Publication No. 05-10975 Face and back 8-1/2 x 11” flat size

Leaflet:

SSA Publication No. 05-10018 Face and back 10-1/2 x 8” flat size,

SSA Publication No. 05-10058 Face and back 14 x 8” flat size

SSA Publication No. 05-10072 Face and back 14 x 8” flat size

SSA Publication No. 70-10281 Face and back 17-1/2 x 8” flat size

SSA Publication No. 05-10972 Face and back 17-1/2 x 8” flat size

SSA Publication No. 70-10283 Face and back 21 x 8” flat size

Green BRM Envelopes Face and back 3-7/8 x 8-7/8”, plus 1-1/2” flap

White BRM Window Envelopes Face and back 3-7/8 x 8-11/16”, plus 1-1/2” flap

CRM Envelopes Face and back 3-7/8 x 8-7/8”, plus 1-1/2” flap

Mailout Envelopes Face and back 4-1/8 x 9-1/4”, plus flap

Face and back 4-1/8 x 9-1/2”, plus flap

Face and back 6-1/8 x 9-1/2”, plus flap

NOTE: All envelopes are face and back (after manufacturing). 

MAKE-UP OF MAILERS: A record will be transmitted for each mailing address. The records will contain all 

the data relevant for the mailing of an associated mail piece. Unique alpha/numeric identifiers will be part of the 

record to ensure accuracy in the insertion process. All files transmitted by SSA will be physical sequential Advanced 

Function Presentation (AFP) Mixed Mode. The agency may transition to Advanced Function Presentation (AFP) 

Fully Composed during this contract. Any alteration of the notice content in the file is not permitted.

The figures indicated below are estimates that are based on historical data of past production runs. The figures show 

the minimum and maximum daily or monthly quantities for the notices; as well as the number of printed pages in a 

notice (notices are duplex printed, and one-side only when an odd page is required), inserts (items that are to be 

inserted into the mailout envelope along with the notice), and how the notice is to be folded. Exact quantities will 

not be known until each run is electronically transmitted to the contractor. NO SHORTAGES WILL BE 

ALLOWED.

FOR QUALITY CONTROL AND AUDITING PURPOSES: The contractor must not merge file dates and 

mailers during processing, printing, and mailing. Any alteration of the notice content in the file is not permitted.

MADCAP and MCS NOTE: MADCAP and MCS files can contain third party notices. The third party notice 

copy is an exact copy of the original notice with a coversheet containing the name and address of a third party 

designated by the beneficiary (such as, an attorney, a representative for the beneficiary (Rep Payee), or others). The 

original MADCAP notice is also in a file, which is printed separately.

NOTICES: Notices ordered under this contract will range from 1 to 24 printed pages (per notice). See the 

following for page counts of each mailer.

MADCAP: There are two MADCAP mailers. MADCAP Mailer 1 notices are considered English but contain

English only notices or English notices with the first few paragraphs in Spanish. Mailer 2 is a Spanish/English 

mailer. This mailer consists of two parts: The first part is the Spanish notice; the second part is the same notice in 

English. Notices will consist of 1 to 14 pages. Mailers may generate any combination of components below.
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 27 of 62

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Mailer 1: Data Set Name: OLBG.BTI.vendor.MDCAFP.M1#aaaaa.RYYMMDD 

Daily Minimum: 1,900

Daily Maximum: 11,000

Approximate Daily Average: 5,850

Printed Notice Pages: 1 to 10 

Personalized English Notice 

Mailout Envelope (6-1/8 x 9-1/2”)

Inserts: Form CMS-2690

Form SSA-3105

Green BRM Envelope

CRM Envelope

SSA Publication No. 05-10018

SSA Publication No. 05-10072

SSA Publication No. 05-10076

SSA Publication No. 05-10077

SSA Publication No. 05-10137

SSA Publication No. 05-10153

SSA Publication No. 70-10281

Folding: Bifold

Mailer 2: Data Set Name: OLBG.BTI.vendor.MDCAFP.M2#aaaaa.RYYMMDD

Daily Minimum: 35

 Daily Maximum: 1,000 

Approximate Daily Average: 200

Printed Notice Pages: 1 to 14 

Personalized Spanish/English Notice

Mailout Envelope (6-1/8 x 9-1/2”)

Inserts: Form CMS-2690

Form SSA-3105

Green BRM Envelope

CRM Envelope

SSA Publication No. 05-10018

SSA Publication No. 05-10072

SSA Publication No. 05-10076

SSA Publication No. 05-10077

SSA Publication No. 05-10137

SSA Publication No. 05-10138

SSA Publication No. 05-10153

SSA Publication No. 70-10281

SSA Publication No. 05-10903

SSA Publication No. 05-10972

SSA Publication No. 05-10976

SSA Publication No. 05-10977

SSA Publication No. 70-10283

Folding: Bifold
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MCS: The MCS mailers are divided into two (2) categories by data set names. These mailers are English only, or 

English containing a Spanish Cover Letter, or Spanish/English Bilingual. Notices will consist of 1 to 24 pages. 

The notices are represented by the following data set names. Mailers may generate any combination of the 

components listed below:

Mailer 3: Data Set Name: OLBG.BTI.vendor_id.MCSAFP.M3#aaaaa.Ryymmdd

 Daily Minimum: 6,100

 Daily Maximum: 73,000

 Approximate Daily Average: 27,000

 Printed Notice Pages: 1 to 12

Personalized Notice (English Only and English with Spanish Cover Letter)

Mailout Envelope (6-1/8 x 9-1/2”)

Inserts: Form CMS-2690

CRM Envelope

SSA Publication No. 05-10007

SSA Publication No. 05-10018

SSA Publication No. 05-10072

SSA Publication No. 05-10075

SSA Publication No. 05-10076

SSA Publication No. 05-10077

SSA Publication No. 05-10137

SSA Publication No. 05-10153

SSA Publication No. 70-10281

Folding: Bifold

Mailer 4: Data Set Name: OLBG.BTI.vendor_id.MCSAFP.M4#aaaaa.Ryymmdd

Daily Minimum: 225

Daily Maximum: 2,100

Approximate Daily Average: 1,200

Printed Notice Pages: 1 to 24 

Personalized Notice (Spanish/English Bilingual)

Mailout Envelope (6-1/8 x 9-1/2”)

Inserts: Form CMS-2690

CRM Envelope

SSA Publication No. 05-10007

SSA Publication No. 05-10018

SSA Publication No. 05-10138

SSA Publication No. 05-10903

SSA Publication No. 05-10972

SSA Publication No. 05-10975

SSA Publication No. 05-10976

SSA Publication No. 05-10977

SSA Publication No. 70-10283

Folding: Bifold

SSA-L991: The SSA-L991 mailers are English only notices represented by the following data set names. Notices 

will consist of 1 to 4 pages. All mailers will consist of components below.

Mailer 5: Data Set Name: OLBG.BTI.vendor.L99AFP.M51aaaaa.RYYMMDD 

Daily Minimum: 800

Daily Maximum: 7,100
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 Approximate Daily Average: 4,500

Printed Notice Pages: 1 to 4

Personalized English Notice

Mailout Envelope (4-1/8 x 9-1/4”)

 Inserts: None

Folding: Trifold

TASTE: The TASTE mailers are divided into three (3) notice categories by data set names. The notices contained 

within these mailers carry the form numbers SSA-1076, SSA-1372-BK, SSA-1372-BK-FC, and SSA-1387. Notices 

can consist of 1 to 10 pages. These mailers may generate any combination of components listed below:

Mailer 6: Data Set Name: OLBG.BTI.vendor.S76AFP.M61aaaaa.Rmmyy

OLBG.BTI.vendor.S76AFP.M62aaaaa.Rmmyy

OLBG.BTI.vendor.S76AFP.M63aaaaa.Rmmyy

OLBG.BTI.vendor.S76AFP.M64aaaaa.Rmmyy

Approximate Monthly Average: 3,000

Printed Notice Pages: 1

Personalized Notice

Mailout (Envelope 4-1/8 x 9-1/2”)

Inserts: None

Folding: Trifold

Mailer 7: Data Set Name: OLBG.BTI.vendor.S72AFP.M71aaaaa.Ryymm01

 OLBG.BTI.vendor.S72AFP.M72aaaaa.Ryymm01

Approximate Monthly Average: 37,000

Printed Notice Pages: 1 to 10

Personalized Notice

Mailout Envelope (4-1/8 x 9-1/2”)

 Inserts: White BRM Window Envelope

Folding: Trifold

Mailer 8: Data Set Name: OLBG.BTI.vendor.S87AFP.M81aaaaa.Ryymm01

 OLBG.BTI.vendor.S87AFP.M82aaaaa.Ryymm01

Approximate Monthly Average: 37,000 

Printed Notice Pages: 1

Personalized Notice

Mailout Envelope (4-1/8 x 9-1/2”)

Inserts: None

Folding: Trifold

NOTE: Mailers 6, 7, and 8 typically transmit during the last week of the month. Frequently, they transmit on the 

same day, but occasionally, will transmit on different days.

TATTER: The TATTER mailers are divided into two (2) categories by data set names. Notices can consist of 1 to 

10 pages. These mailers may generate any combination of components listed below:

Mailer 9: Data Set Name: OLBG.BTI.vendor.EPEAFP.M9#aaaaa.Ryymmdd

Daily Minimum: 200

Daily Maximum: 4,300
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Approximate Daily Average: 585

Printed Notice Pages: 1 to 10

Personalized Notice

Mailout Envelope (6-1/8 x 9-1/2”)

 Inserts: SSA Form SSA-3105

Green BRM Envelope

CRM Envelope

SSA Publication No. 05-10076

SSA Publication No. 05-10095

Folding: Bifold

Mailer 10: Data Set Name: OLBG.BTI.vendor.TLCAFP.MA#aaaaa.Ryymmdd

Daily Minimum: 25

Daily Maximum: 250

Approximate Daily Average: 150

Printed Notice Pages: 1

Personalized Notices

 Mailout Envelope (6-1/8 x 9-1/2”)

Inserts: SSA Publication No. 05-10058

Folding: Bifold

NOTE: During the term of this contract, it is anticipated that SSA will require some of the mailers be sent certified

or registered mail.

FILE NAME MAILER DATA SET NAME*

MADCAP 1 OLBG.BTI.vendor.MDCAFP.M1#aaaaa.Ryymmdd

2 OLBG.BTI.vendor.MDCAFP.M2#aaaaa.Ryymmdd

MCS 3 OLBG.BTI.vendor.MCSAFP.M3#aaaaa.Ryymmdd

4 OLBG.BTI.vendor.MCSAFP.M4#aaaaa.Ryymmdd

SSA-L991 5 OLBG.BTI.vendor.L99AFP.M51aaaaa.Ryymmdd

TASTE 6 OLBG.BTI.vendor.S76AFP.M61aaaaa.Rmmyy

OLBG.BTI.vendor.S76AFP.M62aaaaa.Rmmyy

OLBG.BTI.vendor.S76AFP.M63aaaaa.Rmmyy

OLBG.BTI.vendor.S76AFP.M64aaaaa.Rmmyy

7 OLBG.BTI.vendor.S72AFP.M71aaaaa.Ryymm01

OLBG.BTI.vendor.S72AFP.M72aaaaa.Ryymm01

8 OLBG.BTI.vendorS87AFP.M81aaaaa.Ryymm01

OLBG.BTI.vendor.S87AFP.M82aaaaa.Ryymm01

TATTER 9 OLBG.BTI.vendor.EPEAFP.M9#aaaaa.Ryymmdd

10 OLBG.BTI.vendor.TLCAFP.MA#aaaaa.Ryymmdd

NEW NOTICES: The file names for each new notice workload will be supplied to the contractor as they are 

developed.

All of the data set names are not listed for each mailer. The “aaaaa” represents the unique job identifier that is 

assigned at run time. The “#” will be replaced with 1 through 8 for each of the Payment Service Centers. For 

example, there are 8 files (or data set names) for MADCAP Mailer 1 as follows:

OLBG.BTI.vendor.MDCAFP.M11aaaaa.Ryymmdd 

OLBG.BTI.vendor.MDCAFP.M12aaaaa.Ryymmdd 

OLBG.BTI.vendor.MDCAFP.M13aaaaa.Ryymmdd 
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OLBG.BTI.vendor.MDCAFP.M14aaaaa.Ryymmdd 

OLBG.BTI.vendor.MDCAFP.M15aaaaa.Ryymmdd 

OLBG.BTI.vendor.MDCAFP.M16aaaaa.Ryymmdd 

OLBG.BTI.vendor.MDCAFP.M17aaaaa.Ryymmdd 

OLBG.BTI.vendor.MDCAFP.M18aaaaa.Ryymmdd 

The data set names listed are SSA names. The first three (3) qualifiers will be removed for the file received by the 

contractor. The fourth qualifier in the data set name listed is the file type and the fifth qualifier is the unique 

identifier. This qualifier will be used to match the corresponding files (Mail Run Data file and Banner file) with 

the print file. The MRD file name will be OLBG.BTI.vendor.MDCMRD.M1#aaaaa.Ryymmdd and the Banner 

name will be OLBG.BTI.vendor.MDCBNR.M1#aaaaa.Ryymmdd for the MADCAP file type. The final qualifier 

is the Run Date.

The files will be broken down and transmitted in segments by Program Service Center (PC) codes. Each file 

transmitted will have a banner page identifying the PC and required inserts.

The PC codes correspond to the mailout envelope required as follows:

PC 1 – Northeastern (Jamaica, NY)

PC 2 – Mid-Atlantic (Philadelphia, PA) 

PC 3 – Southeastern (Birmingham, AL)

PC 4 – Great Lakes (Chicago, IL)

PC 5 – Western (Richmond, CA)

PC 6 – Mid-America (Kansas City, MO)

PC 7 – Office of Central Operations (Domestic & Foreign) (Baltimore, MD)

PC 8 – Office of International Operations (Baltimore, MD)

*NOTE: The data set names listed above (and throughout these specifications) are not the final data set names 

that will be transmitted to the contractor. Final data set names will be provided to the contractor at the postaward 

conference. 

MADCAP, MCS, AND TATTER MAILOUT ENVELOPES:

BIFOLD SIZE: 6-1/8 x 9-1/2”

Program Service Center 90-Calendar Day Volumes

PC1 - Northeastern Program Service Center 266,000

PC2 - Mid-Atlantic Program Service Center 241,000

PC3 - Southeastern Program Service Center 328,000

PC4 - Great Lakes Program Service Center 290,000

PC5 - Western Program Service Center 341,000

PC6 -Mid-America Program Service Center 353,000

PC7 - Office of Central Operations 347,000

PC8 - Office of International Operations 16,000

SSA-L991 MAILOUT ENVELOPES:

TRIFOLD SIZE: 4-1/8 x 9-1/4” 90-Calendar Day Volumes

Headquarters Address

Social Security Administration 275,000

6401 Security Boulevard

 Baltimore, MD 21235
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TASTE MAILOUT ENVELOPES:

TRIFOLD SIZE: 4-1/8 x 9-1/2” 90-Calendar Day Volumes

Headquarters Address

Social Security Administration 232,000

6401 Security Boulevard 

 Baltimore, MD 21235 

MADCAP AND TATTER GREEN BRM ENVELOPES:

Program Service Center 90-Calendar Day Volumes

PC2 - Mid-Atlantic Program Service Center 40,000

All MADCAP and TATTER notices with PC1 through PC7 within the data set name, which require a Green 

BRM envelope, will receive a PC2 envelope. The contractor is responsible for setting up their equipment to 

ensure that the correct envelope is inserted.

All MADCAP and TATTER notices with PC8 within the data set name, which require a Green BRM envelope, 

will receive a PC8 CRM envelope, not a PC8 Green BRM envelope. (Business reply mail does not exist in 

International mail.) The contractor is responsible for setting up their equipment to ensure that the correct 

envelope is inserted.

TASTE WHITE BRM WINDOW ENVELOPES:

Headquarters Address 90-Calendar Day Volumes

SSA Headquarters 38,000

6401 Security Boulevard

Baltimore, MD 21235

MADCAP, MCS, and TATTER (PC8 only) CRM ENVELOPES:

Program Service Center 90-Calendar Day Volumes

PC1 – Northeastern Program Service Center 1,400

PC2 - Mid-Atlantic Program Service Center 1,500

PC3 – Southeastern Program Service Center 3,700

PC4 – Great Lakes Program Service Center 1,600

PC5 – Western Program Service Center 1,700

PC6 – Mid-America Program Service Center 2,200

PC7 – Office of Central Operations 11,000

PC8 – Office of International Operations *

*The annual quantity will be less than 200. The contractor is allowed to order the full annual quantity.

NON-ENVELOPE INSERTS – MADCAP, MCS, TASTE, TATTER: 

Form/Publication Number 90-Calendar Day Volumes

SSA Form SSA-3105 40,000

*CMS Form CMS-2690 23,000

SSA Publication No. 05-10007 5,700
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SSA Publication No. 05-10018 7,500

SSA Publication No. 05-10058 8,750

SSA Publication No. 05-10072 207,000

SSA Publication No. 05-10075 1,300

SSA Publication No. 05-10076 100,000

SSA Publication No. 05-10077 1,003,000

SSA Publication No. 05-10095 400

SSA Publication No. 05-10137 5,000

SSA Publication No. 05-10153 167,000

SSA Publication No. 70-10281 12,000

SSA Publication No. 05-10972 15,000

SSA Publication No. 05-10976 3,000

SSA Publication No. 05-10977 42,000

SSA Publication No. 05-10138 1,500

SSA Publication No. 05-10903 7,700

SSA Publication No. 05-10975 60

SSA Publication No. 70-10283 550

*NOTE: When Form CMS-2690 is used for any workload, a CRM will be required.

TATTER PAYMENT STUB NOTE: A micro-perforated payment stub will be on the last leaf of approximately 

25% of the notices. However, the micro-perforation will not be on the same leaf for every notice, because the notices 

have variable page counts. The contractor will be required to identify the payment stub page requiring perforation 

(Form SSA-53-EP prints at the top of the payment stub) and ensure that only these pages are perforated.

If there is a micro-perforated payment stub (Form SSA-53-EP) in the notice, a Green BRM Envelope will be 

required. 

GOVERNMENT TO FURNISH: At the postaward conference, the contractor will be issued either manuscript, 

camera copy, or electronic media for the forms, publications (booklets, factsheets, leaflets), and envelopes used in 

this contract.

If furnished, the electronic media will be furnished as follows:

Platform: Macintosh OSX (or latest version); IBM or compatible using MS Windows (current or most 

current version).

Storage Media: SFTP; CD-R/RW; DVD-R/RW; E-mail.

Software: Adobe Creative Suite (InDesign, Photoshop, and Illustrator); QuarkXPress; Adobe Acrobat 

Professional with LiveCycle Designer; and Adobe Experience Manager (AEM). All files will 

be created in current or near current versions of the above mentioned programs.

NOTE: All platform system and software upgrades (for specified applications) which may 

occur during the term of the contract must be supported by the contractor.

Fonts: All printer and screen fonts for the booklets, factsheets, and leaflets will be 

furnished/embedded, as applicable. The contractor is cautioned furnished fonts are the property 

of the Government and/or its originator. All furnished fonts are to be eliminated from the 

contractor’s archive immediately after completion of the contract.

Additional

Information: Files will be provided in PostScript, native application, and/or PDF format.
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 34 of 62

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A data connection between the exact location specified by the contractor and SSA’s National Computer Center.

Electronic files will be furnished for the notices (see “ELECTRONIC FILES” below).

Manuscript copy for 22 envelopes, as follows:

 1 green BRM envelope (3-7/8 x 8-7/8”)

 1 white BRM window envelope (3-7/8 x 8-11/16”)

 9 CRM envelopes (3-7/8 x 8-7/8”)

 1 mailout envelope (4-1/8 x 9-1/4”)

 1 mailout envelope (4-1/8 x 9-1/2”)

 9 mailout envelopes (6-1/8 x 9-1/2”)

Camera copy for the Facing Identification Mark (FIM) and ZIP+4 Intelligent Mail Barcode (IMB) for reply 

envelopes. 

At the Government’s option, camera copy or electronic files (PostScript format) for the recycled paper logo and 

legend (English and Spanish) may be furnished.

Test and Production files for printing will be furnished in print image. Print image files are formatted for Advanced 

Function Presentation (AFP) Mixed Mode printing platform. NOTE: The agency may transition to Advanced 

Function Presentation (AFP) Fully Composed during this contract.

SSA will provide an Official Government Postage Meter head only, but will not supply the meter mail machine.

All meter equipment and supplies must be borne by the contractor.

Postage and Fees Paid Mailing Indicia.

Coding Accuracy Support System (CASS) Certificate.

National Change of Address (NCOA) Certificate 

PS Form 3615 (Mailing Permit Application, and Customer Profile)

GPO Form 892 (Proof Label).

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

Exhibit B: SSA External Service Provider Security Requirements

Exhibit C: Security Assessment Report (SAR) Template

Exhibit D: Risk Assessment Report (RAR) Template

Exhibit E: External Hosted Information System Plan (ESP) Template

Exhibit F: Security and Suitability Requirements

Exhibit G: Declaration of Federal Employment (Optional Form 306)

Exhibit H: Fair Credit Reporting Act (FCRA) Authorization Form 

Exhibit I: Additional Questions for Public Trust Positions - Branching

Exhibit J: Questionnaire for Public Trust Positions (Standard Form 85P)

Exhibit K: Sample of Fingerprint Card 

Exhibit L: Contractor Personnel Rollover Request Form

Exhibit M: System Plan

Exhibit N: 100% Accountability Audit and Summary Report

Exhibit O: MRD File Record Layout

Exhibit P: Minimum Volume Reduction Program (MVRP) Request Letter

Exhibit Q: Detailed Meter Report

Exhibit R: Postage Meter Activity Log
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ELECTRONIC FILES: All files will be electronically transmitted to the contractor and contain a complete record 

for each notice. Any programming or other format changes necessitated due to the contractor’s method of 

production will be the full responsibility of the contractor and must be completed prior to SSA’s validation. All 

files transmitted by SSA will be physical sequential Advanced Function Presentation mixed mode. The agency may 

transition to Advanced Function Presentation (AFP) Fully Composed during this contract. Any alteration of the 

notice content in the file is not permitted. The contractor must not merge file dates and mailers during processing, 

printing/imaging, and mailing.

The Government will furnish test files for performing the preproduction press and mail run test.

NOTE: The contractor must not compress files in processing data for this contract.

The contractor will receive three (3) files for each print file: the Advanced Function Presentation (AFP) file, the 

Mail Run Data (MRD) file, and the Banner (BNR) file. Similar to the following:

AFP file = vendor***.T2RAFP.M01xaaaaa.Ryymmdd

MRD file = vendor***.T2RAFP.M01xaaaaa.Ryymmdd

BNR file = vendor***.T2RAFP.M01xaaaaa.Ryymmdd

Files provided to the contractor must be retained for 21 workdays after mailing (before destruction).

The notice files for printing are formatted for the AFP printing platform in duplex printing (face and back). For 

proper processing of AFP, SSA supplies resources used for printing notices in AFP format. 

The MRD File will contain all information relevant to each mail piece. This would include, for each mail piece, 

the unique alpha/numeric identifier (the sequential number of the document), the number of sheets of paper, required 

inserts and insertion bin selection, recipient’s address, return address, USPS IMB, the appropriate signature, and 

any required inserts. (See Exhibit O for MRD File Record Layout.)

The BNR file contains information for setting up the intelligent inserters such as file totals, number of mail packets, 

and bin set up for those items being included in the mail packets and total required in each bin.

The contractor will receive an electronic daily task order each morning after transmission with the volumes for 

notices, leaves, pages, and any inserts required.

Prior to the commencement of production of orders placed under this contract, the Government will furnish 

preproduction electronic test files shortly after the postaward conference that are to be used in performing all of the 

preproduction tests (see “PREPRODUCTION TESTS”).

Files will be in print image format and in ZIP Code sequence. Contractor will be required to sort files as necessary 

to obtain maximum USPS Postal discounts (i.e., leaf counts or mail weight). Any alteration of the notice content 

in the file is not permitted.

NOTE: Whenever the contractor makes a change in the programming, the contractor is required to execute a selfcertification statement specifying the date of the last programming change. Prior notification of a programming 

change is required in addition to the self-certification statement for the contractor to schedule a validation test with 

SSA. 
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The contractor shall notify SSA of any reprogramming and/or reformatting of data supplied by transmission 

necessitated due to the contractor’s method of production. Any reprogramming and/or reformatting of data 

necessitated due to the contractor’s method of production shall be the responsibility of the contractor and done at 

no cost to the Government.

Government to provide the following at the postaward conference or shortly thereafter:

Print Resource Library (AFP) (via email): AFP resources include page and form definitions, fonts, page segments, 

and overlays (if applicable) for page formatting.

Preproduction Press and Mail Run Test Files for Transmission: An AFP formatted print file with the 

corresponding Mail Run Data File and Banner file for each workload in the quantities required.

Revised Resource Library (AFP)( via email, when applicable): AFP print resources, overlays, page segments, and 

non-standard fonts provided shortly after the post award conference may change during the term of the contract, in 

which case SSA will provide revised AFP resource file(s) via email to the contractor as a replacement(s).

The contractor is cautioned that there may be a signature change(s) during the term of this contract. If this occurs, 

SSA will provide the contractor with a new AFP resource file. See “PREPRODUCTION TEST, Systems 

Change/Signature Change/New and Existing Notice Files Validation Test” for details.

PRINTER RESOURCES (AFP): 

SSA will provide the AFP resources for each notice workload. These resources will be provided on the contractor’s 

choice of media (transmission or email) shortly after the postaward conference. SSA will also provide test files for 

transmission with samples of each workload to enable the start of the validation process. These test files may be 

used for the preproduction press and mail run test. (For additional information, see “PREPRODUCTION TEST, 

Preproduction Press and Mail Run Test.”)

For proper processing of AFP resources supplied to the contractor by SSA, used for printing notices in AFP ( Mixed 

Mode or Fully Composed) format, the contractor must have software or an operating system which is 100% 

compliant with the most recent release of the IBM MVS/ZOS operating system accompanied by the most recent 

release of IBM Print Services Facility (PSF). 

These compliances relate solely to interpreting and printing files to be provided to the contractor by SSA to ensure 

the contractor is able to print the files as provided without alteration of any kind on the part of SSA. It is solely the 

contractor’s responsibility to redevelop/reprogram the AFP (Mixed Mode or Fully Composed) resources and MRD 

file to ensure proper printing and inserting in their environment.

NOTE: SSA prints 2 UP DUPLEX ROLL IN TO ROLL OUT with the file order reversed for insertion. The 

predominant data file format is AFP Mixed Mode; however, any valid AFP format, such as fully composed AFP, 

is possible and must be printable at the contractor’s location. Each piece of mail will be assigned a unique 

alpha/numeric identifier for tracking, insertion, location, and recovery processes.

The contractor will be responsible for maintaining the AFP resources on each system that processes SSA’s notices. 

SSA will provide updated resources electronically, as necessary. When the contractor receives an update to the 

printer resources, the contractor must install them immediately and provide SSA with up to 100 sample documents, 

representative of the workload involved, from the test file, within three (3) workdays for review. Contractor is to 

continue using existing resources while the samples are being reviewed. 
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Once the samples are approved, the contractor will be instructed as to when to start using the new resources. 

Whenever testing is required, the contractor will be responsible for performing the test on each printer that will be 

used during actual production. SSA may require either hard copy samples or PDF samples. If required, contractor 

to submit hard copy samples to: Social Security Administration, Attn: Kate Schmidt, 1369 Annex Building, 6401 

Security Boulevard, Baltimore, MD 21235-6401. If required, contractor to submit PDF samples via the SFTP site.

During the term of the contract, the Government anticipates making programmatic changes to the daily notices as 

warranted (e.g., changes in language, format, appearance, etc.). When changes occur, SSA will perform testing of 

the workload in their print facility for a short period of time. (The “Dark Days” for the contractor should only last 

a few days.) Only those affected workloads (indicated by filename) will be held back at SSA for validation and 

production. Upon successful testing of the changes by SSA, SSA will then transmit the new print resources (if 

necessary) and resume transmission of the notice file(s).

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. 

Contractor must have programmer(s) capable of handling AFP resources.

Secure File Transfer Protocols (SFTP) Site: Contractor is required to set up, establish, and maintain a contractorhosted SFTP server that multiple users at SSA can access for passing PDF notice validation samples and other 

information that contains PII to SSA and back. Contractor cannot send any notices or information that contain PII 

via email. Appropriate log-on instructions and protocol must be provided at time of award. 

TRANSMISSIONS: The primary data transmission method will be via a dedicated circuit or using an encrypted 

Virtual Private Network (VPN) Internet connection, at the discretion of the Government.

Upon award of this contract, the Government will determine the connectivity method between SSA and the 

contractor. Internet Protocol (IP) will be the connection protocol for the transmissions. The connectivity method 

will be through the Internet using an encrypted VPN tunnel, or the Government will place an order for a dedicated 

circuit to be installed within 60 to 90 calendar days of award between the contractor’s location and SSA’s network 

interface location. Either connectivity method will be encrypted with the AES256 encryption algorithm. For the 

Internet option to be used, the contractor must have an Internet ready VPN IPSec capable hardware device. The 

Government will not be responsible for any cost associated with the VPN Internet connection that the contractor 

may incur. The connection method is at the sole discretion of the Government. The cost of the dedicated circuit 

connection will be borne by the Government. 

The Government shall not be responsible for installation delays of data connections due to any external influences 

such as employee strikes, weather, supplies, etc., which conditions are beyond the control of the Government.

If a dedicated circuit is deemed necessary, SSA will provide the dedicated data connection, including a router, and 

firewall at the contractor’s specified locations. The contractor shall provide adequate rack space for securing the 

router and firewall; the contractor shall provide a dedicated analog dial-up line within eight feet of the router. 

This dedicated analog dial-up line will be used for router management and access for troubleshooting. The line 

must be in place and active prior to the installation of the circuit/router. 

Upon contract award, the contractor shall provide a complete delivery address with nearest cross-street, contact 

name and phone number for installation of data transmission services and equipment. The contractor’s contact 

person shall be available for delivery of services at the specified location. The Government shall not be responsible 

for incorrect or lack of address information, nor for non-availability of contact persons at the delivery site.
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It is the contractor’s responsibility to notify SSA when systems or data line problems arise and transmission(s) 

cannot take place. SSA’s first point of contact for systems or data line problems shall be the HELP DESK at 877-

697-4978.

FILE TRANSFER MANAGEMENT SYSTEM (FTMS) REQUIREMENTS: The contractor shall provide the 

capability to interface with SSA’s National File Transfer Management System (FTMS) for electronic transmission 

of notice files from SSA to the production facility. SSA will provide the necessary data connection into the 

contractor’s location. At the discretion of SSA, the line speed may be either increased or decreased depending on 

utilization. The contractor must provide, at their expense, the equipment and operating software platform, and the 

file transfer software required at their location. The contractor assumes all responsibility for configuration, 

maintenance, and troubleshooting of their equipment and software. 

SSA utilizes, and the contractor must provide compatibility with, Managed File Transfer software from TIBCO. 

The contractor may implement the Managed File Transfer Platform Server that has embedded software encryption 

capable of being enabled. The personal computers/servers must have the capability to run Managed File Transfer 

software with encryption enabled using IP protocols on Windows, UNIX (i.e., IBM’s AIX, SUN or HP), or z/OS 

platforms. 

SSA will not permit any private class A, B, or C IP addresses (i.e., 10.xxx.xxx.xxx type IP addresses) from external 

users on its network. At connection time to SSA, the contractor will be provided a suitable IP address for access to 

SSA’s network via a firewall. SSA will provide the necessary subnet(s) for connection at the remote site. The 

contractor will be responsible for their own name/address translation to fulfill the intended purpose of data transfers. 

SSA will provide Managed File Transfer node information to the contractor as required to accomplish file transfers. 

The contractor may determine the media type on which files from SSA will be received, to the extent that operator 

intervention (e.g., a tape mount) is not required at SSA or the contractor’s production facility. Simultaneous multiple 

transmission sessions must be possible on the contractor’s equipment. All files transmitted by the SSA will be 

written as Physical Sequential or “flat” files at the contractor’s location and will be distinguished with a “run date”

in the contractor’s file name. Virtual Storage Access Method files and Generation Data Groups, supported by 

IBM/MVS or IBM z/OS operating systems are not permitted under this contract. The contractor’s storage format 

must not preclude the availability of the Managed File Transfer software Checkpoint/Restart feature. 

NOTE: The contractor may not use VM/VSE/ESA on a mainframe system, as this hampers automated file 

transmission.

The contractor’s FTMS software shall be operational for the receipt of data files 24 hours per day, seven (7) days 

per week, unless otherwise specified by the Government. The communications protocol between SSA and the 

contractor shall be the Internet Protocol. The contractor must specify the type of Local Area Network (LAN) 

connection that will be used at the location where the SSA connection is to be installed. The contractor is 

responsible for providing complete hardware and software compatibility with SSA’s existing network. Production 

file transfers will be established according to SSA’s standard procedures for transmission control, dataset naming, 

and resource security. The contractor’s file management system must accommodate multiple file transmission 

sessions without intervention at either end. The contractor must have sufficient capacity to support the number of 

concurrent transmission file sessions as dictated by SSA.

The above will apply regardless of the number of workloads transmitted to the contractor daily. If the contractor is 

awarded multiple SSA notice workloads, there must be sufficient capacity at the contractor’s production facility to 

accept transmission of all files according to their schedules.

In the event that the transmission network is unavailable for a time period deemed critical by the Government, the 

files may, at the Government’s option, be processed at the SSA print/mail facility.
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It is the contractor’s responsibility to notify SSA when systems or data line problems arise and transmission(s) 

cannot take place. SSA’s first point of contact for systems or data line problems shall be the HELP DESK at 877-

697-4978.

All data provided by the Government or duplicates made by the contractor or his representatives and any resultant 

printouts must be accounted for and kept under strict security to prevent their release to any unauthorized persons. 

Data may not be duplicated in whole or in part for any other purpose than to create material to be used in the 

performance of this contract.

Any duplicate data and any resultant printouts must be destroyed by the contractor. Data provided to the contractor 

must be retained for 21 workdays after mailing.

PREPRODUCTION TESTS: Prior to the commencement of production of orders placed under this contract, the 

contractor will be required to demonstrate their ability to perform to the contract requirements. The Government 

will furnish electronic test files at the postaward conference, or shortly thereafter, to be used in performing a

Transmission Test, Preproduction Validation Test, Preproduction Press and Mail Run Test, and System Change/New

Notice Files Validation Test. 

Failure of the contractor to perform any of the below tests (Transmission Test, Preproduction Validation Test, 

Preproduction Press and Mail Run Test, and System Change/New Notice Files Validation Test) satisfactorily may 

be cause for default. The Government reserves the right to waive the requirements of any of these tests. The 

contractor will be notified at the postaward conference if any test(s) is to be waived.

The contractor will be required to have all material necessary to perform these tests. Government representatives 

will witness all phases of the Preproduction Press and Mail run Test. 

When Preproduction Validation and/or Validation Tests are required, the Government shall include them on a print 

order. 

The contractor will be required to perform the following tests:

Transmission Test: After award, SSA will notify the contractor when transmission test will be performed. The

contractor will be required to receive within one (1) workday up to 175,750 notices. 

The contractor will be required to perform a record count verification the same workday the complete transmission 

of the test files are received and perform the Coding Accuracy Support System (CASS) certification the same 

workday as receipt of the complete transmission of all notice test files. 

The contractor will be required to run the test file through their CASS certification system to ensure that there are 

no problems with the reading of the address file. Contractor will be required to report back to SSA with the test 

results. 

The contractor will be required to copy the files to their own system and provide Kate Schmidt of SSA’s Division 

of Printing Management with the exact counts received (broken down by data set name) via email to 

Kathryn.Schmidt@ssa.gov before proceeding with any other processing. 

SSA will respond within one (1) workday of receipt thereof. 
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Preproduction Validation Test: Within five (5) workdays of receipt of test files and prior to the Preproduction 

Press and Mail Run Test, the contractor must conduct a preproduction validation test and furnish at least 500

samples of the completed product (50 notices of each mailer including at least five (5) samples from each PC). 

Notices must be complete and include all variable data from Government furnished files. The notices must be 

inserted into envelopes and must include the inserts. The container and accompanying documentation must include 

the GPO jacket, purchase order, and program number, and must be submitted to the attention of Kate Schmidt at 

Social Security Administration, Attn: Kate Schmidt, 1369 Annex Building, 6401 Security Boulevard, Baltimore, 

MD 21235-6401.

The contractor must also provide 25 samples of the payment stub to Social Security Administration, Attn: Danielle 

McCray – DMS, DO NOT OPEN IN MAIL ROOM, 300 Spring Garden, Philadelphia, PA 19123.

The Government will approve, conditionally approve, or disapprove the samples from the Preproduction Validation 

Test within five (5) workdays of receipt thereof. Approval or conditional approval must not relieve the contractor 

from complying with the specifications and all other terms and conditions of the contract. A conditional approval

must state any further action required by the contractor. A notice of disapproval must state the reasons thereof. 

NOTE: If errors are found, additional samples will be required until such time as the validation produces no errors.

Preproduction Press and Mail Run Test: Prior to commencement of production, the contractor will be required to 

demonstrate their ability to perform the contract requirements by performing a 12-hour preproduction press and 

mail run test utilizing test files transmitted electronically. 

Within five (5) workdays of final approval of preproduction validation test samples and contractor’s receipt of 

necessary materials to perform the test (inserts and envelopes), the Government will work with the contractor to 

select a date when the contractor will be required to perform the 12-hour Preproduction Press and Mail Run Test. 

The contractor will use the transmitted test files.

The test shall occur during the regular work week of Monday through Friday (excluding holidays).

The contractor will be issued a print order for the 12-hour test. Upon successful completion of all test requirements, 

the contractor will be reimbursed for all applicable costs in accordance with the contractor’s submitted bid prices 

in the “SCHEDULE OF PRICES.” If the contractor fails to meet all test requirements, they will not be reimbursed 

for any associated costs.

The contractor will be required to have all composition, proofing, printed forms, booklets, factsheets, and leaflets, 

envelopes, scanning equipment, and reports for 100% accountability of production and mailing, completed, 

available, and ready for production prior to beginning the test. Notices are to be completed in accordance with 

contract requirements, inserted with inserts into envelopes, and prepared for mailing. Contractor will be required 

to provide the necessary audit and summary reports for 100% accountability of production and mailing within one 

(1) hour after the run is completed.

NOTE: If a subcontractor is utilized for the presorting and/or mailing of the notices of this contract, the 12-hour test 

must include the use of the subcontractor’s facility. No additional time will be allowed for the transportation and 

handling of the notices to and from this facility.

The contractor must produce a minimum of 87,875 notices, using the notices from the transmission test, in a 

continuous 12-hour period that will prove to the Government representatives the contractor can satisfactorily 

complete the requirements of this contract during live production. 
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During the 12-hour period, the contractor will be required to print and prepare for mailing the following quantities 

of MADCAP, MCS, SSA-L991, TASTE, and TATTER notices:

MADCAP Mailer 1 5,500

Mailer 2 500

MCS Mailer 3 36,500

Mailer 4 1,050

SSA-L991 Mailer 5 3,550

TASTE Mailer 6 1,500

Mailer 7 18,500

Mailer 8 18,500

TATTER Mailer 9 2,150

Mailer 10 125

TOTAL 87,875

The 12-hour period for the printing process will begin when an “O.K. to Print” is given by the Government 

representative on-site. 

The 12-hour period for the inserting, including any necessary reprints, and mailing process will begin within two (2)

hours of the start of the printing to allow the contractor to print sufficient materials to begin the inserting process. 

The test run will incorporate all aspects of the program consisting of the receipt of transmitted data; the duplex printing 

and imaging (and simplex imaging when an odd page is required) of notices; binding; construction; inserting; reprints; 

manifesting; metering (if approved by SSA under certain circumstances); presorting; and preparing finished notices 

for delivery to the USPS. To simulate actual production conditions, the product produced must be in accordance with 

all contract specifications and all USPS regulations. 

The contractor must perform the preproduction press and mail run test on their equipment and using their personnel. 

The test must be performed on the printing equipment and inserting machines with required scanning equipment that

will be used in live production. All samples must be manufactured at the facility in which the contract production 

quantities are to be manufactured.

Samples of the preproduction press and mail run test will be brought back to SSA for validation. 

The Government will approve, conditionally approve, or disapprove the output within seven (7) workdays of receipt 

thereof. 

Approval or conditional approval must not relieve the contractor from complying with the specifications and all other 

terms and conditions of the contract. A conditional approval must state any further action required by the contractor. 

A notice of disapproval must state the reasons thereof.

Failure to meet the requirements of the 12-hour test is grounds to immediately terminate the contract for 

default.
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Systems Change/Signature Change/New Notice Files Validation Test: When required, the Government will furnish 

test files for transmission that are to be used in performing a Systems Change/Signature Change/New Notice Files 

Validation Test. This test is required whenever SSA initiates a systems/programming change, a signature change, or 

when a new notice workload is developed. The contractor must furnish up to 100 printed samples (no envelopes or 

inserts/enclosures). 

Contractor must submit samples within three (3) workdays of receipt of test files. 

SSA may require either hard copy samples or PDF samples. If required, contractor to submit hard copy samples to: 

Social Security Administration, Attn: Kate Schmidt, 1369 Annex Building, 6401 Security Boulevard, Baltimore, MD 

21235-6401. If required, contractor to submit PDF samples via the SFTP site.

The Government will approve, conditionally approve, or disapprove the samples within five (5) workdays of receipt 

thereof.

If errors are found, additionalsamples of notices(as indicated above) will be required until such time as the validation

produces no errors.

The test must occur without a break in production of notices. The Government will inform the contractor in advance 

when the test files are to be provided and what changes are taking place. 

COMPOSITION: 

The contractor will be required to set type for 22 envelopes (return address, indicia, delivery address, and additional 

printing on face and back may be required on some orders). Contractor will be required to set up to approximately 

six (6) lines of type for the envelopes. Helvetica or similar typeface will be utilized.

Century Schoolbook, Sonoran Serif or equivalent fonts are to be used for producing the notices. SSA will provide the 

font numbers. The contractor will be required to validate that they have the proper licenses for each font. SSA cannot 

provide licensed fonts. Obtaining licensed fonts will be the responsibility of the contractor. No alternate typefaces 

will be allowed; however, manufacturers’ generic equivalents may be accepted (upon Government approval) for the 

above typefaces.

Intelligent Mail Barcode font will be required for the start of this contract. The contractor will be required to obtain 

the necessary font; SSA will not provide it with Resources supplied.

PROOFS:

NOTE: SSA uses many of the same booklets, leaflets, factsheets, and forms in several of its print contracts. If SSA 

determines after award the contractor is responsible for the production of any other SSA workloads containing the 

same publications and/or forms required for this program, the revisions may be proofed using one of these other 

programs to reduce the proofing requirements for any revisions. 

When ordered, one (1) “Press Quality” PDF soft proof (for content only) using the same Raster Image Processor (RIP) 

that will be used to produce the final printed product may be required. PDF proof will be evaluated for text flow, 

image position, and color breaks. Proof will not be used for color match.

Proofs must show all margins and dimensions, and indicate trim marks. For envelopes, proofs must show flap, and 

window size and placement, as applicable.

When ordered, three (3) 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. Direct to plate must be used to produce the final product 

with a minimum resolution of 2400 x 2400 dpi. Proofs shall be collated with all elements in proper position (not 

pasted up), imaged face and back, trimmed and folded to the finished size of the product, as applicable.
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When ordered, three (3) sets of inkjet proofs that are G7 profiled and use pigment-based inks. A proofing RIP that 

provides an option for high quality color matching (such as Device Links Technology and/or ICC Profiles 

Technology), and meets or exceeds industry tolerance to ISO 12647-7 Standard for Graphic Technology (as of 

3/19/09, and future amendments) must be utilized plus GRACoL 2006 Coated #1 specifications (CGATS TR006) 

must be achieved. Output must be a minimum of 720 x 720 dpi on a GRACoL or SWOP certified proofing media. 

Proofs must contain the following color control strip to be evaluated for accuracy: IDEAlliance ISO 12647-7 Control 

Strip 2009 or 2013(i1).

Proofs must contain color control bars (such as Brunner, GATF, GRETAG, or RIT) for each color of ink on the sheet. 

Control bars must be placed parallel to the press’s ink rollers and must show areas consisting of minimum 1/8 x 1/8”

solid color patches; tint patches of 25, 50 and 75%; dot gain scale; and gray balance patches for process color (if 

applicable). These areas must be repeated consecutively across the sheet.

The make and model number of the proofing system utilized shall be furnished with the proofs. These proofs must 

contain all elements, be in press configuration, and indicate margins. Proofs will be used for color match on press. 

Direct to plate must be used to produce the final product with a minimum of 2400 x 2400 dpi.

Pantone colors must be simulated on proofs and must be proofed separately on a digital color content, overlay, or 

inkjet proof. Contractor may be required to submit ink draw downs on actual production stock of Pantone color(s) 

used to produce the product.

SSA reserves the right to make changes to all proofs. The Government may require one (1) or more sets of revised 

proofs before rendering an “O.K. to Print.”

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

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

such operations must be accomplished within the original production schedule allotted in the specifications.

The contractor must not print prior to receipt of an “O.K. to Print.” 

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

for the corresponding JCP Code numbers in the “Government Paper Specification Standards No. 12” dated March 

2011. 

Government Paper Specification Standards No. 12 – https://www.gpo.gov/docs/default-source/forms-and-standardsfiles-for-vendors/vol_12.pdf?sfvrsn=2.

Color of paper furnished must be of a uniform shade and a close match by visual inspection of the JCP and/or attached 

color sample(s). The Contracting Officer reserves the right to reject shipments of any order printed on paper the color 

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

All paper used in each copy must be of a uniform shade.

NOTE Regarding JCP Code A60 Only: The requirement for postconsumer fiber (as specified in the Government 

Paper Specification Standards No. 12) for this stock is waived. However, the addition of postconsumer fiber is 

encouraged provided that the requirements of this Standard are met. All other attributes remain the same.

Personalized Notices: White Offset Book, basis weight: 50 lbs. per 500 sheets, 25 x 38”, equal to JCP Code A60.

Form CMS-2690: Yellow Index, basis weight: 90 lbs. per 500 sheets, 25-1/2 x 30-1/2”, equal to JCP Code K10.

Form SSA-3105: White Writing, basis weight: 20 lbs. per 500 sheets, 17 x 22”, equal to JCP Code D10.
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Booklets, Factsheets, and Leaflets: White Offset Book, basis weight: 60 lbs. per 500 sheets, 25 x 38”, equal to JCP 

Code A60.

Green BRM Envelope (3-7/8 x 8-7/8”): Green Writing (match of Pantone 344), basis weight: 20 lbs. per 500 sheets, 

17 x 22”, bursting strength 20 lb/in2, equal to JCP Code D10. 

Envelope color must meet USPS print reflectance difference requirements. At contractor’s option, the Green BRM 

envelopes may be surface tinted. Surface tinting must cover all exposed surfaces (front and back) of the envelope 

when sealed.

White BRM Window Envelope (3-7/8 x 8-11/16”): White Wove, basis weight: 24 lbs. per 500 sheets, 17 x 22”, 

bursting strength 20 lb/in2.

CRM Envelopes (3-7/8 x 8-7/8”): White Writing, basis weight: 20 lbs. per 500 sheets, 17 x 22”, equal to JCP Code 

D10, bursting strength 20 lb/in2, containing a minimum of 50 percent waste paper.

Mailout Envelopes: White Wove, basis weight: 24 lbs. per 500 sheets, 17 x 22”, bursting strength 38 lb/in2.

PRINTING/IMAGING: The contractor will be required to convert furnished data from electronic transmission for 

either laser or ion deposition printing. All imaging/printing must have a minimum resolution of 600 x 600 dpi.

The Government reserves the right to make changes to the envelopes or the format(s)/text of the forms, booklets, 

leaflets and/or factsheets 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 proofs to the Government. 

The contractor is not to preprint or maintain more than a 90-calendar day inventory of any of the components required 

on this contract. The Government will not be required to purchase from the contractor the inventory of any stocked items 

remaining on hand in excess of what was authorized when an envelope or format/text change is implemented. However, 

if a revision occurs which requires destruction of outdated stock and/or increases or decreases in booklet page counts,

all costs incurred are to be in accordance with the “SCHEDULE OF PRICES,” as applicable. No additional charge 

may be incurred.

Within five (5) workdays of stocking the new material, the contractor will be required to report to SSA the remaining 

balance of the outdated stock for reimbursement. In some cases, SSA will require the contractor to exhaust the old 

stock before using the new stock. The instruction to destroy or exhaust stock will be issued with the furnished 

electronic file containing the new artwork.

Notice: Print/image notices duplex (face and back, head-to-head) in black ink only.

 The MADCAP personalized notices print in both English and Spanish/English. 

 The MCS personalized notices print in both English and Spanish/English.

 The SSA-L991 personalized notices print English only. 

 The TASTE personalized notices print English only.

 The TATTER personalized notices print English only with a Spanish cover letter when applicable.

Form CMS-2690: Print face and back in black ink. 

On the face of each Form CMS-2690, a date is required. Each form must be dated 60 workdays (Monday through 

Friday) in the future from the actual mailing date. When a Federal Holiday(s) fall within the 60-day period, that day(s) 

is not to be used; contractor is to skip that day and go to the next available workday. (See “SCHEDULE” for list of 

Federal Holidays.)

Form SSA-3105: Print face and back in black ink.
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Booklet: Print head-to-head and/or head-to-side. Self-cover prints double-sided, full bleed in two Pantone ink colors. 

Balance of pages print in two Pantone ink colors and contain adequate gripper margins. Match Pantone inks specified.

Factsheet: Print face and back, head-to-head. Single leaf prints in two Pantone ink colors on both face and back and contains 

adequate gripper margins. Match Pantone inks color specified.

Leaflet: Print face and back, head-to-head. Face prints in two Pantone ink colors and bleeds three (3) sides; back prints 

in two Pantone ink colors and contains adequate gripper margins. Match Pantone inks specified.

Envelope: Envelopes print face and back (after manufacturing) in black ink. Printing must be in accordance with the 

requirements for the style envelope ordered. All printing must comply with all applicable U.S. Postal Service 

regulations. The envelope must accept printing without feathering or penetrating to the reverse side.

All envelopes require a security tint printed on the inside (back before manufacturing) in black ink. The contractor 

may use his own design but must guarantee that the product will ensure complete opacity and prevent show through 

of any material contained therein.

Green BRM Envelope (3-7/8 x 8-7/8”): Face of envelope to be in BUSINESS REPLY FORMAT. Print FIMs and 

Intelligent Mail Barcodes using the furnished camera copy. The FIMs and Intelligent Mail Barcodes should be placed 

on the mailing piece according to the current U.S. Postal Service’s Domestic Mail Manual, “Barcoded Mail pieces.”

White BRM Window Envelope (3-7/8 x 8-11/16”): Face of envelope to be in BUSINESS REPLY FORMAT. Print 

FIMs and Intelligent Mail Barcodes using the furnished camera copy. The FIMs and Intelligent Mail Barcodes should 

be placed on the mailing piece according to the current U.S. Postal Service’s Domestic Mail Manual, “Barcoded Mail 

pieces.”

