Fillable Printable Reconstitution Questionnaire

Reconstitution Questionnaire

REQUIREMENT: HOMELAND SECURITY PRESIDENTIAL DIRECTIVE 20 / NATIONAL SECURITY PRESIDENTIAL

DIRECTIVE 50 MANDATES CONTINUITY REQUIREMENTS FOR EXECUTIVE DEPARTMENTS AND AGENCIES

SHALL INCLUDE PROVISIONS FOR RECONSTITUTION CAPABILITIES TO ENABLE PROMPT RECOVERY FROM

A CATASTROPHIC EMERGENCY AND RESUMPTION OF NORMAL OPERATIONS. THE GENERAL SERVICES

ADMINISTRATION (GSA) IS ASSIGNED THE PRIMARY MISSION ESSENTIAL FUNCTION OF LEADING THE

PHYSICAL RECONSTITUTION OF THE FEDERAL GOVERNMENT.

GUIDANCE: DEPARTMENT AND AGENCIES SHALL COMPLETE AND SUBMIT THIS FORM VIA THE GSA

OFFICE OF EMERGENCY RESPONSE AND RECOVERY WEB PORTAL. THIS FORM SHALL BE CONFIRMED

FOR ACCURACY ANNUALLY. IT IS IMPORTANT FOR DEPARTMENTS AND AGENCIES TO IDENTIFY

PROJECTED NEEDS THEY WOULD ENCOUNTER UPON TRANSITIONING FROM INITIAL CONTINUITY

ENVIRONMENTS (APPROXIMATELY 30 DAYS POST EVENT).

FORM ACCESS & SUBMISSION: FOR SUBMISSIONS, QUESTIONS OR COMMENTS, CONTACT GSA'S OFFICE

OF MISSION ASSURANCE AT (312) 909-5515 OR (817) 207-6311. A MESSAGE CAN ALSO BE LEFT AT (202)

219-0338.

PURPOSE: THIS QUESTIONNAIRE IS DESIGNED TO ASSIST EXECUTIVE DEPARTMENTS AND AGENCIES IN

THOROUGHLY IDENTIFYING AND DOCUMENTING THEIR PHYSICAL RECONSTITUTION NEEDS.

COMPLETION OF THIS FORM WILL ENABLE A CLEARER UNDERSTANDING OF PERTINENT DEPARTMENT

AND AGENCY NEEDS, CAPABILITIES AND PLANNING REQUIREMENTS. SUBMISSION HERE DOES NOT

GUARANTEE FUTURE REQUESTS, RATHER FORMALLY NOTIFIES GSA OF CURRENTLY PROJECTED NEEDS

AND ENHANCES THE CONTINUAL DEVELOPMENT OF WHOLE OF GOVERNMENT RECONSTITUTION

PLANNING EFFORTS.

ASSUMPTIONS: THE FOLLOWING ASSUMPTIONS APPLY TO THIS QUESTIONNAIRE:

1. WHEN ESTIMATING FUTURE SQUARE FOOTAGE REQUIREMENTS, GSA RECOMMENDS EMPLOYING

AN INDUSTRY STANDARD METRIC OF 200 SQUARE FEET (SF) / FULL TIME EMPLOYEE.

2. DURING A CONTINUITY EVENT, GSA WILL UTILIZE THE LATEST VERSION OF THE CONTINUITY

COMMUNICATIONS PLAN TO CONTACT DEPARTMENTS AND AGENCIES REGARDING

RECONSTITUTION NEEDS.

3. NATIONAL COMMUNICATIONS SYSTEM DIRECTIVE 3-10 AND OMB MEMORANDUM M-05-16 APPLY

TO THE COMMUNICATIONS REQUIREMENTS SECTION.

4. FOLLOWING A MAJOR RECONSTITUTION EVENT, DEPARTMENTS AND AGENCIES MAY OCCUPY A

TEMPORARY REPLACEMENT FACILITY FOR AN UNDETERMINED AMOUNT OF TIME.

