Defense
Security Service (DSS)
Personnel
Security Investigations (PSI) - Projected Requirements Survey
OMB
Control No.: 0704-0417; Expiration Date: XX/XX/XXXX
The
public reporting burden for this collection of information is
estimated to average 80 minutes per response for a single
active, cleared facility submission, including the time for reviewing
instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the
collection of information. Facilities submitting a consolidated
submission of multiple active, cleared facilities may experience a
longer reporting burden.
Send
comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing the
burden to: Department of Defense, Washington Headquarters Services,
Executive Services Directorate, Information Management Division, 4800
Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA
22350-3100. Respondents should be aware that notwithstanding any
other provision of law, no person shall be subject to any penalty for
failing to comply if a valid OMB control number is not
displayed.
PRIVACY
ACT ADVISEMENT: Name
and email information is requested for the purpose of validating
Facility Security Officer (FSO) contact information for the Defense
Security Service records. Any updates to name and email information
will be provided to the appropriate Industrial Security
Representative. The information provided will become part of DSS
records of cleared contractor facility surveys, retrieved by the name
of the facility / CAGE Code, not the FSO contact information.
Providing the requested name and email information on this survey is
voluntary. AUTHORITY: Executive Order (EO) 12829, “National
Industrial Security Program”.
(End
of Page 1)
Survey
Introduction:
The
purpose of this survey is to gather the information necessary to
ensure that funding is available to meet the need for Personnel
Security Investigations (PSIs) for contractor clearances.
Contractor
clearances are part of the National Industrial Security Program
(NISP) that DSS administers on behalf of DoD and 26 other federal
agencies. Funding for the associated industry PSIs is handled
centrally by DSS as part of its NISP responsibilities and DSS is
conducting this survey in order to carry out these responsibilities
effectively.
Survey
results are used by DSS, USDI and OPM for budget
formulation and workload planning.
Please
read all the instructions and follow the prompts to submit your PSI
Projected Requirements Survey to Defense Security Service.
If
you received this survey email invitation, DSS records indicate that
you are the Facility Security Officer for a specific cleared facility
or have recently indicated that you are the proper point of contact
to complete this survey.
General
Information:
This
survey has three Sections (A, B, and C) as described in the following
pages.
If
you right click on any page of the survey, you may select to print
that page for your reference.
Some
pages on this survey have helpful Glossary. This link will open a new
browser window giving information which may be helpful in completing
the survey. The new window may be closed at any time to
return to your survey.
(End
of Page 2 )
Section
A Description:
In Section A you will be asked to review and confirm the name and
email address of the Facility Security Officer's (FSO) or
pre-designated survey contact. You will also be asked to confirm that
the CAGE Code of this cleared facility matches the listed CAGE Code.
Section B
Description:
In Section B of the survey you will be asked to provide your PSI for
clearance projections for DoD and Non-DoD agencies for three fiscal
years: FY 2016 through FY 2018. (The fiscal year runs from Oct 1 to
Sep 30.)
You will provide your projections for Single-Scope Background
Investigations (Top Secret), SSBI Periodic Re-investigations, NACLC
(Secret and Confidential), and NACLC Periodic
Re-investigations.
If you have an employee who works under multiple cleared contracts
who will require a PSI for a clearance, you should only count
them once and toward their primary contracting activity (either DoD
or Non-DoD). Do not "double count".
After you provide your projections, you will identify the agencies
that are requiring the clearances by selecting the agencies from a
list provided.
Section
C Description:
This final section of the survey will provide you with an opportunity
to input general comments or comments for a specific fiscal year.
Do not
submit classified information in the comments section.
If you believe classified information is essential to your facility's
survey response, contact your DSS Industrial Security
Representative for assistance.
Glossary
(End
of Page 3 )
Section
A:
Review
the DSS record data below for your cleared facility. You will
then be asked to separately confirm the information on the following
pages.
Any
comments other than corrections to this data may be provided in the
Comments Section C at the end of this survey.
You
will also be asked if you are submitting a consolidated survey
response for more than one active, cleared facility's CAGE Code or
submitting for only one CAGE Code.
Facility
Name: %[ContactInfo]Q31_4%
Contact
Information from DSS Records
Facility
Security Officer or Survey Contact:
%[ContactInfo]Q31_2%
FSO/Contact
email address: %[ContactInfo]Q31_3%
CAGE
Code: %[ContactInfo]Q31_1%
Glossary
(End
of Page 4 )
Will %[ContactInfo]Q31_2% (%[ContactInfo]Q31_3%) be the one completing this survey for CAGE Code %[ContactInfo]Q31_1%?
Yes, and my listed information above is correct.
Yes, but my listed name and/or email need to be corrected.