CRM Envelope (3-7/8 x 8-7/8”): Face of envelope to be in COURTESTY REPLY FORMAT. Print FIMs and 

Intelligent Mail Barcodes using the furnished camera copy. The FIMs and Intelligent Mail Barcodes should be placed 

on the mailing piece according to the current U.S. Postal Service’s Domestic Mail Manual, “Barcoded Mail pieces.”

RECYCLED PAPER LOGO: If recycled paper is used, the recycled paper logo and legend must be printed in black 

ink on the notices, envelopes, and forms. If the booklets are printed on recycled paper, the recycled paper logo and 

legend must be printed in the same Pantone ink color as the text.

Notices: The recycled paper logo/legend must be digitized by the contractor and imaged in the bottom right corner 

aligned with the contractor’s control number on the first page of each notice. For bilingual notices, the logo will appear 

on the Spanish copy only.

Forms, Booklets, Factsheets, and Leaflets: The SSA furnished manuscript, electronic files, or camera copy will 

already contain the recycled paper logo/legend in either English or Spanish (as appropriate).

Envelopes: The logo/legend must be printed on the back of all envelopes in the bottom left hand corner.

PRESS SHEET INSPECTION: Final makeready press sheets may be inspected and approved at the contractor‘s 

(subcontractor’s) plant for the purpose of establishing specified standards for use during the actual press run. Upon 

approval of the sheets, contractor is charged with maintaining those standards throughout the press run (within QATAP 

tolerances when applicable) and with discarding all makeready sheets that preceded approval. 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. NOTE: A press sheet inspection is for the purpose 

of setting specific standards that are to be maintained throughout the entire run. It does not constitute a prior approval 

of the entire run.
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Press sheets must contain control bars for each color of ink on the sheet. Control bars must be placed parallel to the 

press’s ink rollers. The control bars (such as BRUNNER, GATF, GRETAG, or RIT) must show areas consisting of 

1/8 x 1/8” minimum solid color patches; tint patches of 25, 50, and 75%; dot gain scale; slur targets; two-color 

overprint ink trapping targets and gray balance patches for process color (if applicable). These areas must be repeated 

across the entire press sheet.

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.

MARGINS: Margins will be as indicated on the print order, furnished copy, or furnished electronic file.

BINDING: 

Notice: Trim four sides. Gather all leaves of a notice in numerical sequence. Notices are to be nested together with 

all faces forward. Fold from a flat size of 8-1/2 x 11” down to 8-1/2 x 3-11/16” or 8-1/2 x 5-1/2” as indicated, title 

out.

Address on first page of notice must be visible through window of mailout envelope. Either wraparound or accordion 

folds will be acceptable for the trifold notices.

NOTE: Bilingual Spanish/English notices consist of two parts: the first part is a Spanish notice; the second part is the 

same notice in English. The two parts must be nested together.

Payment Stub: The last leaf of approximately 25% of the TATTER notices only will contain a micro-perforated 

payment stub. However, the micro-perforation will not be on the same leaf for every notice, because the notices have 

variable page counts. The contractor will be required to identify the payment stub page(s) requiring perforation (“SSA53-EP” prints at the top of the payment stub) and ensure that only these pages are perforated.

Perforation: It is critical that the micro-perforation on the payment stub page be 3-1/2” from the bottom of the 

payment stub page and run along the entire 8-1/2” dimension.

Form CMS-2690: Trim four sides.

Form SSA-3105: Trim four sides. Perforate on the fold 7” from left edge. Fold from a flat size of 10-1/2 x 8” down 

to 3-1/2 x 8” with two parallel wraparound folds, title out. Follow sample.

Booklet: Saddle-wire stitch in two places and trim three sides. Each product must contain complete 4-page signatures

after trimming. Single leaves connected with a lip (i.e., binding stub) to left or right side of stitches will not be allowed. 

The finished product will be either 5-1/4 x 8” or 3-1/2 x 8”.

Factsheet: Trim four sides. Fold from flat size of 8-1/2 x 11” down to 8-1/2 x 5-1/2” with one fold, title out.

Leaflet: Trim four sides. Fold from a flat size of 10-1/2 x 8”, 14 x 8”, 17-1/2 x 8”, or 21 x 8” down to 3-1/2 x 8” title 

out, with two or three parallel folds. Follow furnished folding sample.

CONSTRUCTION:

Green BRM Envelope and CRM Envelope (3-7/8 x 8-7/8”): Envelope must be open side, with gummed fold-over flap 

for sealing and contain high-cut diagonal seams or double side seams, at contractor’s option. Flap depth is at 

contractor’s option, but must meet all USPS requirements. Flap must be coated with a suitable remoistenable glue 

that will securely seal the envelope for mailing. Adhesive must not adhere to the contents of the envelope.
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White BRM Window Envelope (3-7/8 x 8-11/16”): Envelope must be open, with gummed fold-over flap for sealing 

and contain high-cut diagonal seams or double side seams, at contractor’s option. Flaps depth must be 1-1/2” and flap 

must be coated with suitable re-moistenable glue that will securely seal the envelope without adhering to contents. 

Face of envelope to contain one die-cut address window (1-1/4 x 3-1/4” in size) with slightly rounded corners. Diecut window is to be located 7/16” from the bottom edge of the envelope and 1-3/16” from the right edge of the envelope 

(the long dimension of the window is to be parallel to the long dimension of the envelope). The contractor has the 

option to adjust the size of the window opening (subject to Government approval), providing the visibility of the 

computer generated mailing address and barcode on the notice is not obscured, and other extraneous information is 

not visible when material is inserted into the envelope.

Mailout Envelope (4-1/8 x 9-1/4”): Envelope must be open side, with gummed fold-over flap for sealing and contain 

high-cut diagonal seams. Flap is at the contractor’s option but must meet all USPS requirements. Flap must be coated 

with suitable glue that will securely seal the envelope without adhering to contents, permit easy opening by the 

recipient, and not permit resealing of the envelope. Face of envelope to contain one die-cut address window (1-1/2 x 

4-1/4” in size) with slightly rounded comers. Die-cut window is to be located 5/8” from the bottom edge of the 

envelope and 3/4” from the left edge of the envelope (the long dimension of the window is to be parallel to the long 

dimension of the envelope). The contractor has the option to adjust the size of the window opening (subject to 

Government approval), providing the visibility of the computer generated mailing address and barcode on the notice 

is not obscured, and other extraneous information is not visible when material is inserted into the envelope. 

Mailout Envelope (4-1/8 x 9-1/2”): Envelope must be open side, with gummed fold-over flap for sealing and contain 

high-cut diagonal seams. Flap depth is at contractor’s option, but must comply with all USPS requirements. Flap 

must be coated with a suitable glue that will securely seal the envelope without adhering to contents, not permit 

resealing of the envelope, and permit easy opening by the recipient. Face of envelope to contain one die-cut address 

window (1-1/2 x 4-1/4” in size) with slightly rounded corners. Die-cut window is to be located 5/8” from the bottom 

edge of the envelope and 3/4” from the left edge of the envelope (the long dimension of the window is to be parallel 

to the long dimension of the envelope). Contractor has the option to adjust the size of the window opening (subject to 

Government approval), providing the visibility of the computer generated mailing address and barcode on the notice 

is not obscured, and other extraneous information is not visible when material is inserted into the envelope. 

Mailout Envelope (6-1/8 x 9-1/2”): Envelope must be open side, with gummed fold-over flap for sealing and contain 

high-cut diagonal seams. Flap depth is at contractor’s option, but must meet all USPS requirements. Flap must be 

coated with a suitable glue that will securely seal the envelope without adhering to contents, not permit resealing of 

the envelope, and permit easy opening by the recipient. Face of envelope to contain one die-cut address window (1-

1/2 x 4-1/4” in size) with slightly rounded corners. Die-cut window is to be located 2” from the bottom edge of the 

envelope and 1/2” from the left edge of the envelope (the long dimension of the window is to be parallel to the long 

dimension of the envelope). Contractor has the option to adjust the size of the window opening (subject to Government 

approval), providing the visibility of the computer generated mailing address and barcode on the notice is not obscured, 

and other extraneous information is not visible when material is inserted into the envelope. 

Windows: For ALL envelopes with a window, the window is to be covered with a suitable transparent, low-gloss, 

poly-type material that must be clear of smudges, lines, and distortions. Poly-type material must be securely affixed 

to the inside of the envelope so as not to interfere with insertion of contents. Window material must meet the current 

USPS readability standards/requirements. 

INSERTING: Gather the appropriate number of leaves per notice, fold as specified, and insert into mailout envelope 

with recipient‘s name and address on first page facing out for visibility through window envelope. 

In the case of bilingual Spanish/English notices, the recipient’s name and address on the Spanish notice should be visible 

through the window envelope. (NOTE: The bilingual Spanish/English notices must be nested together.) 

When required, form(s), booklet(s), factsheet(s), leaflet(s), and/or BRM/CRM envelope(s) should be inserted behind 

the notice (when viewed from the window side of the envelope). 
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It is the contractor’s responsibility to assure that only the computer-generated address and IMB on the notice will be 

visible through the window in the envelope and that only one notice and only one copy of each required insert is 

inserted into each envelope. 

NOTE: When Form CMS-2690 is required, it must be dated 60 workdays in the future (Monday through Friday) from 

the actual mailing date before inserting in the mailing package (see “PRINTING/IMAGING”). 

Seal envelopes.

PRODUCTION INSPECTION: Before production begins on any new workloads, a production inspection(s) may 

be required at the contractor’s plant.

Production inspection(s) may be required at the contractor’s/subcontractor’s plant for the purpose of establishing that 

the receipt of transmitted files, the printing of notices, forms, booklets, leaflets, factsheets, and/or envelopes, the 

imaging, binding, construction, inserting, and mailing is being accomplished in accordance with contract quality 

attributes and requirements. 

A production inspection is for the purpose of setting specific standards that are to be maintained throughout the entire

run. It does not constitute a prior approval of the entire run. 

When a production inspection is required, the Government will notify the contractor.

DISTRIBUTION:

 Deliver f.o.b. destination (on the first order and any order that requires revisions to the booklets, forms, or 

envelopes) three (3) production samples of each to: SSA, Division of Printing Management, Attn: Kate 

Schmidt, 1369 Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401.

 Mail f.o.b. contractor’s each individual mailer. (The contractor is responsible for all costs incurred in 

transporting this product to the U.S. Postal Service facility.)

Domestic First-Class Letter-Size Mail: The contractor is required to prepare domestic First-Class letter-size mail in 

accordance with appropriate USPS rules and regulations, including the USPS Domestic Mail Manual and Postal 

Bulletins in effect at the time of the mailing. 

When volumes warrant, SSA requires the use of a permit imprint. The contractor must use SSA’s “Postage and Fees 

Paid First Class Mail” permit imprint mailing indicia printed on each mail piece. 

Each mail piece sent under this payment method must bear a permit imprint indicia showing that postage is paid. 

Permit imprint indicia may be printed directly on mail pieces. Permit imprint mailings must contain at least 200 

pieces or 50 pounds. 

The contractor is cautioned to use the permit imprint only for mailing material produced under this contract. 

Contractors are strongly encouraged to apply for an exception in the Domestic Mail Manual section 604.5.1.2 called 

the Minimum Volume Reduction Provision (MVRP) through their local BMEU. (See Exhibit P for MVRP Request 

Letter for local BMEU.)

The MVRP provides an exception to the “200 pieces or 50 pounds” rule for Permit Imprint mailings (including 

certified and foreign mail). With the MVRP exception, contractors will be allowed to mail pieces under the 200 pieces 

or less than 50 pounds on a permit imprint eliminating metering (this includes certified and foreign mail). Mailers 

must submit USPS postal paperwork electronically, including piece level barcode information. Contractor will be 

required to contact USPS, prior to any MVRP expiration date (if specified by USPS) all MVRP agreements must be 

current. 
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This workload contains various weight pieces. The contractor is strongly encouraged to use manifest mail when 

postal regulations allow. The contractor must have a Manifest Mailing System (MMS) for First-Class Mail, which 

has been approved by USPS to document postage charges for this mailing. Each mail piece must be identified with 

a unique identification number or with a keyline containing a unique identification number and rate information about 

the piece. Requirements for the MMS are contained in Publication 401 “USPS Guide to the Manifest Mailing 

System” in effect at the time of the mailing. 

NOTE: A copy of the USPS approval for the MMS must be presented at the postaward conference.

If a Government meter is required: All meter equipment and supplies must be borne by the contractor. SSA will 

provide an Official Government Postage Meter head only, but will not supply the meter mail machine. SSA will fund 

the postage for meters through the USPS’ Official Mail Accounting System (OMAS). 

The contractor is responsible for the security of the Government postage meters and access is to be restricted to 

authorized personnel only. The contractor is to advise all staff there is a penalty for the private use of official 

Government postage meters (39USC3203). 

Contractor should always maintain sufficient postage on the Government meter. The contractor should contact SSA 

if they are not sure of how much postage to load or frequency.

The contractor is required to submit spoiled postage/postage error envelope(s)/meter strip(s) and prepare a Postal 

Service Form 3533, Application for Refund of Fees, Products and Withdraw of Customer Accounts. Forms are not 

obtainable from the USPS website since they contain a barcode making each form unique. Contractors will go to local

Post Offices, postal retail units, or Bulk Mailing Units to obtain the hardcopy version of the revised PS Form 3533. 

USPS will credit the postage refund to SSA through the Official Mail Accounting System (OMAS). SSA requires the 

contractor to submit a copy of Form 3533 along with the associated print order in which the spoilage occurred and all 

other postal documentation to the SSA Program Lead.

The contractor must have approval from SSA’s Postage Meter Accountability Team for turn-in of postage meter(s) to 

the meter manufacturer (e.g., excess meter, defective meter, etc.). If the contractor requires a replacement postage 

meter, USPS credits any remaining postage to SSA through the USPS’ Official Mail Accounting System (OMAS) or 

the meter manufacturer may transfer the remaining postage from the old meter to the new meter. The contractor should 

be sure to document the last meter reading (postage remaining amount) before the meter is checked out of service. 

The contractor may receive a PS Form 3601-C, Postage Meter Activity Report, from the meter manufacturer. The 

contractor is to forward a copy of this report to SSA within three (3) workdays of the transaction.

The Government reserves the right to request the contractor to upload funds at any time. These uploads are in addition 

to any routine meter replenishments. As a result of the postage uploads, the contractor may receive a Postage Meter 

Reset Activity Report Statement from the meter manufacturer. If received, the contractor should retain this 

documentation for 12 months.

Contractor is not to relocate any Government postage meter containing SSA postage funds to any other building. 

Contactor is required to contact the SSA Program Lead before any movement of a Government postage meter 

containing SSA postage funds.

The contractor is required to prepare all metered mail in accordance with the rules and regulations in USPS’s Domestic 

Mail Manual and International Mail Manual.

Contractors should not receive invoicing for meter rentals. If an invoice is received, the contractor is to contact the

SSA Program Lead immediately.
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Contractor Sites Using “Official Government” Postage Meters with Automated Reporting Capability (Detailed): 

Postage meters with “Detailed Account Reporting” are capable of providing detailed meter usage reports (see Exhibit 

Q). If the contractor utilizes meters with the detailed account reporting, the contractor is required to provide copies 

of detailed meter usage reports to SSA with each print order. The detailed report must be contract/print order specific.

NOTE: If the contractor produces multiple SSA contracts, they must submit a separate detailed report for each contract 

and each print order. 

When setting up the detail report for SSA, the contractor must set up the meter to record usage via contract program 

number, mailer number and file date. The contractor may have to utilize the account and subaccount feature in order 

to capture the contract program number, mailer number, and file date. 

If the contractor utilizes detailed reporting, the contractor will be required to utilize the postage meter account feature 

for each SSA print program. If the contractor requires assistance with set-up and operating the “accounting” features 

of the postage meters, they are to contact SSA along with the meter manufacturer. 

Contractor Sites Using an SSA Postage Meter Activity Log (Manual Process): If the contractor is using mailing 

equipment that cannot support a postage meter with an internal accounting feature and/or capable of providing SSA 

with the detailed reporting, they will be required to complete an SSA Postage Meter Activity Log (see Exhibit R). 

Contractor must submit a copy of the Postage Meter Activity Log to SSA with each print order. The Postage Meter 

Activity log must be contract/print order specific.

NOTE: If the contractor produces multiple SSA contracts, they must submit a separate SSA Postage Meter Activity 

Log for each contract and each print order. 

Every field must contain an entry or an N/A if the field does not apply. SSA will return incomplete or incorrect activity 

logs to the contractor for correction. NOTE: If a primary meter fails and a backup or replacement meter is needed to 

complete the workload, the contractor will need to document the primary meter log in the note field (i.e., meter failed)

and create a new activity log documenting the necessary fields to use with the backup or replacement meter.

The contractor is required to obtain the maximum USPS postage discounts possible in accordance with the USPS 

First-Class Domestic Mail automated and nonautomated mail discount structure in effect at the time of mailing: (a)

Automation (5-digit); (b) Automation (3-digit); (c) Automation (AADC); (d) Automation (Mixed AADC); (e)

Nonautomation (Presorted); and, (f) Nonautomation (Single Piece).

Mail addressed to United States possessions (e.g., American Samoa, Federated States of Micronesia, Guam, Marshall 

Islands, Northern Mariana Islands, Palau, Puerto Rico and U.S. Virgin Islands, Wake Island) and Military Overseas 

Addresses (APO/FPO mail) is Domestic Mail, not International Mail, and should be included in the discount 

sorting above.

To maximize automation discounts, Intelligent Mail Barcode (IMB) barcoding, delivery address placement and 

envelopes used for the mailing are among the items that must comply with USPS requirements for automationcompatible mail in effect at the time of the mailing.

Contractor will be required to produce and use a USPS Intelligent Mail Barcode Full-Service option and achieve the 

maximum postage discounts available with this option. The contractor will be required to comply with USPS 

requirements and place the IMB on all mail pieces of this workload. The contractor is required to be capable of 

achieving the postage discounts available with the Full-Service option of the IMB program. The Full-Service option 

requires the contractor to use Postal One.

SSA will provide the contractor with a 6-digit Mailer Identifier (MID) for the mailing. The Mailer Identifier is a field 

within the Intelligent Mail barcode that is used to identify the owner of the mail.
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USPS has instituted a verification procedure called a “tap” test. This test is used to screen all mailings with barcoded 

inserts for proper barcode spacing within the envelope window. When the insert showing through the window is 

moved to any of its limits inside the envelope, the entire barcode must remain within the barcode clear zone. In 

addition, a clear space must be maintained that is at least 0.125 inch between the barcode and the left and right edges 

of the window and at least 0.028 inch clearance between the Intelligent Mail Barcode and the top and bottom edges 

of the window.

All letters in a mailing must pass the “tap” test in order to obtain the maximum postal discounts for the agency. The 

contractor will be responsible for payment of any additional postage resulting from a loss of postage discounts due to 

failure to pass the “tap” test because of inaccuracy or failure to conform to USPS specifications.

The contractor should be aware that USPS uses the Mail Evaluation Readability Look-up Instrument (MERLIN) to 

evaluate barcodes. If MERLIN is in effect in the contractor’s geographic area, the contractor must ensure that all 

barcoded mail meets the new barcode standards. The contractor will be responsible for payment of any additional 

postage resulting from a loss of such discounts due to failure of the contractor-generated barcodes to pass the MERLIN 

test because of inaccuracy or failure to conform to USPS specifications.

The contractor is required to fill in all applicable items on USPS form(s) and submit in duplicate to the entry post 

office. The post office will return a verified copy of USPS form(s) to the contractor. The contractor must immediately 

forward a copy to the ordering agency identifying the Program Number, Print Order Number, Jacket Number, as 

appropriate.

Coding Accuracy Support System (CASS): SSA will provide a certificate for the addresses on this contract indicating 

that, within the last 180 calendar days, the addresses have been matched against USPS certified Coding Accuracy 

Support System certified ZIP Code software. New CASS certificates will be provided to the contractor as required 

by the USPS Domestic Mail Manual.

National Change of Address (NCOA): Addresses for MADCAP, MCS, TASTE, and TATTER notices come from 

SSA’s Master Beneficiary Record (MBR) database. SSA will provide the latest USPS National Change of Address 

certificate to the contractor throughout the duration of the contract as required by the USPS Domestic Mail Manual.

NCOA Certification for the SSA-L991: Addresses for the SSA-L991 notices come from SSA’s Supplemental 

Security Record (SSR) database. SSA does not provide an NCOA certificate for these addresses. The contractor is 

required to process the addresses for the SSA-L991 notices through USPS approved NCOA software and furnish 

USPS with the required NCOA certification to achieve the required postal discounts. The contractor is NOT to 

perform move updates, addresses that show an update through NCOA are to mail at a pre-sort or full postage rate.

The contractor is required to fill in all applicable items on USPS form(s) and submit in duplicate to the entry post 

office. The post office will return a verified copy of USPS form(s) to the contractor. The contractor must immediately 

forward a copy to the ordering agency identifying the Program Number, Print Order Number, Jacket Number, as 

appropriate.

Certified Mail: During the term of this contract, it is anticipated that SSA will require some of the mailers be sent 

certified or registered mail.

In the event that any of these notices are Special Notice Option (SNO), the mail pieces included in these mailings will 

be required to be mailed using USPS Certified Mail. The contractor will prepare these mail pieces according to USPS 

regulations contained in the Domestic Mail Manual (DMM) under section 503.3.0, Certified Mail. Notices associated 

with the certified mail file shall be inserted into envelopes and processed as certified mail. The contractor must place 

the current U.S. Postal Service 20-digit certified number and barcode on the envelope. The contractor must prepare 

the file as a separate permit imprint mailing of identical weight pieces using the appropriate U.S. Postal Service 

mailing statement. 
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International Mail: The mail pieces included in these mailings may be required to be mailed using USPS International 

Registered Mail. The contractor will prepare these mail pieces according to USPS regulations contained in the 

International Mail Manual (IMM) under Section 330, Registered Mail.

Notices associated with the registered mail file shall be inserted into envelopes and processed as international 

registered mail. The contractor must place the current Postal Service Form 3806 (Receipt for Registered Mail) and 

PS Label 200 (13-digit registered number and barcode) on the envelope. 

International First-Class Mail: All items mailed must conform to the appropriate USPS International Mail Manual, 

Postal Bulletins, and other USPS rules and regulations in effect at the time of mailing.

Permit Imprint is to be used for International Mail providing the mailing consists of at least 200 pieces. Permit imprint 

may not be used if the mailing is less than 200 pieces. Instead, the mail must be metered and any Permit Imprint must 

be covered/concealed by a meter strip. The contractor will be reimbursed for the metered postage by submitting a 

properly completed Postal Service form (or equivalent). All meter supplies must be borne by the contractor.

If the mailing meets the qualifications for International Priority Airmail (IPA), it must be processed through IPA in 

accordance with USPS rules and regulations in effect at the time of the mailing. Contractor must prepare mail pieces 

in accordance with the shape-based requirements of First-Class Mail International service listed in the USPS 

International Mail Manual and the additional requirements for IPA as specified in the most recent IMM. The contractor 

is required to sort the mail to achieve the maximum postage discounts available with the IPA program. To maximize 

postage savings, the contractor shall sort to the IPA Rate Group 1 through 15. Due to heightened security, many 

foreign postal administrations require complete sender and addressee information in roman letters and arabic numerals 

on postal items.

The complete address of the sender, including ZIP Code and country of origin, should be shown in the upper left 

corner of the address side of the envelope. International Mail return addresses must show as the last line of the 

address “UNITED STATES OF AMERICA,” or “USA,” all in upper-case letters. All International Mail must be 

endorsed “PAR AVION,” or “AIR MAIL,” as described in the USPS IMM. The contractor may use a rubber stamp

to meet these requirements.

NOTE: International mail cannot contain a presort endorsement. Again, mail addressed to United States possessions 

(e.g., American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands, Palua, 

Puerto Rico, Virgin Islands and Wake Island), and Military Overseas addresses (APO/FPO mail) is Domestic 

Mail, NOT International Mail.

Mailing Documentation: The contractor shall provide SSA with complete copies of all documents used by USPS to 

verify and accept the mail (e.g., computer records of presort ZIP+4, barcode breakdown, press runs, etc.) including 

USPS 3607R and/or GPO’s Form 712 (Certificate of Conformance) and/or Certificate of Bulk mailing, etc. Each 

document must be noted with file date and mailer number. 

The contractor must place the number that is on top of the GPO Form 712 (the number that starts with “A”) in the 

space provided on the USPS mailing statements. If no space is provided on the mailing statement, place the number 

in the upper right margin of the mailing statement. The contractor will also use SSA’s Federal Agency Cost Code 

number (276-00043) which must be placed on all mailing documents. All copies must be legible and include both 

obverse and reverse side.

USPS validated copies of postal documentation must be delivered to the SSA Division of Printing Management at the 

email address stated under “SCHEDULE.”

All expenses incidental to picking up and returning materials (as applicable), submitting and picking up proofs (as 

applicable), and furnishing sample copies must be borne by the contractor.
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SCHEDULE: Adherence to this schedule must be maintained. Contractor must not start production of any job prior 

to receipt of the individual task order or print order (GPO Form 2511), as applicable.

In the event that it becomes necessary for the contractor to deviate from the specified mail out date or the quantity to 

be mailed, SSA must be notified immediately.

When required, furnished material and hard copy proofs must be picked up from and delivered to: Social Security 

Administration, Attn: Kate Schmidt, 1369 Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401. 

If applicable, furnished manuscript copy and/or camera copy must be returned with hard copy proofs. 

When ordered, contractor to email PDF soft proof as instructed by SSA. 

If applicable, manuscript copy and/or camera copy, for forms, booklets, factsheets, leaflets, and envelopes will be 

provided at the postaward conference. If applicable, or electronic media will be furnished shortly after preaward 

conference.

The first task order for actual production will be issued in July.

Proof Schedule:

The following schedules begin the workday after receipt of furnished material. The workday after receipt will be the 

first workday of the schedule.

Hard Copy Proofs (for initial startup and anytime a change is made throughout the term of the contract) –

 When ordered, contractor must submit all required proofs for forms, booklets, factsheets, leaflets, and all 

envelopes within seven (7) workdays of receipt of furnished materials. 

 Proofs will be withheld no more than five (5) workdays from their receipt at the ordering agency until they 

are made available for pickup. (NOTE: The first workday after receipt of proofs at the ordering agency is 

day one (1) of the hold time.)

 Submit revised proofs, if necessary due to author’s alterations, within five (5) workdays after receipt of 

furnished material.

 NOTE: If required, due to author’s alterations, the contractor must submit a revised proofs within five (5) 

workdays of receipt of reviewed proofs. Proofs will be withheld no more than three (3) workdays from their 

receipt at the ordering agency. (NOTE: The first workday after receipt of proofs at the ordering agency is 

day one (1) of the hold time.) 

PDF Soft Proofs (for initial startup and anytime a change is made throughout the term of the contract) –

 When ordered, contractor must submit all required PDF soft proofs within two (2) workdays of receipt of 

furnished materials.

 PDF soft proofs will be withheld no more than two (2) workdays from receipt at the ordering agency until 

changes/corrections/“O.K. to Print” is furnished via email. (NOTE: the first workday after receipt of proofs 

at the ordering agency is day one (1) of the hold time.)
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Preproduction Test Schedules:

Prior to receiving transmission of live production data files, the contractor will be required to perform the following 

tests: (The transmission test will begin after the Government is notified of the availability of the system.)

In order for proper arrangements to be made, notification must be given at least three (3) workdays prior to all tests. 

NOTE: Failure of the contractor to perform any of the below tests satisfactorily may be cause for default. The 

Government reserves the right to waive the requirements of these tests. The contractor will be notified at the Post 

Award Conference if any test(s) will be waived.

Transmission Test:

 This test is to be performed after the contract is awarded and the process is ready. The Government will notify 

the contractor when the test will be performed.

 The contractor will be required to receive 175,750 notices within one (1) workday.

 The contractor will be required to perform a record count verification and perform the CASS certification the 

same workday as receipt of the complete transmission of the test files and must provide SSA with the exact 

counts and the CASS certification.

 SSA will respond within one (1) workday of receipt thereof.

Preproduction Validation Test:

 Within five (5) workdays of receipt of test files and prior to the Preproduction Press and Mail Run test, the 

contractor is required to perform a Preproduction Validation Test. 

 The contractor must furnish a total of 500 printed samples of the notices (50 sample notices from each mailer 

including at least five (5) samples from each PC) and 25 samples of the payment stub.

 The Government will approve, conditionally approve or disapprove the samples from the Preproduction 

Validation Test within five (5) workdays of receipt thereof.

Preproduction Press and Mail Run Test: 

 Within five (5) workdays of final Government approval of preproduction validation test samples and 

contractor’s receipt of necessary materials to perform the test (inserts and envelopes), the Government will 

work with the contractor to select a date to perform the 12-hour preproduction press and mail run test. 

The test shall occur during the regular work week of Monday through Friday (excluding holidays).

 The contractor must produce a minimum of 87,875 notices in a continuous 12-hour period.

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

of receipt.
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Systems Change/Signature Change/New Notice Files Validation Test:

 When required, the contractor will furnish up to 50 printed samples (no envelopes or inserts/enclosures) within 

three (3) workdays of receipt of test files.

 The Government will approve, conditionally approve, or disapprove the samples within five (5) workdays of 

receipt thereof.

Production Schedule:

Contractor must not proceed with processing a transmission until counts are verified against the task order. If a 

discrepancy is found, the contractor must call SSA’s Scheduling Helpline immediately at 410-966-5469.

Workday – The term “workday” is defined as Monday through Friday each week, excluding of the days on which 

Federal Government holidays are observed. Also excluded are those days on which the Government Publishing Office 

is not open for the transaction of business, such days of national mourning, hazardous weather, etc.

Federal Government Holidays are as follows: New Year’s Day, Martin Luther King’s Birthday, President’s Day, 

Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, and Christmas Day.

The contractor’s FTMS software must be operational for the receipt of data files 24 hours a day, seven (7) days a 

week, unless otherwise specified by the Government. (See “TRANSMISSIONS” for additional information).

Live production files will be transmitted on a daily basis Tuesday through Saturday for the MADCAP, MCS, SSAL991, and TATTER notices. Live production files for TASTE notices transmit monthly. In the event of Federal 

holidays, the files will transmit on the Federal holiday but will not transmit the day after the holiday. For example, on 

Thanksgiving files will transmit on Thursday. Files will not transmit on Friday. Files will resume transmission on 

Saturday. 

MADCAP Notices (Mailers 1 and 2): Complete production and mailing must be made for all daily MADCAP notices 

within two (2) workdays of receipt of each complete wire transmission (e.g., transmissions received on Tuesday must 

be mailed by close of business Thursday; transmissions received on Saturday must be mailed by close of business 

Tuesday). 

MCS (Mailers 3 and 4): Complete production and mailing must be made within three (3) workdays of receipt of each 

complete wire transmission (e.g., transmissions received on Tuesday must be mailed by the close of business Friday;

transmissions received on Saturday must be mailed by the close of business Wednesday).

SSA-L991 Notices (Mailer 5): Complete production and mailing must be made for all daily SSA-L991 notices within 

three (3) workdays of receipt of each complete transmission (e.g., transmissions received on Tuesday must be mailed 

by close of business Friday; transmissions received on Saturday must be mailed by close of business Wednesday). 

TASTE (Mailers 6, 7, and 8): Complete production and mailing must be made within five (5) workdays of receipt of 

each complete transmission (e.g., transmissions received on Tuesday must be mailed by the close of business the 

following Tuesday; transmissions received on Saturday must be mailed by the close of business Friday).

TATTER (Mailers 9 and 10): Complete production and mailing must be made within five (5) workdays of receipt of 

each complete transmission (e.g., transmissions received on Tuesday must be mailed by the close of business the 

following Tuesday; transmissions received on Saturday must be mailed by the close of business Friday).

Mailing Documentation and Summary Reports: A PDF copy of the summary report(s) and matching USPS 

Certificate of Bulk Mailing, USPS 3607R, and/or GPO 712 form(s) must be submitted to Kathryn.Schmidt@ssa.gov 

for each file date within two (2) workdays of mailing. All copies must be legible and include both obverse and reverse 

side.
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 56 of 63

45-S (06/20)

Invoices: One copy of the invoice for each print order must be emailed within five (5) workdays of the last mailing 

date of the print order to Kathryn.Schmidt@ssa.gov. The invoice must be itemized in accordance with the items in 

the “SCHEDULE OF PRICES.” For more information on the invoicing process, refer to information under 

“PAYMENT.”

Quality Control Samples: Each box of quality control samples should contain the samples for a particular print order 

in a separate box. The contractor must ship the quality control samples each week within two (2) workdays of the 

last mailing date of the print order.

PRESS SHEET AND PRODUCTION INSPECTIONS: The contractor must notify the SSA and GPO of the date

and time of the press sheet inspection or production inspection at least three (3) workdays prior to the inspection(s) 

to allow time to make proper travel arrangements. Notify Kate Schmidt via email at Kathryn.Schmidt@ssa.gov and 

the U.S. Government Publishing Office, Quality Control for Published Products, 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 in GPO Contract

Terms (GPO Publication 310.2, effective December 1, 1987 (Rev. 1-18)). When supplies are not ready at the time 

specified by the contractor for inspection, the Contracting Officer may charge to the contractor the additional cost of

the inspection.

NOTE: If the backup facility is used for the production of these notices, the Government will require a press sheet 

inspection. Notification must be given at least three (3) workdays in advance of production start-up.

The ship/deliver date indicated on the print order is the date products ordered for delivery f.o.b. destination must be 

delivered to the destination(s) specified, and products ordered for mailing f.o.b. contractor’s city must be delivered to 

the post office. 

Unscheduled material such as shipping documents, receipts or instructions, delivery lists, and labels will be furnished

with the order or shortly thereafter. In the event such information is not received in due time, the contractor will

not be relieved of any responsibility in meeting the shipping schedule because of failure to request such information.

For compliance reporting purposes, the contractor must notify the U.S. Government Publishing Office of the date of 

shipment or delivery, as applicable. Upon completion of each order, contractor must contact the Shared Support 

Services Compliance Section via email at compliance@gpo.gov; via telephone at (202) 512-0520; or via facsimile at 

(202) 512-1364. Personnel receiving email, call, or facsimile will be unable to respond to questions of a technical 

nature or to transfer any inquiries. 
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 57 of 63

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SECTION 3. - DETERMINATION OF AWARD

The Government will determine the lowest bid by applying the prices offered in the “SCHEDULE OF PRICES” to 

the following units of production which are the estimated requirements to produce the one (1) year’s production under 

this contract. These units do not constitute, nor are they to be construed as, a guarantee of the volume of work which 

may be ordered under this contract for a like period of time.

The following item designations correspond to those listed in the “SCHEDULE OF PRICES.”

I. 22

II. (a) 320

(b) 320

(c) 42

III. 10

IV. (a) 1

(b) 1

V. (a) 250

(b) 23,400

(c) 92

(d) 160

(e) 28

(f) 5,291

(g) 29

(h) 30

(i) 863

(j) 108

(k) 3

(l) 160

(m) 152

(n) 93

(o) 1,100

(p) 1,000

(q) 8,700

VI. (a) 23,400

(b) 92

(c) 160

(d) 539

(e) 81,943

(f) 29

 (g) 30

(h) 863

(i) 108

(j) 3
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 58 of 63

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VI. (k) 160

(l) 152

(m) 93

(n) 1,100

(o) 1,000

(p) 8,700

VII. 850

VIII. (a) 1,455

(b) 45

(c) 6,700

(d) 300

(e) 1,100

(f) 40

(g) 485

(h) 475

(i) 155

(j) 45
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 59 of 63

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SECTION 4. - SCHEDULE OF PRICES

Bids offered are f.o.b. destination for deliveries and f.o.b. contractor’s city for all mailing.

Bidder must make an entry in each of the spaces provided. Bids submitted with any obliteration, revision, or alteration 

of the order and manner of submitting bids, may be declared nonresponsive.

An entry of NC (No Charge) shall be entered if bidder intends to furnish individual items at no charge to the 

Government.

Bids submitted with NB (No Bid), NA (Not Applicable), or blank spaces for an item may be declared nonresponsive.

The Contracting Officer reserves the right to reject any offer that contains prices for individual items of production 

(whether or not such items are included in the Determination of Award) that are inconsistent or unrealistic in regard 

to other prices in the same offer or to GPO prices for the same operation if such action would be in the best interest of 

the Government.

All billing invoices submitted to the GPO shall be based on the most economical method of production. Fractional 

parts of 1,000 will be prorated at the per-1,000 rate. 

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

Saddle-Stitched Booklets: Unless otherwise specified, no more than three (3) blank pages shall be permitted at the end 

of the text.

Cost of all required paper must be charged under Item VI. “PAPER.”

I. COMPOSITION: Prices offered must be all-inclusive, and must include the cost of all operations required in 

accordance with the terms of these specifications for each of the 22 envelopes.

Envelopes......................................................................................................... per envelope ..... $___________

II. PROOFS: Booklets, Forms, Factsheets, Leaflets, and Envelopes

(a) Color content proofs...................................................................per trim/page-size unit ..... $___________

(b) Ink jet color proofs......................................................................per trim/page-size unit ..... $___________ 

(c) PDF proofs....................................................................................................... per proof ..... $___________

III. PROCESSING/FORMATTING FILES: The contractor will be allowed only one (1) charge per notice 

workload for the term of the contract to process and/or format the AFP files, AFP resources and the Mail Run 

Data Files supplied necessary to print and mail the notices for each notice workload.

Processing/Formatting Files..................................................................per/notice workload ..... $___________

_____________

 (Initials)
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 60 of 63

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IV. PREPRODUCTION TESTS: Price offered must include all costs incurred in performing the tests as 

specified in these specifications. These costs shall cover but are not limited to: machine time, personnel, all 

required materials, transmissions, electronic prepress, plates, paper, printing, imaging, collating, inserting, mail

preparation, and any other operations necessary to produce the required quantities of the product in the time 

specified and in accordance with the specifications.

(a) Transmission Test................................................................................................................. $___________

(b) Preproduction Validation Test.............................................................................................. $___________

V. PRINTING/IMAGING, BINDING, AND CONSTRUCTION: Prices offered must be all-inclusive and include 

the cost of all materials and operations necessary (except paper) for the complete production of the product listed 

in accordance with these specifications.

(a) *Daily makeready/setup charge................................................................................................$__________

*Contractor will be allowed only one (1) makeready/setup charge per day. This combined charge shall include 

all materials and operations necessary to makeready and/or setup the contractor’s equipment for the 10 mailers. 

Contractor cannot submit invoices with more than one makeready/setup charge per day.

(b) Notices: 

Printing and imaging in black only, including binding.........................per 1,000 leaves..... $___________

(c) Form CMS-2690: 

Printing face and back in black ink, including binding ........................ per 1,000 forms..... $___________

(d) Form SSA-3105:

Printing face and back in black ink, including binding ........................ per 1,000 forms..... $___________

(e) Saddle-Stitched Booklet (3-1/2 x 8”):

Printing in two ink colors, including binding ....................per 1,000 complete booklets..... $___________

(f) Saddle-Stitched Booklet (5-1/4 x 8”):

Printing in two ink colors, including binding ....................per 1,000 complete booklets..... $___________

(g) Factsheet (8-1/2 x 11”):

Printing face and back in two ink colors, including binding ..........per 1,000 factsheets..... $___________

(h) Leaflet (10-1/2 x 8”): 

Printing face and back in two ink colors, including binding .............. per 1,000 leaflets..... $___________

(i) Leaflet (14 x 8”):

Printing face and back in two ink colors, including binding .............. per 1,000 leaflets..... $___________

(j) Leaflet (17-1/2 x 8”):

Printing face and back in two ink colors, including binding .............. per 1,000 leaflets..... $___________

(k) Leaflet (21 x 8”):

 Printing face and back in two ink colors, including binding............... per 1,000 leaflets .... $___________

_____________

 (Initials)
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 61 of 63

45-S (06/20)

(l) Green BRM Envelope (3-7/8 x 8-7/8”):

Printing in black ink, including construction..................................per 1,000 envelopes..... $___________

(m) White BRM Window Envelope (3-7/8 x 8-11/16”):

Printing in black ink, including construction..................................per 1,000 envelopes..... $___________

(n) CRM Envelope (3-7/8 x 8-7/8”):

Printing in black ink, including construction..................................per 1,000 envelopes..... $___________

(o) Mailout Envelope (4-1/8 x 9-1/4”):

Printing in black ink, including construction..................................per 1,000 envelopes..... $___________

(p) Mailout Envelope (4-1/8 x 9-1/2”):

Printing in black ink, including construction..................................per 1,000 envelopes..... $___________

(q) Mailout Envelope (6-1/8 x 9-1/2”):

Printing in black ink, including construction..................................per 1,000 envelopes..... $___________

VI. PAPER: Payment for all paper supplied by the contractor under the terms of these specifications, as ordered on 

the individual print order/task order, will be based on the net number of leaves furnished for the product(s) ordered. 

The cost of any paper required for makeready or running spoilage must be included in the prices offered.

Computation of the net number of leaves will be based on the following:

Notices – Each page-size leaf.

Forms – Each page-size leaf.

Booklets – Each page-size leaf.

Factsheets – Each page-size leaf.

Leaflets – Each page-size leaf.

Envelopes – Each envelope.

Per 1,000 Leaves

(a) Notice (8-1/2 x 11”): White Offset Book (50-lb.) ............................................................... $___________

(b) Form CMS-2690 (8-1/2 x 3-1/2”): Yellow Index (90-lb.)................................................... $___________

(c) Form SSA-3105 (10-1/2 x 8”): White Writing (20-lb.)....................................................... $___________

(d) Booklet (3-1/2 x 8”): White Offset Book (60-lb.) ............................................................... $___________

(e) Booklet (5-1/4 x 8”): White Offset Book (60-lb.) ............................................................... $___________

(f) Factsheet (8-1/2 x 11”): White Offset Book (60-lb.)........................................................... $___________

(g) Leaflet (10-1/2 x 8”): White Offset Book (60-lb.)............................................................... $___________

(h) Leaflet (14 x 8”): White Offset Book (60-lb.)..................................................................... $___________

_____________

 (Initials)
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 62 of 63

45-S (06/20)

Per 1,000 Leaves

(i) Leaflet (17-1/2 x 8”): White Offset Book (60-lb.)................................................................ $___________

(j) Leaflet (21 x 8”): White Offset Book (60-lb.)..................................................................... $___________

(k) Green BRM Envelope (3-7/8 x 8-7/8”): Green Writing (20-lb.)......................................... $___________

(l) White BRM Window Envelope (3-7/8 x 8-11/16”): White Wove (24-lb.) ......................... $___________

(m) CRM Envelope (3-7/8 x 8-7/8”): White Writing (20-lb.)..................................................... $___________

(n) Mailout Envelope (4-1/8 x 9-1/4”): White Wove (24-lb.)................................................... $___________

(o) Mailout Envelope (4-1/8 x 9-1/2”): White Wove (24-lb.)................................................... $___________

(p) Mailout Envelope (6-1/8 x 9-1/2”): White Wove (24-lb.)................................................... $___________

VII. ADDITIONAL OPERATIONS:

Destruction of outdated stock ....................................................................per 1,000 pieces..... $___________

VII. INSERTING AND MAILING: Prices offered must include the cost of all required materials and operations 

necessary for the mailing of the notice including cost of inserting the collated and folded notice (single or multiple 

leaves), and appropriate inserts as required (i.e., form(s), pamphlet(s), leaflet(s) and BRM/CRM envelope(s)), 

into mailout envelope and mailing in accordance with these specifications.

(a) Mailer 1............................................................................... per 1,000 complete mailers..... $___________

(b) Mailer 2............................................................................... per 1,000 complete mailers .... $___________

(c) Mailer 3............................................................................... per 1,000 complete mailers .... $___________

(d) Mailer 4............................................................................... per 1,000 complete mailers .... $___________

(e) Mailer 5............................................................................... per 1,000 complete mailers .... $___________

(f) Mailer 6............................................................................... per 1,000 complete mailers .... $___________

(g) Mailer 7............................................................................... per 1,000 complete mailers .... $___________

 

(h) Mailer 8............................................................................... per 1,000 complete mailers .... $___________

(i) Mailer 9............................................................................... per 1,000 complete mailers .... $___________

(j) Mailer 10............................................................................. per 1,000 complete mailers .... $___________

_____________

 (Initials)
MADCAP, MCS, SSA-L991, TASTE and TATTER NOTICES Page 63 of 63

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LOCATION OF POST OFFICE: All mailing will be made from the __________________________________

Post Office located at Street Address _____________________________________________________________,

City_____________________________, State___________________________, Zip Code __________________

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.

NOTE: Failure to provide a 60-day bid acceptance period may result in expiration of the bid prior to award.

BIDDER’S NAME AND SIGNATURE: Unless specific written exception is taken, the bidder, by signing and 

submitting a bid, agrees with and accepts responsibility for all certifications and representations as required by the 

solicitation and GPO Contract Terms - Publication 310.2. When responding by fax or mail, fill out and return one 

copy of all pages in “SECTION 4. – SCHEDULE OF PRICES,” including initialing/signing where indicated.

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
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 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

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 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

Contractor Employee Date 

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

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 B
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	1	

EXHIBIT B 

SSA External Service Provider Security Requirements 

DSPP Home 

All External Service Providers (ESP) are subject to the following security requirements: 

 All ESPs are subjected to SSA’s Security Authorization Process, which will entail 

security testing and evaluation of the in-place security controls. For more 

information see NIST SP 800-37, Revision 1. 

 ESPs must follow NIST SP 800-53 Revision 4 Recommended Security Controls 

for Federal Information Systems and Organizations for protecting Low or 

Moderate impact level information as categorized by FIPS 199 for the information 

system. Note: Systems that contain Personally Identifiable Information (PII) are 

considered “Moderate”. 

 ESPs must document all deployed (applicable) and planned controls for an 

information system in a System Security Plan that is in NIST-compliant format. 

Refer to NIST SP 800-18. 

 ESPs classified as Cloud Service Providers (CSP) must adhere to additional 

FedRAMP security control requirements. Further information may be found at: 

http://www.gsa.gov/portal/category/102371. As part of these requirements CSPs must 

have a security control assessment performed by a Third Party Assessment 

Organization (3PAO). 

 Upon request from SSA, the ESP shall provide the following network security 

information and documentation for review and audit purposes: 

 All information security control artifacts required to support the Security 

Assessment and Authorization (SA&A) process. 

 Intrusion Detection Systems (IDS) configuration. 

 Network firewall configuration. 

 Server and network device patching schedules and compliance. 

 Server, network device, and security logs. 

 Detailed hardware inventory including servers, network devices, and 

storage. 

ESPs are required to adhere to NIST 800-53 Rev.4 security control framework based on 

their assigned categorization. The following sections outline additional security controls 

and SSA organizational defined parameters for NIST 800-53, Rev 4. Security 

requirements below are applicable to low and moderately categorized systems unless 

otherwise designated. For additional information or supplement guidance for these 

controls, refer Appendix F of NIST 800-53, Rev 4. 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	2	

Account Management Requirements 

The purpose of the following is to address requirements for account and session 

management for External Service Providers (ESPs). 

SSA Additional Requirements for ESPs:

 AC-2 ESPs must employ individual account types on external service provider 

systems. The use of group, anonymous or temporary accounts is strictly 

prohibited. 

 AC-2 ESPs must demonstrate the implementation of an approval process that 

describes how system accounts are created, deleted, disabled, or modified. The 

process should account for roles in the system and the appropriate 

authorizations to grant access. Public-facing systems may use a registration 

process in place of the approval process.

 AC-2(3) A deactivation process is required to manage inactive accounts. The 

process must describe how the system identifies and deactivates inactive 

accounts that have not been in use for 90 days or more. ESPs must 

automatically disable inactive accounts after 90 days and then remove these 

disabled accounts after 1 year. 

 AC-2(4) ESPs must provide the capability to produce a record of all account 

management activities that occur on the system and develop an automated 

method to submit these records in the form of a report to SSA. 

 AC-6 ESP administrator accounts and privileged user accounts must be 

customized to only allow access to specific roles and functions on the system. 

ESP must provide a list of these functions to the Contract Officer Technical 

Representative (COTR). (Moderate and High categorized systems only).

 AC-7 ESPs must enforce a limit of 3 consecutive invalid login attempts by a user 

during a 20 minute time frame and automatically lock the account/node for 30 

minutes when the maximum number of unsuccessful attempts is exceeded. The 

account shall remain locked for 30 minutes. (Moderate and High categorized 

systems only).

 AC-8 ESPs providing services to SSA internal users must display the internally 

used and approved warning banner. 

 The SSA internal banner is as follows: 

 Only authorized users can access the system. 

 The system is a U.S. Government computer system subject to 

Federal law. 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	3	

 Unauthorized attempts to access or modify any part of SSA’s 

systems are prohibited and subject to disciplinary, civil action or 

criminal prosecution. 

If the system is serving the general public as its user base, the system must 

display a warning banner containing language that is appropriate to the 

application. The SSA COTR must approve the public warning banner language 

prior to implementation. 

 AC-11 ESPs must enforce termination of user sessions after 30 minutes of 

inactivity. Users must authenticate again after sessions are terminated in order 

to continue using the application. (Moderate and High categorized systems only).

 AC-17(4) ESPs must restrict remote access to approved administrative functions 

and accounts. 

Auditing Requirements 

The purpose of the following is to address requirements for auditing for External 

Service Providers (ESPs). 

SSA Additional Requirements for ESPs:

 (AU-2) ESPs must maintain an audit log of transactions create, modify, or delete 

SSA information. 

 (AU-2) ESPs must maintain an audit log of the following events: Logon/logoff 

events, account management, privilege or role changes, and administrator 

activity. 

 (AU-5) ESPs must report any failure of audit processing that occurs to the SSA 

COTR within 24 hours. 

 (AU-6) ESPs must review and analyze information system audit record for 

indications of inappropriate or unusual activity and report those findings to SSA 

COTR within 24 hours. ESPs must support monitoring and review of the system 

for unusual or inappropriate activity daily. This activity must be provided to the 

COTR immediately for review. 

 (AU-6) ESPs must provide user and transaction log reports to SSA when 

requested. 

 (AU-7(1)) ESPs must allow for scoping of audit criteria for efficient reporting 

capability.

 (AU-11) ESPs must retain online audit logs for 90 days. 

 (AU-11) ESPs must retain audit records for seven (7) years. 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	4	

Awareness and Training Requirements 

The purpose of the following is to address requirements for awareness and training for 

External Service Providers (ESPs). 

SSA Additional Requirements for ESPs:

 (AT-2) ESP contractors and their employees or sub-contractors must complete 

SSA provided security awareness training at least annually. 

 (AT-3) ESPs must provide role based training to all employees who fulfill special 

roles or duties in regards to SSA data or systems. 

 (AT-4) ESPs must retain and produce records of role based training completions 

for 3 years. 

Configuration Management Requirements 

The purpose of the following is to address requirements for configuration 

management for External Service Providers. 

SSA Additional Requirements for ESPs:

 (CM-2(3)) ESPs must define and deploy an approved device configuration on 

each device used to provide services to SSA at least annually. 