5. REQUEST PRIORITIZATION WILL BECOME REQUISITE IN AN ENVIRONMENT OF LIMITED

AVAILABILTY.

6. THE NATIONAL CAPITAL REGION (NCR) CONSTITUTES THE FOCUS OF CONCERN FOR ACCURATE

DATA GATHERING.

STANDARD FORM 2050 (REV. 5/2014)

RECONSTITUTION QUESTIONNAIRE

Required by Federal Continuity Directive (FCD) 1

A. INFORMATION SUMMARY

PROJECTED RECONSTITUTION NEEDS

PERSONNEL COUNT:

SF UNCLASSIFIED OFFICE

SF CLASSIFIED / SCIF:

SF WAREHOUSE:

SF PUBLIC FACING:

DESCRIBE 'OTHER' ABOVE:

ACREAGE OPEN LAND:

SF 'OTHER' / CUSTOM

ENCLOSED SPACE (i.e., LAB):

SF CLASSIFIED / SCIF:

SF WAREHOUSE:

SF PUBLIC FACING:

DESCRIBE 'OTHER' ABOVE:

ACREAGE OPEN LAND:

SF 'OTHER' / CUSTOM

ENCLOSED SPACE (i.e., LAB):

SF UNCLASSIFIED OFFICE

PERSONNEL COUNT:

CURRENT CONDITIONS (NCR)

PRIMARY FACILITIES

INFORMATION SUMMARY

STANDARD FORM 2050 (REV. 5/2014) PAGE 2

Required by Federal Continuity Directive (FCD) 1

AGENCY BUREAU CODE:

DO YOU NEED TRANSPORTATION OF PERSONNEL

TO THE RECONSTITUTION SITE?

NUMBER OF EMPLOYEES THAT WILL WORK AT

THE NEW SITE?

III. PERSONNEL

CURRENT LOCATION OF PRIMARY FACILITY (CITY AND STATE):

NAME OF THE AGENCY:

II. DEPARTMENT INFORMATION

RECONSTITUTION BACK-UP POINT OF CONTACT

NAME:

CELL PHONE NUMBER:

EMAIL:

WHO IS YOUR CLASSIFIED IT POINT OF CONTACT?

WHO IS YOUR SECURITY OFFICE (SECURITY ADMINISTRATION PROGRAMS) POINT OF CONTACT?

WHO IS YOUR UNCLASSIFIED IT POINT OF CONTACT?

EMAIL:

CELL PHONE NUMBER:

NAME:

RECONSTITUTION POINT OF CONTACT

I. POINTS OF CONTACT

B. INFORMATION DETAIL

DO YOU REQUIRE KITCHEN AREAS ON SITE?

DO YOU REQUIRE A CAFETERIA/RESTAURANT ON SITE?

DO YOU REQUIRE BILLETING ON SITE?

WILL ANY OF YOUR EMPLOYEES REQUIRE REASONABLE ACCOMMODATIONS AT THE NEW FACILITY

(PLEASE LIST SPECIFIC NEEDS)?

SQ/FT:

SQ/FT: CONFERENCE ROOMS:

PLANNING ROOMS:

ARCHIVE ROOMS: SQ/FT:

SQ/FT:

HOW MANY DO YOU REQUIRE:

STORAGE ROOMS:

OFFICES:

BRIEFING ROOMS:

OTHER SPACE NEEDS:

HOW MANY

WORKSTATIONS

DO YOU REQUIRE?

WHAT IS YOUR MINIMUM SQUARE

FOOTAGE REQUIREMENT?

DOES YOUR ORGANIZATION REQUIRE A MAIL

PROCESSING FACILITY IN THE IMMEDIATE

PROXIMITY OF THE BUILDING?

DOES YOUR AGENCY CURRENTLY HAVE ANOTHER FACILITY THAT COULD SUPPORT YOUR RECONSTITUTION NEEDS?