No. I am one of %[ContactInfo]Q31_2% 's associates and will be completing the input for Cage Code %[ContactInfo]Q31_1%
No. %[ContactInfo]Q31_2% is a former FSO for CAGE Code %[ContactInfo]Q31_1%
%[ContactInfo]Q31_1% is not the correct CAGE Code for this facility.
(End
of Page 5 )
You
indicated that %[ContactInfo]Q31_2% is no longer the FSO for CAGE
Code %[ContactInfo]Q31_1% .
Please
provide the name of the correct FSO by entering the Last name only in
the first block and then First name in the second block. Also, please
provide their email address.
Last Name: ____________________
First Name: ____________________
Email address: ____________________
(End
of Page 6 )
You
provided your following information as the FSO for CAGE Code
%[ContactInfo]Q31_1%. Does this look correct?
Name
: %[NewFSO]Q75_2% - %[NewFSO]Q75_1%
Email
: %[NewFSO]Q75_3%
YES, the above information is all correct.
If
the above is not correct please select the "Back"
button, correct the information in the previous
question, and press "Next" to return to this confirmation.
(End
of Page 7 )
Will
this corrected FSO - %[NewFSO]Q75_2% %[NewFSO]Q75_1%
(%[NewFSO]Q75_3%) - be the one completing this survey for CAGE Code
%[ContactInfo]Q31_1%?
Yes, and my listed information above is correct.
No. I am one of %[NewFSO]Q75_2% %[NewFSO]Q75_1% 's associates and will be completing the input for Cage Code %[ContactInfo]Q31_1%
(End
of Page 8 )
You
indicated that you are completing the survey on behalf of the FSO for
CAGE Code %[ContactInfo]Q31_1% .
Please
provide your name by entering the Last name only in the first block
and then First name only in the second block. Then, please provide
your email address and relation to the FSO for CAGE Code
%[ContactInfo]Q31_1%.
Last Name: ____________________
First Name: ____________________
Email address: ____________________
Relation to FSO: ____________________
(End
of Page 9 )
You
provided your following information. Does this look correct?
Name
: %[AssociateInfo]Q77_2% - %[AssociateInfo]Q77_1%
Email
: %[AssociateInfo]Q77_3%
Relation
to FSO : %[AssociateInfo]Q77_4%
YES, the above information is all correct.
If
the above is not correct please select the "Back"
button, correct the information in the previous
question, and press "Next" to return to this
confirmation.
(End
of Page 10 )
What
needs to be corrected?
My name %[ContactInfo]Q31_2%
My email address %[ContactInfo]Q31_3%
Both my name and email address
If
the above information is correct, please push "Back" and
select "Yes, and my listed information above is correct"
(End
of Page 11 )
You
indicated that the Facility Security Officer (FSO) or survey contact
name is not correct. Please provide the correct name by
entering the Last name only in the first block and then First name in
the second block.
Last Name: ____________________
First Name: ____________________
(End
of Page 12 )
You
provided the following Last name and First name (with middle initial,
as applicable) as corrections for the Facility Security Officer name.
Does this look correct?
%[Correct_FSO]Q23_1%
, %[Correct_FSO]Q23_2%
YES, the corrections to the name are correct.
If
the above is not correct please select the "Back" button
below, correct the Last name and/or First name for the FSO
for the previous question, and press "Next" to return
to this confirmation.
(End
of Page 13 )
You
indicated that the FSO / contact email address is not correct. Please
provide the correct email address.
Correct Email address: ____________________
(End
of Page 14 )
You
provided the following email address as a correction to the data
currently in DSS files. Does this look
correct?
%[Correct_Email_FSO]Q26_1%
YES, the email address is now correct.
If
the above is not correct please select the "Back"
button, correct the email address in the previous
question, and press "Next" to return to this confirmation.
(End
of Page 15 )
Is
the CAGE Code correct?
Cage
Code : %[ContactInfo]Q31_1%
Yes (CAGE Code is correct for this facility)
No (CAGE Code is not correct for this facility)
---
IMPORTANT NOTES ---
1- By
selecting "No"
you will be directed to the end of this survey and will be contacted
by DSS personnel via email for further clarification of this
response.
2
- If you are submitting projection estimates for more than one
active, cleared facility's CAGE Code - if the above CAGE Code is part
of your submission, please select "Yes"
and then you will be given a chance to input the remaining CAGE Codes
in the next question.
Glossary
(End
of Page 16 )
You
were asked if the CAGE Code %[ContactInfo]Q31_1% is correct for your
cleared facility and you have answered "No"
WARNING
By
selecting "No"
this will end the survey and you will not be able to change your
answer.
You will
be directed to the end of this survey and will be contacted by DSS
personnel via email for further clarification of this response.