 CM-6 ESPs must periodically scan the device configuration of each device used 

to provide services to SSA and identify deviations from the approved device 

configuration. Deviations shall be logged and corrected within 24 hours. The 

ESP shall submit device scan reports to SSA upon request. 

 CM-8 ESPs must maintain an inventory all IT assets that store, process, or 

transmit SSA data and provide to SSA upon request. 

 CM-9 The contractor shall maintain a configuration management plan that 

addresses the roles, responsibilities, processes, and procedures to manage 

inventory throughout the lifecycle. 

Contingency Planning Requirements 

The purpose of the following is to address requirements for contingency planning for 

External Service Providers. 

SSA Additional Requirements for ESPs: 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	5	

 (CP-2) ESP must submit a contingency plan that will support and meet the SSA 

supplied recovery objectives and must be maintained, reviewed and, if necessary 

updated at least annually. 

 (CP-9) ESPs must encrypt all Media used for backup and archiving purposes 

using Federal Information Processing Standard (FIPS) 140-2 compliant 

solutions. (Moderate and High categorized systems only).

Identification and Authentication Requirements 

The purpose of the following is to address requirements for identification and 

authentication for External Service Providers (ESPs). 

SSA Additional Requirements for ESPs: 

 (IA-2(12)) Identity, Authorization and Access Management (IdAAM) - The 

External Service Providers must seamlessly integrate with the SSA’s Federation 

Service. This service is based on oAuth and SAML (Security Assertion Markup 

Language) 2.0 standards and enables SSA to meet its two factor authentication 

requirements as specified in Homeland Security Presidential Directive (HSPD)-

12, dated August 12, 2004. This service enables SSA to leverage an internal 

Microsoft’s Active Directory to create a single SSA-Wide directory of all users. 

Currently, SSA users are required to authenticate using their SSA HSPD-12 PIV 

Smart Card at the workstation. In certain acceptable instances, users can revert 

to user name and password, while the Department is transitioning to HSPD-12 

PIV Smart Card Authentication. The External Service Providers must support 

both authentications methods. 

 (IA-6) ESPs must mask all fields on a system that has a logon screen that 

requires credentials, to prevent unauthorized exposure. 

 (IA-7) The ESP must encrypt credentials used for e-authentication. The 

encryption solution must be compliant with FIPS 140-2. (Moderate and High 

categorized systems only).

Incident Response Requirements 

The purpose of the following is to address requirements for incident response for 

External Service Providers. 

SSA Additional Requirements for ESPs: 

 (IR-6) ESPs will receive the incident response capability timeframe and reporting 

requirements from the SSA COTR. 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	6	

 (IR-6) ESPs Incident Response plan must require all security incidents of US 

CERT categories 1,2,3,4 and 6 must be reported to SSA COTR. 

 (IR-7) ESPs are responsible for notifying the appropriate SSA COTR when there 

is a security incident that has been categorized 1,2,3,4 or 6 per US CERT 

regulations. The COTR is authorized to issue orders to take down external 

systems or components to perform IR, forensics, further loss of data, etc. 

Maintenance Requirements 

The purpose of the following is to address requirements for maintenance for External 

Service Providers. 

SSA Additional Requirements for ESPs: 

 (MA-2) ESP must retain records of maintenance activities performed on IT 

devices used to provide services to SSA. Maintenance activity logs must be 

made available upon request. 

 (MA-2) IT equipment and media used to provide services to SSA must be 

sanitized prior to removal from the ESP’s facility for maintenance or disposal 

purposes. The ESP must maintain a log as evidence that the IT equipment or 

media was sanitized prior to removal. Logs must be made available upon 

request. Refer to NIST SP 800-88 for more information on media sanitization. 

Media Protection Requirements 

The purpose of the following is to address requirements for media protection for 

External Service Providers. 

SSA Additional Requirements for ESPs: 

 (MP-2) Removable media used to store SSA data must be encrypted using a 

FIPS 140-2 compliant encryption solution. 

 (MP-3) ESP must label or mark (human readable) all media containing PII or 

other sensitive SSA data as “SSA Confidential Unclassified Information”. 

(Moderate and High categorized systems only).

 (MP-4) ESP must have a documented process describing how IT equipment and 

media are controlled to ensure the security and confidentiality of SSA data. 

 (MP-5) ESP must maintain chain of custody for IT equipment and media during 

transport outside of controlled-access facilities. Transport of media outside of 

controlled areas must be performed by authorized personnel. 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	7	

Planning Requirements 

The purpose of the following is to address requirements for the planning for External 

Service Providers (ESPs). 

SSA Additional Requirements for ESPs: 

 (PL-2) ESP must develop a System Security Plan (SSP) compliant with SP SP 

800-18. The SSP shall be submitted to the SSA COTR. 

 (PL-2) ESP must conduct an annual security review of the solution used to 

provide services to SSA. The System Security Plan (SSP) must be updated to 

reflect changes affecting the security of SSA data. 

 (PL-4) The SSA COTR will provide the SSA Rules of Behavior (within the SSA 

Information System Security Handbook) for ESP systems that support internal 

users providing services to SSA. The rules of behavior ensure users are familiar 

with information security, privacy, and confidentiality practices. 

Risk Assessment Requirements 

The purpose of the following is to address requirements for risk assessment for 

External Service Providers (ESPs). 

SSA Additional Requirements for ESPs: 

 (RA-3) ESPs shall conduct a risk assessment to assess the risk and magnitude 

of harm that could result from the unauthorized access, use, disclosure, 

disruption, modification, or destruction of sensitive SSA information. The risk 

assessment should be reviewed annually and updated every three years or when 

a significant change occurs. 

 (RA-5) ESP must scan IT equipment used to provide services to SSA for security 

vulnerabilities at least monthly. The contractor must use a commercially 

available scanning tool. The scanning must include vulnerabilities identified in 

DHS national vulnerability database. Vulnerability scan reports must be retained 

for 12 months and submitted to the SSA COTR upon request. 

Security Assessments and Authorization Requirements 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	8	

The purpose of the following is to address requirements for security assessments and 

authorization for External Service Providers (ESPs). 

SSA Additional Requirements for ESPs: 

 (CA-2) ESPs must develop an assessment plan that includes: 

o Annual assessment of a subset of controls 

o Triennial comprehensive assessment (full scope) 

o Assessments as needed when a significant change occurs on the system. 

 (CA-2) ESP and COTR must define what a significant change is and require a 

new assessment whenever a significant change occurs. Significant change is 

defined in NIST Special Publication 800-37 Revision 1, Appendix F. 

 (CA-3) The contractor shall document in the SSA security plan, all connections to 

contractor resources made to external information systems, and applications. 

Examples of connections would include: connections to subcontractor sites, 

connections used for remote administration, connections made to contractor’s 

company/corporate networks, etc. These connections shall be reviewed and 

monitored on an ongoing basis, at least annually to determine the need for 

ongoing use by the contractor management. (Moderately categorized systems 

only).

 (CA-5) For any security reports issued to the contractor, including internal 

independent reviews, the contractor is responsible for developing a POA&M that 

identifies corrective actions and/or mitigating controls for any identified 

vulnerabilities. Contractors shall report to COTR POA&M progress at least 

monthly. In addition, the contractor must provide artifacts to update POA&M 

items at least 7 days prior to milestone completion date to ensure SSA has 

sufficient time to review. 

 (CA-7) ESP must monitoring the effectiveness of its security controls on a 

continual basis and take appropriate corrective actions as necessary to ensure 

SSA data is protected from unauthorized access, modification or disclosure. 

System and Communication Requirements 

The purpose of the following is to address requirements for system and 

communications for External Service Providers (ESPs). 

SSA Additional Requirements for ESPs: 

 (SC-4) ESP must logically or physically segregate SSA data from that of other 

customer if a multi-tenant environment is used to provide services to SSA. 

(Moderate and High categorized systems only).
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	9	

 (SC-7(1)) ESPs shall physically allocate publicly accessible information system 

components to separate subnetworks with separate physical network interfaces. 

 (SC-7(4)) ESPs must provide traffic flow policy for each managed interface to 

SSA COTR for review and approval prior to implementation. 

 (SC-8) ESP must encrypt PII and other sensitive SSA data when stored on 

persistent storage devices, or when transmitted over approved system 

interconnections, using a FIPS 140-2 compliant encryption solution (Moderate 

and High categorized systems only).

 (SC-10) ESPs must terminate user sessions automatically after 15 minutes of 

inactivity. (Moderate and High categorized systems only).

 (SC-15) ESPs use of collaborative computing devices (e.g., networked 

whiteboards, cameras, and microphones) on systems hosting /processing/ shall 

have their remote activation capability removed/disabled. 

 (SC-17) For all ESPs, who manage information systems, the information system 

shall utilize automated mechanisms with supporting procedures in place for 

digital certificate generation, installation, and distribution. Subscriber key pairs 

are generated and stored using FIPS 140-2 Security Level 2 or higher 

cryptographic modules. The same public/private key pair is not to be used for 

both encryption and digital signature. Private keys are protected using, at a 

minimum, a strong password. A certificate is revoked if the associated private 

key is compromised; management requests revocation; or the certificate is no 

longer needed. (Moderate and High categorized systems only).

 (SC-18) Mobile code is software that is executed from a host machine to run 

scripts on a client machine, including animation scripts, movies, etc. Mobile code 

is a powerful computing tool that can introduce risks to the user’s information 

system. Whenever an ESP is developing or deploying the mobile code 

technology, this shall be identified in the ESP’s security plan to SSA. Contractors, 

who use mobile code, shall be subject to a source code review by SSA personnel 

to ensure that there is no potential risk in introducing malicious code into the 

contractor/user’s environment. (Moderate and High categorized systems only).

Personnel Security Requirements 

The purpose of the following is to address requirements for personnel security for 

External Service Providers. 

SSA Additional Requirements for ESPs: 

 (PS-4) ESP must terminate employee and sub-contractor access to the solution 

used to provide services to SSA immediately upon reassignment or separation. 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	10	

 (PS-6) ESP personnel who are granted access to IT equipment, media or data 

used to provide services to SSA must agree and sign a non-disclosure 

agreement prohibiting unauthorized disclosure of SSA data encountered in the 

performance of their duties. 

 (PS-7) ESP sub-contractors are bound to the same security requirements as 

employees. 

 (PS-8) ESP must inform the SSA project officer of any violation of security 

requirements within 24 hours. 

System and Information Integrity Requirements 

The purpose of the following is to address requirements for system and information 

integrity for External Service Providers. 

SSA Additional Requirements for ESPs: 

 (S1-2) ESPs will remediate discovered flaws in the information system according 

to a process that is approved by the COTR. 

 (SI-3) ESP must submit alerts on malicious code detection and actions 

performed on malicious code to the SSA COTR for review. 

 (SI-4) The ESP shall employ tools and techniques to monitor events on the 

information system to detect attacks, vulnerabilities, and detect, deter, and report 

on unauthorized use of the information system. Whenever there is an elevated 

security level, the monitoring efforts shall be increased as necessary to enable 

deterrence, detection, and reporting to take place so that corrective actions shall 

be made to the networked environment. 

 (SI-5) ESPs must receive advisories (from US CERT) on a regular basis and take 

appropriate actions as necessary. 

 (SI-11) The information system shall identify security relevant error conditions 

and handle error conditions in an expeditious manner. (Moderately and High 

categorized systems only). 

Government Access Requirements (FedRAMP) 

To the extent required to carry out a program of inspection to safeguard against threats 

and hazards to the security, confidentiality, integrity, availability, and reliability of any 

non-public government data collected and stored by the Offeror, the Offeror shall afford 

the government access to the Offeror’s facilities, installations, technical capabilities, 
Resource	Page:	SSA	External	Service	Provider	Security	Guidance	 Page	11	

operations, documentation, records and databases. The Provider shall also identify how 

the following compliance, oversight and law enforcement objectives can be effectively 

and efficiently conducted by SSA in the event such activity is deemed by SSA to be 

appropriate and necessary relative to the facilities, installations, operations, 

documentation, databases, IT systems, devices, and personnel used in performance of 

the contract, regardless of the location: 

 Audits; 

 Inspections; 

 Evaluations; 

 Investigations; 

 Continuous monitoring of the security posture and continued effectiveness of 

management, operational and technical controls (including IT asset and device 

discovery, inventory and security configurations); 

 Penetration testing; and 

 Vulnerability testing
EXHIBIT C
UNCLASSIFIED // FOR OFFICIAL USE ONLY 

UNCLASSIFIED // FOR OFFICIAL USE ONLY 

TEMPLATE VERSION (V1.3 FY17) - REMOVE BEFORE PUBLISHING

Security Assessment Report 

Social Security Administration 

(SSA) 

<System Name> (<Acronym>)

Security Categorization: <Enter Categorization>

<DRAFT/FINAL> Version <x.x>

<Month DD, YYYY>

Prepared by 

8229 Boone Blvd., Suite 750 

Vienna, VA 22182 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY ii 

<INSTRUCTIONS: Orange, bracketed text indicates instructions on how a section should be completed or 

sample text, which should be replaced with project specific information or removed. Ensure sample text is 

turned from orange to black where necessary (e.g., headings shall be changed to the standard heading 

color), and all instructions are removed (including this paragraph). Remove the template ID (e.g., TMP V1.3 

FY17) from the footer before publishing. All black text shall remain unchanged.> 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iii 

Assessment Summary 

This document describes the Federal Information Security Modernization Act (FISMA) Security Assessment

Report (SAR) for Social Security Administration (SSA). The primary purpose of this document is to deliver

the independent security assessment findings for <System Name> (hereafter known as <System 

Acronym>). These findings will lead to the initiation of corrective actions or for making risk-based 

decisions. This independent security assessment supports the U.S. Government’s mandate that all 

U.S. Federal information systems comply with FISMA of 2014. 

The assessment took place between <MM DD, YYYY> and <MM DD, YYYY>. The independent 

security assessment followed the approved the Security Assessment Plan (SAP). All deviations from the 

approved SAP are located in Table 7. 

The table below represents the aggregate risk identified from the independent security assessment. 

Table 1: Executive Summary of Risks 

 NOTE: Total is the sum of high, moderate, and low risks with operationally required 

risks being represented as a subset of this total. 

Risk Category Total % of Total Risks 

High <# high risks> <% of total risks> 

Moderate <# moderate risks> <% of total risks> 

Low <# low risks> <% of total risks> 

Total Risks <Sum of all H, M, L 

risks> 

100% 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iv 

Document Revision History 

Version Date Description Author 

1.0 <10/02/2015> Initial release Coalfire 

<1.1> <10/26/2015> <Final template updates FY17> Coalfire 

<1.2> <10/24/2017> <Template updates for FY17> Coalfire 

 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY v 

Table of Contents 

1 INTRODUCTION ....................................................................................................................... 1

1.1 Applicable Laws and Regulations ............................................................................................... 1

1.2 Applicable Standards and Guidance ........................................................................................... 1

1.3 Purpose ....................................................................................................................................... 2

2 SCOPE ................................................................................................................................... 3

2.1 Applicable Security Controls ....................................................................................................... 3

2.2 System Name/Title ...................................................................................................................... 3

2.3 Assessment Documentation ....................................................................................................... 4

2.4 Location of Components Tested ................................................................................................. 4

2.5 Subsystems, Users and Interfaces ............................................................................................. 4

2.6 Assessment Inventory ................................................................................................................. 5

3 SYSTEM OVERVIEW ................................................................................................................ 6

3.1 Security Categorization ............................................................................................................... 6

3.2 System Description and Purpose ................................................................................................ 6

4 ASSESSMENT METHODOLOGY ................................................................................................. 7

4.1 Perform Tests .............................................................................................................................. 7

4.1.1 Assessment Deviations ............................................................................................................. 7

4.2 Identification of Vulnerabilities ..................................................................................................... 7

4.3 Consideration of Threats ............................................................................................................. 8

4.4 Perform Risk Analysis ............................................................................................................... 14

5 SECURITY ASSESSMENT RESULTS ........................................................................................ 16

5.1 Security Assessment Summary ................................................................................................ 17

6 NON-CONFORMING CONTROLS .............................................................................................. 18

6.1 Risks Corrected During Testing ................................................................................................ 18

6.2 Risks with Mitigating Factors ..................................................................................................... 18

6.3 Risks Remaining Due to Operational Requirements ................................................................ 18

7 RISKS KNOWN FOR INTERCONNECTED SYSTEMS ................................................................... 20

8 RECOMMENDATIONS ............................................................................................................. 20

APPENDIX A. ACRONYMS AND TERMS ...................................................................................... 21

APPENDIX B. SECURITY RISK TRACEABILITY MATRIX (SRTM) .................................................. 24

APPENDIX C. INFRASTRUCTURE SCAN RESULTS ....................................................................... 25

Infrastructure Scans: Inventory of Items Scanned .............................................................................. 25

Infrastructure Scans: Raw Scan Results ............................................................................................ 25

Infrastructure Scans: False Positive Reports ...................................................................................... 25

APPENDIX D. DATABASE SCAN RESULTS ................................................................................. 26

Database Scans: Inventory of Databases Scanned ........................................................................... 26

Database Scans: False Positive Reports ........................................................................................... 26

APPENDIX E. WEB APPLICATION SCAN RESULTS...................................................................... 27

Web Application Scans: Inventory of Web Applications Scanned ...................................................... 27

Web Application Scans: False Positive Reports ................................................................................. 27

APPENDIX F. ASSESSMENT RESULTS ....................................................................................... 28
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY vi 

APPENDIX G. PENETRATION TEST REPORT ............................................................................... 29

APPENDIX H. SECURITY ASSESSMENT REPORT SIGNATURE ...................................................... 30

 

List of Tables 

Table 1: Executive Summary of Risks .......................................................................................................... iii

Table 2: Identified Security Controls Assessed ............................................................................................ 3

Table 3: Information System Name and Title ................................................................................................ 3

Table 4: Location of Components ................................................................................................................. 4

Table 5: Users and Interfaces ....................................................................................................................... 5

Table 6: Hardware and Software Inventory .................................................................................................. 5

Table 7: List of Assessment Deviations ........................................................................................................ 7

Table 8: Threat Categories and Type Identifiers........................................................................................... 8

Table 9: Potential Threats ............................................................................................................................. 9

Table 10: Likelihood Definitions from NIST 800-30 Rev. 1 Publication ....................................................... 14

Table 11: Impact Definitions from NIST 800-30 Rev. 1 Publication ............................................................. 14

Table 12: Risk Exposure Ratings from NIST 800-30 Rev. 1 Publication .................................................... 15

Table 13: Risk Exposure ............................................................................................................................. 18

Table 14: Summary of Risks Corrected During Testing ............................................................................. 18

Table 15: Summary of Risks with Mitigating Factors .................................................................................. 18

Table 16: Summary of Risks Remaining Due to Operational Factors ........................................................ 19

Table 17: Risks from Interconnected Systems ........................................................................................... 20

Table 18: Acronyms and Terms .................................................................................................................. 21

Table 19: Security Test Procedure Workbook ............................................................................................ 24

Table 20: Inventory of Items Scanned ........................................................................................................ 25

Table 21: Raw Scan Results ....................................................................................................................... 25

Table 22: Infrastructure Scans: False Positive Reports .............................................................................. 25

Table 23: Inventory of Databases Scanned ................................................................................................ 26

Table 24: Database Scans: False Positive Reports ................................................................................... 26

Table 25: Inventory of Web Applications Scanned ..................................................................................... 27

Table 26: Web Application Scans: False Positive Reports ......................................................................... 27

Table 27: Summary of System Security Risks from FISMA Testing ........................................................... 28

Table 28: SAR Signatures ........................................................................................................................... 30
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 1 

1 Introduction 

This SAR document for <System Acronym> is required by the National Institute of Standards and 

Technology (NIST) 800-53 Revision 4 (Rev 4) document. This SAR contains unbiased and factual 

security findings by an independent security assessment team. This SAR contains the <System Acronym>

system specific security controls tested as per the Security Assessment Plan (SAP) approved by SSA Office 

of Information Security (OIS), the <System Acronym> Security Authorization Manager (SAM), and the 

Coalfire (formally Veris Group) Project Manager (PM). The implementation status of these controls identify 

the residual risk (risk remaining after controls have been implemented). These controls are required per 

NIST 800-53 Rev. 4 to address known information system vulnerabilities. The results are in support of SSA 

Security Authorization program goals, efforts, and activities necessary to achieve compliance with FISMA 

security requirements. 

1.1 Applicable Laws and Regulations 

• Computer Fraud and Abuse Act [Public Law (PL) 99-474, 18 U.S. Code (USC) 1030] 

• E-Authentication Guidance for Federal Agencies [Office of Management and Budget (OMB) M-04-

04] 

• FISMA of 2014 [PL 113-283] 

• Freedom of Information Act (FOIA) As Amended in 2002 [PL 104-232, 5 USC 552] 

• Guidance on Inter-Agency Sharing of Personal Data – Protecting Personal Privacy [OMB M-01-05] 

• Homeland Security Presidential Directive(HSPD)-7, Critical Infrastructure Identification, 

Prioritization and Protection [HSPD-7] 

• Internal Control Systems [OMB Circular A-123] 

• Management of Federal Information Resources [OMB Circular A-130] 

• Management’s Responsibility for Internal Control [OMB Circular A-123, Revised 12/21/2004] 

• Privacy Act of 1974 as amended [5 USC 552a] 

• Protection of Sensitive Agency Information [OMB M-06-16] 

• Records Management by Federal Agencies [44 USC 31] 

• Responsibilities for the Maintenance of Records About Individuals by Federal Agencies [OMB 

Circular A-108, as amended] 

• Security of Federal Automated Information Systems [OMB Circular A-130, Appendix III] 

1.2 Applicable Standards and Guidance 

• A NIST Definition of Cloud Computing [NIST SP 800-145] 

• Computer Security Incident Handling Guide [NIST SP 800-61, Revision 2] 

• Contingency Planning Guide for Federal Information Systems [NIST SP 800-34, Revision 1] 

• Engineering Principles for Information Technology Security (A Baseline for Achieving Security) 

[NIST SP 800-27, Revision A] 

• Assessing Security and Privacy Controls in Federal Information Systems and Organizations [NIST 

SP 800-53A, Revision 4] 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 2 

• Security and Privacy Controls for Federal Information Systems and Organizations [NIST SP 800-

53, Revision 4] 

• Guide for Developing Security Plans for Federal Information Systems [NIST SP 800-18, Revision 

1] 

• Guide for Applying the Risk Management Framework to Federal Information Systems: A Security 

Life Cycle Approach [NIST SP 800-37, Revision 1] 

• Guide for Mapping Types of Information and Information Systems to Security Categories [NIST SP 

800-60, Revision 1] 

• Guide for Security-Focused Configuration Management of Information Systems [NIST SP 800-128] 

• Information Security Continuous Monitoring for Federal Information Systems and Organizations 

[NIST SP 800-137] 

• Managing Information Security Risk: Organization, Mission, and Information System View [NIST 

SP 800-39] 

• Minimum Security Requirements for Federal Information and Information Systems [FIPS 

Publication 200] 

• Personal Identity Verification (PIV) of Federal Employees and Contractors [FIPS Publication 201-

2] 

• Recommended Security Controls for Federal Information Systems [NIST SP 800-53, Revision 4] 

• Guide for Conducting Risk Assessments [NIST SP 800-30, Revision 1] 

• Security Considerations in the System Development Life Cycle [NIST SP 800-64, Revision 2] 

• Security Requirements for Cryptographic Modules [Federal Information Processing Standard 

(FIPS) Publication 140-2] 

• Standards for Security Categorization of Federal Information and Information Systems [FIPS 

Publication 199] 

• Technical Guide to Information Security Testing and Assessment [NIST SP 800-115] 

1.3 Purpose 

The purpose of this document is to provide the System Owner (SO) and the SSA Authorization Official (AO)

with a detailed level of the residual risk for <System Acronym>. An independent security assessment team 

conducted a test for each system specific security control implemented by SSA stakeholders. These 

tests include a combination of interviews, document examinations, and actual technical testing of controls 

when applicable. These controls each had implementation statements listed in the <System Acronym>

System Security Plan (SSP). These statements identified how the controls are in place and the 

assessment team tested the controls based on that criteria. Additionally, the testing ensures the controls 

are in are in compliance with the FISMA baseline security control requirements as defined in NIST 800-53 

Rev 4. FISMA mandates that all Federal Agencies will comply with the NIST 800-53 Rev. 4 standards. 

Assessors from the independent security assessment team are members of contracted Coalfire Federal 

Services (formally Veris Group). 

The system specific security controls for this assessment are in section 2.1 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 3 

2 Scope 

2.1 Applicable Security Controls 

The applicable security controls as listed in the <System Acronym> SAP are in Table 2 of this <System 

Acronym> SAR. The security control assessment authorized by OIS and the <System Acronym> SAM 

gives authority to the Coalfire Independent Security Assessment team to assess the listed controls. 

Table 2: Identified Security Controls Assessed 

Security Control Family Security Control 

Access Control AC-2, AC-2(2), AC-2(3), AC-2(4) 

Awareness and Training 

Audit and Accountability AU-7(1) 

Security Assessment and Authorization CA-5, CA-6 

Configuration Management CM-9 

Contingency Planning 

Identification and Authentication IA-2, IA-(3), IA-5, IA-5(1) 

Planning PL-2, PL-2(3), PL-8 

Personnel Security PS-4, PS-5 

Risk Assessment RA-2, RA-3 

System and Services Acquisition SA-3, SA-4(9), SA-5, SA-8, SA-9, SA-9(2), SA-11 

System and Communications Protection SC-4, SC-39 

System and Information Integrity SI-10, SI-11, SI-16 

2.2 System Name/Title 

The <System Acronym> system unique identifier and system acronyms are in Table 3. Due to the 

number of applications located within <System Acronym>, <only two of the subsystems> fall within the 

scope of this assessment. The authority to use a representative sample is located within NIST 800-53 

Rev 4 Guide for Assessing the Security Controls in Federal Information Systems and Organizations. 

Table 3: Information System Name and Title 

Information System Name: <System Name> 

Information System Acronym: <System Acronym> 

Information System Identifier <System Identifier> 

Security Categorization: (High, Moderate, Low) <Categorization> 

PII data: (Yes/No) <Yes/No> 

e-Authentication Application: (Yes/No) <Yes/No> 

Production Data Used In Development/Test 

Environment (Yes/No) 

<Yes/No> 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 4 

Federal Tax Information (Yes/No) <Yes/No> 

2.3 Assessment Documentation 

Documentation used by the independent assessment team to perform the assessment of the <System 

Acronym> subsystems include the following: 

• <System Acronym> System Security Plan (SSP) 

• <System Acronym> Security Assessment Plan (SAP) 

• Security Operation Division (SOC) Nessus scanner with McAfee, McAfee ePolicy 

Orchestrator (EPO) instance scan statistic reports 

• SSA Information Security Policy (ISP) 

• The <System Acronym> Boundary Scope Memo (BSM) 

• The <System Acronym> Information System Contingency Plan (ISCP) 

• The <System Acronym> Federal Information Processing Standards Publication (FIPS) 199 

2.4 Location of Components Tested 

The physical locations of all the different functional components supporting the testing of the <System 

Acronym> information system is in Table 4. 

Table 4: Location of Components 

System Physical Location and Addresses 

Production Environment Site 

Name 

Address Description of Components 

<EXAMPLE: National Computer 

Center (NCC)>

6401 Security Blvd 

Baltimore, MD 21235 

Production Environment (i.e., 

hardware ) 

(Primary Support) 

Development/Test 

Environment Site Name 

Address Description of Components 

<EXAMPLE: National Support 

Center (NSC)>

3500 Campus Drive, Suite 106 

Urbana, MD 21704 

Development and Testing

Environment (Integration 

Testing) 

Disaster Recovery 

Environment Site Name 

Address Description of Components 

<EXAMPLE: Secondary Support 

Center (SSC)>

3004 Tower Blvd 

Durham, NC 27707 

Production Environment (i.e., 

hardware) 

(Secondary/Failover Support) 

Contractor Owned 

Environment Site Name 

Address Description of Components 

 

2.5 Subsystems, Users and Interfaces 
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<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

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The <System Acronym> system contains the following subsystems, users and interfaces that were tested 

as part of this assessment. They are contained within the embedded Error! Reference source not found.. 

<Complete the embedded spreadsheet with system specific information.>

Table 5: Users and Interfaces 

T2 Internet - Users 

and Interfaces.doc

<Embed the applicable system’s Users and Interface, EXAMPLE attached.>

2.6 Assessment Inventory 

The <System Acronym> hardware and software inventories provided by the SO’s are in Table 6. 

<Complete the embedded spreadsheet with system specific information.> 

Table 6: Hardware and Software Inventory 

T2 Internet - 

HW-SW Inventory.xl

<Embed the applicable system’s Hardware and Software Inventory, EXAMPLE attached.> 

 NOTE: Any changes to the scope of the Authorization Boundary after the Boundary 

Scope Meeting and finalization of the Boundary Scope Memo (BSM) may impact the 

overall Independent Verification and Validation (IV&V) schedule. 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

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3 System Overview 

3.1 Security Categorization 

The FIPS 199 Security Categorization of a Federal Information and Information System publication

determines the risk impact level of data vulnerability exploitation. The identified impact level sets the

security control baseline that needs to be tested. The categorization for <System Acronym> determined 

by the FIPS 199 publication is a Moderate baseline. The NIST 800-53 Rev 4. <Moderate> baseline of 

controls are assessed during the security assessment. 

3.2 System Description and Purpose 

<In the sections below, insert a general description of the information system. Use a description that is 

consistent with the description found in the SSP. The description must only differ from the description in 

the SSP if additional information is going to be included that is not available in the SSP or if the description 

in the SSP is not accurate.> 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

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4 Assessment Methodology 

A summary of the assessment methodologies used to conduct the security assessment for the <System 

Acronym> subsystems are in the following steps: 

 Perform tests on the listed controls in the <System Acronym> SAP and record the results 

 Identify vulnerabilities related to <System Acronym>

 Identify known threats and determine which threats are associated with the cited vulnerabilities 

 Analyze risks based on vulnerabilities and associated threats after mitigating controls 

are implemented 

 Recommend corrective actions for controls that are not satisfied (other than satisfied) 

 Document all security assessment results, which include identified unmitigated risks, 

mitigated risks, and recommend corrective actions. 

4.1 Perform Tests 

Coalfire Federal Services performed security tests on the <System Acronym> subsystems, which 

concluded on <MM DD, YYYY>. The results of the tests are documented within the Security Risk

Traceability Matrix (SRTM) in Appendix B. The SRTM serves as input to this SAR. 

4.1.1 Assessment Deviations 

Table 7 contains any deviations from the SAP if applicable. Coalfire Federal Services did not deviate from

the testing plan. 

Table 7: List of Assessment Deviations 

Deviation ID Deviation Description Justification 

 

4.2 Identification of Vulnerabilities 

Coalfire Federal Services conducts an assessment to identify vulnerabilities for <System 

Acronym> subsystems. These vulnerabilities should have controls in place to mitigate the risk of 

exploitation. 

A vulnerability is an inherent weakness in an information system that can be exploited by a threat or 

threat agent, resulting in an undesirable impact on the protection of the confidentiality, integrity, or 

availability of the system (application and associated data). A vulnerability may be due to a design 

flaw or error in a configuration that makes the network or a host on the network, susceptible to malicious 

attacks from local or remote users. Vulnerabilities can exist in multiple areas of the system or facilities, 

such as in firewalls, application servers, Web servers, operating systems, or fire suppression systems. 

Whether or not a vulnerability has the potential to be exploited by a threat depends on a number of 

variables including (but not limited to): 

• The strength of the security controls in place 

• The ease at which a human actor could purposefully launch an attack 

• The probability of an environmental event or disruption in a given local area 
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An environmental disruption is usually unique to a geographic location. Depending on the level of the risk

exposure, the successful exploitation of a vulnerability can vary from disclosure of information about the

host to a complete compromise of the host. Risk exposure to organizational operations can affect the

business mission, functions, and/or reputation of the organization. 

4.3 Consideration of Threats 

A threat is an adversarial force or phenomenon that could affect the availability, integrity, or confidentiality

of an information system, its networks, and the facility that houses the hardware and software. A threat

agent is an element that provides the delivery mechanism for a threat. An entity that initiates the launch of

a threat agent is referred to as a threat actor. 

A threat actor might purposefully launch a threat agent (e.g., a terrorist igniting a bomb). A threat actor

could also be a trusted employee that acts as an agent by making an unintentional human error (e.g., a

trusted employee clicks on a phishing email that downloads malware). Threat agents may also be

environmental in nature with no purposeful intent (e.g., a hurricane). Threat agents working alone, or in

concert, exploit vulnerabilities to create incidents. FISMA categorizes threats using a threat origination

taxonomy of purposeful (P), unintentional (U), or environmental (E) type threats as described in Table 8. 

Table 8: Threat Categories and Type Identifiers 

Threat Origination Category Type Identifier 

Threats launched purposefully P 

Threats created by unintentional human or machine error U 

Threats caused by environmental agents or disruptions E 

Threat actors for a variety of reasons launch purposeful threats and the reasons may never be fully known.

Curiosity, monetary gain, political gain, social activism, revenge or many other driving forces could motivate

threat actors. It is possible that some threats could have more than one threat origination category. 

Some threat types are more likely to occur than others are. FISMA considers threat types to help 

determine the likelihood that a vulnerability could be exploited. The threat table shown in 

Table 9 describes typical threats to information systems; these threats have been considered for <System 

Acronym>.
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Table 9: Potential Threats 

ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

T-1. Alteration U, P, E Alteration of data, files, or records. ModiT-2. Audit 

Compromise P 

An unauthorized user gains access to the audit trail and could cause audit records to be deleted or modified, or prevents future audit records from being recorded, thus masking a security relevant event. 

Modior destr

T-3. Bomb P An intentional explosion. 

Modior destr

T-4. Communications 

Failure U, E Cut fiber optic lines, trees falling on telephone lines. 

T-5. Compromising 

Emanations P 

Eavesdropping can occur via electronic media directed against large scale electronic facilities that do not process classified National Security Information. 

Disclosure 

T-6. Cyber Brute 

Force P 

Unauthorized user could gain access to the information systems by random or systematic guessing of passwords, possibly supported by password cracking utilities. 

Disclosure 

Modior destr

T-7. Data Disclosure 

Attack P 

An attacker uses techniques that could result in the disclosure of sensitive information by exploiting weaknesses in system design or configuration. 

Disclosure 

T-8. Data Entry Error U 

Human inattention, lack of knowledge, and failure to cross-check system activities could contribute to errors becoming integrated and ingrained in automated systems. 

 Modi

T-9. Denial of Service 

Attack P 

An adversary uses techniques to attack a single target rendering it unable to respond; could cause denial of service for users of the targeted information systems. 
So

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ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

T-10. Distributed Denial 

of Service Attack P 

An adversary uses multiple compromised information systems to attack a single target; could cause denial of service for users of the targeted information systems. 

T-11. Earthquake E 

Seismic activity can damage the information system or its facility. Refer to the following document for earthquake probability maps http://pubs.usgs.gov/of/2008/1128/pdf/OF08-

1128_v1.1.pdf . 

 Dest

T-12. Electromagnetic 

Interference E, P 

Disruption of electronic and wire transmissions could be caused by high frequency (HF), very high frequency (VHF), and ultra-high frequency (UHF) communications devices (jamming) or sun spots. 

T-13. Espionage P The illegal, covert act of copying, reproducing, recording, photographing or intercepting sensitive 

information. 

Disclosure Modi

T-14. Fire E, P Fire can be caused by arson, electrical problems, lightning, chemical agents, or other unrelated proximity 

fires. 

 Dest

T-15. Floods E Water damage caused by flood hazards can be caused by proximity to local flood plains. Flood maps and base 

flood elevation must be considered. 

 Dest

T-16. Fraud P 

Intentional deception regarding data or information about an information system could compromise the confidentiality, integrity, or availability of an information system. 

Disclosure 

Modior destr

T-17. 

Hardware or Equipment Failure 

E Hardware or equipment may fail due to a variety of 

reasons. 

T-18. Hardware 

Tampering P An unauthorized modification to hardware that alters the proper functioning of equipment in a manner that Modi
So

Secu

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ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

degrades the security functionality provided by the asset. 

T-19. Hurricane E A category 1, 2, 3, 4, or 5 land falling hurricane could impact the facilities that house the information systems. DestT-20. Malicious 

Software P Software that damages a system such a virus, Trojan, or worm. Modi

or destr

T-21. Phishing Attack P 

Adversary attempts to acquire sensitive information such as usernames, passwords, or SSNs, by pretending to be communications from a legitimate/trustworthy source. Typical attacks occur via email, instant messaging, or comparable means; commonly directing users to Web sites that appear to be legitimate sites, while actually stealing the entered information. 

Disclosure 

Modior destr

T-22. Power 

Interruptions E 

Power interruptions may be due to any number of reasons such as electrical grid failures, generator failures, uninterruptable power supply (UPS) failures (e.g. spike, surge, brownout, or blackout). 

T-23. Procedural Error U An error in procedures could result in unintended 

consequences. 

Disclosure 

Modior destr

T-24. Procedural 

Violations P Violations of standard procedures. Disclosure 

Modior destr

T-25. Resource 

Exhaustion U 

An errant (buggy) process may create a situation that exhausts critical resources preventing access to services. 
So

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ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

T-26. Sabotage P Underhanded interference with work. 

Modior destr

T-27. Scavenging P Searching through disposal containers (e.g., dumpsters) to acquire unauthorized data. Disclosure T-28. Severe Weather E 

Naturally occurring forces of nature could disrupt the operation of an information system by freezing, sleet, hail, heat, lightning, thunderstorms, tornados, or snowfall. 

 Dest

T-29. Social 

Engineering P 

An attacker manipulates people into performing actions, divulging confidential information, or providing access to computer systems or facilities. 

Disclosure 

T-30. Software 

Tampering P 

Unauthorized modification of software (e.g., files, programs, database records) that alters the proper operational functions. 

Modior destr

T-31. Terrorist P An individual performing a deliberate violent act could use a variety of agents to damage the information 

system, its facility, and/or its operations. 

Modior destr

T-32. Theft P An adversary could steal elements of the hardware. T-33. Time and State P 

An attacker exploits weaknesses in timing or state of functions to perform actions that would otherwise be prevented (e.g., race conditions, manipulation of user state). 

Disclosure Modi

T-34. Transportation 

Accidents E 

Transportation accidents include train derailments, river barge accidents, trucking accidents, and airline accidents. Local transportation accidents typically occur when airports, sea ports, railroad tracks, and major trucking routes occur in close proximity to systems facilities. Likelihood of HAZMAT cargo must 

 Dest
So

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ID Threat Name Type Identifier Description Typical Impact to 

Confidentiality Inte

be determined when considering the probability of local transportation accidents. 

T-35. Unauthorized 

Facility Access P 

An unauthorized individual accesses a facility which may result in comprises of confidentiality, integrity, or availability. 

Disclosure 

Modior destr

T-36. Unauthorized 

Systems Access P An unauthorized user accesses a system or data. Disclosure 

Modior destr

T-37. Volcanic Activity E 

A crack, perforation, or vent in the earth’s crust followed by molten lava, steam, gases, and ash forcefully ejected into the atmosphere. For a list of volcanoes in the U.S. see: http://volcanoes.usgs.gov/about/volcanoes/volcanolist.

php . 

 Dest
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4.4 Perform Risk Analysis 

NIST identifies risk assessment as the first process in the risk management methodology. Organizations

use the risk assessment to determine the extent of the potential threat and the risk associated with an

information system. NIST defines Risk as “a function of the likelihood of a given threat-source’s exercising

a particular vulnerability and the resulting impact of the adverse event on the organization”. The outcome

of performing risk analysis yields risk exposure metrics that can be used to make risk-based decisions. 

The FISMA risk analysis process is a qualitative risk analysis. In qualitative risk analysis, the risk level of

exploiting a threat may be subjective and the justification for each risk is explained in terms of probability.

The following tables have probabilities associated with the likelihood and the impact level of the risk. For

example, when a system is easy to exploit, it has a “Very High” likelihood that a threat could exploit the

vulnerability. Likelihood definitions and probabilities are in Table 10. 

Note: The likelihood levels should not be confused or used interchangeably with the security categorization

of the system even though they use the some of the same terminology. The security categorization is

determined by the sensitivity of the data residing on the information system and is in the FIPS 199

publication. 

Table 10: Likelihood Definitions from NIST 800-30 Rev. 1 Publication 

Likelihood 

Probability Level 

Description 

Very Low If the threat event is initiated or occurs, it is almost certain to have adverse impacts. 

Low If the threat event is initiated or occurs, it is unlikely to have adverse impacts. 

Moderate If the threat event is initiated or occurs, it is somewhat likely to have adverse

impacts. 

High If the threat event is initiated or occurs, it is highly likely to have adverse impacts. 

Very High If the threat event is initiated or occurs, it is almost certain to have adverse impacts. 

Impact refers to the magnitude of potential harm to the information system (or its data) by successful

vulnerability exploitation. Definitions for the impact are in Table 11. Since exploitation has not yet occurred,

these values are perception values based on available information system information if the exploitation of

a vulnerability can cause significant loss to a system (or its data) then the impact is “Very High”. 

Table 11: Impact Definitions from NIST 800-30 Rev. 1 Publication 

Impact 

Probability 

Description 

Very Low The threat event could be expected to have a negligible adverse effect on

organizational operations, organizational assets, individuals other organizations, or 

the Nation. 

Low The threat event could be expected to have a limited adverse effect on

organizational operations, organizational assets, individuals other organizations, or 

the Nation. A limited adverse effect means that, for example, the threat event might: 

(i) cause a degradation in mission capability to an extent and duration that the 

organization is able to perform its primary functions, but the effectiveness of the 

functions is noticeably reduced; (ii) result in minor damage to organizational assets; 

(iii) result in minor financial loss; or (iv) result in minor harm to individuals 
Social Security Administration 

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Moderate The threat event could be expected to have a serious adverse effect on

organizational operations, organizational assets, individuals other organizations, or 

the Nation. A serious adverse effect means that, for example, the threat event might: 

(i) cause a significant degradation in mission capability to an extent and duration 

that the organization is able to perform its primary functions, but the effectiveness 

of the functions is significantly reduced; (ii) result in significant damage to 

organizational assets; (iii) result in significant financial loss; or (iv) result in 

significant harm to individuals that does not involve loss of life or serious lifethreatening injuries. 

High The threat event could be expected to have a severe or catastrophic adverse

effect on organizational operations, organizational assets, individuals, other

organizations, or the Nation. A severe or catastrophic adverse effect means that, for 

example, the threat event might: (i) cause a severe degradation in or loss of mission 

capability to an extent and duration that the organization is not able to perform 

one or more of its primary functions; (ii) result in major damage to organizational 

assets; (iii) result in major financial loss; or (iv) result in severe or catastrophic harm 

to individuals involving loss of life or serious life-threatening injuries. 

Very High The threat event could be expected to have multiple severe or catastrophic

adverse effects on organizational operations, organizational assets, individuals,

other organizations, or the Nation. 

The combination of the Likelihood Probability and the Impact Probability creates the risk exposure. The risk

exposure matrix shown in Table 12 presents the same likelihood and impact severity ratings as those found

in NIST SP 800-30 Rev. 1 Risk Management Guide for Information Technology Systems. 

Table 12: Risk Exposure Ratings from NIST 800-30 Rev. 1 Publication 

Likelihood Impact 

Very Low Low Moderate High Very High 

Very High Very Low Low Moderate High Very High 

High Very Low Low Moderate High Very High 

Moderate Very Low Low Moderate Moderate High 

Low Very Low Low Low Low Moderate 

Very Low Very Low Very Low Very Low Very Low Very Low 

Using Table 12 as a reference, Coalfire Federal Services reviewed all identified vulnerabilities and assigned

a risk exposure located in the <System Acronym> SRTM in Appendix B. 

Documenting the results of security control testing creates a record of the security posture for the system

at a given moment in time. The record can be used by the AO to make risk-based decision and to create

plans of action to mitigate unacceptable residual risks. 

FISMA requires that a Plan of Action and Milestones (POA&M) be developed. The POA&M is a mitigation

plan designed to address specific residual security risks and includes information on costing, resources,

and target dates for remediation efforts resolving the identified security weaknesses. The plan is utilized as

the primary mechanism for tracking all the residual risks and other issues. SSA will leverage the SAR to

create a POA&M for <System Acronym>. 
Social Security Administration 

<System Name> 

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Version <X.X>

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5 Security Assessment Results 

This section describes all security risks found during assessment. The following elements for each security

risk are reported. 

• Identifier 

• Name 

• Source of Discovery 

• Description 

• Affected internet protocol (IP) Address/Hostname/Database 

• Applicable Threats 

• Likelihood (before mitigating controls/factors) 

• Impact (before mitigating controls/factors) 

• Risk Exposure (before mitigating controls/factors) 

• Risk Statement 

• Mitigating Controls/Factors 

• Likelihood (after mitigating controls/factors) 

• Impact (after mitigating controls/factors) 

• Risk Exposure (after mitigating controls/factors) 

• Recommendation 

Below is a description of the SAR security risk elements. 

• Identifier: All weaknesses are assigned a vulnerability identifier (ID) in the form of V#-Security 

Control ID. For example, the first vulnerability listed would be reported as V1-AC-2(2) if the 

vulnerability is for control ID AC-2(2). If there are multiple vulnerabilities for the same security 

control ID, the first part of the vulnerability ID must be incremented, for example V1-AC-2(2), V2-

AC-2(2). 

• Name: A short, unique name for each vulnerability. 

• Source of Discovery: The source of discovery refers to the method that was used to discover the 

vulnerability (e.g., web application scanner, manual testing, security test procedure workbook, 

interview, document review). References must be made to scan reports, security test case 

procedure IDs, staff that were interviewed, manual test results, and document names. All scans 

reports are attached in Appendix C, Appendix D, Appendix E, and Appendix F. Results of manual 

tests can be found in Appendix G. If the source of discovery is from one of the security test 

procedure workbooks, a reference must point to the workbook name, the sheet number, and the 

cell number. Workbook tests results are found in Appendix B. If the source of discovery is from 

an interview, the date of the interview and the people who were present at the interview are named. 

If the source of discovery is from a document, the document must be named. 
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• Description: All security weaknesses must be described in enough detail to be reproduced by the 

stakeholder, the Information System Security Officer (ISSO), or the AO. If a test was performed 

manually, the exact manual procedure and any relevant screenshots must be included. If a test 

was performed using a tool or scanner, a description of the reported scan results for that 

vulnerability must be included along with the vulnerability identifier (e.g., Common Vulnerabilities 

and Exposures (CVE), Common Vulnerability Scoring System (CVSS), Nessus Plugin ID) and 

screenshots of the particular vulnerability being described. If the tool or scanner reports a severity 

level, that level must be reported in this section. Any relevant login information and role information 

must be included for vulnerabilities discovered with scanners or automated tools. If any security 

weaknesses affect a database transaction, a discussion of atomicity violations must be included. 

• Affected IP Address/Hostname(s)/Database: For each reported vulnerability, all affected IP 

addresses/hostnames/databases must be included. If multiple hosts/databases have the same 

vulnerability, list all affected hosts/databases. 

• Applicable Threats: The applicable threats describe the unique threats that have the ability to 

exploit the security vulnerability. (Use threat numbers from Error! Reference source not found..) 

• Likelihood (before mitigating controls/factors): Very High, High, Moderate, Low, or Very Low 

(see Error! Reference source not found.). 

• Impact (before mitigating controls/factors): Very High, High, Moderate, Low, or Very Low (see 

Error! Reference source not found.). 

• Risk Exposure (before mitigating controls/factors): Very High, High, Moderate, Low, or Very 

Low (see Error! Reference source not found.). 

• Risk Statement: Provide a risk statement that describes the risk to the business. (See examples 

in Error! Reference source not found.). Also indicate whether the affected machine(s) is/are 

internally or externally facing. 

• Mitigating Controls/Factors: Describe any applicable mitigating controls/factors that could 

downgrade the likelihood or risk exposure. Also indicate whether the affected machine(s) is/are 

internally or externally facing. Include a full description of any mitigating factors and/or 

compensating controls if the risk is an operational requirement. 

• Likelihood (after mitigating controls/factors): Moderate or Low (see Error! Reference source 

not found.) after mitigating control/factors have been identified and considered. 

• Impact (after mitigating controls/factors): Moderate or Low (see Error! Reference source not 

found.) after mitigating control/factors have been identified and considered. 

• Risk Exposure (after mitigating controls/factors): Moderate or Low (see Error! Reference 

source not found.) after mitigating controls/factors have been identified and considered. 

• Recommendation: The recommendation describes how the vulnerability should be resolved. 

Indicate if there are multiple ways that the vulnerability could be resolved or recommendation for 

acceptance of operational requirement. 

5.1 Security Assessment Summary 

<Two (2) vulnerabilities, (0 high, zero moderate, 2 low)> have been discovered as part of the manual 

security assessment testing. Vulnerability scans provided did not provide enough information to provide 

analysis of scan vulnerability to assessment result. 
Social Security Administration 

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The vulnerabilities summary is contained in the following embedded file: 

Table 13: Risk Exposure 

T2 Risk Exposure 

Table.xlsx

<Embed applicable system’s Risk Exposure table, EXAMPLE attached.> 

6 Non-conforming Controls 

In some cases, the initial risk exposure to the system has been adjusted due to either corrections that 

occurred during testing or to other mitigating factors. Additional detail is provided in the following sections. 

6.1 Risks Corrected During Testing 

Any risks that were discovered during the testing of the <System Acronym> subsystems and subsequently 

mitigated prior to authorization are listed in Table 14. Coalfire Federal Services verified risks corrected 

during testing. The verification method used to determine correction is noted in the right-hand column of 

Table 14. 

Table 14: Summary of Risks Corrected During Testing 

Identifier Description Source of 

Discovery 

Initial Risk 

Exposure 

Remediation 

Description 

Date of 

Remediation 

Verification 

Statement/Testing 

Procedures 

 

6.2 Risks with Mitigating Factors 

Risks that have had their severity levels changed due to mitigating factors are summarized in Table 15.

The factors used to justify changing the initial risk exposure rating are noted in the right-hand column of the

table. See Table 13 for more information on these risks. 

Table 15: Summary of Risks with Mitigating Factors 

Identifier Description Source of 

Discovery 

Initial Risk 

Exposure 

Current Risk 

Exposure 

Description of 

Mitigating 

Factors 

 

6.3 Risks Remaining Due to Operational Requirements 

Risks that reside in the <system acronym> that cannot be corrected due to operational constraints are 

summarized in Error! Reference source not found.. An explanation of the operational constraints and 

risks are included in Error! Reference source not found. as well as in the appropriate security assessment 

test cases and SSP. Because these risks will not be corrected, they are not tracked in the POA&M. See 

Error! Reference source not found.for more information on these risks. 
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Table 16: Summary of Risks Remaining Due to Operational Factors 

Identifier Description Source of Discovery Current Risk Exposure Operational 

Requirements 

Rationale 

 
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7 Risks Known for Interconnected Systems 

Inherent relationships between the system and other interconnected systems may affect the overall system

security posture. A summary of the risks known for systems that connect to <System Acronym> is provided 

in Table 17. 