IV. SPACE

STANDARD FORM 2050 (REV. 5/2014) PAGE 3

Required by Federal Continuity Directive (FCD) 1

NUMBER OF SECURE TELEPHONES (ISDN) REQUIRED:

NUMBER OF UNSECURE TELEPHONES (ANALOG) REQUIRED:

NUMBER OF SECURE TELEPHONES (ANALOG) REQUIRED:

NUMBER OF UNSECURE TELEPHONES (ISDN) REQUIRED:

TELEPHONES

RADIOS

NUMBER OF SECURE FAX MACHINES (ANALOG) REQUIRED:

NUMBER OF UNSECURE FAX MACHINES REQUIRED:

FAX MACHINES

NUMBER OF CLASSIFIED VIDEO TELECONFERENCE UNITS REQUIRED:

NUMBER OF UNCLASSIFIED VIDEO TELECONFERENCE UNITS REQUIRED:

VIDEO TELECONFERENCE EQUIPMENT

HOW MANY UNCLASSIFIED WORKSTATIONS DO

YOU REQUIRE?

HOW MANY CLASSIFIED TELECOMMUNICATIONS

WORKSTATIONS DO YOU REQUIRE?

WHAT SPECIFIC CLASSIFIED DATA

NETWORKS DO YOU REQUIRE?

WHAT SPECIFIC UNCLASSIFIED DATA

NETWORKS DO YOU REQUIRE?

VI. COMMUNICATIONS

NUMBER OF CHAIRS REQUIRED:

NUMBER OF FILE CABINETS REQUIRED:

NUMBER OF SAFES REQUIRED: NUMBER OF DESKS REQUIRED:

NUMBER OF STORAGE CONTAINERS REQUIRED:

NUMBER OF CUBICLES REQUIRED:

V. FURNITURE

OTHER

DO YOU REQUIRE SATELLITE SERVICES, IF SO WHAT SPECIFIC TYPES OF SERVICES (VOICE, VIDEO, OR DATA)?

HOW MANY CABLE/SATELLITE DROPS DO YOU REQUIRE?

NUMBER OF CLASSIFIED SATELLITE PHONES REQUIRED:

NUMBER OF UNCLASSIFIED SATELLITE PHONES REQUIRED:

SATELLITE SERVICES

MODELTYPE

SECURED

UNSECURED

DO YOU REQUIRE RADIOS (INCLUDE TOTAL NUMBER REQUIRED)?

DO YOU REQUIRE A HF/ALE RADIO?

HOW MANY SERVER RACKS DO YOU REQUIRE?

NUMBER OF SECURE VOIP TELEPHONES REQUIRED:

NUMBER OF UNSECURE VOIP TELEPHONES REQUIRED:

WHAT IS THE BILLING NUMBER FOR THE

TELEPHONE SERVICE AT THE IMPACTED

FACILITY?

IS ANYBODY IN YOUR OFFICE TRAINED IN THE

USE OF DISASTER ROUTING SERVICE?

WHAT IS THE PRIMARY TELEPHONE CIRCUIT NUMBER

AT THE IMPACTED FACILITY?

DO YOU HAVE DISASTER ROUTING SERVICE FOR THE

TELEPHONE SERVICE AT THE IMPACTED FACILITY?

WHAT IS THE PHYSICAL LOCATION OF THE IMPACTED FACILITY WHERE THE TELEPHONE SERVICE

TERMINATES (PHYSICAL ADDRESS, TO INCLUDE FLOOR NUMBER IF APPLICABLE)?

PLEASE PROVIDE ALL ADDITIONAL NUMBERS ASSOCIATED WITH THE PRIMARY CIRCUIT OF THE IMPACTED FACILITY.

STANDARD FORM 2050 (REV. 5/2014) PAGE 4

Required by Federal Continuity Directive (FCD) 1

OTHER MISCELLANEOUS REQUIREMENTS

WHAT IS YOUR EXPECTED TOTAL

EQUIPMENT LOAD FOR BACKUP

POWER?