To
verify - Is the following Cage Code correct for your cleared
facility? : %[ContactInfo]Q31_1%
Yes (The CAGE Code is actually correct for this facility)
No (The CAGE Code is not correct for this facility)
(End
of Page 17 )
Submission
Type
%[ContactInfo]Q31_22%
Choose
one of the following to indicate your type of submission:
A) SINGLE SUBMISSION / ONE CAGE CODE: I am submitting data for only one active, cleared facility's CAGE Code.
B) CONSOLIDATED SUBMISSION: I am submitting one consolidated submission for my company for multiple active, cleared facilities' CAGE Codes.
If
you select Option B, the next question will allow you to list
all the CAGE Codes that are covered by your
submission.
Glossary
(End
of Page 18 )
If
you are the sender of a consolidated submission, list each of the
CAGE Codes for cleared facilities covered by these projections. Do
not include CAGE Codes for any uncleared or inactive facilities in
your organization.
'
If
you have provided a CAGE Code list to DSS by early email or via
the February contact information validation, it will appear
below. If so, please highlight the text, copy (Control+C), click in
the editing box below, paste (Control+V), make any needed changes,
and click "Next" to continue. Note, even if the list below
is correct you must still paste it in the box below to confirm and
proceed.
%[ContactInfo]Q31_23%
%[ContactInfo]Q31_24% %[ContactInfo]Q31_25% %[ContactInfo]Q31_26%
%[ContactInfo]Q31_27% %[ContactInfo]Q31_28% %[ContactInfo]Q31_29%
%[ContactInfo]Q31_30%
If
you do not see a list above, please type in your list of active,
cleared CAGE Codes you will be covering in your survey submission -
use both a semicolon and a space (; ) to separate the individual CAGE
Codes in your list.
(example:
3B325; 78H57; 2WH34; 7655X; 98BQ6)
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
(End
of Page 19 )
You
selected "Consolidated Submission" indicating that your
survey covers multiple cleared facilities' CAGE Codes for your
company.
Below
is the list you have provided, does this look
correct?
%[CAGE_Code_LIST]Q33%
YES, the list of CAGE Codes is correct for my submission.
If
the above is not correct please select the "Back"
button, correct the CAGE Codes in the previous
question, and press "Next" to return to this
confirmation.
Glossary
(End
of Page 20 )
Section
B Instructions:
Please
read the following overview of what you will be asked to provide in
this section.
PSIs
for clearance projections:
Note:
For every table you are asked to complete, you must enter at least
the number "zero" in each field of the table before the
survey will let you proceed to the next questions.
B-1.
Methodology or Data
Sources:
Select from the list provided the description(s) that best matches
the methodology or type of data source used to make PSI projections
for this survey.
B-2.
DoD Projections
Input: Input
your best numeric estimate of your facility's projected PSI
requirements for DoD activities for fiscal years 2016-2018 (October 1
through September 30).
Select
the DoD agencies requiring these clearances from the list provided.
You will not be required to break out your projections by specific
agency.
B-3.
Non-DoD Projections
Input: Input
your best numeric estimate of your facility's projected PSI
requirements for Non-DoD activities for fiscal years 2016-2018
(October 1 through September 30).
Select
the non-DoD agencies requiring these clearances from the list
provided. You will not be required to break out your projections by
specific agency.
---Have you reviewed the above instructions?---
I have reviewed the instructions for Section B.
(End
of Page 21 )
SECTION
B-1 - METHODOLOGY / DATA SOURCE
What
methodology / data sources did you use to determine your PSI
projections?
Select
all that apply:
Other
Average over a 3 year period
Average over a 5 year period
Current contracts requiring cleared personnel
Projected contracts requiring cleared personnel
Historical business data for this company
Projected or Strategic business plan data for this company
Human Resources / Personnel data
JPAS data for PR calculations
Statistical Modeling
(End
of Page 22 )
If you selected "Other" as one of your methodologies for your numeric estimates for PSIs, please describe your methodology.
______________________________________________________________
______________________________________________________________
______________________________________________________________
(End
of Page 23 )
Do you project requiring clearances in upcoming fiscal years due to:
Only DoD contracts / activities
Only non-DoD contracts / activities
Both DoD and Non-DoD contracts / activities
I will not be requiring any investigations for new or periodic reinvestigations
(End
of Page 24 )
You
have stated that you are not currently projecting to require any
initial clearances or periodic reinvestigations for clearance in the
upcoming three fiscal years.
Is
this correct?
Yes
If
not - please push "Back" and change your response on the
previous question.
(End
of Page 25 )
SECTION
B-2 - DOD
DATA INPUT
Below
is a table to input your best numeric PSI requirements estimate for
clearances by investigation type for fiscal years 2016, 2017,
2018.