Table 17: Risks from Interconnected Systems 

System Authorization 

Date/Status 

Date of POA&M Control Family 

Identifier 

 

8 Recommendations 

<System Acronym> subsystem risks that were discovered during the assessment have an impact on 

the security posture of the SSA Federal Agency as a whole. These risks must be mitigated and Coalfire 

Federal Services has made recommendations in the Risk Exposure section, Table 14. These

recommendations should be addressed by the SAM, system owners, OIS, and other stakeholders that have

a responsibility for the controlling the overall risk of <System Acronym>. 

 
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Appendix A. Acronyms and Terms 

Acronyms and terms used throughout this SAR are defined in Table 18. 

Table 18: Acronyms and Terms 

Acronym/Term SAR Acronym Definitions

AC Associate Commissioner 

AC Access Control 

AO Authorizing Official 

ARB Architecture Review Board 

ART Analysis and Reporting Tool 

AU Audit and Accountability 

BRI Benefit Rate Increase 

BSM Boundary Scope Memo 

CA Security Assessment and Authorization 

CCB Configuration Control Board 

CIC Customer Information Control System 

CM Configuration Management 

CMP Contingency Management Plan 

COTR Contract Officer’s Technical Representative 

CSAM Cyber Security Assessment & Management 

CSO Component Security Officer 

CVE Common Vulnerabilities and Exposures 

CVSS Common Vulnerability Scoring System 

DCS Deputy Commissioner for Systems 

DSPP Division of Security Policy & PII 

EPECS Electronic Personal Enrollment Credential System 

EPO ePolicy Orchestrator 

FIPS Federal Information Processing Standard 

FISMA Federal Information Security Modernization Act 

FOIA Freedom of Information Act 

HRMIS Human Resources Management Information System 

HRODS Human Resources Operational Data Store 

HSPD Homeland Security Presidential Directive 

IA Identification and Authentication 

ID Identification 
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IP Internet Protocol 

ISCP Information System Contingency Plan 

ISO Information Security Officers

ISP Information Security Policy

ISSO Information System Security Officer 

LIS Low Income Subsidy 

NIST National Institute of Standards and Technology 

NSC National Support Center 

OIS Office of Information Security 

OMB Office of Management and Budget 

OSOHE Office of Systems Operations and Hardware Engineering

OTSO Office of Telecommunications and Systems Operations 

PAM Payment Application Modernization 

PCCB Project Configuration Control Board

PIN Personal Identification Number

PIV Personal Identification Verification 

PL Public Law 

PL (Control) Planning 

PM Program Manager 

POA&M Plan of Action and Milestones 

PRIDE Project Resource Guide 

PS (Control) Personnel Security 

P, U, E Purposeful, Unintentional, Environmental 

SA System and Services Acquisition 

SAM Security Authorization Manager 

SAP Security Assessment Plan 

SARA Security Administration Report Application (User Guide)

SAR Security Assessment Report

SC Systems and Communications Protection 

SDLC System Development Life Cycle 

SI System and Information Integrity 

SMACS Security Management Access Control Systems

SO System Owner

SOC Security Operation Division 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 23 

SP Special Publication 

SRC System Release Certificate

SRTM Security Requirements Traceability Matrix

SSA Social Security Administration 

SSC Secondary Support Center 

SSP System Security Plan 

SVR Security Violations Report

Threat An adversarial force or phenomenon that could affect the availability,

integrity, or confidentiality of an information system, its networks, and the

facility that houses the hardware and software.

Threat Actor An entity that initiates the launch of a threat agent is referred to as a threat

actor. 

Threat Agent An element that provides the delivery mechanism for a threat. 

UPS uninterruptable power supply 

USC United States Code 

Vulnerability An inherent weakness in an information system that can be exploited by a

threat or threat agent, resulting in an undesirable impact in the protection

of the confidentiality, integrity, or availability of the system (application and

associated data). 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 24 

Appendix B. Security Risk Traceability Matrix (SRTM) 

The Security Risk Traceability Matrix (SRTM) with test results and test procedures are within the following

embedded document in Table 19. 

Table 19: Security Test Procedure Workbook 

T2 SRTM 

Worksheet.xlsx

<Embed the applicable system’s Security Risk Traceability Matrix (SRTM), EXAMPLE attached.>
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 25 

Appendix C. Infrastructure Scan Results 

The Nessus scanner along with the McAfee ePolicy Orchestrator (EPO) deployed by the SOC was used to

scan SSA servers. Associated Windows Database servers that have the EPO agent deployed within the

<System Acronym > boundary were scanned. The other <System Acronym> servers did not have 

any vulnerability scanning tools available, which allowed for scanning of mainframe or storage hardware, 

and therefore were not scanned. 

Infrastructure Scans: Inventory of Items Scanned 

Table 20 provides an inventory of infrastructure items scanned during this assessment. 

Table 20: Inventory of Items Scanned 

T2 Scanned 

Inventory Items.xlsx

<Embed the applicable system’s Inventory of Items Scanned, EXAMPLE attached.>

Infrastructure Scans: Raw Scan Results 

Table 21 has the <System Acronym> raw scan results: 

Table 21: Raw Scan Results 

T2 Raw Scan 

Results.xlsx

<Embed the applicable system’s Raw Scan Results, EXAMPLE attached.>

Infrastructure Scans: False Positive Reports 

Table 22 provides a list of false positive reports collected during infrastructure scans if applicable. 

Table 22: Infrastructure Scans: False Positive Reports 

ID# IP Address Scanner Severity Level Finding False Positive 

Explanation 

 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 26 

Appendix D. Database Scan Results 

Database scan results are included in this appendix. 

Database Scans: Inventory of Databases Scanned 

Table 23 provides an inventory of any databases scanned during this assessment if applicable. 

Table 23: Inventory of Databases Scanned 

IP Address Hostname Software and Version Function Comment 

 

Database Scans: False Positive Reports 

Table 24 provides a list of false positive reports collected during database scans if applicable. 

Table 24: Database Scans: False Positive Reports 

ID# IP Address Scanner Severity Level Finding False Positive 

Explanation 

 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 27 

Appendix E. Web Application Scan Results 

Web application scan results are included in this appendix. 

Web Application Scans: Inventory of Web Applications 

Scanned 

Table 25 provides an inventory of all web applications scanned during this assessment if applicable. 

Table 25: Inventory of Web Applications Scanned 

Login URL IP Address of Login Host Function Comments 

 

Web Application Scans: False Positive Reports 

Table 26 provides a list of false positive reports collected during web application scans if applicable. 

Table 26: Web Application Scans: False Positive Reports 

ID# IP Address Scanner Severity Level Finding False Positive 

Explanation 

 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 28 

Appendix F. Assessment Results 

Assessment results are summarized in Table 27. 

Table 27: Summary of System Security Risks from FISMA Testing 

Risk Level Assessment Test Cases Total 

High <# high risks> <% of total risks> 

Moderate <# moderate risks> <% of total risks> 

Low <# low risks> <% of total risks> 

Operationally 

Required 

<# operationally required 

high risks> 

<% of total risks> 

Total <Sum of all H, M, L risks> 100%

 NOTE: Total is the sum of high, moderate, and low risks with operationally required 

risks being represented as a subset of this total. 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

TMP V1.3 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 29 

Appendix G. Penetration Test Report 

<Update the text below to reflect actual penetration test results for this assessment. Embed the penetration 

test report as appropriate.> 

Coalfire Federal Services is not authorized as per the Statement of Work (SOW) to perform a formal

Penetration Test for the <System Acronym> Batch and Internet Services subsystems. Therefore, no data 

from a penetration test is available for this assessment. 
Social Security Administration 

<System Name> 

Security Assessment Report (SAR) 

Version <X.X>

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Appendix H. Security Assessment Report Signature 

Table 28: SAR Signatures 

Acceptance and Signature 

I have read the above Security Assessment Report prepared by the third party assessment organization,

Coalfire Federal Services. I acknowledge the assessment was completed as per the <System 

Acronym> SAP and understand the findings detailed herein. 

Security Authorization Manager/ 

<SAM>: 

OIS Division of Compliance and 

Assessments Director: 

<DD> 
EXHIBIT D
UNCLASSIFIED // FOR OFFICIAL USE ONLY 

UNCLASSIFIED // FOR OFFICIAL USE ONLY 

Social Security Administration (SSA) 

Security Categorization: <Enter Categorization>

Risk Assessment Report (RAR)

FOR 

<System Name> (<Acronym>) 

<DRAFT/FINAL> Version <x.x>

<Month DD, YYYY>

Prepared by 

Office of Information Security
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY ii 

<INSTRUCTIONS: Orange, bracketed text indicates instructions on how a section should be 

completed or sample text, which should be replaced with project specific information or removed. 

Ensure sample text is turned from orange to black where necessary (e.g., headings shall be 

changed to the standard heading color), and all instructions are removed (including this paragraph). 

All black text shall remain unchanged.>
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iii 

Document Revision History 

Revision 

History Date Summary of Changes Author 

1.0 <Month DD, YYYY> Initial release <name>

<x.x> <Month DD, YYYY> <description> <name>

<x.x> <Month DD, YYYY> <description> <name>
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY iv 

Table of Contents 

1 RISK ASSESSMENT REPORT (RAR) BACKGROUND ...................................................... 6

2 RAR EXECUTIVE SUMMARY FOR <SYSTEM NAME> ...................................................... 6

3 <SYSTEM NAME> SYSTEM PURPOSE .............................................................................. 6

3.1 System Name/Title/Unique Identifier ........................................................................................... 6

3.2 Responsible Organization ............................................................................................................ 7

3.3 Security Categorization ................................................................................................................ 8

4 RISK ASSESSMENT APPROACH ....................................................................................... 8

4.1 Risk Assessment Purpose ........................................................................................................... 8

4.2 Risk Assessment Objective ......................................................................................................... 8

4.3 Risk Assessment Scope .............................................................................................................. 9

4.4 Limitations .................................................................................................................................... 9

4.5 Risk Assessors ............................................................................................................................ 9

4.6 Results ....................................................................................................................................... 10

4.7 Recommendation ....................................................................................................................... 11

5 SUMMARY OF FINDINGS .................................................................................................. 12

APPENDIX A. REFERENCE DOCUMENTS .......................................................................... 15
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY v 

List of Tables 

Table 1: <SYSTEM ACRONYM> Points of Contact ..................................................................................... 7

Table 2: <System Name> Security Categorization ....................................................................................... 8

Table 3: Assessment Team Points of Contact ......................................................................................... 9

Table 4: Overall Risk Level ......................................................................................................................... 10

Table 5: <SYSTEM ACRONYM> Results Summary .................................................................................. 12

Table 6: Acronym List ................................................................................................................................. 14
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 6

1 Risk Assessment Report (RAR) Background 

The Office of Management and Budget (OMB) directive requires the Social Security Administration (SSA) 

to assess and re-authorize its major information technology (IT) systems at least once every three years 

and in the event of a major change, when that change occurs. This information must be reported in the 

annual Federal Information Security Modernization Act (FISMA) report to OMB and Congress during the 

fourth quarter (Q4) of each year. OMB has directed Chief Information Officers (CIO) of Federal agencies to 

follow the guidance found in the National Institute of Standards and Technology (NIST) Special Publication 

(SP) 800-37 Revision 1, Guide for Applying the Risk Management Framework to Federal Information 

Systems, to assess and re-authorize their information systems. This security authorization process contains 

subordinate efforts including performing risk-based reviews of the systems, developing/updating system 

security plans (SSP), and assessing and testing the security controls implemented for SSA’s information 

systems. 

2 RAR Executive Summary for <System Name> The Office of Information Security (OIS) contracted with Coalfire Federal Services, a third party assessment 

organization (3PAO), to conduct a system specific risk assessment on <system name> (<ACRONYM>). 

The acting Director of the Division of Compliance and Assessments, and the Security Authorization 

Manager (SAM) of <SYSTEM ACRONYM> approved the controls selected for this risk assessment. Thirtytwo (32) controls were tested over eleven (11) different NIST 800-53 Rev 4 control families. These controls 

were selected out of the <system categorization> baseline due to <SYSTEM ACRONYM> being 

categorized as a <system categorization> system as per the FIPS 199. During the assessment, there were 

<55 manual tests conducted, 62 interviews, and 84 document examinations>. Each of these is a 

requirement of a specific control. At the conclusion of the assessment, two controls were identified as “not 

implemented”. It should be noted that these controls have since been identified as common and should be 

added to the common control list. The controls that were not implemented, identified as PS4 (personnel 

termination), and PS 5 (personnel transfer), requires the SSA Information Security Policy (ISP) to document 

specific exit interview security debrief policies and procedures and the defined time period in which these 

must be carried out. Please refer to Table 5 for specific details. The likelihood of these vulnerabilities being 

exploited combined with the potential system impact is considered an overall LOW risk to the system. It is 

recommended that the <system name> assigned representative from the Security Assessment and 

Authorization Branch (SAAB) work with the System Authorization Manager (SAM) to mitigate these risks. 

Due to the overall identified risk being LOW, it is recommended that this be considered an acceptable risk 

and the system be given an authority to operate (ATO) for the next three years. 

3 <system name> System Purpose 

The <system name> (<ACRONYM>) system, has a <system categorization> Security Categorization. The 

boundaries are designed to aid SSA in the accomplishment of its mission to provide cost-effective and 

reliable services to other Federal agencies, and the public at large. 

<Insert detailed information> 

Coalfire Federal Services’ objective is to provide IT Independent Verification and Validation (IV&V) Support 

Services for <SYSTEM ACRONYM>. 

3.1 System Name/Title/Unique Identifier 

System/Application Name: <system name> (<SYSTEM ACRONYM>)

Unique Identifier : <016-00-SSA/DCS-M-001> 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 7

3.2 Responsible Organization 

Table 1: <SYSTEM ACRONYM> Points of Contact 

Title II Batch 

POCs.xlsx

Title II Internet 

Applications POCs.xlsx

<Embed the applicable system’s POCs, EXAMPLE attached.>
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 8

3.3 Security Categorization 

This authorization boundary has been categorized as <system categorization> risk according to FIPS 

199. Refer to Table 5 below for supporting documentation regarding the determination of the 

application’s security categorization. 

Table 2: <System Name> Security Categorization 

Information Type Confidentiality Integrity Availability 

Accounting 

Mission Area: Financial Management 

Explanation: Selected risk values derived from NIST SP-800-

60, and FIPS 199, considering SSA business case.

L M L

Payments 

Mission Area: Financial Management 

Explanation: Selected risk values derived from NIST SP-800-

60, and FIPS 199, considering SSA business case.

L M L

Reporting & Information 

Mission Area: Financial Management 

Explanation: Based on the protection requirements for 

confidentiality, integrity and availability, the overall system 

sensitivity is <SYSTEM CATEGORIZATION>. The loss, 

misuse or unauthorized access to Agency data can be 

expected to have a serious adverse effect on SSA operations 

and assets.

L M L

Entitlement Event Information 

Mission Area: General Government 

Explanation: Selected risk values derived from NIST SP-800-

60, and FIPS 199, considering SSA business case.

M M M

Personal Identity and Authentication 

Mission Area: General Government

M M M

Information Sharing 

Mission Area: Information and Technology Management 

Explanation: Selected risk values derived from NIST SP-800-

60, and FIPS 199, considering SSA business case.

N/A N/A N/A

Overall M M M 

4 Risk Assessment Approach 

4.1 Risk Assessment Purpose 

The purpose of this Risk Assessment Report (RAR) is to summarize the residual risk identified during the 

security assessment of <SYSTEM ACRONYM>. Risk is a factor derived from a vulnerability that can be 

exploited and the likelihood that it will be exploited. Please see Appendix A for the NIST 800-60 Volume II 

publication for the definition of risk. 

4.2 Risk Assessment Objective 

The objective of the risk assessment is to identify any controls that are not fully implemented as required 

by FISMA. Controls that are not implemented pose a measureable risk to SSA and that risk must be 

mitigated in a timely manner based on the level or risk the non-implemented control creates. For example, 

a low risk may only require an update to a policy or a POA&M that the system’s SAM must execute. Another 

example is a High risk that must have immediate action taken by the SAM and other stakeholders in order 

to prevent a threat actor(s) from exploiting the discovered risk. 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 9

4.3 Risk Assessment Scope 

The previous system specific risk assessment was conducted on <SYSTEM ACRONYM> in <date>. The 

residual risk was identified and submitted to the SSA’s CIO. This submission was in accordance with OMB 

and FISMA guidelines to present the risk level of <SYSTEM ACRONYM> and ask for the ATO <SYSTEM 

ACRONYM> for the next three years. The CIO granted the ATO on <Month DD, YYYY> and allowed 

<SYSTEM ACRONYM> to operate from <Month DD, YYYY> to <Month DD, YYYY>. 

A new risk assessment is required by OMB and FISMA in order to identify the current residual risk and any 

risks associated with controls that are not fully implemented. The assessed controls were selected based 

on the <SYSTEM ACRONYM> Security Assessment Plan (SAP) approved by the OIS Director and the 

<SYSTEM ACRONYM> SAM. 

In addition to the controls selected, SSA uses the Nessus scanner along with the McAfee ePolicy 

Orchestrator (EPO) deployed by the SOC to look for signature based vulnerabilities in accordance with the 

SSA ISP. Associated Windows Database servers that have the EPO agent deployed within the <SYSTEM 

ACRONYM> boundary were scanned. The other <SYSTEM ACRONYM> servers did not have any 

vulnerability scanning tools available that could scan mainframe or storage hardware, and therefore were 

not scanned. 

The risk assessment was performed in accordance with all applicable laws, regulations, rules and orders 

of all governmental agencies and authorities. A complete list of referenced publications and regulations can 

be found in Appendix A. All risks associated with <SYSTEM ACRONYM> that were identified during the 

assessment and the potential impact of those risks are documented in this RAR. 

The RAR complies with the following SSA guidance: 

 SSA ISP

4.4 Limitations 

The <SYSTEM ACRONYM> subsystems, which reside within the National Support Center (NSC), rely on 

the Office of Systems Operations and Hardware Engineering (OSOHE) for hardware, software, and 

maintenance support. Additionally, user access and user profile provisioning for <SYSTEM ACRONYM>

subsystems residing on the mainframe, are provided by CA Top Secret, and managed by the Office of 

Systems Operations and Hardware Engineering (OSOHE), not by <SYSTEM ACRONYM>. Therefore, 

some access controls specific to <SYSTEM ACRONYM> are tested during an enterprise level common 

control assessment, and not during the <SYSTEM ACRONYM> system specific assessment reported 

within this RAR. 

This assessment was limited to the 32 system specific controls as listed in the approved SAP. 

4.5 Risk Assessors 

The participants in this risk assessment included the following Coalfire Federal Services personnel: 

Table 3: Assessment Team Points of Contact 

Name Role Contact Information 

<TJ Crews> Program Manager <Tj.crews@ssa.gov> 

<Kenneth Free> Lead Assessor (Senior Analyst) <kenneth.free@ssa.gov> 

<Gregory Bonham> Junior Assessor <gregory.bonham@ssa.gov> 

<Thomas G. Volpe, Sr.> Lead Assessor (Surge Support) <Thomas.G.Volpe@ssa.gov> 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 10

The following techniques and NIST/FIPS publications were used to gather information relevant to the 

<SYSTEM ACRONYM>: 

 NIST SP 800-60 Volume II Revision 1/ and FIPS 199. The Risk Assessment (RA) Team utilized 

the <SYSTEM ACRONYM> Security Categorization, dated February 16, 2017 to determine 

associated system security categorization for the <SYSTEM ACRONYM>. System security 

categorization determines which recommended set of minimum (baseline) security controls from 

NIST SP 800-53 Revision 4 must be implemented. 

 NIST SP 800-53 Revision 4. The RA Team utilized NIST SP 800-53 Revision 4 to determine the 

recommended set of minimum-security controls. The security controls (management, operational, 

and technical safeguards or countermeasures) were reviewed to ensure they adequately protect 

the confidentiality, integrity, and availability of the <SYSTEM ACRONYM>, and that the selected 

security controls have been implemented, or there is a plan for future implementation. 

 Interviews. Interviews were conducted on-site with the SAM, System Administrator, and Database 

Administrator by the RA Team to collect useful information about the <SYSTEM ACRONYM>. 

Follow-up communications were conducted via email and by telephone to collect additional 

information about the <SYSTEM ACRONYM>. 

 Examination/Document Reviews. The RA Team reviewed documentation from the SSA for 

<SYSTEM ACRONYM>, such as policy and implementation guidance. POA&M, and the prior 

Security Assessment and Authorization (SA&A) Package, including the previous SSP, Risk 

Assessment, and the Security Control Assessment (SCA) Plan were reviewed. 

 Testing of Systems. Testing and Evaluation of security controls for <SYSTEM ACRONYM> was 

based on System Specific and Hybrid security controls defined by the OIS Rev4 SSA Control 

Inheritance Structure Worksheet with a <SYSTEM CATEGORIZATION> Baseline. Using the NIST 

Guidance from NIST SP 800-53A Revision 4, the RA Team tested and evaluated these controls for 

specified conditions that compare actual with expected behavior, the results of which are used to 

support the determination of security control existence, functionality, correctness, completeness, 

and potential for improvement over time. 

4.6 Results 

The overall risk level of the <SYSTEM ACRONYM> was determined to be Low, which is the combination 

of the likelihood of identified threats being able to exploit known system vulnerabilities and the potential the 

impact to <SYSTEM ACRONYM>. 

Low risk indicates that corrective actions are needed and a plan must be developed to incorporate these 

actions within a reasonable period of time. The preliminary review of security measures for the protection 

of the <SYSTEM ACRONYM> identified two low threat-vulnerability pairs (risks) in the overall risk 

assessment as summarized below in Table 2. 

Table 4: Overall Risk Level 

Risk Rating Control Category

Management Operational Technical Total 

Very High 0 0 0 0 

High 0 0 0 0 

Moderate 0 0 0 0 

Low 2 0 0 2 

Very Low 0 0 0 0 

Total 2 0 0 2 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

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4.7 Recommendation 

It is the recommendation from the Office of Information Security that an issuance of an Authority to Operate 

(ATO) for <system name> (<ACRONYM>) be given. This recommendation comes from the assessment 

findings from the 3PAO that conducted a system specific security assessment. The overall security 

categorization of <SYSTEM ACRONYM> is <system categorization> and the findings have an overall risk 

of LOW. 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 12

5 Summary of Findings 

Table 5: <SYSTEM ACRONYM> Results Summary

Item 

No. 

Finding 

(In Order by Control 

Family) 

Threat Source Likelihood 

Level 

Impact 

Level 

Risk 

Level 

Recommended 

Corrective 

Action(s) 

V-1 PS-4.c.1 

PS-4.c.2 

Personnel 

Termination 

SSA ISP does not 

define the security 

debrief topics or policy 

to discuss with 

separating employees. 

In addition, the SSA 

ISP has no policy, 

guidelines for including 

the security debrief 

actions, or SSA specific 

information security 

topics during the exit 

interview as defined in 

PS-4.c.1 and PS-4.c.2. 

Insider Threat with 

Intent (e.g., Poorly 

Trained, 

Disgruntled, 

Malicious, 

Negligent, 

Dishonest, or 

Terminated 

Employees) 

Insider Threat 

without Intent or 

Knowledge 

Computer 

Crime/Hackers 

Espionage (e.g., 

Companies, 

Foreign 

Governments, or 

Other Government 

Interests) 

Low Low Low This is an agency 

requirement that 

must be reflected in 

the SSA ISP and is 

the responsibility of 

Division of Security 

Customer Service 

(DSCS). The 

Security 

Authorization 

Manager (SAM) is 

not responsible for 

updating policy. The 

SSA ISP should be 

updated to include a 

requirement that 

employees sign a 

Non-Disclosure 

Agreement (NDA), 

and have a security 

debrief to discuss 

the importance of 

not disclosing 

knowledge of 

specifics pertaining 

to the SSA 

information system 

environment. The 

ISP section 2.1.1.3 

should be updated 

to reflect this. In 

addition, section 

2.1.1.3 should be 

updated to reflect 

that a security 

debrief must be 

included as part of 

the exit interview. 

Exit interview 

guidance is currently 

located here: 

http://personnel.ba.s

sa.gov/OPE/cpps/exi

tprocedures.html 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

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Item 

No. 

Finding 

(In Order by Control 

Family) 

Threat Source Likelihood 

Level 

Impact 

Level 

Risk 

Level 

Recommended 

Corrective 

Action(s) 

V-2 PS-5.b.1 

PS-5.b.2 

Personnel Transfer 

SSA ISP does not 

define what security 

actions are to be taken 

when an employee is 

transferred or 

reassigned. The SSA 

ISP also does not 

specify the time period 

in which security 

actions that are defined 

in must occur. 

Insider Threat with 

Intent (e.g., Poorly 

Trained, 

Disgruntled, 

Malicious, 

Negligent, 

Dishonest, or 

Terminated 

Employees) 

Insider Threat 

without Intent or 

Knowledge 

Low Low Low This is an agency 

requirement that 

must be reflected in 

the SSA ISP and is 

the responsibility of 

DSCS. The ISP 

section 2.4 should 

be updated to define 

what security actions 

need to occur, in 

what period of time 

and what personnel 

or role is to be 

identified to be 

notified when an 

employee is 

transferred or 

reassigned. 

Authority To Operate (ATO) 

Recommendation 

Acceptance and Signature 

As the Security Authorization Manager (SAM) for <system name>, I hereby certify that this Risk 

Assessment Report provides an accurate representation of the system and its subsystems that were 

assessed. I also certify that it is my recommendation based on the findings that the SSA Chief 

Information Officer (CIO) grant an Authority to Operate (ATO) for <system name> for the next three (3) 

years. 

Security Authorization Manager: 

<name> 

As the Acting Director of the Division of Compliance and Authorization (DCA) in the Office of Information 

Security (OIS), I hereby certify that this Risk Assessment Report provides an accurate representation of 

the system and its subsystems that were assessed. I also certify that it is my recommendation based on 

the findings that the SSA Chief Information Officer (CIO) grant an Authority to Operate (ATO) for <system 

name> for the next three (3) years. 

Division of Compliance and 

Assessments Director 

Steven Harkness 

(Acting)
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 14

Table 6: Acronym List 

Acronym Definition 

AO Authorizing Official 

BSM Boundary Scope Memorandum 

CET Customer Engagement Tool 

CICS Customer Information Control System 

CIO Chief Information Officer 

CSO Component Security Officer 

DCA Division of Compliance and Authorization 

DCS Deputy Commissioner for Systems 

EPO McAfee ePolicy Orchestrator 

FIPS Federal Information Processing Standard 

FISMA Federal Information Security Modernization Act 

FOUO For Official Use Only 

ISA Interconnection Security Agreement 

ISP Information Security Policy 

IT Information Technology 

IV&V Independent Verification and Validation 

L2TP Layer 2 Tunneling Protocol 

LAN Local Area Network 

LIS Low Income Subsidy 

MKS Mortise Kern Systems 

MOA Memorandum of Agreement 

MOU Memorandum of Understanding 

NDA Non-disclosure Agreement 

NSC National Support Center 

NIST National Institute of Standards and Technology 

OIS Office of Information Security 

OMB Office of Management and Budget 

OSOHE Office of Systems Operations and Hardware Engineering 

OTSO Office of Telecommunications and System Operations 

PII Personally Identifiable Information 

POA&M Plan of Action and Milestones 

PSC Program Service Centers 

RA Risk Assessment or Risk Assessor 
Social Security Administration 

<System Name> 

Risk Assessment Report (RAR) 

Version <x.x>

 UNCLASSIFIED // FOR OFFICIAL USE ONLY 15

Acronym Definition 

RAR Risk Assessment Report 

RSDI Retirement, Survivor, or Disability Insurance 

SA&A Security Assessment and Authorization 

SAM Security Authorization Manager 

SAP System Assessment Plan 

SBU Sensitive But Unclassified 

SCA Security Control Assessment 

SO System Owner 

SP Special Publication 

SSA Social Security Administration 

SSP System Security Plan 

VPN Virtual Private Network 

3PAO Third Party assessment Organization 

 

APPENDIX A. REFERENCE DOCUMENTS 

The following documents were reviewed during the risk assessment process of the SSA’s security 

controls: 

 Federal Information Processing Standard (FIPS) 199 

 NIST Special Publication 800-30 Rev. 1, “Guide for Conducting Risk Assessments” 

 Office of Management and Budget (OMB) Circular A-130. 

 NIST Special Publication 800-39 

 NIST Special Publication 800-60 Revision 1, Volumes 1&2 

 NIST Special Publication 800-53 Revision 4 

 SSA Information Security Policy (ISP) 
EXHIBIT E
UNCLASSIFIED // FOR OFFICIAL USE ONLY 

UNCLASSIFIED // FOR OFFICIAL USE ONLY 

TEMPLATE VERSION (V2.2 FY17) 

Social Security Administration (SSA) 

Security Categorization: <Enter Categorization>

 NOTE: The Security Categorization for the system may not be available at the time of 

the development of this document if the system is a newly developed system or has 

undergone a major change which has augmented the data types processed by the 

system. Additional information on completing the security categorization of the 

information system can be found on the DSPP website at: 

http://sharepoint.ba.ssa.gov/DCS/OIS/DSPP/Veris%20TO14%20IVV%20and%20OA/

Forms/AllItems.aspx?RootFolder=%2fDCS%2fOIS%2fDSPP%2fVeris%20TO14%20I

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derCTID=0x0120003BC3DC1169B0CE47BB662BC248F5B5EE. 

<Document Name> 

FOR 

<Externally Hosted Information System Name> 

<(Acronym)> 

<DRAFT/FINAL> Version <X.X> 

<Month DD, YYYY> 

Prepared by 

[COMPANY LOGO] 

[COMPANY STREET ADDRESS] 

[COMPANY CITY, STATE ZIP]
Social Security Administration 

<System Name><System Acronym> 

<Document Name> 

Version <X.X>

TMP V2.2 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY ii

Document Revision History 

Revision 

Number Revision Date Page Number Revision Summary Name of Reviewer 

V[X.X] MM/DD/YYYY All/Page 

No. [E.g. Initial Draft, Annual Review, etc.] 

[Company/Agency 

Name: Contact 

Name] 

 

 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

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PREFACE

To carry out its wide-ranging responsibilities, the Social Security Administration (SSA), and its employees 

and managers have access to diverse and complex automated information systems, which includes, file 

servers, local and wide area networks (LANs/WANs) running on various platforms, and 

telecommunications systems. The components and offices within the SSA depend on the confidentiality, 

integrity, and availability (as defined by the Federal Information Processing Standard (FIPS) 199) of these 

systems and their data in order to accomplish day-to-day operations. 

In accordance with Office of Management and Budget (OMB) Circular A-130, Appendix III, all federal 

systems have value and require some level of protection. The generic term “system” is used to mean 

either a general support system or a major application. (See NIST Special Publication 800-18, Guide for 

Developing Security Plans for Federal Information Systems for additional information). 
Social Security Administration 

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EXECUTIVE SUMMARY

The SSA relies on its information technology (IT) systems, including the [Enter SYSTEM NAME 

(Acronym)], to accomplish its undertaking of providing cost-effective and reliable services to the SSA, 

other Federal agencies, and the public at large. Since this externally hosted information system is part of 

an SSA security authorization boundary, it is subject to meet some or all of the SSA specific security 

requirements depending upon the information it processes and the services it provides for the SSA. 

[Provide an EXECUTIVE SUMMARY and overview of the information system. This summary should 

describe what the information system is, what its importance is to SSA, who is in the user audience, and 

any additional subsystems that is encompassed in the system.] 

The purpose of this system security plan is to provide an overview of the security requirements of the 

[ENTER SYSTEM NAME HERE] system and describe the controls in place or planned for meeting those 

requirements. The system security plan also delineates responsibilities and expected behavior of all 

individuals who access the system. 

The SSP documents the structured process of planning adequate, cost-effective security protection for a 

system. It shall reflect input from various managers/stakeholders with responsibilities concerning the 

system from the hosting company and from the SSA component for which the system provides services. 

 [Note: This SSP template shall be used to document an external hosted Information 

Systems that “IS” associated with one of the existing SSA Security Authorization 

Boundaries. 

As part of the development of this SSP document, the external system ISO or designee along with the 

SSA SAM and the Office of Information Security (OIS) will need to follow the instructions to determine 

which new application/system/sub-system should be included or associated with SSA. See section 1.1 

below for more details related to this process.]  DELETE THESE INSTRUCTIONS UPON 

COMPLETION 
Social Security Administration 

<System Name><(System Acronym)> 

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SYSTEM SECURITY PLAN AGREEMENT SUMMARY

This SSP documents a formal agreement among the organizational officials approving the security 

controls designed to meet the security requirements for the [SYSTEM NAME]. These officials are the 

SSA System Owner (SO), (External Contractor) Information System Security Officer (ISSO), SSA 

Security Authorization Manager (SAM) and the SSA Authorizing Official (AO). 

Each organizational official has signed this agreement summary for the reasons identified below and has 

concurred with the security category of this Controlled Unclassified Information (CUI) system to be 

[LOW/MODERATE]. See Executive Order 13556 for more information on CUI. 

 [Check the box below that is applicable  DELETE] 

Initiation of the System Security Plan (including FIPS 199 security categorization)1

Annual Update of the System Security Plan (no significant changes) 

Acceptance and Signature 

As the Designated Representative(s) for <System Name>, I hereby certify that the <System 

Acronym> System Security Plan described in this document provides an accurate representation 

of the <System Acronym> and its subsystems. 

SSA Security Authorization Manager 

[ENTER NAME OF SAM  DELETE 

<Insert digital signature> 

SSA DSP Director 

[ENTER NAME OF DSP DIRECTOR] 

DELETE 

<Insert digital signature> 

 

1 When there are no significant changes, the System Owner, Information System Security Officer and SSA Security Authorization Manager must sign 

the agreement summary for an annual update. The Authorizing Official is not required to sign if there are no significant changes affecting the 

security posture of the system requiring reauthorization. Reauthorization is addressed via a formal memorandum approving the security plan and 

authorizing the system to operate for a specified period of time.
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Table of Contents 

1 INFORMATION SYSTEM IDENTIFICATION ....................................................................... 1

1.1 DETERMINATION OF SYSTEM .......................................................................................................... 1

1.2 RESPONSIBLE ORGANIZATION ......................................................................................................... 1

1.3 INFORMATION SYSTEM CATEGORIZATION ........................................................................................ 1

1.4 GENERAL DESCRIPTION OF INFORMATION SENSITIVITY .................................................................... 2

1.5 IMPACT LEVEL FOR INFORMATION TYPES ......................................................................................... 2

1.6 SYSTEM POINTS OF CONTACT ........................................................................................................ 3

1.7 ASSIGNMENT OF SECURITY RESPONSIBILITY ................................................................................... 4

1.8 SYSTEM OPERATIONAL STATUS ...................................................................................................... 4

1.9 INFORMATION SYSTEM TYPE ........................................................................................................... 4

1.10 SECURITY STATUS ......................................................................................................................... 5

1.11 GENERAL DESCRIPTION AND PURPOSE ........................................................................................... 5

1.12 DATA TYPES .................................................................................................................................. 5

1.13 INFORMATION SYSTEM BOUNDARY .................................................................................................. 6

1.14 SYSTEM ARCHITECTURE/ENVIRONMENT .......................................................................................... 6

1.15 SECURITY AUTHORIZATION BOUNDARY ........................................................................................... 6

1.16 SYSTEM INVENTORY ....................................................................................................................... 6

1.17 SYSTEM INTERCONNECTIONS.......................................................................................................... 7

2 [SYSTEM ACRONYM] NIST SP 800-53 - REV 4 MINIMUM SECURITY CONTROLS ....... 8

2.1 SECURITY CONTROLS .................................................................................................................... 8

2.1.1 Access Control (AC) ................................................................................................................ 8

2.1.1.1 AC-1 Access Control Policy and Procedures .......................................................................... 8

2.1.1.2 AC-2 Account Management .................................................................................................... 9

2.1.1.3 AC-3 Access Enforcement .................................................................................................... 11

2.1.1.4 AC-4 Information Flow Enforcement ..................................................................................... 12

2.1.1.5 AC-5 Separation of Duties ..................................................................................................... 13

2.1.1.6 AC-6 Least Privilege .............................................................................................................. 13

2.1.1.7 AC-7 Unsuccessful Logon Attempts ..................................................................................... 16

2.1.1.8 AC-8 System Use Notification ............................................................................................... 16

2.1.1.9 AC-11 Session Lock .............................................................................................................. 17

2.1.1.10 AC-12 Session Termination .................................................................................................. 18

2.1.1.11 AC-14 Permitted Actions without Identification or Authentication ......................................... 19

2.1.1.12 AC-17 Remote Access .......................................................................................................... 20

2.1.1.13 AC-18 Wireless Access ......................................................................................................... 22

2.1.1.14 AC-19 Access Control for Mobile Devices ............................................................................ 23

2.1.1.15 AC-20 Use of External Information Systems ......................................................................... 24

2.1.1.16 AC-21 Information Sharing .................................................................................................... 26

2.1.1.17 AC-22 Publicly Accessible Content ....................................................................................... 26

2.1.2 Awareness and Training (AT) ................................................................................................ 27

2.1.2.1 AT-1 Security Awareness and Training Policy and Procedures ........................................... 27

2.1.2.2 AT-2 Security Awareness Training ........................................................................................ 28

2.1.2.3 AT-3 Role-Based Security Training ....................................................................................... 29

2.1.2.4 AT-4 Security Training Records ............................................................................................ 30

2.1.3 Audit and Accountability (AU) ................................................................................................ 30
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2.1.3.1 AU-1 Audit and Accountability Policy and Procedures.......................................................... 30

2.1.3.2 AU-2 Audit Events ................................................................................................................. 31

2.1.3.3 AU-3 Content of Audit Records ............................................................................................. 32

2.1.3.4 AU-4 Audit Storage ............................................................................................................... 33

2.1.3.5 AU-5 Response to Audit Processing Failures ....................................................................... 34

2.1.3.6 AU-6 Audit Review, Analysis, and Reporting ........................................................................ 34

2.1.3.7 AU-7 Audit Reduction and Report Generation ...................................................................... 36

2.1.3.8 AU-8 Time Stamps ................................................................................................................ 37

2.1.3.9 AU-9 Protection of Audit Information ..................................................................................... 38

2.1.3.10 AU-11 Audit Record Retention .............................................................................................. 39

2.1.3.11 AU-12 Audit Generation ........................................................................................................ 40

2.1.4 Security Assessment and Authorization (CA) ....................................................................... 40

2.1.4.1 CA-1 Security Assessment and Authorization Policies and Procedures .............................. 41

2.1.4.2 CA-2 Security Assessments .................................................................................................. 41

2.1.4.3 CA-3 System Interconnections .............................................................................................. 43

2.1.4.4 CA-5 Plan of Action and Milestones ...................................................................................... 44

2.1.4.5 CA-6 Security Authorization .................................................................................................. 44

2.1.4.6 CA-7 Continuous Monitoring ................................................................................................. 45

2.1.4.7 CA-9 Internal System Connections ....................................................................................... 46

2.1.5 Configuration Management (CM) .......................................................................................... 47

2.1.5.1 CM-1 Configuration Management Policy and Procedures .................................................... 47

2.1.5.2 CM-2 Baseline Configuration ................................................................................................ 48

2.1.5.3 CM-3 Configuration Change Control ..................................................................................... 50

2.1.5.4 CM-4 Security Impact Analysis ............................................................................................. 51

2.1.5.5 CM-5 Access Restrictions for Change .................................................................................. 52

2.1.5.6 CM-6 Configuration Settings ................................................................................................. 52

2.1.5.7 CM-7 Least Functionality ....................................................................................................... 53

2.1.5.8 CM-8 Information System Component Inventory .................................................................. 55

2.1.5.9 CM-9 Configuration Management Plan ................................................................................. 57

2.1.5.10 CM-10 Software Usage Restrictions ..................................................................................... 58

2.1.5.11 CM-11 User-Installed Software ............................................................................................. 58

2.1.6 Contingency Planning (CP) ................................................................................................... 59

2.1.6.1 CP-1 Contingency Planning Policy and Procedures ............................................................. 59

2.1.6.2 CP-2 Contingency Plan ......................................................................................................... 60

2.1.6.3 CP-3 Contingency Training ................................................................................................... 62

2.1.6.4 CP-4 Contingency Plan Testing ............................................................................................ 63

2.1.6.5 CP-6 Alternate Storage Site .................................................................................................. 64

2.1.6.6 CP-7 Alternate Processing Site ............................................................................................. 65

2.1.6.7 CP-8 Telecommunications Services ..................................................................................... 67

2.1.6.8 CP-9 Information System Backup ......................................................................................... 69

2.1.6.9 CP-10 Information System Recovery and Reconstitution ..................................................... 70

2.1.7 Identification and Authentication (IA) .................................................................................... 71

2.1.7.1 IA-1 Identification and Authentication Policy and Procedures .............................................. 71

2.1.7.2 IA-2 Identification and Authentication .................................................................................... 72

2.1.7.3 IA-3 Device Identification and Authentication ........................................................................ 75

2.1.7.4 IA-4 Identifier Management ................................................................................................... 76

2.1.7.5 IA-5 Authenticator Management............................................................................................ 76

2.1.7.6 IA-6 Authenticator Feedback ................................................................................................. 79

2.1.7.7 IA-7 Cryptographic Module Authentication ............................................................................ 80

2.1.7.8 IA-8 Identification and Authentication (Non-Organizational Users) ....................................... 80

2.1.8 Incident Response (IR) .......................................................................................................... 82

2.1.8.1 IR-1 Incident Response Policy and Procedures .................................................................... 83

2.1.8.2 IR-2 Incident Response Training ........................................................................................... 83

2.1.8.3 IR-3 Incident Response Testing ............................................................................................ 84
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2.1.8.4 IR-4 Incident Handling ........................................................................................................... 85

2.1.8.5 IR-5 Incident Monitoring ........................................................................................................ 86

2.1.8.6 IR-6 Incident Reporting ......................................................................................................... 87

2.1.8.7 IR-7 Incident Response Assistance ...................................................................................... 88

2.1.8.8 IR-8 Incident Response Plan ................................................................................................. 89

2.1.9 Maintenance (MA) ................................................................................................................. 89

2.1.9.1 MA-1 System Maintenance Policy and Procedures .............................................................. 90

2.1.9.2 MA-2 Controlled Maintenance ............................................................................................... 90

2.1.9.3 MA-3 Maintenance Tools ...................................................................................................... 91

2.1.9.4 MA-4 Nonlocal Maintenance ................................................................................................. 92

2.1.9.5 MA-5 Maintenance Personnel ............................................................................................... 93

2.1.9.6 MA-6 Timely Maintenance ..................................................................................................... 94

2.1.10 Media Protection (MP) ........................................................................................................... 95

2.1.10.1 MP-1 Media Protection Policy and Procedures ..................................................................... 95

2.1.10.2 MP-2 Media Access .............................................................................................................. 95

2.1.10.3 MP-3 Media Marking ............................................................................................................. 96

2.1.10.4 MP-4 Media Storage ............................................................................................................. 97

2.1.10.5 MP-5 Media Transport ........................................................................................................... 97

2.1.10.6 MP-6 Media Sanitization ....................................................................................................... 98

2.1.10.7 MP-7 Media Use .................................................................................................................... 99

2.1.11 Physical and Environmental Protection (PE) ...................................................................... 100

2.1.11.1 PE-1 Physical and Environmental Protection Policy and Procedures ................................ 100

2.1.11.2 PE-2 Physical Access Authorizations ................................................................................. 101

2.1.11.3 PE-3 Physical Access Control ............................................................................................. 102

2.1.11.4 PE-4 Access Control for Transmission Medium .................................................................. 102

2.1.11.5 PE-5 Access Control for Output Devices ............................................................................ 103

2.1.11.6 PE-6 Monitoring Physical Access........................................................................................ 104

2.1.11.7 PE-8 Visitor Access Records .............................................................................................. 105

2.1.11.8 PE-9 Power Equipment and Cabling ................................................................................... 105

2.1.11.9 PE-10 Emergency Shutoff ................................................................................................... 106

2.1.11.10 PE-11 Emergency Power .................................................................................................... 107

2.1.11.11 PE-12 Emergency Lighting .................................................................................................. 107

2.1.11.12 PE-13 Fire Protection .......................................................................................................... 108

2.1.11.13 PE-14 Temperature and Humidity Controls ........................................................................ 109

2.1.11.14 PE-15 Water Damage Protection ........................................................................................ 110

2.1.11.15 PE-16 Delivery and Removal .............................................................................................. 110

2.1.11.16 PE-17 Alternate Work Site .................................................................................................. 111

2.1.12 Planning (PL) ....................................................................................................................... 112

2.1.12.1 PL-1 Security Planning Policy and Procedures ................................................................... 112

2.1.12.2 PL-2 System Security Plan .................................................................................................. 113

2.1.12.3 PL-4 Rules of Behavior ....................................................................................................... 114

2.1.12.4 PL-8 Information Security Architecture ............................................................................... 115

2.1.13 Personnel Security (PS) ...................................................................................................... 116

2.1.13.1 PS-1 Personnel Security Policy and Procedures ................................................................ 116

2.1.13.2 PS-2 Position Risk Designation ........................................................................................... 117

2.1.13.3 PS-3 Personnel Screening .................................................................................................. 117

2.1.13.4 PS-4 Personnel Termination ............................................................................................... 118

2.1.13.5 PS-5 Personnel Transfer ..................................................................................................... 119

2.1.13.6 PS-6 Access Agreements ................................................................................................... 119

2.1.13.7 PS-7 Third-Party Personnel Security .................................................................................. 120

2.1.13.8 PS-8 Personnel Sanctions .................................................................................................. 121

2.1.14 Risk Assessment (RA) ........................................................................................................ 121

2.1.14.1 RA-1 Risk Assessment Policy and Procedures .................................................................. 122

2.1.14.2 RA-2 Security Categorization .............................................................................................. 122
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2.1.14.3 RA-3 Risk Assessment ........................................................................................................ 123

2.1.14.4 RA-5 Vulnerability Scanning ................................................................................................ 124

2.1.15 System and Services Acquisition ........................................................................................ 126

2.1.15.1 SA-1 System and Services Acquisition Policy and Procedures .......................................... 126

2.1.15.2 SA-2 Allocation of Resources .............................................................................................. 127

2.1.15.3 SA-3 System Development Life Cycle ................................................................................ 127

2.1.15.4 SA-4 Acquisition Process .................................................................................................... 128

2.1.15.5 SA-5 Information System Documentation ........................................................................... 130

2.1.15.6 SA-8 Security Engineering Principles ................................................................................. 131

2.1.15.7 SA-9 External Information System Services ....................................................................... 132

2.1.15.8 SA-10 Developer Configuration Management .................................................................... 133

2.1.15.9 SA-11 Developer Security Testing and Evaluation ............................................................. 134

2.1.16 System and Communications Protection ............................................................................ 135

2.1.16.1 SC-1 System and Communications Protection Policy and Procedures .............................. 135

2.1.16.2 SC-2 Application Partitioning ............................................................................................... 136

2.1.16.3 SC-4 Information in Shared Resources .............................................................................. 136

2.1.16.4 SC-5 Denial of Service Protection ....................................................................................... 137

2.1.16.5 SC-7 Boundary Protection ................................................................................................... 137

2.1.16.6 SC-8 Transmission Confidentiality and Integrity ................................................................. 140

2.1.16.7 SC-10 Network Disconnect ................................................................................................. 141

2.1.16.8 SC-12 Cryptographic Key Establishment and Management ............................................... 142

2.1.16.9 SC-13 Cryptographic Protection .......................................................................................... 142

2.1.16.10 SC-15 Collaborative Computing Devices ............................................................................ 143

2.1.16.11 SC-17 Public Key Infrastructure Certificates ....................................................................... 144

2.1.16.12 SC-18 Mobile Code ............................................................................................................. 144

2.1.16.13 SC-19 Voice Over Internet Protocol .................................................................................... 145

2.1.16.14 SC-20 Secure Name / Address Resolution Service (Authoritative Source) ........................ 146

2.1.16.15 SC-21 Secure Name / Address Resolution Service (Recursive or Caching Resolver) ...... 146

2.1.16.16 SC-22 Architecture and Provisioning for Name / Address Resolution Service ................... 147

2.1.16.17 SC-23 Session Authenticity ................................................................................................. 148

2.1.16.18 SC-28 Protection of Information at Rest ............................................................................. 148

2.1.16.19 SC-39 Process Isolation ...................................................................................................... 149

2.1.17 System and Information Integrity......................................................................................... 149

2.1.17.1 SI-1 System and Information Integrity Policy and Procedures ............................................ 149

2.1.17.2 SI-2 Flaw Remediation ........................................................................................................ 150

2.1.17.3 SI-3 Malicious Code Protection ........................................................................................... 151

2.1.17.4 SI-4 Information System Monitoring .................................................................................... 153

2.1.17.5 SI-5 Security Alerts, Advisories, and Directives .................................................................. 155

2.1.17.6 SI-7 Software, Firmware, and Information Integrity ............................................................. 156

2.1.17.7 SI-8 Spam Protection .......................................................................................................... 157

2.1.17.8 SI-10 Information Input Validation ....................................................................................... 159

2.1.17.9 SI-11 Error Handling ............................................................................................................ 159

2.1.17.10 SI-12 Information Handling and Retention .......................................................................... 160

2.1.17.11 SI-16 Memory Protection ..................................................................................................... 161

3 APPENDIX LISTING ......................................................................................................... 162

3.1 REQUIRED APPENDICES ............................................................................................................. 162

3.2 SYSTEM SPECIFIC APPENDICES .................................................................................................. 162

3.3 ACRONYM LIST .......................................................................................................................... 163

3.4 DEFINITIONS/GLOSSARY ............................................................................................................. 165

3.5 APPLICABLE LAWS AND REFERENCES ......................................................................................... 169
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LIST OF FIGURES 

Figure 1: [System Acronym] Architecture Diagram ....................................................................................... 6

Figure 2: [System Acronym] Accreditation Boundary ................................................................................... 6

LIST OF TABLES 

Table 1: System Name/Identifier ................................................................................................................... 1

Table 2: Responsible Organization ............................................................................................................... 1

Table 3: Security Categorization ................................................................................................................... 1

Table 4: Impact Level for Information Types ................................................................................................. 3

Table 5: <System Name> Points of Contact ................................................................................................. 3

Table 6: [System Acronym] (Contractor) Information System Security Officer (ISSO) ................................. 4

Table 7: SSA Security Authorization Manager (SAM) ................................................................................. 4

Table 8: Information System Operational Status .......................................................................................... 4

Table 9: Information System Type ................................................................................................................ 5

Table 10: NIST SP 800-60 Vol 2. Information Data Types ........................................................................... 5

Table 11: Inventory: List of Technologies ..................................................................................................... 6

Table 12: [System Acronym] System Interconnections ................................................................................ 7
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1 Information System Identification 

1.1 Determination of System 

Table 1: System Name/Identifier 

System Name/Title: System ID No: 

<System name: external information system 

name> ( short name-subsystem short name)

1.2 Responsible Organization 

Table 2: Responsible Organization 

Organization Address 

 

1.3 Information System Categorization 

Security categorizations are to be performed as the first step in the security authorization process as 

required by Federal Information Processing Standard (FIPS) 199 in order to select appropriate system 

security controls to be addressed throughout the rest of the security authorization. FIPS 199 categories 

are derived according to the potential impact on the agency that would occur if its Confidentiality, 

Integrity, or Availability were compromised. FIPS 199 category definitions are as follows: 

 High Impact: The loss of confidentiality, integrity, or availability could be expected to have a 

severe or catastrophic adverse effect on organizational operations, organizational assets, or 

individuals. 