DO YOU REQUIRE EMERGENCY

GENERATOR MAINTENANCE?

DO YOU REQUIRE EMERGENCY

GENERATORS?

DO YOU REQUIRE DEDICATED

LOAD CIRCUITS?

WHAT IS YOUR TOTAL EQUIPMENT LOAD FOR UNINTERRUPTED

POWER SUPPLY?

HOW MANY 220 VOLT POWER

CIRCUITS DO YOU REQUIRE?

HOW MANY 110 VOLT POWER

CIRCUITS DO YOU REQUIRE?

WHAT IS YOUR EXPECTED TOTAL

EQUIPMENT LOAD FOR

COMMERCIAL POWER?

DO YOU HAVE SPECIAL HVAC REQUIREMENTS FOR EQUIPMENT ROOMS (I.E. SERVER ROOMS, ETC…)?

NUMBER OF CONNEXES/SHIPPING CONTAINERS REQUIRED:

DO YOU REQUIRE A WAREHOUSE

IN THE IMMEDIATE PROXIMITY OF

THE BUILDING?

DO YOU REQUIRE LOADING DOCKS?

LOADING DOCK SQ/FT:

DO YOU REQUIRE VEHICLE

STORAGE?

PARKING REQUIRED?

ACCESS TO PUBLIC

TRANSPORTATION REQUIRED?

QUANTITY: TYPE: DO YOU REQUIRE VEHICLES?

VII. MISCELLANEOUS

VEHICLES

STORAGE

HVAC/POWER

COMPUTERS

JANITORIAL

FOOD

MECHANICAL

HVAC

PLUMBING

SECURITY

OTHER

MOVEMENT COORDINATION OF PERSONNEL/EQUIPMENT

SECURITY PRODUCTS AND SERVICES

FURNITURE AND PERSONAL PROPERTY DISPOSAL

LOCAL AND LONG-DISTANCE TELEPHONE SERVICE

IT/NETWORK AND TELECOMMUNICATIONS SERVICES

DO YOU REQUIRE SERVICE CONTRACTS FOR:

VIII. CONTRACT ASSISTANCE

STANDARD FORM 2050 (REV. 5/2014) PAGE 5

Required by Federal Continuity Directive (FCD) 1

LIST OF CUSTOMER REPS WITH ALL CONTRACTORS

AGENCY PHYSICAL SECURITY REQUIREMENTS

ORGANIZATION CHART OF PLANNED, RECONSTITUTED PERSONNEL (REPLACEMENTS FOR

MISSING/UNACCOUNTED FOR PERSONNEL CAN BE UPDATED DURING MOVEMENT)

STAFF LIST

AGENCY SPACE STANDARDS

X. ATTACHMENTS

OTHER:

WHAT SPECIFIC PHYSICAL SECURITY REQUIREMENTS DO YOU HAVE? (NUMBER OF GUARDS, ARMED

GUARDS, LOCKING MECHANISMS, ACCESS CONTROL, CCTV, IDS, FENCING, ETC…)

DO YOU REQUIRE CLASSIFIED CONFERENCE ROOMS? (SPECIFY THE NUMBER, TYPE, AND SQUARE FOOTAGE)

SCIF SQ/FT. REQUIREMENT: PORTABLE OR PERMANENT SCIF?

DO YOU REQUIRE A SENSITIVE COMPARTMENTED

INFORMATION FACILITY (SCIF)?

DO YOU REQUIRE GSA APPROVED SECURITY

CONTAINERS?

TOTAL CLASSIFIED WORKSPACE SQ/FT:

DO YOU REQUIRE A SECURE WORK SPACE AND

WHAT IS THE HIGHEST CLASSIFICATION LEVEL IT

NEEDS TO MEET?

