Attachment 21: item a TEIS IV - Security Classification (DD 254)

CLASSIFICATION (When filled in): UNCLASSIFIED

DEPARTMENT OF DEFENSE

CONTRACT SECURITY CLASSIFICATION SPECIFICATION

OMB No. 0704-0567

OMB approval expires:
August 31, 2028

(The requirements of the National Industrial Security Program (NISP) apply to all security aspects of this effort involving classified information.) The public reporting burden for this collection of information, 0704-0567, is estimated to average 70 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

RETURN COMPLETED FORM AS DIRECTED IN THE INSTRUCTIONS.

1. CLEARANCE AND SAFEGUARDING

a. LEVEL OF FACILITY SECURITY CLEARANCE (FCL) REQUIRED

b. LEVEL OF SAFEGUARDING FOR CLASSIFIED INFORMATION/

MATERIAL REQUIRED AT CONTRACTOR FACILITY

(See Instructions)

TOP SECRET

SECRET

2. THIS SPECIFICATION IS FOR: (X and complete as applicable.)

3. THIS SPECIFICATION IS: (X and complete as applicable.)

DATE(YYYYMMDD)

a. PRIME CONTRACT NUMBER (See instructions.)

a. ORIGINAL (Complete date in all cases.)

b. SUBCONTRACT NUMBER

c. SOLICITATION OR OTHER NUMBER

DUE DATE(YYYYMMDD)

W9129Z26RA006

4. IS THIS A FOLLOW-ON CONTRACT?

b. REVISED (Supersedes all previous specifications.)
REVISON NO.

DATE(YYYYMMDD)

c. FINAL (Complete Item 5 in all cases.)

DATE(YYYYMMDD)

20260828
No

Yes

If yes, complete the following:

Classified marterial received or generated under

5. IS THIS A FINAL DD FORM 254?

20260811

(Preceding Contract Number) is transferred to this follow-on contract.

No

Yes

In response to the contractors request dated

If yes, complete the following:

, retention of the classified material is authorized for the period of:

days

6. CONTRACTOR (Include Commercial and Government Entity (CAGE) Code)

a. NAME, ADDRESS, AND ZIP CODE

b. CAGE CODE

TBD

TBD

c. COGNIZANT SECURITY OFFICE(S) (CSO)

(Name, Address, ZIP Code, Telephone required; Email Address optional)

7. SUBCONTRACTOR(S) (Click button if you choose to add or list the subcontractors