 Moderate Impact: The loss of confidentiality, integrity, or availability could be expected to have 

a serious adverse effect on organizational operations, organizational assets, or individuals. (At 

SSA, the highest security categorization is currently Moderate) 

 Low Impact: The loss of confidentiality, integrity, or availability could be expected to have a 

limited adverse effect on organizational operations, organizational assets, or individuals. 

Based on the system categorization of this externally hosted system the [SYSTEM ACRONYM] system 

has been categorized as a [LOW/MODERATE] system according to FIPS 199. 

 [Enter an “X” in the applicable section]  DELETE 

Table 3: Security Categorization 

Low 

Moderate 
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1.4 General Description of Information Sensitivity 

Sensitive information is defined by the Computer Security Act (section 552a of Title 5, United States 

Code) as any information, the loss, misuse, or unauthorized access to or modification of which could 

adversely affect the national interest or the conduct of federal programs, or the privacy to which 

individuals are entitled. The National Institute of Standards and Technology (NIST) Special Publication 

800-122 Guide to Protecting the Confidentiality of Personally Identifiable Information (PII) further defines 

the requirements for Personal Identity Information (PII) which SSA follows with regard to protecting its 

sensitive PII. 

FIPS 199 defines security categories for information systems based on potential impact on organizations, 

assets, or individuals should there be a breach of security—that is, a loss of confidentiality, integrity, or 

availability. FIPS 199 security categories play an important part in defining information system security 

boundaries by partitioning the agency's information systems according to the criticality or sensitivity of the 

information and information systems and the importance of those systems in accomplishing the agency's 

mission. This is particularly important when there are various FIPS 199 impact levels contained in one 

information system. The FIPS 199 requirement to secure an information system to the high watermark or 

highest impact level must be applied when grouping minor applications/subsystems with varying FIPS 

199 impact levels into a single general support system or major application unless there is adequate 

boundary protection, e.g., firewalls and encryption, around those subsystems or applications with the 

highest impact level. Additionally, there must be assurance that the shared resources, i.e., networks, 

communications, and physical access within the whole general support system or major application, are 

protected adequately for the highest impact level. Having the ability to isolate the high impact systems will 

not only result in more secure systems, but will also reduce the amount of resources required to secure 

many applications/systems that do not require that level of security. NIST SP 800-53 provides three 

security control baselines, i.e., low, moderate, and high (high is not addressed by this SSP), that are 

associated with the three FIPS 199 impact levels; as the impact level increases, so do the minimum 

assurance requirements. For reporting purposes, i.e., FISMA annual report, when an information system 

has varying FIPS 199 impact levels, that system is categorized at the highest impact level on that 

information system. 

1.5 Impact Level for Information Types 

The following tables identify the information types that are input, stored, processed, and/or output from 

[System Acronym]. The selection of the information types is based on guidance provided by OMB 

Federal Enterprise Architecture Program Management Office Business Reference Model 2.0 

(http://www.whitehouse.gov/omb/e-gov/fea), and the FIPS 199, Standards for Security Categorization of 

Federal Information and Information Systems, and NIST Special Publication (SP) 800-60, Guide for 

Mapping Types of Information and Information Systems to Security Categories. SP 800-60 includes two 

volumes: Volume I is a basic guideline and Volume II contains appendices. Users should review the 

guidelines provided in Volume I, then refer to only the material from the appendices that is applicable. 

NIST SP 800-60 is available for download at http://csrc.nist.gov/publications/. 

The potential impact is LOW if— 

The loss of confidentiality, integrity, or availability could be expected to have a limited adverse 

effect on organizational operations, organizational assets, or individuals. 

A limited adverse effect means that, for example, the loss of confidentiality, integrity, or availability 

might: (i) cause a degradation in mission capability to an extent and duration that the organization 

is able to perform its primary functions, but the effectiveness of the functions is noticeably 

reduced; (ii) result in minor damage to organizational assets; (iii) result in minor financial loss; or 

(iv) result in minor harm to individuals. 

The potential impact is MODERATE if— 
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The loss of confidentiality, integrity, or availability could be expected to have a serious adverse 

effect on organizational operations, organizational assets, or individuals. 

A serious adverse effect means that, for example, the loss of confidentiality, integrity, or 

availability might: (i) cause a significant degradation in mission capability to an extent and 

duration that the organization is able to perform its primary functions, but the effectiveness of the 

functions is significantly reduced; (ii) result in significant damage to organizational assets; (iii) 

result in significant financial loss; or (iv) result in significant harm to individuals that does not 

involve loss of life or serious life threatening injuries. 

The potential impact is HIGH if— 

The loss of confidentiality, integrity, or availability could be expected to have a severe or 

catastrophic adverse effect on organizational operations, organizational assets, or individuals. 

A severe or catastrophic adverse effect means that, for example, the loss of confidentiality, 

integrity, or availability might: (i) cause a severe degradation in or loss of mission capability to an 

extent and duration that the organization is not able to perform one or more of its primary 

functions; (ii) result in major damage to organizational assets; (iii) result in major financial loss; or 

(iv) result in severe or catastrophic harm to individuals involving loss of life or serious life 

threatening injuries. 

 [List the different information types per NIST SP 800-60 and indicate provisional impact level. Add or 

modify information types if necessary]. This information can be copy/pasted from the SSA Parent 

System FIPS199 Security Categorization Review documentation, Section 4.  DELETE THESE 

INSTRUCTIONS UPON COMPLETION 

Table 4: Impact Level for Information Types 

NIST Information 

Type 

NIST 

SP 800-60, 

Volume II 

Reference 

NIST Recommended Provisional Impact Levels 

System Owner 

Selected Impact Levels Comments 

Confidentiality Integrity Availability Confidentiality Integrity Availability 

EXAMPLE: 

Personal 

Identity and 

Authentication 

Information 

Type

C.2.8.9 M M M M M M None

 

1.6 System Points of Contact 

<Complete the attached spreadsheet with system specific information.> 

Table 5: <System Name> Points of Contact 

SSP-Point of 

Contacts.xlsx
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1.7 Assignment of Security Responsibility 

Table 6: [System Acronym] (Contractor) Information System Security Officer (ISSO) 

Name: 

Title: 

Agency: 

Address: 

Telephone: 

Email: 

Responsibility: Individual with assigned responsibility for maintaining the appropriate operational 

security posture for an information system or program. Information System Security 

Officer (ISSO). 

Table 7: SSA Security Authorization Manager (SAM) 

Name: 

Title: 

Agency: 

Address: 

Telephone: 

Email: 

Responsibility: SSA Security Authorization Manager 

1.8 System Operational Status 

The [SYSTEM ACRONYM] and its component systems are in the [INITIATION, 

ACQUISITION/DEVELOPMENT, IMPLEMENATION, OPERATIONAL/MAINTENANCE] phase of their 

System Development Life Cycles (SDLC). 

 [Enter an “X” in the applicable section]  DELETE 

Table 8: Information System Operational Status 

Initiation Development Implementation Operational 

 

1.9 Information system Type 

 [Enter an “X” in the applicable section below]  DELETE 
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Table 9: Information System Type 

Subsystem/Application Major Application General Support System 

 

1.10 Security Status 

[SECURTIY AUTHORIZATION ACRONYM/ EXTERNAL INFORMATION SYSTEM ACRONYM] received 

a full Authority to Operate (ATO) on [Enter DATE of ATO]. 

1.11 General Description and Purpose 

 [This section should contain a detailed general description and overall purpose for the information 

system. It should identify the system's purpose, capabilities, users, arrangements for hosting, 

connection and/or interface to SSA, and information data flow; discuss the hardware, software and 

firmware implemented in support of the information system]  DELETE 

1.12 Data Types 

Table 10: NIST SP 800-60 Vol 2. Information Data Types 

NIST 

Information 

Type 

NIST SP 800-60, Volume II 

Reference Data Type Description 

EXAMPLE: 

Personal 

Identity 

Information 

Type

C.2.8.9 Personal identity and authentication information includes that 

information necessary to ensure that all persons who are 

potentially entitled to receive any federal benefit are 

enumerated and identified so that Federal agencies can 

have reasonable assurance that they are paying or 

communicating with the right individuals. This information 

include individual citizen’s Social Security Numbers, names, 

dates of birth, places of birth, parents’ names, etc. 

 

 

 
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1.13 Information System Boundary 

The [SYSTEM ACRONYM] system architecture, environment and agreement boundary is described 

below. 

1.14 System Architecture/Environment 

[Provide a description of the information system architecture/environment, explaining where and by whom 

it is hosted, whether it is a web-based (or cloud, etc.) application, what Software (SW) it is utilizing, what 

SW sits on the front end, back end, OS, how many users access the system, describe user interfaces, 

and designate whether connectivity to SSA and/or the outside is through VPN or WAN, etc.]  DELETE 

 [INSERT a diagram of the information system architecture, including its connections/interfaces/other 

relationships to SSA].  DELETE 

Figure 1: [System Acronym] Architecture Diagram 

1.15 Security Authorization Boundary 

[Provide information of where the information system is located; where backups and restores are 

conducted, and specifically where databases are housed. Provide an explanation of where the servers 

are located (company facility, datacenter, etc.), personnel, public access or not, how the systems are 

connected, how remote users can connect and how in and outbound internet connections are secured 

and maintained].  DELETE 

 [INSERT a diagram of the information security authorization boundary showing its 

connections/interfaces/other relationships to SSA.] DELETE

Figure 2: [System Acronym] Accreditation Boundary

1.16 System Inventory 

The hardware (HW) and software (SW) components included in the externally hosted, non-SSA [System 

Acronym] boundary are listed in the tables below. <System acronym> consists of multiple technologies. 

Table 11 contains a listing of technologies (hardware, software, technologies and platforms) that reside 

within the <system acronym> authorization boundary. Technology is listed per system and subsystem: 

<Complete the embedded spreadsheet with system specific information.> 

Table 11: Inventory: List of Technologies 
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Table 6_Inventory - 

List of Technologies - 

 NOTE: Any changes to the scope of the Authorization Boundary after the Boundary 

Scope Meeting and finalization of the BSM may impact the overall IV&V schedule. 

1.17 System Interconnections 

The externally hosted [SYSTEM ACRONYM] requires that written agreements (e.g., Memorandums of 

Understanding (MOUs), Memorandums of Agreement (MOAs), Interconnection Security Agreements 

(ISAs), etc., on the security controls to be enforced on interconnecting systems and must be obtained 

prior to connecting and/or sharing sensitive data/information. Table 18 shows the status of these 

agreements between [SYSTEM ACRONYM] and the external systems that share its information. 

[SYSTEM ACRONYM] [Has /does not have] external communications requiring MOUs or ISAs. 

Table 12: [System Acronym] System Interconnections 

Information 

System 

Organization Type 

(GSS/MA) 

Agreement 

(ISA/MOU/MOA) 

Date FIPS 199 

Category 

C&A 

Status 

DAA 

N/A N/A N/A N/A N/A N/A N/A N/A 

 
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2 [System Acronym] NIST SP 800-53 - Rev 4 

MINIMUM SECURITY CONTROLS 

The minimum security control baseline for [LOW/MODERATE]-impact systems from NIST SP 800-53 

Revision 4 is documented below. Specifically, this section provides a description of how all the minimumsecurity controls in the baseline are being implemented, planned, and compensated or how they will be 

implemented in the future. The table contains: (1) the NIST SP Publication and revision number (2) the 

security control family and specific control with applicable enhancements; (3) if the security control is a 

common control, hybrid or system specific (4) the implementation statement; how the security control is 

being implemented or how it will be implemented (5) the implementation status to determine whether the 

control is in place, not in place, compensated or not applicable and (6) comments to capture specific 

notes about the control’s implementation. (Note: if not in place, an explanation will need to be provided 

under this section). Implementation statements of controls identified as common will reference the system 

and/or SSP that the control is inherited from.

2.1 Security Controls 

Organizations employ security controls in federal information systems and the environments in which 

those systems operate in accordance with FIPS Publication 199, FIPS Publication 200, and NIST Special 

Publications 800-37 and 800-39. Security categorization of federal information and information systems, 

as required by FIPS Publication 199, is the first step in the risk management process. Next, organizations 

select an appropriate set of security controls for their information systems by satisfying the minimumsecurity requirements set forth in FIPS Publication 200. Appendix D includes three security control 

baselines that are associated with the designated impact levels of information systems as determined 

during the security categorization process. After baseline selection, organizations tailor the baselines by: 

(i) identifying/designating common controls; (ii) applying scoping considerations; (iii) selecting 

compensating controls, if needed; (iv) assigning control parameter values in selection and assignment 

statements; (v) supplementing the baseline controls with additional controls and control enhancements 

from the security control catalog; and (vi) providing additional information for control implementation. 

2.1.1 Access Control (AC) 

2.1.1.1 AC-1 Access Control Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

b. An access control policy that addresses purpose, scope, roles, responsibilities, management 

commitment, coordination among organizational entities, and compliance; and 

c. Procedures to facilitate the implementation of the access control policy and associated 

access controls; and 

d. Reviews and updates the current: 

e. Access control policy [Assignment: organization-defined frequency]; and 

f. Access control procedures [Assignment: organization-defined frequency]. 
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NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-1] 

Implementation Statement: 

AC-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.2 AC-2 Account Management 

The organization: 

a. Identifies and selects the following types of information system accounts to support 

organizational missions/business functions: [Assignment: organization-defined information 

system account types]; 

b. Assigns account managers for information system accounts; 

c. Establishes conditions for group and role membership; 

d. Specifies authorized users of the information system, group and role membership, and 

access authorizations (i.e., privileges) and other attributes (as required) for each account; 

e. Requires approvals by [Assignment: organization-defined personnel or roles] for requests to 

create information system accounts; 

f. Creates, enables, modifies, disables, and removes information system accounts in 

accordance with [Assignment: organization-defined procedures or conditions]; 

g. Monitors the use of, information system accounts; 

h. Notifies account managers: 

1. When accounts are no longer required; 

2. When users are terminated or transferred; and 

3. When individual information system usage or need-to-know changes; 

i. Authorizes access to the information system based on: 

1. A valid access authorization; 

2. Intended system usage; and 

3. Other attributes as required by the organization or associated missions/business 

functions; 

j. Reviews accounts for compliance with account management requirements [Assignment: 

organization-defined frequency]; and 

k. Establishes a process for reissuing shared/group account credentials (if deployed) when 

individuals are removed from the group. 
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(1) ACCOUNT MANAGEMENT | AUTOMATED SYSTEM ACCOUNT MANAGEMENT 

The organization employs automated mechanisms to support the management of information 

system accounts. 

(2) ACCOUNT MANAGEMENT | REMOVAL OF TEMPORARY / EMERGENCY ACCOUNTS 

The information system automatically [Selection: removes; disables] temporary and 

emergency accounts after [Assignment: organization-defined time period for each type of 

account]. 

(3) ACCOUNT MANAGEMENT | DISABLE INACTIVE ACCOUNTS 

The information system automatically disables inactive accounts after [Assignment: 

organization-defined time period]. 

(4) ACCOUNT MANAGEMENT | AUTOMATED AUDIT ACTIONS 

The information system automatically audits account creation, modification, enabling, 

disabling, and removal actions, and notifies [Assignment: organization-defined personnel or 

roles]. 

NIST SP 800-53 Access Controls Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-2] 

Implementation Statement: 

AC-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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<Document Name> 

Version <X.X> 

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Comments: 

Control Enhancement AC-2(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-2(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-2(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.3 AC-3 Access Enforcement 
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<System Name><(System Acronym)> 

<Document Name> 

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The information system enforces approved authorizations for logical access to information and system 

resources in accordance with applicable access control policies. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-3] 

Implementation Statement: 

AC-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.4 AC-4 Information Flow Enforcement 

The information system enforces approved authorizations for controlling the flow of information within the 

system and between interconnected systems based on [Assignment: organization-defined information 

flow control policies]. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-4] 

Implementation Statement: 

AC-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Comments:

2.1.1.5 AC-5 Separation of Duties 

The organization: 

a. Separates [Assignment: organization-defined duties of individuals]; 

b. Documents separation of duties of individuals; and 

c. Defines information system access authorizations to support separation of duties. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-5] 

Implementation Statement: 

AC-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.6 AC-6 Least Privilege 

The organization employs the principle of least privilege, allowing only authorized accesses for users (or 

processes acting on behalf of users) which are necessary to accomplish assigned tasks in accordance 

with organizational missions and business functions. 

Control Enhancements: 

(1) LEAST PRIVILEGE | AUTHORIZE ACCESS TO SECURITY FUNCTIONS 

The organization explicitly authorizes access to [Assignment: organization-defined security functions 

(deployed in hardware, software, and firmware) and security-relevant information]. 
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(2) LEAST PRIVILEGE | NON-PRIVILEGED ACCESS FOR NONSECURITY FUNCTIONS 

The organization requires that users of information system accounts, or roles, with access to 

[Assignment: organization-defined security functions or security-relevant information], use non-privileged 

accounts or roles, when accessing nonsecurity functions. 

(5) LEAST PRIVILEGE | PRIVILEGED ACCOUNTS 

The organization restricts privileged accounts on the information system to [Assignment: organizationdefined personnel or roles]. 

(9) LEAST PRIVILEGE | AUDITING USE OF PRIVILEGED FUNCTIONS 

The information system audits the execution of privileged functions. 

(10) LEAST PRIVILEGE | PROHIBIT NON-PRIVILEGED USERS FROM EXECUTING PRIVILEGED 

FUNCTIONS 

The information system prevents non-privileged users from executing privileged functions to include 

disabling, circumventing, or altering implemented security safeguards/countermeasures. 

NIST SP 800-53 Access Controls Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-6] 

Implementation Statement: 

AC-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-6(1) 

Implementation Statement: 
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<Document Name> 

Version <X.X> 

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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-6(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-6(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-6(9) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Control Enhancement AC-6(10) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.7 AC-7 Unsuccessful Logon Attempts 

The information system: 

a. Enforces a limit of [Assignment: organization-defined number] consecutive invalid logon 

attempts by a user during a [Assignment: organization-defined time period]; and 

b. Automatically [Selection: locks the account/node for an [Assignment: organization-defined 

time period]; locks the account/node until released by an administrator; delays next logon 

prompt according to [Assignment: organization-defined delay algorithm]] when the maximum 

number of unsuccessful attempts is exceeded. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-7] 

Implementation Statement: 

AC-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.8 AC-8 System Use Notification 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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The information system: 

a. Displays to users [Assignment: organization-defined system use notification message or 

banner] before granting access to the system that provides privacy and security notices 

consistent with applicable federal laws, Executive Orders, directives, policies, regulations, 

standards, and guidance and states that: 

1. Users are accessing a U.S. Government information system; 

2. Information system usage may be monitored, recorded, and subject to audit; 

3. Unauthorized use of the information system is prohibited and subject to criminal and civil 

penalties; and 

4. Use of the information system indicates consent to monitoring and recording; 

b. Retains the notification message or banner on the screen until users acknowledge the usage 

conditions and take explicit actions to log on to or further access the information system; and 

c. For publicly accessible systems: 

1. Displays system use information [Assignment: organization-defined conditions], before 

granting further access; 

2. Displays references, if any, to monitoring, recording, or auditing that are consistent with 

privacy accommodations for such systems that generally prohibit those activities; and 

3. Includes a description of the authorized uses of the system. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-8] 

Implementation Statement: 

AC-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.9 AC-11 Session Lock 

The information system: 

a. Prevents further access to the system by initiating a session lock after [Assignment: 

organization-defined time period] of inactivity or upon receiving a request from a user; and 

b. Retains the session lock until the user reestablishes access using established identification 

and authentication procedures. 

Control Enhancements: 
Social Security Administration 

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(1) SESSION LOCK | PATTERN-HIDING DISPLAYS 

The information system conceals, via the session lock, information previously visible on the display with a 

publicly viewable image. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-11] 

Implementation Statement: 

AC-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Implementation Statement: 

AC-11(1) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.10 AC-12 Session Termination 

The information system automatically terminates a user session after [Assignment: organization-defined 

conditions or trigger events requiring session disconnect].
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<Document Name> 

Version <X.X> 

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NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-12] 

Implementation Statement: 

AC-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.11 AC-14 Permitted Actions without Identification or Authentication 

The organization: 

a. Identifies [Assignment: organization-defined user actions] that can be performed on the 

information system without identification or authentication consistent with organizational 

missions/business functions; and 

b. Documents and provides supporting rationale in the security plan for the information system, 

user actions not requiring identification or authentication. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-14] 

Implementation Statement: 

AC-14 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Comments:

2.1.1.12 AC-17 Remote Access 

The organization: 

a. Establishes and documents usage restrictions, configuration/connection requirements, and 

implementation guidance for each type of remote access allowed; and 

b. Authorizes remote access to the information system prior to allowing such connections. 

Control Enhancements: 

(1) REMOTE ACCESS | AUTOMATED MONITORING / CONTROL 

The information system monitors and controls remote access methods. 

(2) REMOTE ACCESS | PROTECTION OF CONFIDENTIALITY / INTEGRITY USING ENCRYPTION 

The information system implements cryptographic mechanisms to protect the confidentiality and integrity 

of remote access sessions. 

 

(3) REMOTE ACCESS | MANAGED ACCESS CONTROL POINTS 

The information system routes all remote accesses through [Assignment: organization-defined number] 

managed network access control points. 

(4) REMOTE ACCESS | PRIVILEGED COMMANDS / ACCESS 

The organization: 

(a) Authorizes the execution of privileged commands and access to security-relevant 

information via remote access only for [Assignment: organization-defined needs]; and 

(b) Documents the rationale for such access in the security plan for the information system. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-17] 
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Version <X.X> 

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Implementation Statement: 

AC-17 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-17(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-17(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-17(3) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-17(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.13 AC-18 Wireless Access 

The organization: 

a. Establishes usage restrictions, configuration/connection requirements, and implementation 

guidance for wireless access; and 

b. Authorizes wireless access to the information system prior to allowing such connections. 

Control Enhancements: 

(1) WIRELESS ACCESS | AUTHENTICATION AND ENCRYPTION 

The information system protects wireless access to the system using authentication of [Selection (one or 

more): users; devices] and encryption. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-18] 

Implementation Statement: 

AC-18 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-18(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.14 AC-19 Access Control for Mobile Devices 

The organization: 

a. Establishes usage restrictions, configuration requirements, connection requirements, and 

implementation guidance for organization-controlled mobile devices; and 

b. Authorizes the connection of mobile devices to organizational information systems. 

(5) ACCESS CONTROL FOR MOBILE DEVICES | FULL DEVICE / CONTAINER-BASED 

ENCRYPTION 

The organization employs [Selection: full-device encryption; container encryption] to protect the 

confidentiality and integrity of information on [Assignment: organization-defined mobile devices]. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-19] 

Implementation Statement: 

AC-19 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 24 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-19(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.1.15 AC-20 Use of External Information Systems 

The organization establishes terms and conditions, consistent with any trust relationships established with 

other organizations owning, operating, and/or maintaining external information systems, allowing 

authorized individuals to: 

a. Access the information system from external information systems; and 

b. Process, store, or transmit organization-controlled information using external information 

systems. 

Control Enhancements: 

(1) USE OF EXTERNAL INFORMATION SYSTEMS | LIMITS ON AUTHORIZED USE 

The organization permits authorized individuals to use an external information system to access the 

information system or to process, store, or transmit organization-controlled information only when the 

organization: 

(a) Verifies the implementation of required security controls on the external system as 

specified in the organization’s information security policy and security plan; or 

(b) Retains approved information system connection or processing agreements with the 

organizational entity hosting the external information system. 

(2) USE OF EXTERNAL INFORMATION SYSTEMS | PORTABLE STORAGE DEVICES 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 25 

The organization [Selection: restricts; prohibits] the use of organization-controlled portable storage 

devices by authorized individuals on external information systems. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-20] 

Implementation Statement: 

AC-20 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AC-20(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement AC-20(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 26 

Comments: 

2.1.1.16 AC-21 Information Sharing 

The organization: 

a. Facilitates information sharing by enabling authorized users to determine whether access 

authorizations assigned to the sharing partner match the access restrictions on the 

information for [Assignment: organization-defined information sharing circumstances where 

user discretion is required]; and 

b. Employs [Assignment: organization-defined automated mechanisms or manual processes] to 

assist users in making information sharing/collaboration decisions. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-21] 

Implementation Statement: 

AC-21 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.1.17 AC-22 Publicly Accessible Content 

The organization: 

a. Designates individuals authorized to post information onto a publicly accessible information 

system; 

b. Trains authorized individuals to ensure that publicly accessible information does not contain 

nonpublic information; 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 27 

c. Reviews the proposed content of information prior to posting onto the publicly accessible 

information system to ensure that nonpublic information is not included; and 

d. Reviews the content on the publicly accessible information system for nonpublic information 

[Assignment: organization-defined frequency] and removes such information, if discovered. 

NIST SP 800-53 Access Control Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [AC-22] 

Implementation Statement: 

AC-22 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.2 Awareness and Training (AT) 

2.1.2.1 AT-1 Security Awareness and Training Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A security awareness and training policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the security awareness and training policy 

and associated security awareness and training controls; and 

b. Reviews and updates the current: 

1. Security awareness and training policy [Assignment: organization-defined frequency]; 

and 

2. Security awareness and training procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 Awareness and 

Training 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 28 

Revision 4 [AT-1] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

AT-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.2.2 AT-2 Security Awareness Training 

The organization provides basic security awareness training to information system users (including 

managers, senior executives, and contractors): 

a. As part of initial training for new users; 

b. When required by information system changes; and 

c. [Assignment: organization-defined frequency] thereafter. 

Control Enhancements: 

(2) SECURITY AWARENESS | INSIDER THREAT 

The organization includes security awareness training on recognizing and reporting potential indicators of 

insider threat. 

NIST SP 800-53 Awareness and 

Training 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AT-2] 

Implementation Statement: 

AT-2 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 29 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AT-2(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.2.3 AT-3 Role-Based Security Training 

The organization provides role-based security training to personnel with assigned security roles and 

responsibilities: 

a. Before authorizing access to the information system or performing assigned duties; 

b. When required by information system changes; and 

c. [Assignment: organization-defined frequency] thereafter. 

NIST SP 800-53 Awareness and 

Training 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AT-3] 

Implementation Statement: 

AT-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 30 

Comments:

2.1.2.4 AT-4 Security Training Records 

The organization: 

a. Documents and monitors individual information system security training activities including 

basic security awareness training and specific information system security training; and 

b. Retains individual training records for [Assignment: organization-defined time period]. 

NIST SP 800-53 Awareness and 

Training 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AT-4] 

Implementation Statement: 

AT-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3 Audit and Accountability (AU) 

2.1.3.1 AU-1 Audit and Accountability Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. An audit and accountability policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 31 

2. Procedures to facilitate the implementation of the audit and accountability policy and 

associated audit and accountability controls; and 

b. Reviews and updates the current: 

1. Audit and accountability policy [Assignment: organization-defined frequency]; and 

2. Audit and accountability procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-1] 

Implementation Statement: 

AU-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.2 AU-2 Audit Events 

The organization: 

a. Determines that the information system is capable of auditing the following events: 

[Assignment: organization-defined auditable events]; 

b. Coordinates the security audit function with other organizational entities requiring auditrelated information to enhance mutual support and to help guide the selection of auditable 

events; 

c. Provides a rationale for why the auditable events are deemed to be adequate to support 

after-the-fact investigations of security incidents; and 

d. Determines that the following events are to be audited within the information system: 

[Assignment: organization-defined audited events (the subset of the auditable events defined 

in AU-2 a.) along with the frequency of (or situation requiring) auditing for each identified 

event]. 

Control Enhancements: 

(3) AUDIT EVENTS | REVIEWS AND UPDATES 

The organization reviews and updates the audited events [Assignment: organization-defined frequency]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 32 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-2] 

Implementation Statement: 

AU-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-2(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.3 AU-3 Content of Audit Records 

The information system generates audit records containing information that establishes what type of 

event occurred, when the event occurred, where the event occurred, the source of the event, the outcome 

of the event, and the identity of any individuals or subjects associated with the event. 

Control Enhancements: 

(1) CONTENT OF AUDIT RECORDS | ADDITIONAL AUDIT INFORMATION 

The information system generates audit records containing the following additional information: 

[Assignment: organization-defined additional, more detailed information]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 33 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-3] 

Implementation Statement: 

AU-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-3(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.4 AU-4 Audit Storage 

The organization allocates audit record storage capacity in accordance with [Assignment: organizationdefined audit record storage requirements]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-4] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 34 

Implementation Statement: 

AU-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.5 AU-5 Response to Audit Processing Failures 

The information system: 

a. Alerts [Assignment: organization-defined personnel or roles] in the event of an audit 

processing failure; and 

b. Takes the following additional actions: [Assignment: organization-defined actions to be taken 

(e.g., shut down information system, overwrite oldest audit records, stop generating audit 

records)]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-5] 

Implementation Statement: 

AU-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.6 AU-6 Audit Review, Analysis, and Reporting 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 35 

The organization: 

a. Reviews and analyzes information system audit records [Assignment: organization-defined 

frequency] for indications of [Assignment: organization-defined inappropriate or unusual 

activity]; and 

b. Reports findings to [Assignment: organization-defined personnel or roles]. 

Control Enhancements: 

(1) AUDIT REVIEW, ANALYSIS, AND REPORTING | PROCESS INTEGRATION 

The organization employs automated mechanisms to integrate audit review, analysis, and reporting 

processes to support organizational processes for investigation and response to suspicious activities. 

(3) AUDIT REVIEW, ANALYSIS, AND REPORTING | CORRELATE AUDIT REPOSITORIES 

The organization analyzes and correlates audit records across different repositories to gain organizationwide situational awareness. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-6] 

Implementation Statement: 

AU-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-6(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 36 

Scoped 

Comments: 

Control Enhancement AU-6(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.7 AU-7 Audit Reduction and Report Generation 

The information system provides an audit reduction and report generation capability that: 

a. Supports on-demand audit review, analysis, and reporting requirements and after-the-fact 

investigations of security incidents; and 

b. Does not alter the original content or time ordering of audit records. 

Control Enhancements: 

(1) AUDIT REDUCTION AND REPORT GENERATION | AUTOMATIC PROCESSING 

The information system provides the capability to process audit records for events of interest based on 

[Assignment: organization-defined audit fields within audit records]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-7] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

AU-7 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 37 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Implementation Statement: 

AU-7(1) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.8 AU-8 Time Stamps 

The information system: 

a. Uses internal system clocks to generate time stamps for audit records; and 

b. Records time stamps for audit records that can be mapped to Coordinated Universal Time 

(UTC) or Greenwich Mean Time (GMT) and meets [Assignment: organization-defined 

granularity of time measurement]. 

Control Enhancements: 

(1) TIME STAMPS | SYNCHRONIZATION WITH AUTHORITATIVE TIME SOURCE 

The information system: 

(a) Compares the internal information system clocks [Assignment: organization-defined 

frequency] with [Assignment: organization-defined authoritative time source]; and 

(b) Synchronizes the internal system clocks to the authoritative time source when the time difference 

is greater than [Assignment: organization-defined time period]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 [AU-8] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 38 

 System Specific Control

Implementation Statement: 

AU-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.9 AU-9 Protection of Audit Information 

The information system protects audit information and audit tools from unauthorized access, modification, 

and deletion. 

Control Enhancements: 

(4) PROTECTION OF AUDIT INFORMATION | ACCESS BY SUBSET OF PRIVILEGED USERS 

The organization authorizes access to management of audit functionality to only [Assignment: 

organization-defined subset of privileged users]. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 39 

Revision 4 [AU-9] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

AU-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement AU-9(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.3.10 AU-11 Audit Record Retention 

The organization retains audit records for [Assignment: organization-defined time period consistent with 

records retention policy] to provide support for after-the-fact investigations of security incidents and to 

meet regulatory and organizational information retention requirements. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-11] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 40 

Implementation Statement: 

AU-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.3.11 AU-12 Audit Generation 

The information system: 

a. Provides audit record generation capability for the auditable events defined in AU-2 a. at 

[Assignment: organization-defined information system components]; 

b. Allows [Assignment: organization-defined personnel or roles] to select which auditable events 

are to be audited by specific components of the information system; and 

c. Generates audit records for the events defined in AU-2 d. with the content defined in AU-3. 

NIST SP 800-53 Audit and 

Accountability 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [AU-12] 

Implementation Statement: 

AU-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.4 Security Assessment and Authorization (CA) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 41 

2.1.4.1 CA-1 Security Assessment and Authorization Policies and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A security assessment and authorization policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the security assessment and authorization 

policy and associated security assessment and authorization controls; and 

b. Reviews and updates the current: 

1. Security assessment and authorization policy [Assignment: organization-defined 

frequency]; and 

2. Security assessment and authorization procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-1] 

Implementation Statement: 

CA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.4.2 CA-2 Security Assessments 

The organization: 

a. Develops a security assessment plan that describes the scope of the assessment including: 

1. Security controls and control enhancements under assessment; 

2. Assessment procedures to be used to determine security control effectiveness; and 

3. Assessment environment, assessment team, and assessment roles and responsibilities; 

b. Assesses the security controls in the information system and its environment of operation 

[Assignment: organization-defined frequency] to determine the extent to which the controls 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 42 

are implemented correctly, operating as intended, and producing the desired outcome with 

respect to meeting established security requirements; 

c. Produces a security assessment report that documents the results of the assessment; and 

d. Provides the results of the security control assessment to [Assignment: organization-defined 

individuals or roles]. 

Control Enhancements: 

(1) SECURITY ASSESSMENTS | INDEPENDENT ASSESSORS 

The organization employs assessors or assessment teams with [Assignment: organization-defined level 

of independence] to conduct security control assessments. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-2] 

Implementation Statement: 

CA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CA-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 43 

2.1.4.3 CA-3 System Interconnections 

The organization: 

a. Authorizes connections from the information system to other information systems through the 

use of Interconnection Security Agreements; 

b. Documents, for each interconnection, the interface characteristics, security requirements, and 

the nature of the information communicated; and 

c. Reviews and updates Interconnection Security Agreements [Assignment: organizationdefined frequency]. 

Control Enhancements: 

(5) SYSTEM INTERCONNECTIONS | RESTRICTIONS ON EXTERNAL SYSTEM CONNECTIONS 

The organization employs [Selection: allow-all, deny-by-exception; deny-all, permit-by-exception] policy 

for allowing [Assignment: organization-defined information systems] to connect to external information 

systems. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-3] 

Implementation Statement: 

CA-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CA-3(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 44 

Scoped 

Comments: 

2.1.4.4 CA-5 Plan of Action and Milestones 

The organization: 

a. Develops a plan of action and milestones for the information system to document the 

organization’s planned remedial actions to correct weaknesses or deficiencies noted during 

the assessment of the security controls and to reduce or eliminate known vulnerabilities in 

the system; and 

b. Updates existing plan of action and milestones [Assignment: organization-defined frequency] 

based on the findings from security controls assessments, security impact analyses, and 

continuous monitoring activities. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-5] 

Implementation Statement: 

CA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.4.5 CA-6 Security Authorization 

The organization: 

a. Assigns a senior-level executive or manager as the authorizing official for the information 

system; 

b. Ensures that the authorizing official authorizes the information system for processing before 

commencing operations; and 

c. Updates the security authorization [Assignment: organization-defined frequency]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 45 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-6] 

Implementation Statement: 

CA-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.4.6 CA-7 Continuous Monitoring 

The organization develops a continuous monitoring strategy and implements a continuous monitoring 

program that includes: 

a. Establishment of [Assignment: organization-defined metrics] to be monitored; 

b. Establishment of [Assignment: organization-defined frequencies] for monitoring and 

[Assignment: organization-defined frequencies] for assessments supporting such monitoring; 

c. Ongoing security control assessments in accordance with the organizational continuous 

monitoring strategy; 

d. Ongoing security status monitoring of organization-defined metrics in accordance with the 

organizational continuous monitoring strategy; 

e. Correlation and analysis of security-related information generated by assessments and 

monitoring; 

f. Response actions to address results of the analysis of security-related information; and 

g. Reporting the security status of organization and the information system to [Assignment: 

organization-defined personnel or roles] [Assignment: organization-defined frequency]. 

Control Enhancements: 

(1) CONTINUOUS MONITORING | INDEPENDENT ASSESSMENT 

The organization employs assessors or assessment teams with [Assignment: organization-defined level 

of independence] to monitor the security controls in the information system on an ongoing basis. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 46 

Revision 4 [CA-7] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

CA-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CA-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.4.7 CA-9 Internal System Connections 

The organization: 

a. Authorizes internal connections of [Assignment: organization-defined information system 

components or classes of components] to the information system; and 

b. Documents, for each internal connection, the interface characteristics, security requirements, 

and the nature of the information communicated. 

NIST SP 800-53 Security Assessment 

and Authorization 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CA-9] 
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Implementation Statement: 

CA-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.5 Configuration Management (CM) 

2.1.5.1 CM-1 Configuration Management Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A configuration management policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the configuration management policy and 

associated configuration management controls; and 

b. Reviews and updates the current: 

1. Configuration management policy [Assignment: organization-defined frequency]; and 

2. Configuration management procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-1] 

Implementation Statement: 

CM-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments:

2.1.5.2 CM-2 Baseline Configuration 

The organization develops, documents, and maintains under configuration control, a current baseline 

configuration of the information system. 

Control Enhancements: 

(1) BASELINE CONFIGURATION | REVIEWS AND UPDATES 

The organization reviews and updates the baseline configuration of the information system: 

(a) [Assignment: organization-defined frequency]; 

(b) When required due to [Assignment organization-defined circumstances]; and 

(c) As an integral part of information system component installations and upgrades. 

(3) BASELINE CONFIGURATION | RETENTION OF PREVIOUS CONFIGURATIONS 

The organization retains [Assignment: organization-defined previous versions of baseline configurations 

of the information system] to support rollback. 

(7) BASELINE CONFIGURATION | CONFIGURE SYSTEMS, COMPONENTS, OR DEVICES FOR 

HIGH-RISK AREAS 

The organization: 

(a) Issues [Assignment: organization-defined information systems, system components, or 

devices] with [Assignment: organization-defined configurations] to individuals traveling to 

locations that the organization deems to be of significant risk; and 

(b) Applies [Assignment: organization-defined security safeguards] to the devices when the 

individuals return. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-2] 
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Implementation Statement: 

CM-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CM-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-2(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-2(7) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.5.3 CM-3 Configuration Change Control 

The organization: 

a. Determines the types of changes to the information system that are configuration-controlled; 

b. Reviews proposed configuration-controlled changes to the information system and approves 

or disapproves such changes with explicit consideration for security impact analyses; 

c. Documents configuration change decisions associated with the information system; 

d. Implements approved configuration-controlled changes to the information system; 

e. Retains records of configuration-controlled changes to the information system for 

[Assignment: organization-defined time period]; 

f. Audits and reviews activities associated with configuration-controlled changes to the 

information system; and 

g. Coordinates and provides oversight for configuration change control activities through 

[Assignment: organization-defined configuration change control element (e.g., committee, 

board] that convenes [Selection (one or more): [Assignment: organization-defined frequency]; 

[Assignment: organization-defined configuration change conditions]]. 

Control Enhancements: 

(2) CONFIGURATION CHANGE CONTROL | TEST / VALIDATE / DOCUMENT CHANGES 

The organization tests, validates, and documents changes to the information system before implementing 

the changes on the operational system. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-3] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

CM-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Scoped 

Comments:

Control Enhancement CM-3(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.5.4 CM-4 Security Impact Analysis 

The organization analyzes changes to the information system to determine potential security impacts 

prior to change implementation. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-4] 

Implementation Statement: 

CM-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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2.1.5.5 CM-5 Access Restrictions for Change 

The organization defines documents, approves, and enforces physical and logical access restrictions 

associated with changes to the information system. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-5] 

Implementation Statement: 

CM-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.5.6 CM-6 Configuration Settings 

The organization: 

a. Establishes and documents configuration settings for information technology products 

employed within the information system using [Assignment: organization-defined security 

configuration checklists] that reflect the most restrictive mode consistent with operational 

requirements; 

b. Implements the configuration settings; 

c. Identifies, documents, and approves any deviations from established configuration settings 

for [Assignment: organization-defined information system components] based on 

[Assignment: organization-defined operational requirements]; and 

d. Monitors and controls changes to the configuration settings in accordance with organizational 

policies and procedures. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-6] 
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Implementation Statement: 

CM-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.5.7 CM-7 Least Functionality 

The organization: 

a. Configures the information system to provide only essential capabilities; and 

b. Prohibits or restricts the use of the following functions, ports, protocols, and/or services: 

[Assignment: organization-defined prohibited or restricted functions, ports, protocols, 

and/or services]. 

Control Enhancements: 

(1) LEAST FUNCTIONALITY | PERIODIC REVIEW 

The organization: 

(a) Reviews the information system [Assignment: organization-defined frequency] to identify 

unnecessary and/or nonsecure functions, ports, protocols, and services; and 

(b) Disables [Assignment: organization-defined functions, ports, protocols, and services 

within the information system deemed to be unnecessary and/or nonsecure]. 

(2) LEAST FUNCTIONALITY | PREVENT PROGRAM EXECUTION 

The information system prevents program execution in accordance with [Selection (one or more): 

[Assignment: organization-defined policies regarding software program usage and restrictions]; rules 

authorizing the terms and conditions of software program usage]. 

(4) LEAST FUNCTIONALITY | UNAUTHORIZED SOFTWARE / BLACKLISTING 

The organization: 

(a) Identifies [Assignment: organization-defined software programs not authorized to execute 

on the information system]; 
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(b) Employs an allow-all, deny-by-exception policy to prohibit the execution of unauthorized 

software programs on the information system; and 

(c) Reviews and updates the list of unauthorized software programs [Assignment: organizationdefined frequency]. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-7] 

Implementation Statement: 

CM-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CM-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-7(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments: 

Control Enhancement CM-7(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.5.8 CM-8 Information System Component Inventory 

The organization: 

a. Develops and documents an inventory of information system components that: 

1. Accurately reflects the current information system; 

2. Includes all components within the authorization boundary of the information system; 

3. Is at the level of granularity deemed necessary for tracking and reporting; and 

4. Includes [Assignment: organization-defined information deemed necessary to achieve 

effective information system component accountability]; and 

b. Reviews and updates the information system component inventory [Assignment: 

organization-defined frequency]. 

Control Enhancements: 

(1) INFORMATION SYSTEM COMPONENT INVENTORY | UPDATES DURING INSTALLATIONS / 

REMOVALS 

The organization updates the inventory of information system components as an integral part of 

component installations, removals, and information system updates. 

(3) INFORMATION SYSTEM COMPONENT INVENTORY | AUTOMATED UNAUTHORIZED 

COMPONENT DETECTION 

The organization: 

(a) Employs automated mechanisms [Assignment: organization-defined frequency] to detect 

the presence of unauthorized hardware, software, and firmware components within the 

information system; and 
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(b) Takes the following actions when unauthorized components are detected: [Selection (one 

or more): disables network access by such components; isolates the components; notifies 

[Assignment: organization-defined personnel or roles]]. 

(5) INFORMATION SYSTEM COMPONENT INVENTORY | NO DUPLICATE ACCOUNTING OF 

COMPONENTS 

The organization verifies that all components within the authorization boundary of the information system 

are not duplicated in other information system inventories. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-8] 

Implementation Statement: 

CM-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CM-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-8(3) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CM-8(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.5.9 CM-9 Configuration Management Plan 

The organization develops, documents, and implements a configuration management plan for the 

information system that: 

a. Addresses roles, responsibilities, and configuration management processes and procedures; 

b. Establishes a process for identifying configuration items throughout the system development 

life cycle and for managing the configuration of the configuration items; 

c. Defines the configuration items for the information system and places the configuration items 

under configuration management; and 

d. Protects the configuration management plan from unauthorized disclosure and modification. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-9] 

Implementation Statement: 

CM-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Scoped 

Comments:

2.1.5.10 CM-10 Software Usage Restrictions 

The organization: 

a. Uses software and associated documentation in accordance with contract agreements and 

copyright laws; 

b. Tracks the use of software and associated documentation protected by quantity licenses to 

control copying and distribution; and 

c. Controls and documents the use of peer-to-peer file sharing technology to ensure that this 

capability is not used for the unauthorized distribution, display, performance, or reproduction 

of copyrighted work. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-10] 

Implementation Statement: 

CM-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.5.11 CM-11 User-Installed Software 

The organization: 

a. Establishes [Assignment: organization-defined policies] governing the installation of 

software by users; 

b. Enforces software installation policies through [Assignment: organization-defined 

methods]; and 
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c. Monitors policy compliance at [Assignment: organization-defined frequency]. 

NIST SP 800-53 Configuration 

Management 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [CM-11] 

Implementation Statement: 

CM-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.6 Contingency Planning (CP) 

2.1.6.1 CP-1 Contingency Planning Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A contingency planning policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the contingency planning policy and 

associated contingency planning controls; and 

b. Reviews and updates the current: 

1. Contingency planning policy [Assignment: organization-defined frequency]; and 

2. Contingency planning procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-1] 
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Implementation Statement: 

CP-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.6.2 CP-2 Contingency Plan 

The organization: 

a. Develops a contingency plan for the information system that: 

1. Identifies essential missions and business functions and associated contingency 

requirements; 

2. Provides recovery objectives, restoration priorities, and metrics; 

3. Addresses contingency roles, responsibilities, assigned individuals with contact 

information; 

4. Addresses maintaining essential missions and business functions despite an information 

system disruption, compromise, or failure; 

5. Addresses eventual, full information system restoration without deterioration of the 

security safeguards originally planned and implemented; and 

6. Is reviewed and approved by [Assignment: organization-defined personnel or roles]; 

b. Distributes copies of the contingency plan to [Assignment: organization-defined key 

contingency personnel (identified by name and/or by role) and organizational elements]; 

c. Coordinates contingency planning activities with incident handling activities; 

d. Reviews the contingency plan for the information system [Assignment: organization-defined 

frequency]; 

e. Updates the contingency plan to address changes to the organization, information system, or 

environment of operation and problems encountered during contingency plan 

implementation, execution, or testing; 

f. Communicates contingency plan changes to [Assignment: organization-defined key 

contingency personnel (identified by name and/or by role) and organizational elements]; and 

g. Protects the contingency plan from unauthorized disclosure and modification. 

Control Enhancements: 

(1) CONTINGENCY PLAN | COORDINATE WITH RELATED PLANS 

The organization coordinates contingency plan development with organizational elements responsible for 

related plans. 
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(3) CONTINGENCY PLAN | RESUME ESSENTIAL MISSIONS / BUSINESS FUNCTIONS 

The organization plans for the resumption of essential missions and business functions within 

[Assignment: organization-defined time period] of contingency plan activation. 

(8) CONTINGENCY PLAN | IDENTIFY CRITICAL ASSETS 

The organization identifies critical information system assets supporting essential missions and business 

functions. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-2] 

Implementation Statement: 

CP-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CP-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CP-2(3) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CP-2(8) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.3 CP-3 Contingency Training 

The organization provides contingency training to information system users consistent with assigned roles 

and responsibilities: 

a. Within [Assignment: organization-defined time period] of assuming a contingency role or 

responsibility; 

b. When required by information system changes; and 

c. [Assignment: organization-defined frequency] thereafter. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-3] 

Implementation Statement: 

CP-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments:

2.1.6.4 CP-4 Contingency Plan Testing 

The organization: 

a. Tests the contingency plan for the information system [Assignment: organization-defined 

frequency] using [Assignment: organization-defined tests] to determine the effectiveness of 

the plan and the organizational readiness to execute the plan; 

b. Reviews the contingency plan test results; and 

c. Initiates corrective actions, if needed. 

Control Enhancements: 

(1) CONTINGENCY PLAN TESTING | COORDINATE WITH RELATED PLANS 

The organization coordinates contingency plan testing with organizational elements responsible for 

related plans. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-4] 

Implementation Statement: 

CP-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CP-4(1) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.5 CP-6 Alternate Storage Site 

The organization: 

a. Establishes an alternate storage site including necessary agreements to permit the storage 

and retrieval of information system backup information; and 

b. Ensures that the alternate storage site provides information security safeguards equivalent to 

that of the primary site. 

Control Enhancements: 

(1) ALTERNATE STORAGE SITE | SEPARATION FROM PRIMARY SITE 

The organization identifies an alternate storage site that is separated from the primary storage site to 

reduce susceptibility to the same threats. 

. 

(3) ALTERNATE STORAGE SITE | ACCESSIBILITY 

The organization identifies potential accessibility problems to the alternate storage site in the event of an 

area-wide disruption or disaster and outlines explicit mitigation actions. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-6] 

Implementation Statement: 

CP-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments:

Control Enhancement CP-6(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CP-6(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.6 CP-7 Alternate Processing Site 

The organization: 

a. Establishes an alternate processing site including necessary agreements to permit the 

transfer and resumption of [Assignment: organization-defined information system operations] 

for essential missions/business functions within [Assignment: organization-defined time 

period consistent with recovery time and recovery point objectives] when the primary 

processing capabilities are unavailable; 

b. Ensures that equipment and supplies required to transfer and resume operations are 

available at the alternate processing site or contracts are in place to support delivery to the 

site within the organization-defined time period for transfer/resumption; and 

c. Ensures that the alternate processing site provides information security safeguards 

equivalent to that of the primary site. 
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Control Enhancements: 

(1) ALTERNATE PROCESSING SITE | SEPARATION FROM PRIMARY SITE 

The organization identifies an alternate processing site that is separated from the primary processing site 

to reduce susceptibility to the same threats. 

(2) ALTERNATE PROCESSING SITE | ACCESSIBILITY 

The organization identifies potential accessibility problems to the alternate processing site in the event of 

an area-wide disruption or disaster and outlines explicit mitigation actions. 

(3) ALTERNATE PROCESSING SITE | PRIORITY OF SERVICE 

The organization develops alternate processing site agreements that contain priority-of-service provisions 

in accordance with organizational availability requirements (including recovery time objectives). 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-7] 

Implementation Statement: 

CP-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CP-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments: 

Control Enhancement CP-7(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement CP-7(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.7 CP-8 Telecommunications Services 

The organization establishes alternate telecommunications services including necessary agreements to 

permit the resumption of [Assignment: organization-defined information system operations] for essential 

missions and business functions within [Assignment: organization-defined time period] when the primary 

telecommunications capabilities are unavailable at either the primary or alternate processing or storage 

sites. 

Control Enhancements: 

(1) TELECOMMUNICATIONS SERVICES | PRIORITY OF SERVICE PROVISIONS 

The organization: 
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(a) Develops primary and alternate telecommunications service agreements that contain priorityof-service provisions in accordance with organizational availability requirements (including 

recovery time objectives); and 

(b) Requests Telecommunications Service Priority for all telecommunications services used for 

national security emergency preparedness in the event that the primary and/or alternate 

telecommunications services are provided by a common carrier. 