IX. SECURITY

STANDARD FORM 2050 (REV. 5/2014) PAGE 6

Required by Federal Continuity Directive (FCD) 1

SECTION A: INFORMATION SUMMARY

CURRENT CONDITIONS (NCR): All information gathered is in regards to the primary, department/agency

headquarters and associated facilities in the Washington D.C. area (National Capital Region-NCR).

box: Enter the number of personnel that currently occupy primary facilities in the Washington D.C. area

(National Capital Region-NCR)

box: Enter the current count of unclassified, office space square footage occupied.

box: Enter the current count of classified, office space square footage (if applicable).

box: Enter the current square footage of warehouse space, associated with your primary facilities

(includes storage, etc).

box: Enter the current amount of square footage of public facing space required.

box: Enter the current square footage amount of enclosed spaces, such as Labs; weapons range;

simulators.

box: Enter descriptions of space included as 'other' in box 6 above.

box: Enter the current acreage of open land your department/agency currently using

PROJECTED RECONSTITUTION NEEDS: D/A shall provide educated assumptions for their projected

needs noting current state of NCR primary facilities as a baseline for reconstitution needs.

box: Enter the projected number of personnel that would need to be supported under a NCR reconstitution

effort.

box: Enter the projected unclassified, office space square footage needed.

box: Enter the projected classified, office space square footage needed.

box: Enter the projected square footage of warehouse space.

box: Enter the projected amount of square footage of public facing space needed.

box: Enter the projected square footage amount of enclosed spaces, such as Labs; weapons range;

simulators.

box: Enter the descriptions of any space included as 'other' in box 6 above.

box: Enter the projected acreage of open land your department/agency would need

SECTION B: INFORMATION DETAIL

POINTS OF CONTACT: Enter the point of contact information for both the primary and back-up

Reconstitution Manager for your department/agency.

1-2

box: Enter the contact information for the primary and secondary reconstitution manager.

box: Enter the Information Technology point of contact for unclassified systems (if applicable).

box: Enter the Information Technology point of contact for classified systems (if applicable).

box: Enter the point of contact for your department/agency's security program (i.e. Special Security Officer

[SSO]).

INSTRUCTIONS

STANDARD FORM 2050 (REV. 5/2014) PAGE 7

Required by Federal Continuity Directive (FCD) 1

DEPARTMENT INFORMATION: Enter the information for your department/agency.

box: Enter your department/agency's name.

box: Enter the Agency Bureau Code for your agency's account. The Agency/Bureau code is the code

assigned to your agency and bureau by the Executive Office of the President, Office of Management and

Budget (OMB). These codes are unclassified are located in OMB Circular A-11; Appendix C (2012).

//www.whitehouse.gov/sites/default/files/omb/assets/a11_current_year/app_c.pdf

box: Enter the current city that your department/agency is located in.

box: Enter the current state that your department/agency is located in.

PERSONNEL: All information gathered in this section will be in regards to the projected needs of the

personnel projected to work at the reconstitution facility, taking into account possible future policy

requirements/needs (i.e. telework). This section does not take into account current needs and uses.

box: Enter the projected number of employees that will work at the future site, taking into account future

policy requirements/needs (i.e. telework).

box: Enter YES or NO for the projected transportation needs of personnel to the new site.

box: Enter YES or NO for the projected needs of your employees that would require reasonable

accommodations at the new facility. Enter those specific needs in the designated space provided.

box: Enter YES or NO for billeting requirements on the new site.

box: Enter YES or NO for projected cafeteria/restaurant requirements at the new site.

box: Enter YES or NO for projected kitchen requirements at the new site.

