Security Self-assessment template

IT Security Self-Assessment Attestation
I, [print full name of the Guaranty Agency CIO or Executive]___________________________,
hereby attest that as the duly authorized executive for the agency, that the attached IT Security
Self-Assessment completed by my company, [print the name of the Guaranty Agency]
____________________________________, and submitted to Federal Student Aid (FSA)
accurately and comprehensively describes the IT security controls in place for our system(s), as
well as the infrastructure employed to support compliance with the applicable Federal statutes
and their implementing regulations for Title IV, HEA Federal student loans that we service.
Furthermore, I attest that the information in this IT Security Self-Assessment to be accurate and
complete. I agree that FSA or their representatives may visit my organization to verify the IT
Security Self-Assessment information.

Signature: ________________________________ Signature Date: __________________
Date IT Security Self-Assessment Completed: ________________________________________
Date IT Security Self-Assessment Submitted to FSA: ___________________________________

OMB Control Number: 1845-0134
Expiration Date: 2018 Clearance