(2) TELECOMMUNICATIONS SERVICES | SINGLE POINTS OF FAILURE 

The organization obtains alternate telecommunications services to reduce the likelihood of sharing a 

single point of failure with primary telecommunications services. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-8] 

Implementation Statement: 

CP-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Implementation Statement: 

CP-8(1) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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Implementation Statement: 

CP-8(2) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.6.8 CP-9 Information System Backup 

The organization: 

a. Conducts backups of user-level information contained in the information system [Assignment: 

organization-defined frequency consistent with recovery time and recovery point objectives]; 

b. Conducts backups of system-level information contained in the information system 

[Assignment: organization-defined frequency consistent with recovery time and recovery 

point objectives]; 

c. Conducts backups of information system documentation including security-related 

documentation [Assignment: organization-defined frequency consistent with recovery time 

and recovery point objectives]; and 

d. Protects the confidentiality, integrity, and availability of backup information at storage 

locations. 

Control Enhancements: 

(1) INFORMATION SYSTEM BACKUP | TESTING FOR RELIABILITY / INTEGRITY 

The organization tests backup information [Assignment: organization-defined frequency] to verify media 

reliability and information integrity. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-9] 
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Implementation Statement: 

CP-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement CP-9(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.6.9 CP-10 Information System Recovery and Reconstitution 

The organization provides for the recovery and reconstitution of the information system to a known state 

after a disruption, compromise, or failure. 

Control Enhancements: 

(2) INFORMATION SYSTEM RECOVERY AND RECONSTITUTION | TRANSACTION RECOVERY 

The information system implements transaction recovery for systems that are transaction-based. 

NIST SP 800-53 Contingency Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [CP-10] 
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Implementation Statement: 

CP-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Implementation Statement: 

CP-10(2) 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.7 Identification and Authentication (IA) 

2.1.7.1 IA-1 Identification and Authentication Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. An identification and authentication policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the identification and authentication policy 

and associated identification and authentication controls; and 

b. Reviews and updates the current: 

1. Identification and authentication policy [Assignment: organization-defined frequency]; and 

2. Identification and authentication procedures [Assignment: organization-defined 

frequency]. 
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NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-1] 

Implementation Statement: 

IA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.7.2 IA-2 Identification and Authentication 

The information system uniquely identifies and authenticates organizational users (or processes acting on 

behalf of organizational users). 

Control Enhancements: 

(1) IDENTIFICATION AND AUTHENTICATION | NETWORK ACCESS TO PRIVILEGED ACCOUNTS 

The information system implements multifactor authentication for network access to privileged accounts. 

(2) IDENTIFICATION AND AUTHENTICATION | NETWORK ACCESS TO NON-PRIVILEGED 

ACCOUNTS 

The information system implements multifactor authentication for network access to non-privileged 

accounts. 

(3) IDENTIFICATION AND AUTHENTICATION | LOCAL ACCESS TO PRIVILEGED ACCOUNTS 

The information system implements multifactor authentication for local access to privileged accounts. 

(8) IDENTIFICATION AND AUTHENTICATION | NETWORK ACCESS TO PRIVILEGED ACCOUNTS - 

REPLAY RESISTANT 

The information system implements replay-resistant authentication mechanisms for network access to 

privileged accounts. 
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(11) IDENTIFICATION AND AUTHENTICATION | REMOTE ACCESS - SEPARATE DEVICE 

The information system implements multifactor authentication for remote access to privileged and nonprivileged accounts such that one of the factors is provided by a device separate from the system gaining 

access and the device meets [Assignment: organization-defined strength of mechanism requirements]. 

(12) IDENTIFICATION AND AUTHENTICATION | ACCEPTANCE OF PIV CREDENTIALS 

The information system accepts and electronically verifies Personal Identity Verification (PIV) credentials. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-2] 

Implementation Statement: 

IA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IA-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-2(2) 

Implementation Statement: 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-2(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-2(8) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-2(11) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments: 

Control Enhancement IA-2(12) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.7.3 IA-3 Device Identification and Authentication 

The information system uniquely identifies and authenticates [Assignment: organization-defined specific 

and/or types of devices] before establishing a [Selection (one or more): local; remote; network] 

connection. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-3] 

Implementation Statement: 

IA-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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2.1.7.4 IA-4 Identifier Management 

The organization manages information system identifiers by: 

a. Receiving authorization from [Assignment: organization-defined personnel or roles] to assign 

an individual, group, role, or device identifier; 

b. Selecting an identifier that identifies an individual, group, role, or device; 

c. Assigning the identifier to the intended individual, group, role, or device; 

d. Preventing reuse of identifiers for [Assignment: organization-defined time period]; and 

e. Disabling the identifier after [Assignment: organization-defined time period of inactivity]. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-4] 

Implementation Statement: 

IA-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.7.5 IA-5 Authenticator Management 

The organization manages information system authenticators by: 

a. Verifying, as part of the initial authenticator distribution, the identity of the individual, group, 

role, or device receiving the authenticator; 

b. Establishing initial authenticator content for authenticators defined by the organization; 

c. Ensuring that authenticators have sufficient strength of mechanism for their intended use; 

d. Establishing and implementing administrative procedures for initial authenticator distribution, 

for lost/compromised or damaged authenticators, and for revoking authenticators; 

e. Changing default content of authenticators prior to information system installation; 

f. Establishing minimum and maximum lifetime restrictions and reuse conditions for 

authenticators; 

g. Changing/refreshing authenticators [Assignment: organization-defined time period by 

authenticator type]; 

h. Protecting authenticator content from unauthorized disclosure and modification; 

i. Requiring individuals to take, and having devices implement, specific security safeguards to 

protect authenticators; and 
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j. Changing authenticators for group/role accounts when membership to those accounts 

changes. 

Control Enhancements: 

 

(1) AUTHENTICATOR MANAGEMENT | PASSWORD-BASED AUTHENTICATION 

The information system, for password-based authentication: 

a. Enforces minimum password complexity of [Assignment: organization-defined requirements 

for case sensitivity, number of characters, mix of upper-case letters, lower-case letters, 

numbers, and special characters, including minimum requirements for each type]; 

b. Enforces at least the following number of changed characters when new passwords are 

created: [Assignment: organization-defined number]; 

c. Stores and transmits only encrypted representations of passwords; 

d. Enforces password minimum and maximum lifetime restrictions of [Assignment: organizationdefined numbers for lifetime minimum, lifetime maximum]; 

e. Prohibits password reuse for [Assignment: organization-defined number] generations; and 

f. Allows the use of a temporary password for system logons with an immediate change to a 

permanent password. 

(2) AUTHENTICATOR MANAGEMENT | PKI-BASED AUTHENTICATION 

The information system, for PKI-based authentication: 

a. Validates certifications by constructing and verifying a certification path to an accepted trust 

anchor including checking certificate status information; 

b. Enforces authorized access to the corresponding private key; 

c. Maps the authenticated identity to the account of the individual or group; and 

d. Implements a local cache of revocation data to support path discovery and validation in case 

of inability to access revocation information via the network. 

(3) AUTHENTICATOR MANAGEMENT | IN-PERSON OR TRUSTED THIRD-PARTY REGISTRATION 

The organization requires that the registration process to receive [Assignment: organization-defined types 

of and/or specific authenticators] be conducted [Selection: in person; by a trusted third party] before 

[Assignment: organization-defined registration authority] with authorization by [Assignment: organizationdefined personnel or roles]. 

(11) AUTHENTICATOR MANAGEMENT | HARDWARE TOKEN-BASED AUTHENTICATION 

The information system, for hardware token-based authentication, employs mechanisms that satisfy 

[Assignment: organization-defined token quality requirements]. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 
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Revision 4 [IA-5] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

IA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IA-5(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-5(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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Control Enhancement IA-5(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-5(11) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.7.6 IA-6 Authenticator Feedback 

The information system obscures feedback of authentication information during the authentication 

process to protect the information from possible exploitation/use by unauthorized individuals. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-6] 

Implementation Statement: 

IA-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Scoped 

Comments:

2.1.7.7 IA-7 Cryptographic Module Authentication 

The information system implements mechanisms for authentication to a cryptographic module that meet 

the requirements of applicable federal laws, Executive Orders, directives, policies, regulations, standards, 

and guidance for such authentication. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-7] 

Implementation Statement: 

IA-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.7.8 IA-8 Identification and Authentication (Non-Organizational Users) 

The information system uniquely identifies and authenticates non-organizational users (or processes 

acting on behalf of non-organizational users). 

Control Enhancements: 

(1) IDENTIFICATION AND AUTHENTICATION | ACCEPTANCE OF PIV CREDENTIALS FROM 

OTHER AGENCIES 
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The information system accepts and electronically verifies Personal Identity Verification (PIV) credentials 

from other federal agencies. 

(2) IDENTIFICATION AND AUTHENTICATION | ACCEPTANCE OF THIRD-PARTY 

CREDENTIALS 

The information system accepts only FICAM-approved third-party credentials. 

(3) IDENTIFICATION AND AUTHENTICATION | USE OF FICAM-APPROVED PRODUCTS 

The organization employs only FICAM-approved information system components in [Assignment: 

organization-defined information systems] to accept third-party credentials. 

(4) IDENTIFICATION AND AUTHENTICATION | USE OF FICAM-ISSUED PROFILES 

The information system conforms to FICAM-issued profiles. 

NIST SP 800-53 Identification and 

Authentication 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [IA-8] 

Implementation Statement: 

IA-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IA-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments: 

Control Enhancement IA-8(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-8(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement IA-8(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.8 Incident Response (IR) 
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2.1.8.1 IR-1 Incident Response Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. An incident response policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the incident response policy and 

associated incident response controls; and 

b. Reviews and updates the current: 

1. Incident response policy [Assignment: organization-defined frequency]; and 

2. Incident response procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-1] 

Implementation Statement: 

IR-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.8.2 IR-2 Incident Response Training 

The organization provides incident response training to information system users consistent with 

assigned roles and responsibilities: 

a. Within [Assignment: organization-defined time period] of assuming an incident response role 

or responsibility; 

b. When required by information system changes; and 

c. [Assignment: organization-defined frequency] thereafter. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-2] 
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Implementation Statement: 

IR-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.8.3 IR-3 Incident Response Testing 

The organization tests the incident response capability for the information system [Assignment: 

organization-defined frequency] using [Assignment: organization-defined tests] to determine the incident 

response effectiveness and documents the results. 

Control Enhancements: 

(2) INCIDENT RESPONSE TESTING | COORDINATION WITH RELATED PLANS 

The organization coordinates incident response testing with organizational elements responsible for 

related plans. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-3] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

IR-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Comments:

Control Enhancement IR-3(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.8.4 IR-4 Incident Handling 

The organization: 

a. Implements an incident handling capability for security incidents that includes preparation, 

detection and analysis, containment, eradication, and recovery; 

b. Coordinates incident handling activities with contingency planning activities; and 

c. Incorporates lessons learned from ongoing incident handling activities into incident response 

procedures, training, and testing/exercises, and implements the resulting changes 

accordingly. 

Control Enhancements: 

(1) INCIDENT HANDLING | AUTOMATED INCIDENT HANDLING PROCESSES 

The organization employs automated mechanisms to support the incident handling process. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-4] 

Implementation Statement: 

IR-4 

Implementation Status: Status (check all that apply): 
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 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IR-4(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.8.5 IR-5 Incident Monitoring 

The organization tracks and documents information system security incidents. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-5] 

Implementation Statement: 

IR-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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2.1.8.6 IR-6 Incident Reporting 

The organization: 

a. Requires personnel to report suspected security incidents to the organizational incident 

response capability within [Assignment: organization-defined time period]; and 

b. Reports security incident information to [Assignment: organization-defined authorities]. 

Control Enhancements: 

(1) INCIDENT REPORTING | AUTOMATED REPORTING 

The organization employs automated mechanisms to assist in the reporting of security incidents. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-6] 

Implementation Statement: 

IR-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IR-6(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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2.1.8.7 IR-7 Incident Response Assistance 

The organization provides an incident response support resource, integral to the organizational incident 

response capability that offers advice and assistance to users of the information system for the handling 

and reporting of security incidents. 

Control Enhancements: 

(1) INCIDENT RESPONSE ASSISTANCE | AUTOMATION SUPPORT FOR AVAILABILITY OF 

INFORMATION / SUPPORT 

The organization employs automated mechanisms to increase the availability of incident response-related 

information and support. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-7] 

Implementation Statement: 

IR-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement IR-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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2.1.8.8 IR-8 Incident Response Plan 

The organization: 

a. Develops an incident response plan that: 

1. Provides the organization with a roadmap for implementing its incident response 

capability; 

2. Describes the structure and organization of the incident response capability; 

3. Provides a high-level approach for how the incident response capability fits into the 

overall organization; 

4. Meets the unique requirements of the organization, which relate to mission, size, 

structure, and functions; 

5. Defines reportable incidents; 

6. Provides metrics for measuring the incident response capability within the 

organization; 

7. Defines the resources and management support needed to effectively maintain and 

mature an incident response capability; and 

8. Is reviewed and approved by [Assignment: organization-defined personnel or roles]; 

b. Distributes copies of the incident response plan to [Assignment: organization-defined incident 

response personnel (identified by name and/or by role) and organizational elements]; 

c. Reviews the incident response plan [Assignment: organization-defined frequency]; 

d. Updates the incident response plan to address system/organizational changes or problems 

encountered during plan implementation, execution, or testing; 

e. Communicates incident response plan changes to [Assignment: organization-defined incident 

response personnel (identified by name and/or by role) and organizational elements]; and 

f. Protects the incident response plan from unauthorized disclosure and modification. 

NIST SP 800-53 Incident Response Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [IR-8] 

Implementation Statement: 

IR-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.9 Maintenance (MA) 
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2.1.9.1 MA-1 System Maintenance Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A system maintenance policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the system maintenance policy and 

associated system maintenance controls; and 

b. Reviews and updates the current: 

1. System maintenance policy [Assignment: organization-defined frequency]; and 

2. System maintenance procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-1] 

Implementation Statement: 

MA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.9.2 MA-2 Controlled Maintenance 

The organization: 

a. Schedules, performs, documents, and reviews records of maintenance and repairs on 

information system components in accordance with manufacturer or vendor specifications 

and/or organizational requirements; 

b. Approves and monitors all maintenance activities, whether performed on site or remotely and 

whether the equipment is serviced on site or removed to another location; 

c. Requires that [Assignment: organization-defined personnel or roles] explicitly approve the 

removal of the information system or system components from organizational facilities for offsite maintenance or repairs; 
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d. Sanitizes equipment to remove all information from associated media prior to removal from 

organizational facilities for off-site maintenance or repairs; 

e. Checks all potentially impacted security controls to verify that the controls are still functioning 

properly following maintenance or repair actions; and 

f. Includes [Assignment: organization-defined maintenance-related information] in 

organizational maintenance records. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-2] 

Implementation Statement: 

MA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.9.3 MA-3 Maintenance Tools 

The organization approves, controls, and monitors information system maintenance tools. 

Control Enhancements: 

(1) MAINTENANCE TOOLS | INSPECT TOOLS 

The organization inspects the maintenance tools carried into a facility by maintenance personnel for 

improper or unauthorized modifications. 

(2) MAINTENANCE TOOLS | INSPECT MEDIA 

The organization checks media containing diagnostic and test programs for malicious code before the 

media are used in the information system. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

Revision 4 Hybrid (Partially Inherited Control) [MA-3] 
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 System Specific Control

Implementation Statement: 

MA-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement MA-3(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.9.4 MA-4 Nonlocal Maintenance 

The organization: 

a. Approves and monitors nonlocal maintenance and diagnostic activities; 

b. Allows the use of nonlocal maintenance and diagnostic tools only as consistent with 

organizational policy and documented in the security plan for the information system; 

Employs strong authenticators in the establishment of nonlocal maintenance and diagnostic sessions; 

Maintains records for nonlocal maintenance and diagnostic activities; and terminates session and network 

connections when nonlocal maintenance is completed. 

Control Enhancements: 

(2) NONLOCAL MAINTENANCE | DOCUMENT NONLOCAL MAINTENANCE 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 93 

The organization documents in the security plan for the information system, the policies and procedures 

for the establishment and use of nonlocal maintenance and diagnostic connections. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-4] 

Implementation Statement: 

MA-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement MA-4(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.9.5 MA-5 Maintenance Personnel 

The organization: 

a. Establishes a process for maintenance personnel authorization and maintains a list of 

authorized maintenance organizations or personnel; 

b. Ensures that non-escorted personnel performing maintenance on the information system 

have required access authorizations; and 

c. Designates organizational personnel with required access authorizations and technical 

competence to supervise the maintenance activities of personnel who do not possess the 

required access authorizations. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 94 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-5] 

Implementation Statement: 

MA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.9.6 MA-6 Timely Maintenance 

The organization obtains maintenance support and/or spare parts for [Assignment: organization-defined 

information system components] within [Assignment: organization-defined time period] of failure. 

NIST SP 800-53 Maintenance Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MA-6] 

Implementation Statement: 

MA-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 95 

2.1.10 Media Protection (MP) 

2.1.10.1 MP-1 Media Protection Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A media protection policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the media protection policy and associated 

media protection controls; and 

b. Reviews and updates the current: 

1. Media protection policy [Assignment: organization-defined frequency]; and 

2. Media protection procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-1] 

Implementation Statement: 

MP-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.10.2 MP-2 Media Access 

The organization restricts access to [Assignment: organization-defined types of digital and/or non-digital 

media] to [Assignment: organization-defined personnel or roles 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

Revision 4 Hybrid (Partially Inherited Control) [MP-2] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 96 

 System Specific Control

Implementation Statement: 

MP-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.10.3 MP-3 Media Marking 

The organization: 

a. Marks information system media indicating the distribution limitations, handling caveats, and 

applicable security markings (if any) of the information; and 

b. Exempts [Assignment: organization-defined types of information system media] from marking 

as long as the media remain within [Assignment: organization-defined controlled areas]. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-3] 

Implementation Statement: 

MP-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 97 

2.1.10.4 MP-4 Media Storage 

The organization: 

a. Physically controls and securely stores [Assignment: organization-defined types of digital 

and/or non-digital media] within [Assignment: organization-defined controlled areas]; and 

b. Protects information system media until the media are destroyed or sanitized using approved 

equipment, techniques, and procedures. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-4] 

Implementation Statement: 

MP-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.10.5 MP-5 Media Transport 

The organization: 

a. Protects and controls [Assignment: organization-defined types of information system media] 

during transport outside of controlled areas using [Assignment: organization-defined security 

safeguards]; 

b. Maintains accountability for information system media during transport outside of controlled 

areas; 

c. Documents activities associated with the transport of information system media; and 

d. Restricts the activities associated with the transport of information system media to 

authorized personnel. 

Control Enhancements: 

(4) MEDIA TRANSPORT | CRYPTOGRAPHIC PROTECTION 

The information system implements cryptographic mechanisms to protect the confidentiality and integrity 

of information stored on digital media during transport outside of controlled areas. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 98 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-5] 

Implementation Statement: 

MP-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement MA-5(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.10.6 MP-6 Media Sanitization 

The organization: 

a. Sanitizes [Assignment: organization-defined information system media] prior to disposal, 

release out of organizational control, or release for reuse using [Assignment: organizationdefined sanitization techniques and procedures] in accordance with applicable federal and 

organizational standards and policies; and 

b. Employs sanitization mechanisms with the strength and integrity commensurate with the 

security category or classification of the information. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 99 

Revision 4 [MP-6] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

MP-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.10.7 MP-7 Media Use 

The organization [Selection: restricts; prohibits] the use of [Assignment: organization-defined types of 

information system media] on [Assignment: organization-defined information systems or system 

components] using [Assignment: organization-defined security safeguards]. 

Control Enhancements: 

(1) MEDIA USE | PROHIBIT USE WITHOUT OWNER 

The organization prohibits the use of portable storage devices in organizational information systems when 

such devices have no identifiable owner. 

NIST SP 800-53 Media Protection Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [MP-7] 

Implementation Statement: 

MP-7 

Implementation Status: Status (check all that apply): 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 100 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

MP-7(1) Control Enhancement 

Implementation Statement: 

Implementation Status: Status (check all that apply 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.11 Physical and Environmental Protection (PE) 

2.1.11.1 PE-1 Physical and Environmental Protection Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A physical and environmental protection policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the physical and environmental protection 

policy and associated physical and environmental protection controls; and 

b. Reviews and updates the current: 

1. Physical and environmental protection policy [Assignment: organization-defined 

frequency]; and 

2. Physical and environmental protection procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-1] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 101 

Implementation Statement: 

PE-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.2 PE-2 Physical Access Authorizations 

The organization: 

a. Develops, approves, and maintains a list of individuals with authorized access to the facility 

where the information system resides; 

b. Issues authorization credentials for facility access; 

c. Reviews the access list detailing authorized facility access by individuals [Assignment: 

organization-defined frequency]; and 

d. Removes individuals from the facility access list when access is no longer required. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-2] 

Implementation Statement: 

PE-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 102 

2.1.11.3 PE-3 Physical Access Control 

The organization: 

a. Enforces physical access authorizations at [Assignment: organization-defined entry/exit 

points to the facility where the information system resides] by; 

1. Verifying individual access authorizations before granting access to the facility; and 

2. Controlling ingress/egress to the facility using [Selection (one or more): [Assignment: 

organization-defined physical access control systems/devices]; guards]; 

b. Maintains physical access audit logs for [Assignment: organization-defined entry/exit points]; 

c. Provides [Assignment: organization-defined security safeguards] to control access to areas 

within the facility officially designated as publicly accessible; 

d. Escorts visitors and monitors visitor activity [Assignment: organization-defined circumstances 

requiring visitor escorts and monitoring]; 

e. Secures keys, combinations, and other physical access devices; 

f. Inventories [Assignment: organization-defined physical access devices] every [Assignment: 

organization-defined frequency]; and 

g. Changes combinations and keys [Assignment: organization-defined frequency] and/or when 

keys are lost, combinations are compromised, or individuals are transferred or terminated. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-3] 

Implementation Statement: 

PE-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.4 PE-4 Access Control for Transmission Medium 

The organization controls physical access to [Assignment: organization-defined information system 

distribution and transmission lines] within organizational facilities using [Assignment: organization-defined 

security safeguards]. 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 103 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-4] 

Implementation Statement: 

PE-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.5 PE-5 Access Control for Output Devices 

The organization controls physical access to information system output devices to prevent unauthorized 

individuals from obtaining the output. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-5] 

Implementation Statement: 

PE-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 104 

2.1.11.6 PE-6 Monitoring Physical Access 

The organization: 

a. Monitors physical access to the facility where the information system resides to detect and 

respond to physical security incidents; 

b. Reviews physical access logs [Assignment: organization-defined frequency] and upon 

occurrence of [Assignment: organization-defined events or potential indications of events]; 

and 

c. Coordinates results of reviews and investigations with the organizational incident response 

capability. 

Control Enhancements: 

(1) MONITORING PHYSICAL ACCESS | INTRUSION ALARMS / SURVEILLANCE EQUIPMENT 

The organization monitors physical intrusion alarms and surveillance equipment. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-6] 

Implementation Statement: 

PE-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement PE-6(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 105 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.11.7 PE-8 Visitor Access Records 

The organization: 

a. Maintains visitor access records to the facility where the information system resides for 

[Assignment: organization-defined time period]; and 

b. Reviews visitor access records [Assignment: organization-defined frequency]. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-8] 

Implementation Statement: 

PE-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.8 PE-9 Power Equipment and Cabling 

The organization protects power equipment and power cabling for the information system from damage 

and destruction. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-9] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 106 

Implementation Statement: 

PE-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.9 PE-10 Emergency Shutoff 

The organization: 

a. Provides the capability of shutting off power to the information system or individual system 

components in emergency situations; 

b. Places emergency shutoff switches or devices in [Assignment: organization-defined location 

by information system or system component] to facilitate safe and easy access for personnel; 

and 

c. Protects emergency power shutoff capability from unauthorized activation. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-10] 

Implementation Statement: 

PE-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 107 

2.1.11.10 PE-11 Emergency Power 

The organization provides a short-term uninterruptible power supply to facilitate [Selection (one or more): 

an orderly shutdown of the information system; transition of the information system to long-term alternate 

power] in the event of a primary power source loss. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-11] 

Implementation Statement: 

PE-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.11 PE-12 Emergency Lighting 

The organization employs and maintains automatic emergency lighting for the information system that 

activates in the event of a power outage or disruption and that covers emergency exits and evacuation 

routes within the facility. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-12] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 108 

Implementation Statement: 

PE-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.12 PE-13 Fire Protection 

The organization employs and maintains fire suppression and detection devices/systems for the 

information system that are supported by an independent energy source. 

Control Enhancements: 

(3) FIRE PROTECTION | AUTOMATIC FIRE SUPPRESSION 

The organization employs an automatic fire suppression capability for the information system when the 

facility is not staffed on a continuous basis. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-13] 

Implementation Statement: 

PE-13 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 109 

Comments:

Control Enhancement PE-13(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.11.13 PE-14 Temperature and Humidity Controls 

The organization: 

a. Maintains temperature and humidity levels within the facility where the information system 

resides at [Assignment: organization-defined acceptable levels]; and 

b. Monitors temperature and humidity levels [Assignment: organization-defined frequency]. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-14] 

Implementation Statement: 

PE-14 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 110 

Comments:

2.1.11.14 PE-15 Water Damage Protection 

The organization protects the information system from damage resulting from water leakage by providing 

master shutoff or isolation valves that are accessible, working properly, and known to key personnel. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-15] 

Implementation Statement: 

PE-15 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.15 PE-16 Delivery and Removal 

The organization authorizes, monitors, and controls [Assignment: organization-defined types of 

information system components] entering and exiting the facility and maintains records of those items. 

NIST SP 800-53 Physical and 

Environmental 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 111 

Protection Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-16] 

Implementation Statement: 

PE-16 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.11.16 PE-17 Alternate Work Site 

The organization: 

a. Employs [Assignment: organization-defined security controls] at alternate work sites; 

b. Assesses as feasible, the effectiveness of security controls at alternate work sites; and 

c. Provides a means for employees to communicate with information security personnel in case 

of security incidents or problems. 

NIST SP 800-53 

Physical and 

Environmental 

Protection 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 System Specific Control [PE-17] 

Implementation Statement: 

PE-17 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 112 

2.1.12 Planning (PL) 

2.1.12.1 PL-1 Security Planning Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A security planning policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the security planning policy and associated 

security planning controls; and 

b. Reviews and updates the current: 

1. Security planning policy [Assignment: organization-defined frequency]; and 

2. Security planning procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PL-1] 

Implementation Statement: 

PL-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 113 

2.1.12.2 PL-2 System Security Plan 

The organization: 

a. Develops a security plan for the information system that: 

1. Is consistent with the organization’s enterprise architecture; 

2. Explicitly defines the authorization boundary for the system; 

3. Describes the operational context of the information system in terms of missions and 

business processes; 

4. Provides the security categorization of the information system including supporting 

rationale; 

5. Describes the operational environment for the information system and relationships with 

or connections to other information systems; 

6. Provides an overview of the security requirements for the system; 

7. Identifies any relevant overlays, if applicable; 

8. Describes the security controls in place or planned for meeting those requirements 

including a rationale for the tailoring and supplementation decisions; and 

9. Is reviewed and approved by the authorizing official or designated representative prior to 

plan implementation; 

b. Distributes copies of the security plan and communicates subsequent changes to the plan to 

[Assignment: organization-defined personnel or roles]; 

c. Reviews the security plan for the information system [Assignment: organization-defined 

frequency]; 

d. Updates the plan to address changes to the information system/environment of operation or 

problems identified during plan implementation or security control assessments; and 

e. Protects the security plan from unauthorized disclosure and modification. 

Control Enhancements: 

(1) SYSTEM SECURITY PLAN | PLAN / COORDINATE WITH OTHER ORGANIZATIONAL ENTITIES 

The organization plans and coordinates security-related activities affecting the information system with 

[Assignment: organization-defined individuals or groups] before conducting such activities in order to 

reduce the impact on other organizational entities. 

NIST SP 800-53 Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PL-2] 

Implementation Statement: 

PL-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 114 

Scoped 

Comments:

Control Enhancement PL-2(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.12.3 PL-4 Rules of Behavior 

The organization: 

a. Establishes and makes readily available to individuals requiring access to the information 

system, the rules that describe their responsibilities and expected behavior with regard to 

information and information system usage; 

b. Receives a signed acknowledgment from such individuals, indicating that they have read, 

understand, and agree to abide by the rules of behavior, before authorizing access to 

information and the information system; 

c. Reviews and updates the rules of behavior [Assignment: organization-defined frequency]; 

and 

d. Requires individuals who have signed a previous version of the rules of behavior to read and 

resign when the rules of behavior are revised/updated. 

Control Enhancements: 

(1) RULES OF BEHAVIOR | SOCIAL MEDIA AND NETWORKING RESTRICTIONS 

The organization includes in the rules of behavior, explicit restrictions on the use of social 

media/networking sites and posting organizational information on public websites. 

NIST SP 800-53 Planning Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PL-4] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

TMP V7.4 FY17 UNCLASSIFIED // FOR OFFICIAL USE ONLY 115 

Implementation Statement: 

PL-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement PL-4(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.12.4 PL-8 Information Security Architecture 

The organization: 

a. Develops an information security architecture for the information system that: 

1. Describes the overall philosophy, requirements, and approach to be taken with regard to 

protecting the confidentiality, integrity, and availability of organizational information; 

2. Describes how the information security architecture is integrated into and supports the 

enterprise architecture; and 

3. Describes any information security assumptions about, and dependencies on, external 

services; 

b. Reviews and updates the information security architecture [Assignment: organization-defined 

frequency] to reflect updates in the enterprise architecture; and 

c. Ensures that planned information security architecture changes are reflected in the security 

plan, the security Concept of Operations (CONOPS), and organizational 

procurements/acquisitions. 

NIST SP 800-53 Planning Common (Fully Inherited Control) 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Revision 4 [PL-8] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

PL-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13 Personnel Security (PS) 

2.1.13.1 PS-1 Personnel Security Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A personnel security policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the personnel security policy and 

associated personnel security controls; and 

b. Reviews and updates the current: 

1. Personnel security policy [Assignment: organization-defined frequency]; and 

2. Personnel security procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-1] 

Implementation Statement: 

PS-1 
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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.2 PS-2 Position Risk Designation 

The organization: 

a. Assigns a risk designation to all organizational positions; 

b. Establishes screening criteria for individuals filling those positions; and 

c. Reviews and updates position risk designations [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-2] 

Implementation Statement: 

PS-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.3 PS-3 Personnel Screening 

The organization: 

a. Screens individuals prior to authorizing access to the information system; and 

b. Rescreens individuals according to [Assignment: organization-defined conditions requiring 

rescreening and, where rescreening is so indicated, the frequency of such rescreening]. 
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NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-3] 

Implementation Statement: 

PS-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.4 PS-4 Personnel Termination 

The organization, upon termination of individual employment: 

a. Disables information system access within [Assignment: organization-defined time period]; 

b. Terminates/revokes any authenticators/credentials associated with the individual; 

c. Conducts exit interviews that include a discussion of [Assignment: organization-defined 

information security topics]; 

d. Retrieves all security-related organizational information system-related property; 

e. Retains access to organizational information and information systems formerly controlled by 

terminated individual; and 

f. Notifies [Assignment: organization-defined personnel or roles] within [Assignment: 

organization-defined time period]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-4] 

Implementation Statement: 

PS-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Scoped 

Comments:

2.1.13.5 PS-5 Personnel Transfer 

The organization: 

a. Reviews and confirms ongoing operational need for current logical and physical access 

authorizations to information systems/facilities when individuals are reassigned or transferred 

to other positions within the organization; 

b. Initiates [Assignment: organization-defined transfer or reassignment actions] within 

[Assignment: organization-defined time period following the formal transfer action]; 

c. Modifies access authorization as needed to correspond with any changes in operational need 

due to reassignment or transfer; and 

d. Notifies [Assignment: organization-defined personnel or roles] within [Assignment: 

organization-defined time period]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-5] 

Implementation Statement: 

PS-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.6 PS-6 Access Agreements 

The organization: 

a. Develops and documents access agreements for organizational information systems; 
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b. Reviews and updates the access agreements [Assignment: organization-defined frequency]; 

and 

c. Ensures that individuals requiring access to organizational information and information 

systems: 

1. Sign appropriate access agreements prior to being granted access; and 

2. Re-sign access agreements to maintain access to organizational information systems 

when access agreements have been updated or [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-6] 

Implementation Statement: 

PS-6 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.7 PS-7 Third-Party Personnel Security 

The organization: 

a. Establishes personnel security requirements including security roles and responsibilities for 

third-party providers; 

b. Requires third-party providers to comply with personnel security policies and procedures 

established by the organization; 

c. Documents personnel security requirements; 

d. Requires third-party providers to notify [Assignment: organization-defined personnel or roles] 

of any personnel transfers or terminations of third-party personnel who possess 

organizational credentials and/or badges, or who have information system privileges within 

[Assignment: organization-defined time period]; and 

e. Monitors provider compliance. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-7] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Statement: 

PS-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.13.8 PS-8 Personnel Sanctions 

The organization: 

a. Employs a formal sanctions process for individuals failing to comply with established information 

security policies and procedures; and 

b. Notifies [Assignment: organization-defined personnel or roles] within [Assignment: organizationdefined time period] when a formal employee sanctions process is initiated, identifying the 

individual sanctioned and the reason for the sanction. 

NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [PS-8] 

Implementation Statement: 

PS-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.14 Risk Assessment (RA) 
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Version <X.X> 

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2.1.14.1 RA-1 Risk Assessment Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A risk assessment policy that addresses purpose, scope, roles, responsibilities, 

management commitment, coordination among organizational entities, and compliance; 

and 

2. Procedures to facilitate the implementation of the risk assessment policy and associated 

risk assessment controls; and 

b. Reviews and updates the current: 

1. Risk assessment policy [Assignment: organization-defined frequency]; and 

2. Risk assessment procedures [Assignment: organization-defined frequency]. 

NIST SP 800-53 Risk Assessment Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [RA-1] 

Implementation Statement: 

RA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.14.2 RA-2 Security Categorization 

The organization: 

a. Categorizes information and the information system in accordance with applicable federal 

laws, Executive Orders, directives, policies, regulations, standards, and guidance; 

b. Documents the security categorization results (including supporting rationale) in the security 

plan for the information system; and 

c. Ensures that the security categorization decision is reviewed and approved by the authorizing 

official or authorizing official designated representative. 

NIST SP 800-53 Risk Assessment Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Revision 4 [RA-2] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

RA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.14.3 RA-3 Risk Assessment 

The organization: 

a. Conducts an assessment of risk, including the likelihood and magnitude of harm, from the 

unauthorized access, use, disclosure, disruption, modification, or destruction of the 

information system and the information it processes, stores, or transmits; 

b. Documents risk assessment results in [Selection: security plan; risk assessment report;

[Assignment: organization-defined document]]; 

c. Reviews risk assessment results [Assignment: organization-defined frequency]; 

d. Disseminates risk assessment results to [Assignment: organization-defined personnel or 

roles]; and 

e. Updates the risk assessment [Assignment: organization-defined frequency] or whenever 

there are significant changes to the information system or environment of operation (including 

the identification of new threats and vulnerabilities), or other conditions that may impact the 

security state of the system. 

NIST SP 800-53 Risk Assessment Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [RA-3] 

Implementation Statement: 

RA-3 

Implementation Status: Status (check all that apply): 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.14.4 RA-5 Vulnerability Scanning 

The organization: 

a. Scans for vulnerabilities in the information system and hosted applications [Assignment: 

organization-defined frequency and/or randomly in accordance with organization-defined 

process] and when new vulnerabilities potentially affecting the system/applications are 

identified and reported; 

b. Employs vulnerability scanning tools and techniques that facilitate interoperability among 

tools and automate parts of the vulnerability management process by using standards for: 

1. Enumerating platforms, software flaws, and improper configurations; 

2. Formatting checklists and test procedures; and 

3. Measuring vulnerability impact; 

c. Analyzes vulnerability scan reports and results from security control assessments; 

d. Remediates legitimate vulnerabilities [Assignment: organization-defined response times] in 

accordance with an organizational assessment of risk; and 

e. Shares information obtained from the vulnerability scanning process and security control 

assessments with [Assignment: organization-defined personnel or roles] to help eliminate 

similar vulnerabilities in other information systems (i.e., systemic weaknesses or 

deficiencies). 

Control Enhancements: 

(1) VULNERABILITY SCANNING | UPDATE TOOL CAPABILITY 

The organization employs vulnerability scanning tools that include the capability to readily update the 

information system vulnerabilities to be scanned. 

(2) VULNERABILITY SCANNING | UPDATE BY FREQUENCY / PRIOR TO NEW SCAN / WHEN 

IDENTIFIED 

The organization updates the information system vulnerabilities scanned [Selection (one or more): 

[Assignment: organization-defined frequency]; prior to a new scan; when new vulnerabilities are identified 

and reported]. 

(5) VULNERABILITY SCANNING | PRIVILEGED ACCESS 

The information system implements privileged access authorization to [Assignment: organizationidentified information system components] for selected [Assignment: organization-defined vulnerability 

scanning activities]. 
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<System Name><(System Acronym)> 

<Document Name> 

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NIST SP 800-53 Personnel Security Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control

Revision 4 [RA-5] 

Implementation Statement: 

RA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement RA-5(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement RA-5(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Control Enhancement RA-5(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.15 System and Services Acquisition 

2.1.15.1 SA-1 System and Services Acquisition Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A system and services acquisition policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the system and services acquisition policy 

and associated system and services acquisition controls; and 

b. Reviews and updates the current: 

1. System and services acquisition policy [Assignment: organization-defined frequency]; 

and 

2. System and services acquisition procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-1] 

Implementation Statement: 

SA-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Scoped 

Comments:

2.1.15.2 SA-2 Allocation of Resources 

The organization: 

a. Determines information security requirements for the information system or information 

system service in mission/business process planning; 

b. Determines, documents, and allocates the resources required to protect the information 

system or information system service as part of its capital planning and investment control 

process; and 

c. Establishes a discrete line item for information security in organizational programming and 

budgeting documentation. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-2] 

Implementation Statement: 

SA-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.3 SA-3 System Development Life Cycle 

The organization: 

a. Manages the information system using [Assignment: organization-defined system 

development life cycle] that incorporates information security considerations; 

b. Defines and documents information security roles and responsibilities throughout the system 

development life cycle; 
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c. Identifies individuals having information security roles and responsibilities; and 

d. Integrates the organizational information security risk management process into system 

development life cycle activities. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-3] 

Implementation Statement: 

SA-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.4 SA-4 Acquisition Process 

The organization includes the following requirements, descriptions, and criteria, explicitly or by reference, 

in the acquisition contract for the information system, system component, or information system service in 

accordance with applicable federal laws, Executive Orders, directives, policies, regulations, standards, 

guidelines, and organizational mission/business needs: 

a. Security functional requirements; 

b. Security strength requirements; 

c. Security assurance requirements; 

d. Security-related documentation requirements; 

e. Requirements for protecting security-related documentation; 

f. Description of the information system development environment and environment in which 

the system is intended to operate; and 

g. Acceptance criteria. 

Control Enhancements: 

(1) ACQUISITION PROCESS | FUNCTIONAL PROPERTIES OF SECURITY CONTROLS 

The organization requires the developer of the information system, system component, or information 

system service to provide a description of the functional properties of the security controls to be 

employed. 
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(2) ACQUISITION PROCESS | DESIGN / IMPLEMENTATION INFORMATION FOR SECURITY 

CONTROLS 

The organization requires the developer of the information system, system component, or information 

system service to provide design and implementation information for the security controls to be employed 

that includes: [Selection (one or more): security-relevant external system interfaces; high-level design; 

low-level design; source code or hardware schematics; [Assignment: organization-defined 

design/implementation information]] at [Assignment: organization-defined level of detail]. 

(9) ACQUISITION PROCESS | FUNCTIONS / PORTS / PROTOCOLS / SERVICES IN USE 

The organization requires the developer of the information system, system component, or information 

system service to identify early in the system development life cycle, the functions, ports, protocols, and 

services intended for organizational use. 

(10) ACQUISITION PROCESS | USE OF APPROVED PIV PRODUCTS 

The organization employs only information technology products on the FIPS 201-approved products list 

for Personal Identity Verification (PIV) capability implemented within organizational information systems. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-4] 

Implementation Statement: 

SA-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SA-4(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Scoped 

Comments: 

Control Enhancement SA-4(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SA-4(9) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SA-4(10) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.15.5 SA-5 Information System Documentation 
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The organization: 

a. Obtains administrator documentation for the information system, system component, or 

information system service that describes: 

1. Secure configuration, installation, and operation of the system, component, or service; 

2. Effective use and maintenance of security functions/mechanisms; and 

3. Known vulnerabilities regarding configuration and use of administrative (i.e., privileged) 

functions; 

b. Obtains user documentation for the information system, system component, or information 

system service that describes: 

1. User-accessible security functions/mechanisms and how to effectively use those security 

functions/mechanisms; 

2. Methods for user interaction, which enables individuals to use the system, component, or 

service in a more secure manner; and 

3. User responsibilities in maintaining the security of the system, component, or service; 

c. Documents attempts to obtain information system, system component, or information system 

service documentation when such documentation is either unavailable or nonexistent and 

[Assignment: organization-defined actions] in response; 

d. Protects documentation as required, in accordance with the risk management strategy; and 

e. Distributes documentation to [Assignment: organization-defined personnel or roles]. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-5] 

Implementation Statement: 

SA-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.6 SA-8 Security Engineering Principles 

The organization applies information system security engineering principles in the specification, design, 

development, implementation, and modification of the information system. 
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NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-8] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SA-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.7 SA-9 External Information System Services 

The organization: 

a. Requires that providers of external information system services comply with organizational 

information security requirements and employ [Assignment: organization-defined security 

controls] in accordance with applicable federal laws, Executive Orders, directives, policies, 

regulations, standards, and guidance; 

b. Defines and documents government oversight and user roles and responsibilities with regard 

to external information system services; and 

c. Employs [Assignment: organization-defined processes, methods, and techniques] to monitor 

security control compliance by external service providers on an ongoing basis. 

Control Enhancements: 

(2) EXTERNAL INFORMATION SYSTEMS | IDENTIFICATION OF FUNCTIONS / PORTS / 

PROTOCOLS / SERVICES 

The organization requires providers of [Assignment: organization-defined external information system 

services] to identify the functions, ports, protocols, and other services required for the use of such 

services. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

Revision 4 [SA-9] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 System Specific Control

Implementation Statement: 

SA-9 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SA-9(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.15.8 SA-10 Developer Configuration Management 

The organization requires the developer of the information system, system component, or information 

system service to: 

a. Perform configuration management during system, component, or service [Selection (one or 

more): design; development; implementation; operation]; 

b. Document, manage, and control the integrity of changes to [Assignment: organization-defined 

configuration items under configuration management]; 

c. Implement only organization-approved changes to the system, component, or service; 

d. Document approved changes to the system, component, or service and the potential security 

impacts of such changes; and 

e. Track security flaws and flaw resolution within the system, component, or service and report 

findings to [Assignment: organization-defined personnel]. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Revision 4 [SA-10] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SA-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.15.9 SA-11 Developer Security Testing and Evaluation 

The organization requires the developer of the information system, system component, or information 

system service to: 

a. Create and implement a security assessment plan; 

b. Perform [Selection (one or more): unit; integration; system; regression] testing/evaluation at 

[Assignment: organization-defined depth and coverage]; 

c. Produce evidence of the execution of the security assessment plan and the results of the 

security testing/evaluation; 

d. Implement a verifiable flaw remediation process; and 

e. Correct flaws identified during security testing/evaluation. 

NIST SP 800-53 System and Services 

Acquisition 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SA-11] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SA-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
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Version <X.X> 

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Comments:

2.1.16 System and Communications Protection 

2.1.16.1 SC-1 System and Communications Protection Policy and Procedures 

The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A system and communications protection policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the system and communications protection 

policy and associated system and communications protection controls; and 

b. Reviews and updates the current: 

1. System and communications protection policy [Assignment: organization-defined 

frequency]; and 

2. System and communications protection procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-1] 

Implementation Statement: 

SC-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.16.2 SC-2 Application Partitioning 

The information system separates user functionality (including user interface services) from information 

system management functionality. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-2] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SC-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.3 SC-4 Information in Shared Resources 

The information system prevents unauthorized and unintended information transfer via shared system 

resources. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-3] 

Implementation Statement: 

SC-4 

Implementation Status: Status (check all that apply): 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.4 SC-5 Denial of Service Protection 

The information system protects against or limits the effects of the following types of denial of service 

attacks: [Assignment: organization-defined types of denial of service attacks or reference to source for 

such information] by employing [Assignment: organization-defined security safeguards]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-5] 

Implementation Statement: 

SC-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.5 SC-7 Boundary Protection 

The information system: 

a. Monitors and controls communications at the external boundary of the system and at key 

internal boundaries within the system; 

b. Implements subnetworks for publicly accessible system components that are [Selection: 

physically; logically] separated from internal organizational networks; and 
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c. Connects to external networks or information systems only through managed interfaces 

consisting of boundary protection devices arranged in accordance with organizational 

security architecture. 

Control Enhancements: 

(3) BOUNDARY PROTECTION | ACCESS POINTS 

The organization limits the number of external network connections to the information system. 

Supplemental Guidance: Limiting the number of external network connections facilitates more 

comprehensive monitoring of inbound and outbound communications traffic. The Trusted Internet 

Connection (TIC) initiative is an example of limiting the number of external network connections. 

(4) BOUNDARY PROTECTION | EXTERNAL TELECOMMUNICATIONS SERVICES 

The organization: 

(a) Implements a managed interface for each external telecommunication service; 

(b) Establishes a traffic flow policy for each managed interface; 

(c) Protects the confidentiality and integrity of the information being transmitted across each 

interface; 

(d) Documents each exception to the traffic flow policy with a supporting mission/business 

need and duration of that need; and 

(e) Reviews exceptions to the traffic flow policy [Assignment: organization-defined frequency] 

and removes exceptions that are no longer supported by an explicit mission/business 

need. 

(5) BOUNDARY PROTECTION | DENY BY DEFAULT / ALLOW BY EXCEPTION 

The information system at managed interfaces denies network communications traffic by default and 

allows network communications traffic by exception (i.e., deny all, permit by exception). 

(7) BOUNDARY PROTECTION | PREVENT SPLIT TUNNELING FOR REMOTE DEVICES 

The information system, in conjunction with a remote device, prevents the device from simultaneously 

establishing non-remote connections with the system and communicating via some other connection to 

resources in external networks. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-7] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Statement: 

SC-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SC-7(3) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SC-7(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SC-7(5) 

Implementation Statement: 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SC-7(7) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.16.6 SC-8 Transmission Confidentiality and Integrity 

The information system protects the [Selection (one or more): confidentiality; integrity] of transmitted 

information. 

Control Enhancements: 

(1) TRANSMISSION CONFIDENTIALITY AND INTEGRITY | CRYPTOGRAPHIC OR ALTERNATE 

PHYSICAL PROTECTION 

The information system implements cryptographic mechanisms to [Selection (one or more): prevent 

unauthorized disclosure of information; detect changes to information] during transmission unless 

otherwise protected by [Assignment: organization-defined alternative physical safeguards]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-8] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Statement: 

SC-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SC-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.16.7 SC-10 Network Disconnect 

The information system terminates the network connection associated with a communications session at 

the end of the session or after [Assignment: organization-defined time period] of inactivity.

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-10] 

Implementation Statement: 

SC-10 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.8 SC-12 Cryptographic Key Establishment and Management 

The organization establishes and manages cryptographic keys for required cryptography employed within 

the information system in accordance with [Assignment: organization-defined requirements for key 

generation, distribution, storage, access, and destruction]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-12] 

Implementation Statement: 

SC-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.9 SC-13 Cryptographic Protection 

The information system implements [Assignment: organization-defined cryptographic uses and type of 

cryptography required for each use] in accordance with applicable federal laws, Executive Orders, 

directives, policies, regulations, and standards. 
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NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-13] 

Implementation Statement: 

SC-13 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.10 SC-15 Collaborative Computing Devices 

The information system: 

a. Prohibits remote activation of collaborative computing devices with the following exceptions: 

[Assignment: organization-defined exceptions where remote activation is to be allowed]; and 

b. Provides an explicit indication of use to users physically present at the devices. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-15] 

Implementation Statement: 

SC-15 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.16.11 SC-17 Public Key Infrastructure Certificates 

The organization issues public key certificates under an [Assignment: organization-defined certificate 

policy] or obtains public key certificates from an approved service provider 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-17] 

Implementation Statement: 

SC-17 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.12 SC-18 Mobile Code 

The organization: 

a. Defines acceptable and inacceptable mobile code and mobile code technologies; 

b. Establishes usage restrictions and implementation guidance for acceptable mobile code and 

mobile code technologies; and 

c. Authorizes, monitors, and controls the use of mobile code within the information system. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Revision 4 [SC-18] Hybrid (Partially Inherited Control) 

 System Specific Control

Implementation Statement: 

SC-18 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.13 SC-19 Voice Over Internet Protocol 

The organization: 

a. Establishes usage restrictions and implementation guidance for Voice over Internet Protocol 

(VoIP) technologies based on the potential to cause damage to the information system if 

used maliciously; and 

b. Authorizes, monitors, and controls the use of VoIP within the information system. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-19] 

Implementation Statement: 

SC-19 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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2.1.16.14 SC-20 Secure Name / Address Resolution Service (Authoritative Source) 

The information system: 

a. Provides additional data origin and integrity artifacts along with the authoritative name 

resolution data the system returns in response to external name/address resolution queries; 

and 

Provides the means to indicate the security status of child zones and (if the child supports secure 

resolution services) to enable verification of a chain of trust among parent and child domains, when 

operating as part of a distributed, hierarchical namespace. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-20] 

Implementation Statement: 

SC-20 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.15 SC-21 Secure Name / Address Resolution Service (Recursive or Caching 

Resolver) 

The information system requests and performs data origin authentication and data integrity verification on 

the name/address resolution responses the system receives from authoritative sources. 
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<System Name><(System Acronym)> 

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Version <X.X> 

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NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-21] 

Implementation Statement: 

SC-21 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.16 SC-22 Architecture and Provisioning for Name / Address Resolution 

Service 

The information systems that collectively provide name/address resolution service for an organization are 

fault-tolerant and implement internal/external role separation 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-22] 

Implementation Statement: 

SC-22 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Comments:

2.1.16.17 SC-23 Session Authenticity 

The information system protects the authenticity of communications sessions. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-23] 

Implementation Statement: 

SC-23 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.18 SC-28 Protection of Information at Rest 

The information system protects the [Selection (one or more): confidentiality; integrity] of [Assignment: 

organization-defined information at rest]. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-28] 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Statement: 

SC-28 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.16.19 SC-39 Process Isolation 

The information system maintains a separate execution domain for each executing process. 