SPACE: All information gathered in this section will be in regards to the projected space requirements at the

future department/agency reconstituted facility, taking into account possible future policy requirements/needs

(i.e. telework). This section does not take into account current needs and uses.

box: Enter YES or NO if your department/agency plans to use another building for your department/

agency's reconstitution needs.

box: Enter YES or NO if your department/agency requires a mail processing facility in the immediate

proximity of the building.

box: Enter the projected total office square footage requirement

box: Enter the total projected number of workstations required at the new facility

box: Enter the total projected number of required storage rooms

box: Enter the total projected square footage of the future storage room requirement.

box: Enter the total projected number of offices required.

box: Enter the total projected office square footage.

box: Enter the total projected number of briefing rooms required.

box: Enter the total projected briefing room square footage.

box: Enter the total projected number conference rooms required.

box: Enter the total projected conference room square footage.

box: Enter the total projected number of planning rooms required.

box: Enter the total projected planning room square footage.

box: Enter the total projected number of archive rooms required.

box: Enter the total projected archive room square footage.

box: Enter the other space requirements not identified or special requirements needed (i.e. a conference

room needs to be a certain square footage).

**Note: it is very important to identify if your agency has another facility that could support reconstitution

needs. Depending on the agency and circumstances, your agency might assume the alternate facility and

new work space will be obtained for the work force currently assigned there.

STANDARD FORM 2050 (REV. 5/2014) PAGE 8

Required by Federal Continuity Directive (FCD) 1

FURNITURE: All information gathered in this section will be in regards to the projected needs of the

personnel projected to work at the reconstituted facility, taking into account possible future policy

requirements/needs (i.e. telework). This section does not take into account current needs and uses.

box: Enter the total amount of the projected number of cubicles required.

box: Enter the total amount of the projected number of chairs required.

box: Enter the total amount of the projected number of storage containers required.

box: Enter the total amount of the projected number of file cabinets required.

box: Enter the total amount of the projected number of desks required.

box: Enter the total amount of the projected number of safes required.

COMMUNICATIONS: All information gathered in this section will be in regards to the projected needs of the

personnel projected to work at the reconstituted facility, taking into account possible future policy

requirements/needs (i.e. telework). This section does not take into account current needs and uses.

box: Enter the specific UNCLASSIFIED data network that is required. This is typically the network that

your agency uses for daily, UNCLASSIFIED, office work. (i.e. GSA Network)

box: Enter the total number of UNCLASSIFIED workstations required.

box: Enter the specific CLASSIFIED data network that is required. This is typically the network that your

agency uses for daily, CLASSIFIED, office work.

box: Enter the total number of CLASSIFIED workstations required.

VIDEO TELECONFERENCE EQUIPMENT: All information gathered in this section will be in regards to the

projected needs of the personnel projected to work at the reconstituted facility, taking into account possible

future policy requirements/needs (i.e. telework). This section does not take into account current needs and

uses.

box: Enter the total number of UNCLASSIFIED video teleconference units required.

box: Enter the total number of CLASSIFIED video teleconference units required.

FAX MACHINES: All information gathered in this section will be in regards to the projected needs of the

personnel projected to work at the reconstituted facility, taking into account possible future policy

requirements/needs (i.e. telework). This section does not take into account current needs and uses.

box: Enter the total number of UNSECURE fax machines required.

box: Enter the total number of SECURE fax machines required.

STANDARD FORM 2050 (REV. 5/2014) PAGE 9

Required by Federal Continuity Directive (FCD) 1

TELEPHONES: All information gathered in this section will be in regards to the projected needs of the

personnel projected to work at the reconstituted facility, taking into account possible future policy

requirements/needs (i.e. telework). This section DOES take into account some current needs and uses.

box: Enter the total number of ISDN telephones; UNSECURE & SECURE required.

box: Enter the total number of ANALOG telephones; UNSECURE & SECURE required.

box: Enter the total number of VoIP telephones; UNSECURE & SECURE required.

box: Enter YES or NO if there is “disaster routing service” for the telephone service at the impacted site.

box: Enter YES or NO if anyone in your office knows how to use “disaster routing service” site.

box: Enter the primary telephone circuit number at the impacted facility.

box: Enter the billing telephone number for the telephone service at the impacted site.

box: Enter the address of the physical location where the telephone service ends.

box: Enter additional phone numbers associated with the primary circuit of the impacted facility.

box: Enter the projected number of computer server racks that are required at the new facility.