Please
provide your best estimates for PSI requirements where a -DoD-
contract or activity requires a clearance.
Question Text
Single-Scope Background Investigation (Top Secret)
2016 |
____________________
|
2017 |
____________________
|
2018 |
____________________
|
SSBI Periodic Reinvestigation
2016 |
____________________
|
2017 |
____________________
|
2018 |
____________________
|
NACLC (Secret / Confidential)
2016 |
____________________
|
2017 |
____________________
|
2018 |
____________________
|
NACLC Periodic Reinvestigation
2016 |
____________________
|
2017 |
____________________
|
2018 |
____________________
|
If the
survey will not let you proceed, check to ensure that you have input
at least the number zero in each field of the table.
For your projections above, please select the DoD agencies which are requiring the PSI for clearance.
Air Force,
Army,
Marine Corps,
Navy,
DARPA,
DCAA,
DCMA,
DIA,
DISA,
DLA,
DSCA,
DSS,
DTRA,
MDA,
NATO,
NGA,
NSA,
OSD,
Other DoD (If you use this selection, please provide details in your comments in Section C )
(End
of Page 26 )
SECTION
B-3 - NON-DOD
DATA INPUT
Below
is a table to input your best numeric PSI requirements estimate for
clearances by investigation type for fiscal years 2016, 2017 and
2018.
Please
provide your best estimates for PSI requirements where a -non-DoD-
contract or activity requires a clearance.
Question Text
Single-Scope Background Investigation (Top Secret)
2016 |
____________________
|
2017 |
____________________
|
2018 |
____________________
|
SSBI Periodic Reinvestigation
2016 |
____________________
|
2017 |
____________________
|
2018 |
____________________
|
NACLC (Secret / Confidential)
2016 |
____________________
|
2017 |
____________________
|
2018 |
____________________
|
NACLC Periodic Reinvestigation
2016 |
____________________
|
2017 |
____________________
|
2018 |
____________________
|
If the
survey will not let you proceed, check to ensure that you have input
at least the number zero in each field of the table.
For
your projections above, please select the Non-DoD agencies which are
requiring the PSI for clearance.
Dept of Agriculture,
Dept of Commerce,
Dept of Education,
Dept of Health and Human Services,
Dept of Homeland Security,
Dept of Interior,
Dept of Justice,
Dept of Labor,
Dept of State,
Dept of Transportation,
Dept of Treasury,
Environmental Protection Agency,
Federal Communications Commission,
Federal Reserve System,
Government Accountability Office,
General Services Administration,
National Aeronautics and Space Administration - NASA,
National Archives and Records Administration
National Science Foundation,
Nuclear Regulatory Commission,
Office of Personnel Management
Overseas Private Investment Corporation
Small Bussiness Administration
U.S. Agency for International Development,
U.S. International Trade Commission,
U.S. Trade Representative
(End
of Page 27 )
Section
C: Comments
The
comment section is free form text. You may add optional comments in
general about the survey and/or regarding a particular fiscal year.
Do
not submit classified information. If
you feel it is essential to pass along any classified information
pertaining to this survey please contact your Defense Security
Service Industrial Security Representative to resolve how to submit
such information.
Time
-
Approximately
how long, in minutes, did it take you to complete this Survey
(including data collection) ?
Time, In Minutes : ____________________
Comments
-
--If
leaving a comment, please select the category type it falls
under:
(If you have multiple comments that fall under
more than one category please select "other")
Survey Design/Layout
Technical Issue
Projections Clarification
Other
General
Comments:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Comments concerning FY 2016
______________________________________________________________
______________________________________________________________
______________________________________________________________
Comments concerning FY 2017
______________________________________________________________
______________________________________________________________
______________________________________________________________
Comments concerning FY 2018
______________________________________________________________
______________________________________________________________
______________________________________________________________
(End
of Page 28 )
Copy
of Input
--Please
Click the Button Below--
You will
receive an email with the totals of your projections
for PSIs for clearances broken down for DoD, Non-DoD, the
agencies requiring PSIs, the Combined overall total projections, and
any comments you provided.
Send me an email with a copy of the information I provided as described above.
NOTE
- With the button
selected, click "Next" to be directed to the final page of
the survey where you will officially submit your input.
(End
of Page 29 )
You
are now at the end of the survey. Thank you for the time and effort
you have taken to complete this survey.
When
you click the button below you will not be able to change or retract
your information without directly contacting DSS through your IS Rep
or the DSS Survey mailbox at [email protected]
.
----IMPORTANT----
To complete the survey process please click the "Click Here To
Submit" button below.
(End
of Page 30 )
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Ea, Dany, CIV, DSS |
File Modified | 0000-00-00 |
File Created | 2021-01-26 |