NIST SP 800-53 System and 

Communications 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SC-39] 

Implementation Statement: 

SC-39 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17 System and Information Integrity 

2.1.17.1 SI-1 System and Information Integrity Policy and Procedures 
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<Document Name> 

Version <X.X> 

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The organization: 

a. Develops, documents, and disseminates to [Assignment: organization-defined personnel or 

roles]: 

1. A system and information integrity policy that addresses purpose, scope, roles, 

responsibilities, management commitment, coordination among organizational entities, 

and compliance; and 

2. Procedures to facilitate the implementation of the system and information integrity policy 

and associated system and information integrity controls; and 

b. Reviews and updates the current: 

1. System and information integrity policy [Assignment: organization-defined frequency]; 

and 

2. System and information integrity procedures [Assignment: organization-defined 

frequency]. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-1] 

Implementation Statement: 

SI-1 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17.2 SI-2 Flaw Remediation 

The organization: 

a. Identifies, reports, and corrects information system flaws; 

b. Tests software and firmware updates related to flaw remediation for effectiveness and 

potential side effects before installation; 

c. Installs security-relevant software and firmware updates within [Assignment: organizationdefined time period] of the release of the updates; and 

d. Incorporates flaw remediation into the organizational configuration management process. 

Control Enhancements: 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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(2) FLAW REMEDIATION | AUTOMATED FLAW REMEDIATION STATUS 

The organization employs automated mechanisms [Assignment: organization-defined frequency] to 

determine the state of information system components with regard to flaw remediation. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-2] 

Implementation Statement: 

SI-2 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-2(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.3 SI-3 Malicious Code Protection 

The organization: 

a. Employs malicious code protection mechanisms at information system entry and exit points 

to detect and eradicate malicious code; 

b. Updates malicious code protection mechanisms whenever new releases are available in 

accordance with organizational configuration management policy and procedures; 
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c. Configures malicious code protection mechanisms to: 

1. Perform periodic scans of the information system [Assignment: organization-defined 

frequency] and real-time scans of files from external sources at [Selection (one or more); 

endpoint; network entry/exit points] as the files are downloaded, opened, or executed in 

accordance with organizational security policy; and 

2. [Selection (one or more): block malicious code; quarantine malicious code; send alert to 

administrator; [Assignment: organization-defined action]] in response to malicious code 

detection; and 

d. Addresses the receipt of false positives during malicious code detection and eradication and 

the resulting potential impact on the availability of the information system. 

Control Enhancements: 

(1) MALICIOUS CODE PROTECTION | CENTRAL MANAGEMENT 

The organization centrally manages malicious code protection mechanisms. 

(2) MALICIOUS CODE PROTECTION | AUTOMATIC UPDATES 

The information system automatically updates malicious code protection mechanisms. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-3] 

Implementation Statement: 

SI-3 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-3(1) 

Implementation Statement: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SI-3(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.4 SI-4 Information System Monitoring 

The organization: 

a. Monitors the information system to detect: 

1. Attacks and indicators of potential attacks in accordance with [Assignment: 

organization-defined monitoring objectives]; and 

2. Unauthorized local, network, and remote connections; 

b. Identifies unauthorized use of the information system through [Assignment: organizationdefined techniques and methods]; 

c. Deploys monitoring devices: (i) strategically within the information system to collect 

organization-determined essential information; and (ii) at ad hoc locations within the system 

to track specific types of transactions of interest to the organization; 

d. Protects information obtained from intrusion-monitoring tools from unauthorized access, 

modification, and deletion; 

e. Heightens the level of information system monitoring activity whenever there is an indication 

of increased risk to organizational operations and assets, individuals, other organizations, or 

the Nation based on law enforcement information, intelligence information, or other credible 

sources of information; 

f. Obtains legal opinion with regard to information system monitoring activities in accordance 

with applicable federal laws, Executive Orders, directives, policies, or regulations; and 

g. Provides [Assignment: organization-defined information system monitoring information] to 

[Assignment: organization-defined personnel or roles] [Selection (one or more): as needed;

[Assignment: organization-defined frequency]]. 

Control Enhancements: 
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(2) INFORMATION SYSTEM MONITORING | AUTOMATED TOOLS FOR REAL-TIME ANALYSIS 

The organization employs automated tools to support near real-time analysis of events. 

(4) INFORMATION SYSTEM MONITORING | INBOUND AND OUTBOUND COMMUNICATIONS 

TRAFFIC 

The information system monitors inbound and outbound communications traffic [Assignment: 

organization-defined frequency] for unusual or unauthorized activities or conditions. 

(5) INFORMATION SYSTEM MONITORING | SYSTEM-GENERATED ALERTS 

The information system alerts [Assignment: organization-defined personnel or roles] when the following 

indications of compromise or potential compromise occur: [Assignment: organization-defined compromise 

indicators]. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-4] 

Implementation Statement: 

SI-4 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-4(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Control Enhancement SI-4(4) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SI-4(5) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.5 SI-5 Security Alerts, Advisories, and Directives 

The organization: 

a. Receives information system security alerts, advisories, and directives from [Assignment: 

organization-defined external organizations] on an ongoing basis; 

b. Generates internal security alerts, advisories, and directives as deemed necessary; 

c. Disseminates security alerts, advisories, and directives to: [Selection (one or more):

[Assignment: organization-defined personnel or roles]; [Assignment: organization-defined 

elements within the organization]; [Assignment: organization-defined external organizations]]; 

and 

d. Implements security directives in accordance with established time frames, or notifies the 

issuing organization of the degree of noncompliance. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-5] 
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<Document Name> 

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Implementation Statement: 

SI-5 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17.6 SI-7 Software, Firmware, and Information Integrity 

The organization employs integrity verification tools to detect unauthorized changes to [Assignment: 

organization-defined software, firmware, and information]. 

Control Enhancements: 

(1) SOFTWARE, FIRMWARE, AND INFORMATION INTEGRITY | INTEGRITY CHECKS 

The information system performs an integrity check of [Assignment: organization-defined software, 

firmware, and information] [Selection (one or more): at startup; at [Assignment: organization-defined 

transitional states or security-relevant events]; [Assignment: organization-defined frequency]]. 

(7) SOFTWARE, FIRMWARE, AND INFORMATION INTEGRITY | INTEGRATION OF DETECTION 

AND RESPONSE 

The organization incorporates the detection of unauthorized [Assignment: organization-defined securityrelevant changes to the information system] into the organizational incident response capability. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-7] 
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<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SI-7 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-7(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

Control Enhancement SI-7(7) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.7 SI-8 Spam Protection 

The organization: 
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<Document Name> 

Version <X.X> 

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a. Employs spam protection mechanisms at information system entry and exit points to detect 

and take action on unsolicited messages; and 

b. Updates spam protection mechanisms when new releases are available in accordance with 

organizational configuration management policy and procedures. 

Control Enhancements: 

(1) SPAM PROTECTION | CENTRAL MANAGEMENT 

The organization centrally manages spam protection mechanisms. 

(2) SPAM PROTECTION | AUTOMATIC UPDATES 

The information system automatically updates spam protection mechanisms. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-8] 

Implementation Statement: 

SI-8 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

Control Enhancement SI-8(1) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 
Social Security Administration 

<System Name><(System Acronym)> 

<Document Name> 

Version <X.X> 

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Control Enhancement SI-8(2) 

Implementation Statement: 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments: 

2.1.17.8 SI-10 Information Input Validation 

The information system checks the validity of [Assignment: organization-defined information inputs]. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-10] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SI-10 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17.9 SI-11 Error Handling 

The information system: 
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<Document Name> 

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a. Generates error messages that provide information necessary for corrective actions without 

revealing information that could be exploited by adversaries; and 

b. Reveals error messages only to [Assignment: organization-defined personnel or roles]. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-11] 

Implementation Statement: 

SI-11 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:

2.1.17.10 SI-12 Information Handling and Retention 

The organization handles and retains information within the information system and information output 

from the system in accordance with applicable federal laws, Executive Orders, directives, policies, 

regulations, standards, and operational requirements. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-12] 

Implementation Statement: 

SI-12 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 
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Scoped 

Comments:

2.1.17.11 SI-16 Memory Protection 

The information system implements [Assignment: organization-defined security safeguards] to protect its 

memory from unauthorized code execution. 

NIST SP 800-53 System and 

Information Integrity 

 Common (Fully Inherited Control) 

 Hybrid (Partially Inherited Control) 

 System Specific Control Revision 4 [SI-16] 

Implementation Statement: Does not apply to Low systems according to NIST SP 800-53 Rev 4. 

SI-16 

Implementation Status: Status (check all that apply): 

 Implemented (In Place) Planned (Not in Place) Compensated Not Applicable 

Scoped 

Comments:
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3 APPENDIX LISTING 

3.1 Required Appendices 

APPENDIX DESCRIPTION STATUS 

A Acronym List Refer to Appendix 3.2 below 

B Definitions Refer to Appendix 3.3 below 

C Applicable Laws and References Refer to Appendix 3.4 below 

D Agency IT Master Inventory System Security Plan Appendices.doc 

E Security Assessment Report Matrix SecurityAssessmentReport.pdf 

G System Documentation [ENTER NAME OF SSP]

H System Rules of Behavior System Security Plan Appendices.doc 

I Security Awareness and Training 

Plan 

System Security Plan Appendices.doc 

J Incident Response Plan System Security Plan Appendices.doc 

K Configuration Management Plan System Security Plan Appendices.doc 

3.2 System Specific Appendices 

APPENDIX DESCRIPTION STATUS 

E2 Prior Security Assessment Report 

Matrix 

[System Name] SAR Matrix.doc 
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3.3 Acronym List 

TERM DEFINITION 

AO Authorizing Official 

ASSERT Automated Security Self-Evaluation and Remediation Tracking 

ATO Authorization to Operate 

BSM Boundary Scope Memo 

CIO Chief Information Officer 

CISO Chief Information Security Officer 

CONOPS Concept of Operations 

COTS Commercial off the Shelf 

CSAM Cyber Security and Asset Management 

CSO Component Security Officer 

FICAM Federal Identity, Credential, and Access Management 

FIPS Federal Information Processing Standard(s) 

FISMA Federal Information Security Management Act 

GMT Greenwich Mean Time 

HW Hardware 

ISA Interconnection Security Agreement 

ISSH Information System Security Handbook 

IT Information Technology 

MD Maryland 

MOA Memorandum of Agreement 

MOU Memorandum of Understanding 

NCC National Coordinating Center for Communications 

NIST National Institute of Standards and Technology 

OIG Office of Inspector General 

OIS Office of Information Security 

OMB Office of Management and Budget 

OS Operating System 

PIV Personal Identity Verification 

POA&M Plan of Action and Milestones 

POC Point of Contact 
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TERM DEFINITION 

PRIDE Project Resource Guide 

PSC Program Support Center 

RBD Risk-Based Decision 

SAM Security Authorization Manager 

SAR Security Assessment Report 

SBU Sensitive But Unclassified 

SDLC Systems Development Life Cycle 

SDLCM Systems Development Life Cycle Methodology 

SME Subject Matter Expert 

SO System Owner 

SP Special Publication 

SPM System Project Manager 

SRA Security Risk Assessment 

SSA Social Security Administration 

SSC Secure Standards Council 

SSP System Security Plan 

SW Software 

TIC Trusted Internet Connection 

TSL Transport Layer Security 

U.S.C. United States Code 

UTC Coordinated Universal Time 

VoIP Voice Over Internet Protocol 

VPN Virtual Private Network 

WAN Wide Area Network 
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3.4 Definitions/Glossary 

Term Definition 

Accreditation The official management decision given by a senior agency official to 

authorize operation of an information system and to explicitly accept the risk 

to agency operations (including mission, functions, image, or reputation), 

agency assets, or individuals, based on the implementation of an agreedupon set of security controls. 

Accreditation 

Boundary 

All components of an information system to be accredited by an authorizing 

official and excludes separately accredited systems, to which the information 

system is connected. 

Accreditation Package The evidence provided to the authorizing official to be used in the security 

accreditation decision process. Evidence includes, but is not limited to: (i) the 

system security plan; (ii) the assessment results from the security 

certification; and (iii) the plan of action and milestones. 

Assessment 

Procedure 

A set of activities or actions employed by an assessor to determine the extent 

to which a security control is implemented correctly, operating as intended, 

and producing the desired outcome with respect to meeting the security 

requirements for the system. 

Automated Information 

System (AIS) 

An assembly of computer hardware, software and/or firmware configured to 

collect, create, communicate, compute, disseminate, process, store, and/or 

control data or information. 

Certification The comprehensive evaluation of the technical and non-technical security 

features of an AIS and other safeguards, made in support of the accreditation 

process that establishes the extent to which a particular design and 

implementation meet a specified set of security requirements. 

Common Security 

Control 

Security control that can be applied to one or more agency information 

systems and has the following properties: (i) the development, 

implementation, and assessment of the control can be assigned to a 

responsible official or organizational element (other than the information 

system owner); and (ii) the results from the assessment of the control can be 

used to support the C&A processes of an agency information system where 

that control has been applied. 

Confidentiality Preserving authorized restrictions on information access and disclosure, 

including means for protecting personal privacy and proprietary information. 

[44 U.S.C., Sec. 3542] 

Configuration Control Process for controlling modifications to hardware, firmware, software, and 

documentation to ensure the information system is protected against 

improper modifications prior to, during, and after system implementation. 

[CNSS Inst. 4009] 
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Term Definition 

General Support 

System 

An interconnected set of information resources under the same direct 

management control that shares common functionality. It normally includes 

hardware, software, information, data, applications, communications, and 

people. [OMB Circular A-130, Appendix III] 

Information Owner Official with statutory or operational authority for specified information and 

responsibility for establishing the controls for its generation, collection, 

processing, dissemination, and disposal. [CNSS Inst. 4009] 

Information Security The protection of information and information systems from unauthorized 

access, use, disclosure, disruption, modification, or destruction in order to 

provide confidentiality, integrity, and availability. [44 U.S.C., Sec. 3542] 

Information Security 

Policy 

Aggregate of directives, regulations, rules, and practices that prescribe how 

an organization manages, protects, and distributes information. [CNSS Inst. 

4009] 

Information System A discrete set of information resources organized for the collection, 

processing, maintenance, use, sharing, dissemination, or disposition of 

information. [44 U.S.C., Sec. 3502] [OMB Circular A-130, Appendix III] 

Information Type A specific category of information (e.g., privacy, medical, proprietary, 

financial, investigative, contractor sensitive, security management), defined 

by an organization or in some instances, by a specific law, Executive Order, 

directive, policy, or regulation. [FIPS 199] 

Integrity Guarding against improper information modification or destruction, and 

includes ensuring information non-repudiation and authenticity. [44 U.S.C., 

Sec. 3542] 

Major Application An application that requires special attention to security due to the risk and 

magnitude of harm resulting from the loss, misuse, or unauthorized access to 

or modification of the information in the application. [OMB Circular A-130, 

Appendix III] 

Management Controls The security controls (i.e., safeguards or countermeasures) for an information 

system that focus on the management of risk and the management of 

information system security. [NIST SP 800-18] 

Minor Application An application, other than a major application, that requires attention to 

security due to the risk and magnitude of harm resulting from the loss, 

misuse, or unauthorized access to or modification of the information in the 

application. Minor applications are typically included as part of a general 

support system. 

Operational Controls The security controls (i.e., safeguards or countermeasures) for an information 

system that primarily are implemented and executed by people (as opposed 

to systems). [NIST SP 800-18] 

Plan of Action and 

Milestones 

A document that identifies tasks needing to be accomplished. It details 

resources required to accomplish the elements of the plan, any milestones in 

meeting the tasks, and scheduled completion dates for the milestones. [OMB 

Memorandum M-02-09] 
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Term Definition 

Risk The level of impact on agency operations, (including mission, functions, 

image, or reputation), agency assets, or individuals, resulting from the 

operation of an information system given the potential impact of a threat and 

the likelihood of that threat occurring. [NIST SP 800-30] 

Risk Assessment The process of identifying risks to agency operations (including mission, 

functions, image, or reputation), agency assets, or individuals by determining 

the probability of occurrence, the resulting impact, and additional security 

controls that would mitigate this impact. Part of risk management, 

synonymous with risk analysis, and incorporates threat and vulnerability 

analyses. [NIST SP 800-30] 

Risk Management The process of managing risks to agency operations (including mission, 

functions, image, or reputation), agency assets, or individuals resulting from 

the operation of an information system. It includes risk assessment; costbenefit analysis; the selection, implementation, and assessment of security 

controls; and the formal authorization to operate the system. The process 

considers effectiveness, efficiency, and constraints due to laws, directives, 

policies, or regulations. [NIST SP 800-30] 

Security Category The characterization of information or an information system based on an 

assessment of the potential impact that a loss of confidentiality, integrity, or 

availability of such information or information system would have on 

organizational operations, organizational assets, or individuals. [FIPS 199] 

Security Controls The management, operational, and technical controls (i.e., safeguards or 

countermeasures) prescribed for an information system to protect the 

confidentiality, integrity, and availability of the system and its information. 

[FIPS 199] 

Subsystem A major subdivision or component of an information system consisting of 

information, information technology, and personnel that performs one or more 

specific functions. 

System Security Plan Formal document that provides an overview of the security requirements for 

the information system and describes the security controls in place or planned 

for meeting those requirements. [NIST SP 800-18] 

System-specific 

Security Control 

A security control for an information system that has not been designated as 

a common security control. 

Technical Controls The security controls (i.e., safeguards or countermeasures) for an information 

system that are primarily implemented and executed by the information 

system through mechanisms contained in the hardware, software, or firmware 

components of the system. [NIST SP 800-18] 

Threat Any circumstance or event with the potential to adversely impact agency 

operations (including mission, functions, image, or reputation), agency assets, 

or individuals through an information system via unauthorized access, 

destruction, disclosure, modification of information, and/or denial of service. 

[CNSS Inst. 4009, Adapted] 
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Term Definition 

User Person or process accessing an AIS either by direct connections (e.g., via 

terminals), or indirect connections (e.g., prepare input data or receive output 

that is not reviewed for content or classification by a responsible individual). 

Vulnerability Weakness in an information system, system security procedures, internal 

controls, or implementation that could be exploited or triggered by a threat 

source. [CNSS Inst. 4009, Adapted] 

Vulnerability 

Assessment 

Formal description and evaluation of the vulnerabilities in an information 

system. [CNSS Inst. 4009] 
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3.5 Applicable Laws and References 

Applicable Laws or Regulations Affecting the System 

Federal Policies/Directives/Guidance 

Committee on National Security Systems (CNSS) Instruction 4009, National Information Assurance 

Glossary, June 2006 

Committee on National Security Systems (CNSS) Instruction 1253, Security Categorization and Control 

Selection for National Security Systems, October 2009 

Freedom of Information Act (FOIA) 

Federal Information Security Management Act (FISMA) of 2002 

Federal Information Security Modernization Act (FISMA) of 2014 

Federal Managers’ Financial Integrity Act (FMFIA) 

Federal Information Processing Standards (FIPS) 199, Standards for Security Categorization of 

Federal Information and Information Systems, February 2004 

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

2006 

Homeland Security Presidential Directive (HSPD)-7, Critical Infrastructure Identification, Prioritization, 

and Protection 

Homeland Security Presidential Directive/HSPD-12, Policy for a Common Identification Standard for 

Federal Employees and Contractors 

Homeland Security Presidential Directive/HSPD-20, National Continuity Policy 

National Archives & Records Administration (NARA) 

National Institute of Standards and Technology (NIST) Special Publications (SP) 800-18, Revision 1, 

Guide for Developing Security Plans for Federal Information Systems, February 2006 

NIST SP 800-27, Revision A, Engineering Principles for Information Technology Security (A Baseline 

for Achieving Security), June 2004 

NIST SP 800-30, Revision 1, Guide for Conducting Risk Assessments, September 2012 

NIST SP 800-34, Revision 1, Contingency Planning Guide for Federal Information Systems, May 2010 

NIST SP 800-37, Revision 1, Guide for Applying the Risk Management Framework to Federal 

Information Systems: A Security Life Cycle Approach, February 2010 

NIST SP 800-39, Managing Information Security Risk: Organization, Mission, and Information System 

View, March 2011 

NIST SP 800-50, Building an Information Technology Security Awareness and Training Program, 

October 2003 

NIST SP 800-52, Guidelines for Selecting and Use of Transport Layer Security (TSL) Implementations, 

April 2014 

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

Organizations, April 2013 

NIST SP 800-53A, Revision 4, Assessing Security and Privacy Controls in Federal Information 
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Applicable Laws or Regulations Affecting the System 

Systems and Organizations: Building Effective Assessment Plans, December 2014 

NIST SP 800-59, Guideline for Identifying an Information System as a National Security System, 

August 2003. 

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

Security Categories, August 2008. 

NIST SP 800-64, Rev 2, Security Consideration in the Information System Development Life Cycle, 

October 2008 

NIST SP 800-70, Revision 3, National Checklist Program for IT Products: Guidelines for Checklist 

Users and Developers, March 2015 

NIST SP 800-122, Guide to Protecting the Confidentiality of Personally Identifiable Information (PII), 

April 2010 

NIST SP 800-126, Revision 1, The Technical Specification for the Security Content Automation 

Protocol (SCAP): SCAP Version 1.2, February 2011. 

Office of Management and Budget (OMB) Circular A-123 Management Accountability and Control, 

1995 

OMB Circular A-127 Financial Management Systems, 1993 

OMB Circular A-130 Management of Federal Information Resources, 2000 

NIST SP 800-144, Guidelines on Security and Privacy in Public Cloud Computing, December 2011 

NIST SP 800-145, The NIST Definition of Cloud Computing, September 2011 

NIST SP 800-146, Cloud Computing Synopsis and Recommendations, May 2012 

OMB Circular M-02-01, Guidance for Preparing and Submitting Security Plans of Action and 

Milestones, October 2001. 

Paperwork Reduction Act, May 1995 

Privacy Act of 1974, as amended 

Social Security Act of 2013 

SSA Departmental Guidance 

ISSH, Information System Security Handbook - http://eis.ba.ssa.gov/ssasso/issh/tableofcontents.htm

OIS Guidance, http://ois.ssahost.ba.ssa.gov/dspp/fisma/security_assessment_authorization.htm 

PRIDE, http://pride.ssahost.ba.ssa.gov/ 

CSAM, https://csamssa.justapps.doj.gov/CSAM/login.aspx?ReturnUrl=%2fCSAM%2fDefault.aspx 

ISAHB, Information Security Authorization Handbook (dated June 2014) 
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Appendix A. <Appendix Name>Appendix body 

 NOTE: Automatic section numbering (Heading 1, Heading 2, etc.) should not be 

applied to the appendix body. The numbering will be a continuation of the numbering 

from the body of the document, and will not accurately reflect the appendix location. 

 
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Appendix B. Acronym List 

 Make sure all acronyms within this document are included in the acronym list. Delete 

any that are not used. 

Acronym Definition 

AO Authorizing Official 

APM Application Portfolio Management 

APP Application 

BRM Business Reference Model 

BSM Boundary Scope Memorandum 

CSAM Cybersecurity Assessment and Management 

CSO Component Security Officer 

DB Database 

DBMS Database Management System 

DCS Deputy Commissioner for Systems 

FIPS Federal Information Processing Standard 

FISMA Federal Information Security Modernization Act 

FOUO For Official Use Only 

FTP File Transfer Protocol 

HW Hardware 

ID Identification 

IPSEC Internet Protocol Security 

ISA Interconnection Security Agreement 

IT Information Technology 

IV&V Independent Verification and Validation 

L2TP Layer 2 Tunneling Protocol 

MA Major Application 

MOA Memorandum of Agreement 

MOU Memorandum of Understanding 

NCC National Computer Center 

NIST National Institute of Standards and Technology 

NMS Network Management System 

OIS Office of Information Security 

OS Operating System 

PDA Personal Digital Assistant 
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Acronym Definition 

SAM Security Authorization Manager 

SBU Sensitive But Unclassified 

SCQ Significant Change Questionnaire 

SO System Owner 

SP Special Publication 

SSA Social Security Administration 

SSC Secondary Support Center 

SSP System Security Plan 

V-HW Virtual Hardware 

VPN Virtual Private Network 
EXHIBIT F
1 

EXHIBIT F

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 
EXHIBIT G
All your answers must be truthful and complete. A false statement on any part of this declaration or attached forms or sheets

may be grounds for not hiring you, or for firing you after you begin work. Also, you may be punished by a fine orimprisonment (U.S. Code, title 18, section 1001).Either type your responses on this form or print clearly in dark ink. If you need additional space, attach letter-size sheets (8.5" X 11").

Include your name, Social Security Number, and item number on each sheet. We recommend that you keep a photocopy of your

completed form for your records.

Privacy Act Statement

The Office of Personnel Management is authorized to request this information under sections 1302,3301,3304,3328, and 8716 of

title 5, U. S. Code. Section 1104 of title 5 allows the Office of Personnel Management to delegate personnel management functionsto other Federal agencies. If necessary, and usually in conjunction with another form or forms, this form may be used in conducting

an investigation to determine your suitability or your ability to hold a security clearance, and it may be disclosed to authorized officials

making similar, subsequent determinations.

Your Social Security Number (SSN) is needed to keep our records accurate, because other people may have the same name and

birth date. Public Law 104-134 (April 26, 1996) asks Federal agencies to use this number to help identify individuals in agency

records. Giving us your SSN or any other information is voluntary. However, if you do not give us your SSN or any other informationrequested, we cannot process your application. Incomplete addresses and ZIP Codes may also slow processing.

ROUTINE USES: Any disclosure of this record or information in this record is in accordance with routine uses found in SystemNotice OPM/GOVT-1, General Personnel Records. This system allows disclosure of information to: training facilities; organizations

deciding claims for retirement, insurance, unemployment, or health benefits; officials in litigation or administrative proceedings where

the Government is a party; law enforcement agencies concerning a violation of law or regulation; Federal agencies for statistical

reports and studies; officials of labor organizations recognized by law in connection with representation of employees; Federal

agencies or other sources requesting information for Federal agencies in connection with hiring or retaining, security clearance,

security or suitability investigations, classifying jobs, contracting, or issuing licenses, grants, or other benefits; public and private

organizations, including news media, which grant or publicize employee recognitions and awards; the Merit Systems Protection

Board, the Office of Special Counsel, the Equal Employment Opportunity Commission, the Federal Labor Relations Authority, theNational Archives and Records Administration, and Congressional offices in connection with their official functions; prospectivenon-Federal employers concerning tenure of employment, civil service status, length of service, and the date and nature of action for

separation as shown on the SF 50 (or authorized exception) of a specifically identified individual; requesting organizations or

individuals concerning the home address and other relevant information on those who might have contracted an illness or been

exposed to a health hazard; authorized Federal and non-Federal agencies for use in computer matching; spouses or dependentchildren asking whether the employee has changed from a self-and-family to a self-only health benefits enrollment; individuals

working on a contract, service, grant, cooperative agreement, or job for the Federal government; non-agency members of an

agency's performance or other panel; and agency-appointed representatives of employees concerning information issued to the

employees about fitness-for-duty or agency-filed disability retirement procedures.

Public Burden Statement

Public burden reporting for this collection of information is estimated to vary from 5 to 30 minutes with an average of 15minutes per response, including time for reviewing instructions, searching existing data sources, gathering the data needed,and

completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of thecollection of information, including suggestions for reducing this burden, to the U.S. Office of Personnel Management, Reports and

Forms Manager (3206-0182), Washington, DC 20415-7900. The 0MB number, 3206-0182, is valid. OPM may not collect this

information, and you are not required to respond, unless this number is displayed.

U.S. Office of Personnel Management

5 U.S.C. 1302,3301, 3304, 3328 & 8716

Optional Form 306

Revised October 2011

Previous editions obsolete and unusable
I, YES [— NO (If "NO", provide country of citizenship) •

5. OTHER NAMES EVER USED (For example, maiden name, nickname, etc)

••

•

6. PHONE NUMBERS (Include area codes)

Day •

Night •

Selective Service Registration

If you are a male born after December 31, 1959, and are at least 18 years of age, civil service employment law (5 U.S.C. 3328) requires that you

must register with the Selective Service System, unless you meet certain exemptions.

Ii YES [~ NO (If "NO", proceed to 8.)f— YES (If "YES", proceed to 8.) [~; NO (If "NO", proceed to 7c.)

7a. Are you a male born after December 31, 1959?7b. Have you registered with the Selective Service System?

7c. If "NO," describe your reason(s) in item 16.

Military Service

8. Have you ever served in the United States military? |YES (If "YES", provide information below) | NO

If you answered "YES," list the branch, dates, and type of discharge for all active duty.If your only active duty was training in the Resen/es or National Guard, answer "NO. "

Branch From (MM/DD/YYYY) To (MM/DD/YTTQ Type of Discharge

Background Information

For all questions, provide all additional requested information under item 16 or on attached sheets. The circumstances of each event

you list will be considered. However, in most cases you can still be considered for Federal jobs.

For questions 9,10, and 11, your answers should include convictions resulting from a plea of nolo contendere (no contest), but omit (1) traffic

fines of $300 or less, (2) any violation of law committed before your 16th birthday, (3) any violation of law committed before your 18th birthday iffinally decided in juvenile court or under a Youth Offender law, (4) any conviction set aside under the Federal Youth Corrections Act or similarstate law, and (5) any conviction for which the record was expunged under Federal or state law.9. During the last 7 years, have you been convicted, been imprisoned, been on probation, or been on parole? |— yES I— NO

(Includes felonies, firearms or explosives violations, misdemeanors, and all other offenses.) If "YES," use item 16

to provide the date, explanation of the violation, place of occurrence, and the name and address of the policedepartment or court involved.

10. Have you been convicted by a military court-martial in the past 7 years? ('/f no m///te/yse/v/ce, answer "A/0.'^/f |— YES I— NO

"YES," use item 16 to provide the date, explanation of the violation, place of occurrence, and the name and

address of the military authority or court involved.

11. Are you currently under charges for any violation of law? If "YES," use item 16 to provide the date, explanation of |YES || NO

the violation, place of occurrence, and the name and address of the police department or court involved.

12. During the last 5 years, have you been fired from any job for any reason, did you quit after being told that you |— yES I—i NO

would be fired, did you leave any job by mutual agreement because of specific problems, or were you debarred

from Federal employment by the Office of Personnel Management or any other Federal agency? If "YES," use item

16 to provide the date, an explanation of the problem, reason for leaving, and the employer's name and address.

13. Are you delinquent on any Federal debt? (Includes delinquencies arising from Federal taxes, loans, overpayment ]— yES |—' NO

of benefits, and other debts to the U.S. Government, plus defaults of Federally guaranteed or insured loans suchas student and home mortgage loans.) // "YES," use item 16 to provide the type, length, and amount of the

delinquency or default, and steps that you are taking to correct the error or repay the debt.

U.S. Office of Personnel Management . Rev°SoS^

5 U.S.C. 1302. 3301, 3304. 3328 & 8716 Previous editions obsolete and unusable
Continuation Space / Agency Optional Questions

16. Provide details requested in items 7 through 15 and 18c in the space below or on attached sheets. Be sure to identify attached sheets with

your name, Social Security Number, and item number, and to include ZIP Codes in all addresses. If any questions are printed below, please

answer as instructed (these questions are specific to your position and your agency is authorized to ask them).

Certifications / Additional Questions

APPLICANT: If you are applying for a position and have not yet been selected, carefully review your answers on this form and any

attached sheets. When this form and all attached materials are accurate, read item 17, and complete 17a.

APPOINTEE: If you are being appointed, carefully review your answers on this form and any attached sheets, including any other application

materials that your agency has attached to this form. If any information requires correction to be accurate as of the date you are signing, makechanges on this form or the attachments and/or provide updated information on additional sheets, initialing and dating all changes and additions.

When this form and all attached materials are accurate, read item 17, complete 17b, read 18, and answer 18a, 18b, and 18c as appropriate.

17. I certify that, to the best of my knowledge and belief, all of the information on and attached to this Declaration for Federal Employment,

including any attached application materials, is true, correct, complete, and made in good faith . I understand that a false or fraudulent

answer to any question or item on any part of this declaration or its attachments may be grounds for not hiring me, or for firing

me after I begin work, and may be punishable by fine or imprisonment. I understand that any information I give may be investigated

for purposes of determining eligibility for Federal employment as allowed by law or Presidential order. I consent to the release of

information about my ability and fitness for Federal employment by employers, schools, law enforcement agencies, and other individuals

and organizations to investigators, personnel specialists, and other authorized employees or representatives of the Federal Government. I

understand that for financial or lending institutions, medical institutions, hospitals, health care professionals, and some other sources ofinformation, a separate specific release may be needed, and I may be contacted for such a release at a later date.

17a. Applicant's Signature:

(Sign in ink)

17b. Appointee's Signature:

DateDate

Appointing Officer:

Enter Date of Appointment or Conversion

MM / DD / YYYY

(Sign in ink)

18. Appointee (Only respond if you have been employed by the Federal Government before): Your elections of life insurance during

previous Federal employment may affect your eligibility for life insurance during your new appointment. These questions are asked to help

your personnel office make a correct determination.

18a. When did you leave your last Federal job?

MM / DO / YYYY

DATE:

18b. When you worked for the Federal Government the last time, did you waive Basic Life

Insurance or any type of optional life insurance?

j— Y^g F ^Q F DO NOT KNOW

18c. If you answered "YES" to item 18b, did you later cancel the waiver(s)? If your answer to item I—YES I— NO I— DO NOT KNOW

18c is "NO," use item 16 to identify the type(s) of insurance for which waivers were not

canceled.

U.S. Office of Personnel Management Rev%ac;oFbem2^6

5 U.S.C. 1302. 3301.3304. 3328 & 8716 Previous editions obsolete and unusable
EXHIBIT H
Updated 5/2016

Federal Investigations Notice

Fair Credit Reporting Act of 1970, as amended 

PLEASE TAKE NOTICE THAT ONE OR MORE CONSUMER CREDIT REPORTS MAY BE 

OBTAINED FOR EMPLOYMENT PURPOSES PURSUANT TO THE FAIR CREDIT 

REPORTING ACT, AS AMENDED, 15 U. S. C., §1681, ET SEQ. SHOULD A DECISION TO 

TAKE ANY ADVERSE ACTION AGAINST YOU BE MADE, BASED EITHER IN WHOLE 

OR IN PART ON THE CONSUMER CREDIT REPORT, THE CONSUMER REPORTING 

AGENCY THAT PROVIDED THE REPORT PLAYED NO ROLE IN THE AGENCY'S 

DECISION TO TAKE SUCH ADVERSE ACTION. 

Information provided by you on this form will be furnished to the consumer reporting agency in 

order to obtain information in connection with an investigation to determine your (1) fitness for 

Federal employment, (2) clearance to perform contractual service for the Federal Government, 

and/or (3) security clearance or access. The information obtained may be redisclosed to other 

Federal agencies for the above purposes and in fulfillment of official responsibilities to the extent 

that such disclosure is permitted by law. 

I hereby authorize the _____________________________ to obtain such report(s) from any 

(Name of Requesting Agency) 

consumer/credit reporting agency for employment purposes. 

________________________________ _______________________ 

 (Print Name) (SSN) 

_________________________________ _______________________ 

 (Signature) (Date)

Your Social Security Number is needed to keep records accurate, because other people may have 

the same name. Executive Order 9397 also asks Federal agencies to use this number to help 

identify individuals in agency records. 
Updated 5/2016

FAIR CREDIT AUTHORIZATION FORM

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of 

information in the files of consumer reporting agencies. There are many types of consumer 

reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell 

information about check writing histories, medical records, and rental history records). Here is a 

summary of your major rights under the FCRA. For more information, including information 

about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer 

Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. 

 You must be told if information in your file has been used against you. Anyone who 

uses a credit report or another type of consumer report to deny your application for credit, 

insurance, or employment – or to take another adverse action against you – must tell you, 

and must give you the name, address, and phone number of the agency that provided the 

information. 

 You have the right to know what is in your file. You may request and obtain all the 

information about you in the files of a consumer reporting agency (your “file 

disclosure”). You will be required to provide proper identification, which may include 

your Social Security number. In many cases, the disclosure will be free. You are entitled 

to a free file disclosure if: 

o a person has taken adverse action against you because of information in your 

credit report; 

o you are the victim of identity theft and place a fraud alert in your file; 

o your file contains inaccurate information as a result of fraud; 

o you are on public assistance; 

o you are unemployed but expect to apply for employment within 60 days. 

In addition, all consumers are entitled to one free disclosure every 12 months upon request from 

each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See 

www.consumerfinance.gov/learnmore for additional information. 

 You have the right to ask for a credit score. Credit scores are numerical summaries of 

your credit-worthiness based on information from credit bureaus. You may request a 

credit score from consumer reporting agencies that create scores or distribute scores used 

in residential real property loans, but you will have to pay for it. In some mortgage 

transactions, you will receive credit score information for free from the mortgage lender. 

 You have the right to dispute incomplete or inaccurate information. If you identify 

information in your file that is incomplete or inaccurate, and report it to the consumer 

reporting agency, the agency must investigate unless your dispute is frivolous. See

www.consumerfinance.gov/learnmore for an explanation of dispute procedures.

 Consumer reporting agencies must correct or delete inaccurate, incomplete, or 

unverifiable information. Inaccurate, incomplete, or unverifiable information must be 

removed or corrected, usually within 30 days. However, a consumer reporting agency 

may continue to report information it has verified as accurate. 
Updated 5/2016

 Consumer reporting agencies may not report outdated negative information. In most 

cases, a consumer reporting agency may not report negative information that is more than 

seven years old, or bankruptcies that are more than 10 years old. 

 Access to your file is limited. A consumer reporting agency may provide information 

about you only to people with a valid need -- usually to consider an application with a 

creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a 

valid need for access. 

 You must give your consent for reports to be provided to employers. A consumer 

reporting agency may not give out information about you to your employer, or a potential 

employer, without your written consent given to the employer. Written consent generally 

is not required in the trucking industry. For more information, go to 

www.consumerfinance.gov/learnmore.

 You many limit “prescreened” offers of credit and insurance you get based on 

information in your credit report. Unsolicited “prescreened” offers for credit and 

insurance must include a toll-free phone number you can call if you choose to remove 

your name and address from the lists these offers are based on. You may opt out with the 

nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688). 

 You may seek damages from violators. If a consumer reporting agency, or, in some 

cases, a user of consumer reports or a furnisher of information to a consumer reporting 

agency violates the FCRA, you may be able to sue in state or federal court. 

 Identity theft victims and active duty military personnel have additional rights. For 

more information, visit www.consumerfinance.gov/learnmore. 

States may enforce the FCRA, and many states have their own consumer reporting laws. In 

some cases, you may have more rights under state law. For more information, contact your 

state or local consumer protection agency or your state Attorney General. For information 

about your federal rights, contact:

TYPE OF BUSINESS: CONTACT:

1.a. Banks, savings associations, and credit 

unions with total assets of over $10 billion and 

their affiliates 

b. Such affiliates that are not banks, savings 

associations, or credit unions also should list, 

in addition to the CFPB: 

a. Consumer Financial Protection Bureau 

1700 G Street, N.W. Washington, DC 20552

b. Federal Trade Commission: Consumer 

Response Center – FCRA

Washington, DC 20580 

(877) 382-4357 

2. To the extent not included in item 1 above: 

a. National banks, federal savings associations, 

and federal branches and federal agencies of 

foreign banks 

b. State member banks, branches and agencies 

of foreign banks (other than federal branches, 

federal agencies, and Insured State Branches of 

a. Office of the Comptroller of the Currency 

Customer Assistance Group 

1301 McKinney Street, Suite 3450 

Houston, TX 77010-9050 

b. Federal Reserve Consumer Help Center 

P.O. Box. 1200 

Minneapolis, MN 55480
Updated 5/2016

Foreign Banks), commercial lending 

companies owned or controlled by foreign 

banks, and organizations operating under 

section 25 or 25A of the Federal Reserve Act 

c. Nonmember Insured Banks, Insured State 

Branches of Foreign Banks, and insured state 

savings associations 

d. Federal Credit Unions 

c. FDIC Consumer Response Center 

1100 Walnut Street, Box #11 

Kansas City, MO 64106 

d. National Credit Union Administration 

Office of Consumer Protection (OCP) 

Division of Consumer Compliance and 

Outreach (DCCO) 

1775 Duke Street 

Alexandria, VA 22314 

3. Air carriers Asst. General Counsel for Aviation 

Enforcement & Proceedings 

Aviation Consumer Protection Division 

Department of Transportation 

1200 New Jersey Avenue, S.E. 

Washington, DC 20590 

4. Creditors Subject to the Surface 

Transportation Board 

Office of Proceedings, Surface Transportation 

Board, Department of Transportation 

395 E Street, S.W. Washington, DC 20423 

5. Creditors Subject to the Packers and 

Stockyards Act, 1921 

Nearest Packers and Stockyards 

Administration Area Supervisor 

6. Small Business Investment Companies Associate Deputy Administrator for Capital 

Access, United States Small Business 

Administration 

409 Third Street, S.W., 8th Floor 

Washington, DC 20416 

7. Brokers and Dealers Securities and Exchange Commission 

100 F Street, N.E.

Washington, DC 20549 

8. Federal Land Banks, Federal Land Bank 

Associations, Federal Intermediate Credit 

Banks, and Production Credit Associations 

Farm Credit Administration 

1501 Farm Credit Drive 

McLean, VA 22102-5090 

9. Retailers, Finance Companies, and All Other 

Creditors Not Listed Above 

FTC Regional Office for region in which the 

creditor operates or Federal Trade

Commission: Consumer Response Center –

FCRA 

Washington, DC 20580 (877) 382-4357 

Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la 

Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
EXHIBIT I
 

 

 

 

 

 

Additional Questions for Public Trust Positions - Branching

INSTRUCTIONS 

This form is a supplement to the Standard Form 85P, Questionnaire for Public Trust Positions, currently in use in NBIB automated systems. Use 

of this form in addition to the e-QIP SF85P equates to the SF85P approved by OMB in October 2017. This is an interim collection method until 

 such time the SF85P is updated in e-QIP.

IDENTIFICATION INFORMATION 

1 - FULL NAME: Enter your name as it appears on your SF 85P, Questionnaire for Public Trust Positions.

Last Name First Name Middle Name Jr., II, etc. 

2 - NBIB CASE NUMBER: If applicable. 

PUBLIC TRUST QUESTIONS 

3 - EDUCATION: Have you received a degree more than seven (7) years ago? If YES, 

provide details in section 3A. 

Yes No 

3A – Education Details 

Dates of Attendance 

FROM: 

TO: 

(MM/YY Month and Year)

Choose Type of 

Qualification 





Degree 

Other 

If other please provide: 

Date Awarded 

MONTH:

YEAR: 

Choose the most appropriate 

characterization of the school 





College/University/Military 

College 

Vocational/Technical/Trade 

School 

 Correspondence/Distance/ 

Extension/Online School 

Name of School 

Street Address of School City State Zip code 

Use the continuation sheet on the back if you have more than one degree earned more than 7 years ago.

For each Yes response on questions 4 through 30, corresponding branching questions starting 

on page 5 must be completed.

Yes/No Questions Yes No 

4 – Have you EVER been issued a passport (or identity card for travel) by a country other 

than the U.S.? 

5 – In the last seven (7) years, have you received a written warning, been officially 

reprimanded, suspended, or disciplined for misconduct in the workplace, such as violation of 

a security policy? 

6 – In the last seven (7) years, have you been subject to court martial or other disciplinary 

procedure under the Uniform Code of Military Justice (UCMJ), such as Article 15, Captain’s 

Mast, Article 135 Court of Inquiry, etc.? (If no prior military service, answer “No”.) 

7 – Have you EVER served as a civilian or military member, in a foreign country’s military, 

intelligence, diplomatic, security forces, militia, other defense force, or government agency? 

8 – Have you EVER been convicted of an offense involving domestic violence or a crime 

of violence (such as battery or assault) against your child, dependent, cohabitant, spouse 

or legally recognized civil union/domestic partner, former spouse or former legally 

recognized civil union/domestic partner, or someone with whom you share a child in 

common? 
9 – Is there currently a domestic violence protective order or restraining order issued against 

you? 

 

 

 

 

 

 

 

 

10 – In the last seven (7) years, have you illegally used any drugs or controlled substances? 

Use of a drug or controlled substance includes injecting, snorting, inhaling, swallowing, 

experimenting with or otherwise consuming any drug or controlled substance. 

11 – In the last seven (7) years, have you been involved in the illegal purchase, 

manufacture, cultivation, trafficking, production, transfer, shipping, receiving, handling or 

sale of any drug or controlled substance? 

12 – In the last seven (7) years, have you illegally used or otherwise been involved with a 

drug or controlled substance while employed as a law enforcement officer, prosecutor, or 

courtroom official; or while in a position directly and immediately affecting the public safety 

other than previously listed? 

13 – In the last seven (7) years, have you intentionally engaged in the misuse of prescription 

drugs, regardless of whether or not the drugs were prescribed for you or someone else? 

Yes/No Questions Yes No 

14 – In the last seven (7) years, have you been ordered, advised, or asked to seek 

counseling or treatment as a result of your illegal use of drugs or controlled substances? 

15 – In the last seven (7) years, have you voluntarily sought counseling or treatment as a 

result of your use of a drug or controlled substance? 

16 – In the last seven (7) years, have you filed a petition under any chapter of the 

bankruptcy code? 

17 – In the last seven (7) years, have you failed to meet financial obligations due to 

gambling? 

18 – In the past seven (7) years, have you failed to file or pay Federal, state or other taxes 

when required by law or ordinance? 

19 – In the past seven (7) years, have you been over 120 days delinquent on any debt? 

(Include financial obligations for which you were the sole debtor, as well as those for which 

you were a cosigner or guarantor.) 

20 – In the last seven (7) years, has your use of alcohol had a negative impact on your work 

performance, your professional relationships, or resulted in intervention by law 

enforcement/public safety personnel? 

21 – In the last seven (7) years, have you illegally or without proper authorization 

accessed or attempted to access any information technology system? 
 

 

 

 

 

 

Yes/No Questions Yes No 

22 – In the last seven (7) years, have you illegally or without authorization, modified, 

destroyed, manipulated, or denied others access to information residing on an information 

technology system or attempted any of the above? (Above refers to the actions listed in this 

question) 

23 – In the last seven (7) years, have you introduced, removed, or used hardware, 

software, or media in connection with any information technology system without 

authorization, when specifically prohibited by rules, procedures, guidelines, or regulations or 

attempted any of the above? (Above refers to the actions listed in this question) 

24 – Are you now or have you EVER been a member of an organization dedicated to 

terrorism, either with an awareness of the organization’s dedication to that end, or with the 

specific intent to further such activities? 

25 – Have you EVER knowingly engaged in any acts of terrorism? 

26 – Have you EVER advocated any acts of terrorism or activities designed to overthrow 

the U.S. Government by force? 

27 – Have you EVER been a member of an organization dedicated to the use of violence 

or force to overthrow the U.S. Government, and which engaged in activities to that end with 

an awareness of the organization’s dedication to that end or with the specific intent to 

further such activities? 

28 – Have you EVER been a member of an organization that advocates or practices 

commission of acts of force or violence to discourage others from exercising their rights 

under the U.S. Constitution or any state of the United States with the specific intent to further 

such action? 

29 – Have you EVER knowingly engaged in activities designed to overthrow the 

U.S. Government by force? 

30 – Have you EVER associated with anyone involved in activities to further terrorism? 

CERTIFICATION 

Certification That My Answers Are True 

My statements on this form, and any attachments to it, are true, complete, and correct to the best of my 

knowledge and belief and are made in good faith. I understand that a knowing and willful false statement on 

this form can be punished by fine or imprisonment or both. (See section 1001 of title 18, United States Code). 

Signature Date 
Question 4

4a. Country in which the passport (or identity card ) was issued

4b. Date the passport (or identity card) was issued

4c. Place the passport (or identity card) was issued (City and Country)

4d. Full Name under which passport (or identity card) was issued 

4e. Passport (or identity card) Number

4f. Passport (or identity card) expiration date

4g. What is the reason for the foreign passport (or identity card)?

4h. Have you ever used this passport (or identity card) for foreign travel? No Yes 

4i. Countries to which you have traveled on this passport (or identity card) and the dates involved with each

4j. Do you have an additional foreign passport (or identity card)?

If yes, please use the continuation sheet on page 20 to provide the information

Question 5

5a. Date of incident (Month/Year)

5b. Reason/details

5c. Location of incident (Street address, City, State, Zip Code or Country)

5d. Final outcome/result

5e. Date of outcome/result (Month/Year)

Country From To

Country From To

Country From To 

Country From To

Country From To

Country From To

5f. Do you have other incidents to report? Yes No

Yes No

Estimated

Estimated

If yes, please use the continuation sheet on page 20 to provide the information
Question 6

6a. Date of the court martial or other disciplinary procedure

(month/year)

6b. Description of the Uniform Code of Military Justice (UCMJ) offense(s) for which you were charged

6c. Name of the disciplinary procedure, such as court martial, Article15, Captains Mast, Article 135 Court of inquiry, etc...

6d. Description of the military court or other authority in which you were charged (title of court 

or convening authority, address, to include city and state or country if overseas)

6e. Description of the final outcome of the disciplinary procedure, such as found guilty, found not 

guilty, fine, reduction of rank, imprisonment, etc.

6f. Do you have other instances of military discipline in the last seven years? Yes No

If yes, please use the continuation sheet on page 20 to provide the information

Question 7

7a. During your foreign service, which organization were you serving under:

Military (Army, Navy, Air Force, Marines, etc. Intelligence Service

Diplomatic Service 

Militia 

Security Forces

Other Defense Forces (Specify)

Other Government Agency (Specify)

If other Government Agency or Defense Forces, please specify

7b. Name of the foreign organization

7c. Period of Service (Estimated)

7d. Name of Country Served 7e. Highest position/rank held 

7f. Division/department/office in which you served 

7g. Describe the circumstances of your association with this organization

7h. Describe reason for leaving this service

7i. Do you have further foreign service? Yes No

If yes, please use the continuation sheet on page 20 to provide the information

Estimated
Question 8

8a. Date of the offense (Month/Year) Estimated

8b. Describe the nature of the offense 

8c. Name of the court 8d. Court location (Street address, City, State, Zip Code or Country

8e. Provide all charges brought against you for this offense, and the outcome of each charged offense (such as 

found guilty, found not guilty, or charge dropped or "nolle pros," etc.). If you were found guilty of or plead guilty to a 

lesser offense, list both the original charge and the lesser offense separately.

8f. Felony/Misdemeanor/Other? 8g. What was the charge

8h. Date of the outcome (Month/Year)

8i. Were you sentenced as a result of these charges? Yes No

1. If yes, describe the sentence

2. Were you sentenced to imprisonment for a term exceeding one year? No

3. Were you incarcerated as a result of that sentence for not less than 1 year? Yes No

4. If the conviction resulted in

imprisonment, provide the dates that

you were incarcerated

From

To

8j. If no to being sentenced, are you currently on trial, awaiting trial, or awaiting sentencing on

criminal charges for this offense? Explain

8k. Do you have any other offenses? 

If yes, please use the continuation sheet on page 20 to provide 

information Question 9

 9a. Date the order was issued Estimated

 9b. Name of the court or agency that issued the order.

9c. Location of court or agency that issued the order (Street address, City, State, Zip Code, Country) 

9d. Do you have any other domestic violence protective orders or restraining 

orders currently issued against you? Yes No

Yes

Yes No

If yes, please use the continuation sheet on page 20 to provide information
 Estimated

Question 10

10a. Type of drug or controlled substance:

Cocaine or crack cocaine (Such as rock, freebase, etc.) 

Stimulants (Such as amphetamines, speed, crystal meth, ecstasy, etc.)

THC (Such as marijuana, weed, pot, hashish, etc.)