RADIOS: All information gathered in this section will be in regards to the projected needs of the personnel

projected to work at the reconstituted facility, taking into account possible future policy requirements/needs (i.

e. telework). This section DOES take into account some current needs and uses.

box: Enter YES or NO if you currently use a HF/ALE radio?

box: Enter total number of projected number of UNSECURED radios.

box: Enter total number of projected number of SECURED radios.

box: Enter type of radio that is required.

box: Enter the model of radio that is required.

SATELLITE SERVICES: All information gathered in this section will be in regards to the projected needs at

the reconstituted facility, taking into account possible future policy requirements/needs (i.e. telework). This

section DOES NOT take into account some current needs and uses.

box: Enter the number total number of projected UNCLASSIFIED and CLASSIFIED satellite phones.

box: Enter the satellite services that are required (i.e. voice; video; etc…).

box: Enter any other satellite services that may be needed that were not mentioned above.

MISCELLANEOUS

VEHICLES: All information gathered in this section will be in regards to the projected needs at the

reconstituted facility, taking into account possible future policy requirements/needs (i.e. telework). This

section DOES NOT take into account some current needs and uses.

box: Enter YES or NO if you require vehicles. Also, enter the type and quantity of vehicles needed.

box: Enter YES or NO if you require vehicle storage.

box: Enter YES or NO if you require parking for the vehicles.

box: Enter YES or NO if you require access to public transportation.

STORAGE: All information gathered in this section will be in regards to the projected needs at the

reconstituted facility, taking into account possible future policy requirements/needs (i.e. telework). This

section DOES NOT take into account some current needs and uses.

box: Enter YES or NO if you require loading docks.

box: Enter the projected square footage required for the loading dock.

box: Enter YES or NO if you require a warehouse in the immediate proximity of the new site.

box: Enter the projected number of connexes/shipping containers required at the new site.

STANDARD FORM 2050 (REV. 5/2014) PAGE 10

Required by Federal Continuity Directive (FCD) 1

HVAC/POWER: All information gathered in this section will be in regards to the projected needs at the

reconstituted facility, taking into account possible future policy requirements/needs (i.e. telework). This

section DOES NOT take into account current needs and uses

box: Enter YES or NO if you have special HVAC requirements for the equipment rooms.

box: Enter the projected total expected equipment load.

box: Enter the projected number of 110 volt power circuits.

box: Enter the projected number of 220 volt power circuits.

box: Enter YES or NO for the projected need of dedicated load circuits.

box: Enter the projected total equipment load for uninterrupted power supply.

box: Enter YES or NO for the projected need of emergency generators.

box: Enter YES or NO for the projected need of emergency generator maintenance.

box: Enter the projected total equipment load for backup power.

box: Enter any requirements not noted in this section.

CONTRACT ASSISTANCE: List any specific contract assistance you will project needing from GSA for

support at your physical location in a normal work environment.

box: Check the appropriate boxes.

**Note: GSA can procure support from vendors already established on the GSA schedule

SECURITY: All information gathered in this section will be in regards to the projected needs at the

reconstituted facility, taking into account possible future policy requirements/needs (i.e. telework). This

section DOES NOT take into account current needs and uses.

box: Enter YES or NO for the projected need of a secure work space.

box: Enter the projected highest classification level required.

box: Enter the total projected classified workspace square footage.

box: Enter YES or NO if you require GSA approved security containers.

box: Enter YES or NO if you require a sensitive compartmented information facility (SCIF).

box: Enter the projected type of SCIF (i.e. portable or permanent).

box: Enter the projected total SCIF square footage.

box: Enter YES or NO for the projected number of classified conference rooms. If yes, enter the type, total

square footage, and quantity.

box: Enter the projected physical security needs (i.e. access controls, CCTV, etc….).

box: Enter any requirements not noted in this section.

ATTACHMENTS: In this section, attach any document(s) that details any projected requirements in

reestablishing a normal work environment.