Depressants (Such as barbituates, methaqualone, tranquilizers, etc)

Ketamine (Such as special K, jet, etc)

Narcotics (Such as opium, morphine, codeine, heroine, etc.)

Hallucinogenic (Such as LSD, PCP, mushrooms, etc.)

Steroids (Such as the clear, juice, etc.)

Inhalants (Such as toluene, amyl nitrate, etc.)

Other (Provide Explanation)

10b. Estimate month and year of first use Estimated

10c. Estimate month and year of most recent use

10d. Nature of use, frequency and number of times used

10e. Was your use while you were employed as a law enforcement officer, prosecutor, or courtroom

official, or while in a position directly and immediately affecting public safety? Yes No

10f. Was your use while possessing a security clearance? Yes No

10g. Do you intend to use this drug or controlled substance in the future? Yes No

10h. Explain why you intend or do not intend to use this drug or controlled substance in the future.

Yes No

10i. Do you have an additional instance(s) of illegal use of a drug or controlled substance?

If yes, please use the continuation sheet on page 20 to provide information

Question 11

11a. Type of drug or controlled substance:

Cocaine or crack cocaine (Such as rock, freebase, etc.) 

Stimulants (Such as amphetamines, speed, crystal meth, ecstasy, etc.)

THC (Such as marijuana, weed, pot, hashish, etc.)

Depressants (Such as barbituates, methaqualone, tranquilizers, etc)

Ketamine (Such as special K, jet, etc)

Narcotics (Such as opium, morphine, codeine, heroine, etc.)

Hallucinogenic (Such as LSD, PCP, mushrooms, etc.)

Steroids (Such as the clear, juice, etc.)

Inhalants (Such as toluene, amyl nitrate, etc.)

Other (Provide Explanation)

11b. Estimate month and year of first involvement 

11c. Estimate month and year of most recent involvement Estimated

Estimated
11d. Nature of involvement and frequency

11e. Reason for engagement in the activity

11f. Was your involvement while you were employed as a law enforcement officer, prosecutor, or courtroom 

official, or while in a position directly and immediately affecting public safety? Yes No

11g. Was your involvement while possessing a security clearance? Yes No

11h. Do you intend to be involved with this drug or controlled substance in the future? Yes No

11i. Explain why you intend or do not intend to be involved with this drug or controlled substance in the future

11j. Do you have an additional instance(s) of illegal involvement with any drug or controlled substance?

If yes, please use the continuation sheet on page 20 to provide information Yes No

Question 12

12a. Describe the drugs or controlled substances used and your involvement

12b. Dates of involvement From To Estimated

12c. Estimate the number of times you used and/or were involved with this drug or controlled substance

 while employed in this capacity

12d. Do you have an additional instance(s) of illegal use or involvement with a drug or controlled 

substance while employed as a law enforcement officer, prosecutor, or courtroom official; or while in 

a position directly and immediately affecting the public safety? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 13

13a. Name of the prescription drug that you misused

13b. Dates of involvement From To Estimated

13c. Reason(s) for and circumstances of the misuse of the prescription drug
13d. Was your involvement while you were employed as a law enforcement officer, prosecutor, or courtroom 

official, or while in a position directly and immediately affecting the public safety?

Yes No

13e. Was your involvement while possessing a security clearance? Yes No

13f. Do you have additional instance(s) of intentionally engaging in the misuse of prescription 

drugs in the last seven (7) years? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 14

14a. Have any of the following ordered, advised, or asked you to seek counseling or treatment as a result of

your illegal use of drugs or controlled substances?

An employer, military commander, or employee assistance program

A medical professional

A mental health professional

A court official/judge

14b. If you have not been ordered, advised, or asked to seek counseling or treatment by one of partie

already mentioned, explain

s

14c. Did you take action to receive counseling or treatment? Yes No

1. If no, explain

2. If yes, type of drug or controlled substance for which you were treated:

A. Type of drug or controlled substance for which you were treated:

Cocaine or crack cocaine (Such as rock, freebase, etc.) 

Stimulants (Such as amphetamines, speed, crystal meth, ecstasy, etc.)

THC (Such as marijuana, weed, pot, hashish, etc.)

Depressants (Such as barbituates, methaqualone, tranquilizers, etc)

Ketamine (Such as special K, jet, etc)

Narcotics (Such as opium, morphine, codeine, heroine, etc.)

Hallucinogenic (Such as LSD, PCP, mushrooms, etc.)

Steroids (Such as the clear, juice, etc.)

Inhalants (Such as toluene, amyl nitrate, etc.)

Other (Provide Explanation)

B. Name of the treatment provider (Last name, First Name)

C. Address for the treatment provider (address, City, State, Zip Code, or Country )
D. Phone Number of the treatment provider

E. Dates of Treatment From To Estimated

F. Did you successfully complete the treatment? Yes No

1. If no, explain?

14d. Do you have any other instances of having been ordered, advised, or asked to seek drug or

controlled substance counseling or treatment in the last seven (7) years? Yes No

If yes, please us the continuation sheet on page 20 to provide information

Question 15

15a. Type of drug or controlled substance for which you were treated:

Cocaine or crack cocaine (Such as rock, freebase, etc.) 

Stimulants (Such as amphetamines, speed, crystal meth, ecstasy, etc.)

THC (Such as marijuana, weed, pot, hashish, etc.)

Depressants (Such as barbituates, methaqualone, tranquilizers, etc)

Ketamine (Such as special K, jet, etc)

Narcotics (Such as opium, morphine, codeine, heroine, etc.)

Hallucinogenic (Such as LSD, PCP, mushrooms, etc.)

Steroids (Such as the clear, juice, etc.)

Inhalants (Such as toluene, amyl nitrate, etc.)

Other (Provide Explanation)

15b. Name of the treatment provider (Last name, First name)

15c. Address for the treatment provider (address, City, State, Zip Code, or Country )

15d. Phone Number of the treatment provider

15e. Dates of Treatment From To Estimated 

15f. Did you successfully complete the treatment? Yes No

If no, explain?

15g. Do you have any other instances of ever voluntarily seeking counseling or treatment as a result 

of your use of a drug or controlled substance? Yes No

If yes, please use the continuation sheet on page 20 to provide information

 

 
Question 16

16a. Type of bankrupcy petition: Chapter 7 Chapter 11 Chapter 12 Chapter 13

1. If Chapter 12 or 13, provide: Name of Trustee

2. Address of Trustee (Street address, City, State, Zip Code or Country)

16b. Bankrupcy court docket/account number

16c. Date bankrupcy was filed Estimated

16d. Date of bankrupcy discharge Estimated

16e. Total amount (in U.S. dollars) involved in the bankrupcy Estimated

16f. Name debt is recorded under (Last, First, Middle, Suffix)

16g. Name of court involved

16h. Address of court involved (Street address, City, State, Zip Code or Country)

16i. Were you discharged of all debts claimed in the bankrupcy? Explain

16j. In the past seven (7) years, have you filed any additional petitions under any chapter of the bankrupcy

code? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 17

17a. Date range of your financial problems due to gambling From To Estimated

17b. Estimate the amount (in U.S. dollars) of gambling losses incurred

17c. Describe your financial problems due to gambling

17d. If you have taken any action(s) to rectify your financial problems due to gambling, describe 

your actions. If you have not taken any action(s), explain

 
17e. In the last seven (7) years, have you failed to meet other financial obligations due to gambling?

Yes 

If yes, please use the continuation sheet on page 20 to provide information

Question 18

18a. Did you fail to file, pay as required, or both?

To file Pay as required Both

18b. Year you failed to file or pay your federal, state, or other taxes

18c. Reason(s) for your failure to file or pay required taxes

18d. Federal, state or other agency to which you failed to file or pay taxes

18e. Type of taxes you failed to file or pay (such as property, income, sales, etc.)

18f. Amount (in U.S. dollars) of the taxes Estimated

18g. Date satisfied (Estimated), if applcable

18h. Describe any action(s) you have taken to satisfy this debt (such as withholdings, frequency and 

amount of payments, etc.) If you have not taken any action(s), explain

18i. Are there any other instances in the past seven (7) years where you failed to file or pay federal,

state or other taxes when required by law or ordinance? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 19

19a. Loan/account number(s) involved

19b. Identify/describe the type of property involved (if any)

19c. Amount (in U.S. dollars) of the financial issue (Estimated)

19d. Reason(s) for the financial issue

19e. Current status of the financial issue

19f. Date the financial issue began

19g. Date the financial issue was resolved, if applicable

 

No
19h. Describe any action(s) you have taken to satisfy this debt (such as withholdings, fequency and 

amount of payments, etc.). If you have not taken any action(s), explain 

19i. Do you have another delinquent debt of 120 days or more in the last seven(7) years?

Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 20

20a. Month/Year when this negative impact occurred Estimated

20b. Explain the circumstances and the negative impact

20c. Dates of involvement or use From To Estimated

20d. Has the use of alcohol had any other negative impacts on your work performance, your professional 

relationships, or resulted in intervention by law enforcement/public safety personnel?

Yes No

If so, please use the continuation sheet on page 19 to provide information

20e. In the last seven (7) years, have you been ordered, advised, or asked to seek counseling or 

treatment as a result of your use of alcohol? Yes No

1. If yes, did you take action to seek counseling or treatment? Yes No

2. If no action taken, please explain

20f. If yes to taking action to seek counseling or treatment

1. Dates of counseling or treatment From To Estimated

2. Name of the individual counselor or treatment provider

3. Address of the counseling/treatment provider (Street address, City, State, Zip Code or Country)

4. Telephone number (Number/extension)

5. Did you successfully complete the treatment program? Yes No

6. If no, please explain
20g. Do you have additional instances of having been ordered, advised, or asked to seek counseling or 

treatment as a result of your use of alcohol? Yes No

If so, please use the continuation sheet on page 20 to provide information 

20h. In the last seven (7) years, have you voluntarily sought counseling or treatment as a result of your use 

of alcohol? Yes No

1. Dates of counseling or treatment From To Estimated

2. Name of the individual counselor or treatment provider

3. Address of the counseling/treatment provider (Street address, City, State, Zip Code or Country)

4. Telephone number (Number/extension)

5. Did you successfully complete the treatment program? Yes No

6. If no, please explain

20i. Do you have additional instances where you have voluntarily sought counseling or 

treatment resulting from your use of alcohol? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 21

21a. Date of the incident (Month/Year) Estimated

21b. Describe the nature of the incident or offense

21c. Location of the incident (Street address and City, State, Zip Code or Country)

21d. Describe the action (administrative, criminal, or other) taken as a result of this incident

21e. Are there any other incidents? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 22

22a. Date of the incident (Month/Year) Estimated

22b. Describe the nature of the incident or offense

 
22c. Location of the incident (Street address and City, State, Zip Code or Country)

22d. Describe the action (administrative, criminal, or other) taken as a result of this incident

22e. Are there any other incidents? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 23

23a. Date of the incident (Month/Year) Estimated

23b. Describe the nature of the incident or offense

23c. Location of the incident (Street address and City, State, Zip Code or Country)

23d. Describe the action (administrative, criminal, or other) taken as a result of this incident

23e. Are there any other incidents? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 24

24a. Full name of the organization

24b. Address/location of the organization (Street address, City, State, Zip Code or Country)

24c. Dates of your involvement with the organization

From To Estimated

24d. All positions held in the organization, if any

24e. All contributions made to the organization, if any

24f. Describe the nature of and reasons for your involvement with the organization

 
24g. Do you have any other instances of being a member of an organization dedicated to 

terrorism, either with an awareness of the organizations dedication to that end, or with 

the specific intent to further such activities? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 25

25a. Describe the nature and reasons for the activity

25b. Dates for any such activities From To Estimated

25c. Do you have any other instances of knowingly engaging in acts of terrorism? 

Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 26

26a. Reason(s) for advocating acts of terrorism

26b. Dates of advocating acts of terrorism From To Estimated

26c. Do you have any other instances of advocating acts of terrorism or activities designed 

to overthrow the U.S. Government by force? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 27

27a. Full name of the organization

27b. Address/location of the organization (Street address, City, State, Zip Code or Country)

27c. Dates of your involvement with the organization From To Estimated

27d. All positions held in the organization, if any

27e. All contributions made to the organization, if any

27f. Describe the nature of and reasons for your involvement with the organization
27g. Do you have any other instances of being a member of an organization dedicated to the use 

of violence or force to overthrow the U.S. Government, which engaged in activities to that end

with an awareness of the organizations dedication to that end or with the specific intent to further

such activities? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 28

28a. Full name of the organization

28b. Address/location of the organization (Street address, City, State, Zip Code or Country)

28c. Dates of your involvement with the organization 

From To

28d. All positions held in the organization, if any

28e. All contributions made to the organization, if any

28f. Describe the nature of and reasons for your involvement with the organization

28g. Do you have any other instances of being a member of an organization that advocates or 

practices commission of acts of force or violence to discourage others from exercising their 

rights under the U.S. Constitution or any state of the United States with the specific intent to 

further such action? Yes No

If yes, please use the continuation sheet on page 20 to provide information

Question 29

29a. Describe the nature and reasons for the activity

29b. Dates of such activities From To Estimated

29c. Do you have any other instances of having knowingly engaged in activities designed to

overthrow the U.S. government by force? Yes No

If yes, please use the continuation sheet on page 20 to provide information
30a. Have you ever associated with anyone involved in activities to further terrorism? Explain

Question 30
Continuation sheet

For any questions you have additional information for, please refer to the question number, then provide 

all information that was requested in that section. 
EXHIBIT J
Purpose of this FormThe U.S. Government conducts background investigations andreinvestigations to establish that applicants or incumbents either

employed by the Government or working for the Government undercontract, are suitable for the job and/or eligible for a public trust or

sensitive position. Information from this form is used primarily as the

basis for this investigation. Complete this form only after a conditional

offer of employment has been made.Giving us the information we ask for is voluntary. However, we maynot be able to complete your investigation, or complete it in a timelymanner, if you don't give us each item of information we request. This

may affect your placement or employment prospects.

Authority to Request this InformationThe U.S. Government is authorized to ask for this information underExecutive Orders 10450 and 10577, sections 3301 and 3302 of title 5,

U.S. Code; and parts 5, 731, 732, and 736 of Title 5, Code of Federal

Regulations.Your Social Security number is needed to keep records accurate,because other people may have the same name and birth date. Executive

Order 9397 also asks Federal agencies to use this number to helpidentify individuals in agency records.The Investigative Process

Background investigations are conducted using your responses on this

form and on your Declaration for Federal Employment (OF 306) todevelop information to show whether you are reliable, trustworthy, ofgood conduct and character, and loyal to the United States. Theinformation that you provide on this form is confirmed during theinvestigation. Your current employer must be contacted as part of theinvestigation, even if you have previously indicated on applications or

other forms that you do not want this.In addition to the questions on this form, inquiry also is made about a

person's adherence to security requirements, honesty and integrity,vulnerability to exploitation or coercion, falsification, misrepresentation, and any other behavior, activities, or associations thattend to show the person is not reliable, trustworthy, or loyal.

Your Personal Interview

Some investigations will include an interview with you as a normal part

of the investigative process. This provides you the opportunity toupdate, clarify, and explain information on your form more completely,which often helps to complete your investigation faster. It is importantthat the interview be conducted as soon as possible after you are

contacted. Postponements will delay the processing of yourinvestigation, and declining to be interviewed may result in yourinvestigation being delayed or canceled.

You will be asked to bring identification with your picture on it, such as

a valid State driver's license, to the interview. There are otherdocuments you may be asked to bring to verify your identity as well.

These include documentation of any legal name change. Social Security

card, and/or birth certificate.

You may also be asked to bring documents about information youprovided on the form or other matters requiring specific attention.

These matters include alien registration, delinquent loans or taxes,bankmptcy, judgments, liens, or other financial obligations, agreements

involving child custody or support, alimony or property settlements,arrests, convictions, probation, and/or parole.

Instructions for Completing this Form

1. Follow the instmctions given to you by the person who gave you the

form and any other clarifying instructions furnished by that person toassist you in completion of the form. Find out how many copies of theform you are to turn in. You must sign and date, in black ink, theoriginal and each copy you submit.2. Type or legibly print your answers in black ink (if your form is not

legible, it will not be accepted). You may also be asked to submit yourform in an approved electronic format.3. All questions on this form must be answered. If no response is

necessary or applicable, indicate this on the form (for example, enter

"None" or "N/A"). If you find that you cannot report an exact date,

approximate or estimate the date to the best of your ability and indicatethis by marking "APPROX." or "EST."

4. Any changes that you make to this form after you sign it must be

initialed and dated by you. Under certain limited circumstances,agencies may modify the form consistent with your intent.

5. You must use the State codes (abbreviations) listed on the back of

this page when you fill out this form. Do not abbreviate the names ofcities or foreign countries.6; The 5-digit postal ZIP codes are needed to speed the processing of

your investigation. The office that provided the fonn will assist you in

completing the ZIP codes.7. All telephone numbers must include area codes.8. All dates provided on this form must be in Month/Day/Year or

Month/Year format. Use numbers (1-12) to indicate months. For

example, June 10,1978, should be shown as 6/10/78.

9. Whenever "City (Country)" is shown in an address block, also

provide in that block the name of the country when the address is

outside the United States.

10. If you need additional space to list your residences or

employments/self-employments/unemployments or education, youshould use a continuation sheet, SF 86A. If additional space is neededto answer other items, use a blank piece of paper. Each blank piece of

paper you use must contain your name and Social Security Number

at the top of the page.
falsifying or concealing a material fact is a felony which may result infines of up to $10,000, and/or 5 years imprisonment, or both. In

addition. Federal agencies generally fire, do not grant a security

clearance, or disqualify individuals who have materially anddeliberately falsified these forms, and this remains a part of the

permanent record for future placements. Because the position for whichyou are being considered is one of public tmst or is sensitive, your

tmstworthiness is a very important consideration in deciding your

suitability for placement or retention in the position.

requested the investigation and the agency which conducted the

investigation have published notices in the Federal Register describing

the system of records in which your records will be maintained. Youmay obtain copies of the relevant notices from the person who gave youthis form. The information on this form, and information we collectduring an investigation may be disclosed without your consent aspermitted by the Privacy Act (5 USC 552a(b)) and as follows:

PRIVACY ACT ROUTINE USES

1. To the Department of Justice when: (a) the agency or any component thereof; or(b) any employee of the aciency in his or her official capacity; or (c} any employee of

the agency in his or her Individual capacity where the Department of Justice has

agreed to represent the employee; or (d) the United States Government, is a party tolitigation or has interest in such litigation, and by careful review, the agencydetermines that the records are both relevant and necessary to the litigation arid theuse of such records by the Department of Justice is therefore deemed by the agency

to be for a purpose that is compatible with the purpose for which the agency

collected the records.2. To a court or adjudicative body in a proceeding when: (a) the agency or anycomponent thereof; or (b) any employee of the agency in his or her official capacity;

or (c) any employee of the agency in his or her individual capacity where the

Department of Justice has agreed to represent the employee; or (d) the United

States Government is a party to litigation or has interest in such litigation, and bycareful review, the agency determines that the records are both relevant andnecessary to the litigation and the use of such records is therefore deemed by the

agency to be for a purpose that is compatible with the purpose for which the agency

collected the records.3. Except as noted in Question 21, when a record on its face, or in conjunction with

other records, indicates a violation or potential violation of law, whether civil, criminal,

or regulatory in nature, and whether arising by general statute, particular programstatute, regulation, rule, or order issued pursuant thereto, the relevant records maybe disclosed to the appropriate Federal, foreign, State, local, tribal, or other publicauthority responsible for enforcing, investigating or prosecuting such violation or

charged with enforcing or implementing the statute, rule, regulation, or order.4. To any source or potential source from which information is requested in the

course of an investigation concerning the hiring or retention of an employee or otherpersonnel action, or the issuing or retention of a security clearance, contract, grant,

license, or other benefit, to the'extent necessary to identify the individual, inform the

source of the nature and purpose of the investigation, and to identify the type ofinformation requested.

5. To a Federal, State, local, foreign, tribal, or other public authority the fact that this

system of records contains information relevant to the retention of an employee, or

the retention of a security clearance, contract, license, grant, or other benefit. Theother agency or licensing organization may then make a request supported by

written consent of the individual for the entire record if it so chooses. No disclosure

will be made unless the information has been determined to be sufficiently reliable to

support a referral to another office within the agency or to another Federal agency for

criminal, civil, administrative, personnel, or regulatory action.6. To contractors, grantees, experts, consultants, or volunteers when necessary to

perform a function or service related to this record for which they have been

engaged. Such recipients shall be required to comply with the Privacy Act of 1974,as amended.7. To the news media or the general public, factual information the disclosure ofwhich would be in the public interest and which would not constitute an unwarranted

invasion of personal privacy.8. To a Federal, State, or local agency, or other appropriate entities or individuals, or

through established liaison channels to selected foreign governments, in order to

enable an intelligence agency to carry out its responsibilities under the NationalSecurity Act of 1947 as amended, the CIA Act of 1949 as amended, Executive Order

12333 or any successor order, applicable national security directives, or classified

implementing procedures approved by the Attorney General and promulgatedpursuant to such statutes, orders or directives.

?. To a Member of Congress or to a Congressional staff member in response to an

inquiry of the Congressional office made at the written request of the constituent

about whom the record is maintained.

10. To the National Archives and Records Administration for records management

inspections conducted under 44 USC 2904 and 2906.

11. To the Office of Management and Budget when necessary to the review of

private relief legislation.

STATE CODES (ABBREVIATIONS)

Alabama

AlaskaArizona

Arkansas

California

ColoradoConnecticut

DelawareFlorida

GeorgiaAmerican Samoa

Trust Territory

ALAKAZ

AR

CA

coCT

DEFL

GA

ASrr

Hawaii

Idaho

IllinoisIndiana

Iowa

Kansas

Kentucky

LouisianaMaineMarylandDistrict of Columbia

Virgin Islands

HI

IDILINIA

KSKY

LAME

MD

DC

VI

MassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyGuam

MA

Ml

MNMS

MO

MTNE

NV

NHNJGU

New Mexico

New York

North CarolinaNorth DakotaOhioOklahoma

Oregon

Pennsylvania

Rhode IslandSouth CarolinaNorthern Marianas

NM

NY

NCNDOHOKOR

PA

RlscCM

South Dakota

TennesseeTexas

Utah

VermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Puerto Rico

PUBLIC BURDEN INFORMATION

so

TNTX

UT

VTVAWAvwWlWY

PR

Public burden reporting for this collection of information is estimated to average 60 minutes per response, including time for reviewing instructions,

searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Sendcomments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Reports

and Forms Management Officer, U.S. Office of Personnel Management, 1900 E Street, N.W., Room CHP-500, Washington, D.C. 20415. Do not send

your completed form to this address.
SON

L

SOI

NOPAC-ALC

Number

P Requesting

Official

of Official

Personnel

Folder

M Location

of Security

Folder

NPRC

At SON

None

AtSOI

NPI

Other Address

0 Accounting Data and/or

Agency Case Number

Name and Title

ZIP Code

Signature Telephone Number

( )

Date

Persons completing this form should begin with the questions below.

^| FULL • If you have only initials In your name, use them and state (10).

NAME • If you have no middle name, enter "NMN".

Last Name

- If you are a "Jr.," "Sr.," "II," etc., enter this in the

box after your middle name.

First Name Middle Name

(PLACE OF BIRTH - Use the two letter code for the State."City County State Country (if not in the United States)

Jr., II, etc.

0 DATE OF

BIRTH

Month Day "YeaF

Q SOCIAL SECURFTY NUMBER

'OTHER NAMES USED

Name

#1

Month/Year Month/Year

To

Name

#3

Month/Year Month/Year

To

Name

#2

Month/Year Month/Year

To

Name

#4

Month/Year Month/Year

To

I OTHER'IDENTIFYING

INFORMATION

Height (feet and Inches) Weight (pounds) Hair Color Eye Color Sex (Mark one box)

II Female || Male

OTELEPHONE

NUMBERS

Work (include Area Code and extension)

DayNight

Home (include Area Code)

Da^Night

QCITIZENSHIP

Mark the box at the right that

reflects your current citizenship

status, and follow its instructions.

I am a U.S. citizen or national by birth in the U.S. or U.S. territory/possession. Answer

items b and d.I am a U.S. citizen, but I was NOT born in the U.S. Answer items b. c and d.

I am not a U.S. citizen. Answer Items b and e.

Your Mother's Maiden Name

UNITED STATES CITIZENSHIP If you are a U.S. Citizen, but were not born in the U.S., provide information about one or more of the following proofs of your citizenship.

Naturalization Certificate (Where were you naturalized?)Court "City' State Certificate Number Month/Day/Year IssuedCitizenship Certificate (Where was the certificate Issued?)

City State , Certificate Number Month/Day/Year Issued

State Department Form 240 - Report of Birth Abroad of a Citizen of the United StatesGive the date the form wasprepared and give an explanationif needed.

Month/Day/Year Explanation

U.S. Passport

This may be either a current or previous U.S. Passport

Passport Number Month/Day/Year Issued

DUAL CITIZENSHIP If you are (or were) a dual citizen of the United States and another country,

provide the name of that country in the space to the right.

Country

ALIEN If you are an alien, provide the following information:

Place YouEntered theUnited States:

City State . Date You Entered U.S.

Month i Day i Year

Alien Registration Number Country(ies) of Citizenship

Exception to SF8S, SF85P, SF85P-S, SF86, and SF86A approved by GSA September, 1995.

Designed using Perform Pro, WHS/DIOR, Sep 95

Page 1
Name of Person Who Knows You

Month/Year Month/Year

#2 ToName of Person Who Knew You

Month/Year MonthA'ear

#3 ToName of Person Who Knew You

Month/Year Month/Year

#A To

Name of Person Who Knew You

Month/Year Month/Year

#5 TOName of Person Who Knew You

Street Address Apt. #Street Address

Street Address Apt. #Street AddressStreet Address Apt. #Street AddressStreet Address Apt. #Street Address

Street Address Apt. #

City (Country)

Apt. #

State ZIP Code

City (Country)

City (Country)

Apt. #

State ?IP Code"

City (Country)

City (Country)

Apt. #

State ZIP Code

City (Country)

City (Country)

Apt. #

State ZIP Code

City (Country)

City (Country) State ZIP Code

Telephone Number

( )

State

(State

ZIP Code

Telephone Number e Number

ZIP Code

Telephone Number

( )State ZIP Code

Telephone Number

( )State ZIP Code

Telephone Number

( )

^OWHERE YOU WENT TO SCHOOL

List the schools you have attended, beyond Junior High School, beginning with the most recent (#1) and working back 7 years. List all College or University degrees

and the dates they were received. If all of your education occurred more than 7 years ago, list your most recent education beyond high school, no matter when thateducation occurred.

•Use one of the following codes In the "Code" block:

1 - High School 2 - College/University/Military College 3 - Vocational/Technical/Trade School

•For schools you attended in the past 3 years, list a person who knew you at school (an instructor, student, etc.). Do not list people for education

completely outside this 3-year period.

*For correspondence schools and extension classes, provide the address where the records are maintained.

Month/Year MonthA'ear

#1 To

Code Name of School Degree/Diploma/Other

Street Address and City (Country) of School

Name of Person Who Knew You

Month/Year MonthA'ear

#2 TO

Street Address Apt. #

Code

City (Country)

Name of School

"State

State

ZIP-CodeDegree/Dlploma/Other

Street Address and City (Country) of SchoolName of Person Who Knew You

Month/Year Month/Year

#3 To

Street Address Apt. #

Code

City (Country)

Name of School

State

State

ZIPCode

Degree/Diploma/Other

Street Address and City (Country) of SchoolName of Person Who Knew You Street Address Apt. # City (Country) State

State

^IP Code

Month/Year Awarded

ZIP Code

Telephone Number

( )Month/Year Awarded

ZIP CodeTelephone Number

( )

Month/Year Awarded

ZIPCodeTelephone Number

( )

Enter your Social Security Number before going to the next pagePage 2
your military duty locations or home ports.

Previous Periods of Activity. Complete these lines if you worked for an employer on more than one occasion at the same location. After entering the most recent

period of employment in the initial numbered block, provide previous periods of employment at the same location on the additional lines provided. For example, if you

worked at XY Plumbing in Denver, CO, during 3 separate periods of time, you would enter dates and information concerning the most recent period of employment first,and provide dates, position titles, and supervisors for the two previous periods of employment on the lines below that Information.

Month/Year Month/Year

*"* To Present

Code Employer/Verifier Name/Military Duty Location

Employer's/Verifier's Street AddressStreet Address of Job Location (if different than Employer's Address)Supervisor's Name & Street Address (if different than Job Location)

PREVIOUS

PERIODS

OF

ACTIVIPi'

(Block #1)

f different than Job Location)

Month/Year Month/Year

To

Month/Year Month/Year

To

Month/Year Month/Year

To

MonthA'ear Month/Year

#2 To

Code

City (Country)

City (Country)City (Country)

Position TitlePosition Title

Position Title

Your Position Title/Military Rank

StateStateState

ZIP CodeZIP Code

ZIP Code

Telephone Number

( )

Telephone Number

( )

Telephone Number

( )

Supervisor

Supervisor

Supervisor

EmployerA/erifier Name/Milltary Duty Location

Employer'sA/erifier's Street AddressStreet Address of Job Location (if different than Employer's Address)Supervisor's Name & Street Address (if different than Job Location)

PREVIOUS

PERIODS

OF

ACTIVITV

(Block #2)

Month/Year Month/Year

To

MonthA'ear Month/Year

To

Month/Year Month/Year

To

Month/Year Month/Year

#3 To

Code

City (Country)

City (Country)City (Country)

Position Title

Position Title

Position Title

Your Position Title/Mllitary Rank

StateState

State

ZIP Code

ZIP CodeZIP Code

Telephone Number

( )

Telephone Number

( )

Telephone Number

( )

Supervisor

Supervisor

Supervisor

EmployerA/erifier Name/Military Duty Location

Employer'sA/erifier's Street AddressStreet Address of Job Location (if different than Employer's Address)Supervisor's Name & Street Address (if different than Job Location)

PREVIOUS

PERIODS

OF

ACTIVITY

(Block #3)

Month/Year Month/Year

To

Month/Year Month/Year

To

Month/Year Month/Year

To

City (Country)City (Country)City (Country)

Position TitlePosition TitlePosition Title

Your Position Title/Military Rank

StateStateState

ZIP CodeZIP Code

ZIP Code

Telephone Number

( )

Telephone Number

( )

Telephone Number

( )

SupervisorSupervisor

Supervisor

Enter your Social Security Number before going to the next pagePage 3
PERIODS

OF

ACTIVIH'

(Block #4)

Month/Year MonthA'ear

To

Month/Year Month/Year

To

Month/Year" ~ Month/Year"

#5 To

Code

Position Title

Position Title

SupervisorSupervisor

Employer/Verifier Name/Military Duty Location

Employer's/Verifler's Street AddressStreet Address of Job Location (if different than Employer's Address)Supervisor's Name & Street Address (if different than Job Location)

PREVIOUS

PERIODS

OF

ACTIVIFf

(Block #5)

Month/Year Month/Year

To

Month/Year Month/Year

To

Month/Year Month/Year

To

Month/Year Month/Year

#6 To

Code

City (Country)

City (Country)

City (Country)

Position TitlePosition TitlePosition Title

Your Position Title/Military Rank

StateStateState

ZIP CodeZIP CodeZIP Code

'elephone Number

)

'elephone Number

)

'elephone Number

)

SupervisorSupervisorSupervisor

Employer/Verifler Name/Mllltary Duty Location

Employer's/Verlfier's Street AddressStreet Address of Job Location (if different than Employer's Address)

Supervisor's Name & Street Address (if different than Job Location)

PREVIOUS

PERIODS

OF

ACTIVITY

(Block #6)

Month/Year Month/Year

To

Month/Year Month/Year

To

Month/Year Month/Year

To

City (Country)

City (Country)

City (Country)

Position Title

Position Title

Position Title

Your Position Title/Military Rank

StateState

State

ZIP CodeZIP CodeZIP Code

'elephone Number

)

'elephone Number

)

'elephone Number

)

Supervisor

Supervisor

Supervisor

YOUR EMPLOYMENT RECORD

Has any of the following happened to you in the last 7 years? If "Yes," begin with the most recent occurrence and go backward, providing date

fired, quit, or left, and other information requested.

Yes No

Use the following codes and explain the reason your employment was ended:1 - Fired from a job 3 - Left a job by mutual agreement following allegations of misconduct 5 - Left a job for other reasons

under unfavorable circumstances

2 - Quit a job after being told

you'd be fired

4 - Left a job by mutual agreement following allegations of

unsatisfactory performance

Month/Year I Code Specify Reason Employer's Name and Address (Include clty/Country if outside U.S.) State ZIP Code

Enter your Social Security Number before going to the next page.Page 4
Name#3

Dates Known

Month/Year Month/Year

_To_

Home or Work Address

Tele

ihone Number

DayNight

City (Country) State ZIP Code

(E) YOUR MARITAL STATUS

Mark one of the following boxes to show your current marital status:

1 - Never married (go to question 15) \ ] 3 - Separated2 - Married | | 4 - Legally Separated

5 - Divorced6 - Widowed

Current Spouse Complete the following about your current spouse.

Full Name Date of Birth (Mo./Day/Yr.) Place of Birth (Include country If outside the U.S.) Social Security Number

Other Names Used (Specify maiden name, names by other marriages, etc., and show dates used for each name)Country of Citizenship Date Married (Mo./Day/Yr.) Place Married (Include country if outside the U.S.) State

If Separated, Date of Separation (Mo./Day/Yr.) If Legally Separated, Where is the Record Located? City (Country) State

Address of Current Spouse (Street, city, and country if outside the U.S.) State ZIP Code

0 YOUR RELATIVES

Give the full name, correct code, and other requested information for each of your relatives, living or dead, specified below.1 - Mother (first) 3 - Stepmother 5 - Foster Parent

2 - Father (second) 4 - Stepfather 6 - Child (adopted also)

7 - Stepchild

Full Name (If deceased, check box on the

left before entering name) Code

1

2

Date of Birth

Month/Day/Year Country of Birth Country(ies) of Citizenship Current Street Address and City (country) of Living Relatives State

Enter your Social Security Number before going to the next pagePage 5
•Country. If your service was with other than the U.S. Armed Forces, identify the country for which you served.

Month/Year Month/Year

ToTo

Code Service/Certificate No. _Q_ _E_ Status Active Active

Reserve

Inactive

Reserve

National

Guard

CS(a(9;

Country

Q^ YOUR SELECTIVE SERVICE RECORD

Are you a male born after December 31,1959? If "No," go to 18. If "Yes," go to b.

Have you registered with the Selective Service System? If "Yes," provide your registration number. If "No," show the reason for your legal

exemption below.

Registration Number

Yes No

Legal Exemption Explanation

(^> YOUR INVESTIGATIONS RECORD

Has the United States Government ever investigated your background and/or granted you a security clearance? If "Yes," use the codes that

follow to provide the requested information below. If "Yes," but you can't recall the investigating agency and/or the security clearance

received, enter "Other" agency code or clearance code, as appropriate, and "Don't know" or "Don't recall" under the "Other Agency"

heading, below. If your response is "No," or you don't know or can't recall if you were investigated and cleared, check the "No" box.

Yes No

Codes for Investigating Agency

1 - Defense Department

2 - State Department

3 - Office of Personnel Management

4-FBI

5 - Treasury Department

6 - Other (Specify)

Codes for Security Clearance Received

0 - Not Required 3 - Top Secret

1 - Confidential 4 - Sensitive Compartmented Information2 - Secret 5 - Q

6-L7 - Other

Month/Year | A9ency Ie Other Agency Clearance Code Month/Year | A9encyIe Other Agency Clearance Code

To your knowledge, have you ever had a clearance or access authorization denied, suspended, or revoked, or have you ever been debarredfrom government employment? If "Yes," give date of action and agency. Note: An administrative downgrade or termination of a securityclearance is not a revocation.

Yes No

Month/Year Department or Agency Taking Action Month/Year Department or Agency Taking Action

<E> FOREIGN COUNTRIES YOU HAVE VISITED

List foreign countries you have visited, except on travel under official Government orders, beginning with the most current (#1) and working back 7 years. (Travel as a

dependent or contractor must be listed.)•Use one of these codes to indicate the purpose of your visit: 1 - Business 2-Pleasure 3-Education 4-Other•Include short trips to Canada or Mexico. If you have lived near a border and have made short (one day or less) trips to the neighboring countiy, you do

not need to list each trip. Instead, provide the time period, the code, the country, and a note ("Many Short Trips").

#1

#2#3#4

•Do not repeat travel covered in items 9,

Month/Year Month/Year

ToToTo

To

Code

10,or11.

er your Social Security Number before

Country

going to the

#5#6

#7#8

next page

Month/Year Month/Year

ToTo

ToTo

Code Country

Page 6
Q| ILLEGAL DRUGS

The following questions pertain to the illegal use of drugs or drug activity. You are required to answer the questions fully and truthfully, and yourfailure to do so could be grounds for an adverse employment decision or action against you, but neither your truthful responses nor information

derived from your responses will be used as evidence against you in any subsequent criminal proceeding.

In the last year, have you illegally used any controlled substance, for example, marijuana, cocaine, crack cocaine, hashish, narcotics (opium,morphine, codeine, heroin, etc.), amphetamines, depressants (barbiturates, methaqualone, tranqulllzers, etc.), hallucinogenics (LSD, PCP, etc.), orprescription drugs?

In the last 7 years, have you been involved in the illegal purchase, manufacture, trafficking, production, transfer, shipping, receiving, or sale of any

narcotic, depressant, stimulant, hallucinogen, or cannabls, for your own intended profit or that of another?

Yes No

If you answered "Yes" to "a" above, provide information relating to the types of substance(s), the nature of the activity, and any other details relating

to your involvement with illegal drugs. Include any treatment or counseling received.

Month/Year Month/Year

To

Controlled Substance/Prescription Drug Used Number of Times Used

ToTo

YOUR FINANCIAL RECORD

In the last 7 years, have you, or a company over which you exercised some control, filed for bankruptcy, been declared bankrupt, been subject to a

tax lien, or had legal judgment rendered against you for a debt? If you answered "Yes," provide date of initial action and other Information requested

below.

Yes No

Month/Year Type of Action Name Action Occurred Under Name/Address of Court or Agency Handling Case State ZIP Code

Are you now over 1 80 days delinquent on any loan or financial obligation? Include loans or obligations funded or guaranteed by the Federal

Government.

If you answered "Yes," provide the information requested below:

Yes No

Month/Year Type of Loan or Obligation

and Account ff

Name/Address of Creditor or Obligee State ZIP Code

After completing this form and any attachments, you should review your answers to all questions to make sure the form is complete and accurate, and then sign and date the

following certification and sign and date the release on Page 8.

Certification That My Answers Are True

My statements on this form, and any attachments to it, are true, complete, and correct to the best of my knowledge and belief and aremade in good faith. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment orboth. (See section 1001 of title 18, United States Code).

Signature (Sign in ink) , Date

Enter your Social Security Number before going to the next page

Page?
I Authorize any investigator, special agent, or other duly accredited representative of the authorized Federal agency conducting my

background investigation, to obtain any information relating to my activities from individuals, schools, residential management

agents, employers, criminal justice agencies, credit bureaus, consumer reporting agencies, collection agencies, retail business

establishments, or other sources of information. This information may include, but is not limited to, my academic, residential,

achievement, performance, attendance, disciplinary, employment history, criminal history record information, and financial andcredit information. I authorize the Federal agency conducting my investigation to disclose the record of my backgroundinvestigation to the requesting agency for the purpose of making a determination of suitability or eligibility for a security clearance.

I Understand that, for financial or lending institutions, medical institutions, hospitals, health care professionals, and other sources of

information, a separate specific release will be needed, and I may be contacted for such a release at a later date. Where a separate

release is requested for information relating to mental health treatment or counseling, the release will contain a list of the specific

questions, relevant to the job description, which the doctor or therapist will be asked.I Further Authorize any investigator, special agent, or other duly accredited representative of the U.S. Office of Personnel

Management, the Federal Bureau of Investigation, the Department of Defense, the Defense Investigative Service, and any other

authorized Federal agency, to request criminal record information about me from criminal justice agencies for the purpose ofdetermining my eligibility for assignment to, or retention in a sensitive National Security position, in accordance with 5 U.S.C. 9101.

I understand that I may request a copy of such records as may be available to me under the law.

I Authorize custodians of records and other sources of information pertaining to me to release such information upon request of the

investigator, special agent, or other duly accredited representative of any Federal agency authorized above regardless of any previousagreement to the contrary.

I Understand that the information released by records custodians and sources of information is for official use by the FederalGovernment only for the purposes provided in this Standard Form 85P, and that it may be redisclosed by the Government only as

authorized by law.

Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid forfive (5) years from the date signed or upon the termination of my affiliation with the Federal Government, whichever is sooner.Signature (Sign In ink) Full Name (Type or Print Legibly)Other Names UsedCurrent Address (Street, City) State ZIP Code

Date SignedSocial Security Number

Home Telephone Number(Include Area Code)( )

PageS
Instructions for Completing this Release

This is a release for the investigator to ask your health practitioner(s) the three questions below concerning your mental health

consultations. Your signature will allow the practitioner(s) to answer only these questions.

I am seeking assignment to or retention in a position of public tmst with the Federal Government as a(n)(Investigator instructed to write in position title.)

As part of the investigative process, I hereby authorize the investigator, special agent, or duly accredited representative of the

authorized Federal agency conducting my background investigation, to obtain the following information relating to my mental healthconsultations:

Does the person under investigation have a condition or treatment that could impair his/her judgment or reliability?

If so, please describe the nature of the condition and the extent and duration of the impairment or treatment.

What is the prognosis?

I understand that the information released pursuant to this release is for use by the Federal Government only for purposes provided in

the Standard Form 85P and that it may be redisclosed by the Government only as authorized by law.

Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for 1

year from the date signed or upon termination of my affiliation with the Federal Government, whichever is sooner.

Signature (Sign in ink) Full Name (Type or Print Legibly)Other Names Used

Current Address (Street, City) "State ZIP Code

Date SignedSocial Security NumberHome Telephone Number(Include Area Code)( )
EXHIBIT K
EXHIBIT K- Fingerprint Card 
EXHIBIT L
CONTRACTOR PERSONNEL ROLLOVER REQUEST FORM

Social Security Administration (SSA)                                                       Center for Suitability and Personnel Security (CSPS)

March 2018

Submit this document to your designated contracting officer’s representative‐contracting officer’s technical

representative (COR‐COTR) via secure email.  The COR‐COTR must ensure the information is complete and

accurate (all fields are required) and then submit to ^DCHR OPE Suitability.   

    

Only use this form when contractor personnel already working on an SSA contract need to move to another SSA

contract.  The information on this form must be typed, complete, and accurate.  Failure to do so may result in a

delay in receiving a suitability letter.  The company point of contact (CPOC) and COR‐COTR will receive suitability

letters from the Center for Suitability and Personnel Security (CSPS) once the rollover is complete.

FULL NAME

SOCIAL

SECURITY

NUMBER

DATE OF BIRTH FROM TO ACTIVE ON BOTH   

CONTRACTS?

  LAST           FIRST         MIDDLE    000‐00‐0000    MM/DD/YYYY   CONTRACT NUMBER   CONTRACT NUMBER    YES   NO

      

CPOC INFORMATION:

NAME: ______________________________________      EMAIL ADDRESS: _________________________________

PHONE: _____________________________________      DATE OF SUBMISSION:_____________________________

COR‐COTR INFORMATION:

NAME: ______________________________________      EMAIL ADDRESS: _________________________________

PHONE: _____________________________________
EXHIBIT M
EXHIBIT M

SYSTEM PLAN 

TYPE OF PROPOSED MAINFRAME PLATFORM_____________________________ 

TYPE OF PERSONAL COMPUTER_________________________________________ 

MEDIA TO BE USED FOR RECEIPT OF FILE TRANSMISSION_________________ 

FILE STORAGE MEDIUM_________________________________________________ 

MANAGED FILE TRANSFER PLATFORM SERVER INSTALLED?______________ 

AMOUNT OF AVAILABLE FILE STORAGE SPACE___________________________ 

TYPE OF PRINT STREAM MAIL RUN CONTROL SYSTEM____________________ 

TYPE OF NETWORK PLATFORM (i.e., NOVELL/NT/UNIX)____________________ 
EXHIBIT N
Exhibit N 

100% Accountability and Summary Reports 

Full Audit report must include the following information (reprints must have the same information): 

1. Program Number/Job Name/Print Order/File Date 

2. PC#/Sequence numbers/Total Volume 

3. Inserter ID and Operator 

4. Date of insertion 

5. Start and End time 

6. Start and End Range (sequence numbers) 

7. Total for each Start and End Range 

8. Event (i.e. Processed, Spoiled, Diverted and reason: Missing Piece, Unverified, Misread etc.) 

9. Status (i.e. Inserted, Routed to Reprint Area, etc.) 

10. Totals 

a. Machine inserted 

b. Sent to Reprint 

c. Reprints Recovered 

d. Records Accounted For 

e. Duplicates 

f. Duplicated Verified 

g. Records less duplicates 

h. Reported Output 

i. Variances 

Example: 

Inserter ID Date Start Time End Time Start Range End Range Total EVENT STATUS

Inserter 1 05/10/12 10:31:04 AM 11:12:45 AM 19386 21567 2182 Standard Processing Inserted

Operator Joe 05/10/12 11:12:50 AM 11:12:50 AM 21568 1 Diverted Routed to Reprint

05/10/12 11:13:10 AM 11:28:06 AM 21569 22516 948 Standard Processing Inserted

05/10/12 11:28:07 AM 11:28:10 AM 22517 22518 2 Diverted/ leave count unverified Routed to Reprint

05/10/12 11:29:30 AM 11:29:35 AM 22519 22521 3 Diverted/missing piece Routed to Reprint

05/10/12 11:29:45 AM 11:30:15 AM 22522 1 Diverted/manual insertion of pub Manual Scan

05/10/12 11:30:34 AM 11:40:35 AM 22523 1 Diverted/misread Manual Scan

Inserter 2 05/11/12 8:12:50 AM 8:12:50 AM 21568 1 Standard Processing Inserted

(REPRINTS) 05/11/12 8:28:07 AM 8:28:10 AM 22517 22518 2 Standard Processing Inserted

Operator Sue 05/11/12 8:29:30 AM 8:29:35 AM 22519 22521 3 Standard Processing Inserted

26604

582

Reprints Recovered: 582

27186

16

16

27170

27170

0

TOTALS

Records Accounted for:

Duplicates:

Duplicates Verified:

Records Less Duplicates:

Reported Output:

Variance:

Audit Report

Program 123-S/SSA Notices Name/PO#54001/File Date

PC # and Sequence Numbers and Volume

Machine Inserted:

Sent to Reprints:
Exhibit N (cont’d) 

The Summary Report must include the following; Reprints must also have all of the same information: 

1. Job Name/Print Order 

2. Piece Quantity 

3. Sequence number range (Start and End Range) 

4. Start date and time 

5. End date and time 

6. Total Processed Pieces 

7. Total Reprints 

8. Total Pieces Inserted 

9. Total Variances 

10. Job Complete or Incomplete 

Summary Report 

Job Information Operation Information 

Job Name: XYZ Notice 

PO # 54001 Start Range: 1 

Piece Quantity: 35862 End Range 35862 

Job Status: Completed 

Start Date &Time: 05/10/12 10:29:54 

End Date & Time: 05/11/12 14:22:34 

 

 

Statistical Summary 

35537 Processed Pieces - Completed 05/10/12 

10:29:54 

325 Processed Reprints - Completed 05/11/12 

14:22:34 

35862 Total Pieces Inserted - 

0 Variances - 

Completed 05/11/12 

14:22:34 

Job Complete 
EXHIBIT O
EXHIBIT O 

Mail Run Data File (MRDF) 

Or Item Level Accountability File 

Record Descriptions Position Length 

Job ID 1 – 5 5 

Piece ID 6 – 11 6 

Total Pages 12 – 13 2 

Select Feeder 2 (0 = No Feed, 1 = Feed) 14 1 

Select Feeder 3 15 1 

Select Feeder 4 16 1 

Select Feeder 5 17 1 

Select Feeder 6 18 1 

Select Feeder 7 19 1 

Select Feeder 8 20 1 

Select Feeder 9 21 1 

Select Feeder 10 22 1 

Vertical Stacker 1 (Seal envelope, do not meter) 23 1 

Vertical Stacker 2 (Do not seal envelope, do not meter) 24 1 

Vertical Stacker 3 (Overweight) 25 1 

Vertical Stacker 4 (Trash) 26 1 

Sealer (0 = No Outsort, 1 = Outsort) 27 1 

Meter 1 (0 = Print, 1 = No Print) 28 1 

Meter 2 29 1 

Customer Name 30 40 

 Address Line 1 70 40 

 Address Line 2 110 40 

 Address Line 3 150 40 

 Address Line 4 190 40 

 Address Line 5 230 40 

 Address Line 6 270 40 

Zip Code 310 5 

+4 315 4 

+2 319 2 

Return Name 321 40 

 Address Line 1 361 40 

 Address Line 2 401 40 

 Address Line 3 441 40 

 Address Line 4 481 40 

Account ID 521 16 

Input File Name 537 44 

IMBC Codes 581 65 

Service Type 646 3 

IMBC SerialID 649 9 

Filler 658 3

User Defined 661 29 

 Vendor ID 690 4 

 Code Name 694 5 

 Total Documents 699 2 

End 701 1

NOTE: There is one record for each mail packet. 
EXHIBIT P
YOUR LETTERHEAD 

DATE: 

TO: Business Mailer Support 

RE: USPS Minimum Volume Reduction Program 

To Whom It May Concern: 

I am writing to request approval to use USPS Minimum Volume Reduction Program as shown in 

Publication 401 - Guide to the Manifest Mailing System. The exception is for the “200 piece or 

50 pound” rule for permit imprint mailings (including certified and foreign mail). 

If approved, we would submit the paperwork electronically and include piece level barcode 

information. 

A large portion of our business is government mailings and the use of this exception would 

greatly expedite our mail processing. 

Please let me know if any additional information is required. My contact information is below. 

Thank you for your time and consideration. 

NAME AND PHONE NUMBER OF YOUR CONTACT 

 
EXHIBIT Q
Account Name Meter Serial Number Job ID 1 Operator Transaction Start Time

####### SSA Mailer # 

and File Date

Grand Total

SSA Contract Program # 
Transaction End Time Date Location Meter Model Class of Mail
Pieces Postage Fee Amount Surcharge Total Charged
EXHIBIT R
TODAY'S

DATE METER DATE

WORKLOAD MAILER NUMBER /

NAME

SSA PRINT ORDER # /

CONTRACTOR ORDER #

FILE

DATE

BEGINNING

METER BALANCE

AMOUNT

METER REPLENISH‐

MENT AMOUNT (if

applicable) METER RATE

CERT. BULK

MAILING

CHARGES

applicable)

TOTAL

NUMBER OF

PIECES

METERED

SPOILED

POSTAGE /

POSTAGE

ERRORS

(actual cost)

TOTALMETER

POSTAGE

USED

ENDING

METER

BALANCEAMOUNT

SSA POSTAGE METER ACTIVITY LOG

METER MANUFACTURER:METER SERIAL NUMBER:

CONTRACT NUMBER: