/ FIPS-199 Categorization Change Form – Authorization to Process
Instructions: /
  1. Please complete this form, then print and sign.
  2. Email a scanned copy of the form to

CSP Contact Information
Company Name
System Name
System Owner / Name / Title
Primary POC / Name / Title
Phone / Email
System Information
Type of System(please choose from drop down menu) / Choose an item. /
Please briefly describe your system
Demand/Justification
Which customers require this change? (if applicable)
Write a summary justification as to why the change is needed?
List all current and pending Federal Customers(NOTE: “Pending” means the system is not in production yet for that customer, but there is either an active RFP in some stage of procurement, or an existing contract is in place.What Federal customer(s) are driving this change?)
3PAO Information
3PAO Company Name
3PAO Primary POC / Name / Title
Phone / Email
☐Already engaged / ☐Expected to engage on Click here to enter a date.
Currently on contract for significant change proposed? / ☐Yes ☐No
Nature of Change(This is ONLY for a change of FIPS-199 Level [such as Moderate to High]. Use the Significant Change form for all other changes)
System Component(s) Impacted(List all)
Security Controls Impacted / If changing from Moderate to High, use the pages at the end of this form. Otherwise, attach pages as needed.
Status of Change(For Moderate to High, please attach a control-by-control status of implementation)
Validation
Please describe how the impacted controls will be validated once the change is complete.
CSP Signature(To be signed by an individual with the authority to represent the CSP to FedRAMP)
Name(Type): / Title:
______
Signature / ______
Date
FedRAMP Standing (to be Completed by FedRAMP)
Annual Assessment
Was the last Assessment Completed? / ☐Yes ☐No
When is the next Annual Assessment Due? / Click here to enter a date. /
Note: If Significant Change is approved and AA is within 3 months, FedRAMP will likely require this to be included in AA rather than a standalone Significant Change, unless there are exigent circumstances
Is CSP currently overdue on its Annual Assessment? / ☐Yes ☐No
If Yes, why:
ConMon Performance
Was CSP on any CAPS (formal or informal) in the past six months? / ☐Yes ☐No
For FedRAMP PMO Use Only
Approved:☐Yes ☐No / Date:

New controls required when changing from Moderate to High:

Control / Applicability / Implementation Status Notes
If “Pending Implementation”, provide implementation date.
If “Not Applicable”, explain why.
Implemented / Pending Implementation / Not Applicable
AC-02 (11) / ☐ / ☐ / ☐ /
AC-02 (13) / ☐ / ☐ / ☐ /
AC-04 (08) / ☐ / ☐ / ☐ /
AC-06 (03) / ☐ / ☐ / ☐ /
AC-06 (07) / ☐ / ☐ / ☐ /
AC-06 (08) / ☐ / ☐ / ☐ /
AC-07 (02) / ☐ / ☐ / ☐ /
AC-12 (01) / ☐ / ☐ / ☐ /
AC-18 (03) / ☐ / ☐ / ☐ /
AC-18 (04) / ☐ / ☐ / ☐ /
AC-18 (05) / ☐ / ☐ / ☐ /
AT-03 (03) / ☐ / ☐ / ☐ /
AT-03 (04) / ☐ / ☐ / ☐ /
AU-03 (02) / ☐ / ☐ / ☐ /
AU-05 (01) / ☐ / ☐ / ☐ /
AU-05 (02) / ☐ / ☐ / ☐ /
AU-06 (04) / ☐ / ☐ / ☐ /
AU-06 (05) / ☐ / ☐ / ☐ /
AU-06 (06) / ☐ / ☐ / ☐ /
AU-06 (07) / ☐ / ☐ / ☐ /
AU-06 (10) / ☐ / ☐ / ☐ /
AU-09 (03) / ☐ / ☐ / ☐ /
AU-10 / ☐ / ☐ / ☐ /
AU-12 (01) / ☐ / ☐ / ☐ /
AU-12 (03) / ☐ / ☐ / ☐ /
CA-07 (03) / ☐ / ☐ / ☐ /
CM-03 (01) / ☐ / ☐ / ☐ /
CM-03 (02) / ☐ / ☐ / ☐ /
CM-03 (04) / ☐ / ☐ / ☐ /
CM-03 (06) / ☐ / ☐ / ☐ /
CM-04 (01) / ☐ / ☐ / ☐ /
CM-05 (02) / ☐ / ☐ / ☐ /
CM-06 (02) / ☐ / ☐ / ☐ /
CM-08 (02) / ☐ / ☐ / ☐ /
CM-08 (04) / ☐ / ☐ / ☐ /
CM-11 (01) / ☐ / ☐ / ☐ /
CP-02 (04) / ☐ / ☐ / ☐ /
CP-02 (05) / ☐ / ☐ / ☐ /
CP-03 (01) / ☐ / ☐ / ☐ /
CP-04 (02) / ☐ / ☐ / ☐ /
CP-06 (02) / ☐ / ☐ / ☐ /
CP-07 (04) / ☐ / ☐ / ☐ /
CP-08 (03) / ☐ / ☐ / ☐ /
CP-08 (04) / ☐ / ☐ / ☐ /
CP-09 (02) / ☐ / ☐ / ☐ /
CP-09 (05) / ☐ / ☐ / ☐ /
CP-10 (04) / ☐ / ☐ / ☐ /
IA-02 (04) / ☐ / ☐ / ☐ /
IA-02 (09) / ☐ / ☐ / ☐ /
IA-05 (08) / ☐ / ☐ / ☐ /
IA-05 (13) / ☐ / ☐ / ☐ /
IR-02 (01) / ☐ / ☐ / ☐ /
IR-02 (02) / ☐ / ☐ / ☐ /
IR-04 (02) / ☐ / ☐ / ☐ /
IR-04 (03) / ☐ / ☐ / ☐ /
IR-04 (04) / ☐ / ☐ / ☐ /
IR-04 (06) / ☐ / ☐ / ☐ /
IR-04 (08) / ☐ / ☐ / ☐ /
IR-05 (01) / ☐ / ☐ / ☐ /
MA-02 (02) / ☐ / ☐ / ☐ /
MA-04 (03) / ☐ / ☐ / ☐ /
MA-04 (06) / ☐ / ☐ / ☐ /
MP-06 (01) / ☐ / ☐ / ☐ /
MP-06 (03) / ☐ / ☐ / ☐ /
PE-03 (01) / ☐ / ☐ / ☐ /
PE-06 (04) / ☐ / ☐ / ☐ /
PE-08 (01) / ☐ / ☐ / ☐ /
PE-11 (01) / ☐ / ☐ / ☐ /
PE-13 (01) / ☐ / ☐ / ☐ /
PE-15 (01) / ☐ / ☐ / ☐ /
PE-18 / ☐ / ☐ / ☐ /
PS-04 (02) / ☐ / ☐ / ☐ /
RA-05 (04) / ☐ / ☐ / ☐ /
RA-05 (10) / ☐ / ☐ / ☐ /
SA-12 / ☐ / ☐ / ☐ /
SA-15 / ☐ / ☐ / ☐ /
SA-16 / ☐ / ☐ / ☐ /
SA-17 / ☐ / ☐ / ☐ /
SC-03 / ☐ / ☐ / ☐ /
SC-07 (10) / ☐ / ☐ / ☐ /
SC-07 (20) / ☐ / ☐ / ☐ /
SC-07 (21) / ☐ / ☐ / ☐ /
SC-12 (01) / ☐ / ☐ / ☐ /
SC-23 (01) / ☐ / ☐ / ☐ /
SC-24 / ☐ / ☐ / ☐ /
SI-02 (01) / ☐ / ☐ / ☐ /
SI-04 (11) / ☐ / ☐ / ☐ /
SI-04 (18) / ☐ / ☐ / ☐ /
SI-04 (19) / ☐ / ☐ / ☐ /
SI-04 (20) / ☐ / ☐ / ☐ /
SI-04 (22) / ☐ / ☐ / ☐ /
SI-04 (24) / ☐ / ☐ / ☐ /
SI-05 (01) / ☐ / ☐ / ☐ /
SI-07 (02) / ☐ / ☐ / ☐ /
SI-07 (05) / ☐ / ☐ / ☐ /
SI-07 (14) / ☐ / ☐ / ☐ /

Controls with different FedRAMP parameters when changing from Moderate to High:

Control / Applicability / Implementation Status Notes
If “Parameter Pending”, provide implementation date.
If “Not Applicable”, explain why.
Parameter /Control Updated / Parameter Pending Update / Not Applicable
AC-01 / ☐ / ☐ / ☐ /
AC-02 / ☐ / ☐ / ☐ /
AC-02 (02) / ☐ / ☐ / ☐ /
AC-02 (03) / ☐ / ☐ / ☐ /
AC-02 (04) / ☐ / ☐ / ☐ /
AC-02 (05) / ☐ / ☐ / ☐ /
AC-02 (07) / ☐ / ☐ / ☐ /
AC-02 (09) / ☐ / ☐ / ☐ /
AC-02 (12) / ☐ / ☐ / ☐ /
AC-02 (13) / ☐ / ☐ / ☐ /
AC-06 (01) / ☐ / ☐ / ☐ /
AC-06 (03) / ☐ / ☐ / ☐ /
AC-06 (07) / ☐ / ☐ / ☐ /
AC-06 (08) / ☐ / ☐ / ☐ /
AC-07 / ☐ / ☐ / ☐ /
AC-07 (02) / ☐ / ☐ / ☐ /
AT-03 (04) / ☐ / ☐ / ☐ /
AT-04 / ☐ / ☐ / ☐ /
AU-01 / ☐ / ☐ / ☐ /
AU-03 (01) / ☐ / ☐ / ☐ /
AU-03 (02) / ☐ / ☐ / ☐ /
AU-05 (02) / ☐ / ☐ / ☐ /
AU-06 (05) / ☐ / ☐ / ☐ /
AU-06 (07) / ☐ / ☐ / ☐ /
AU-08 / ☐ / ☐ / ☐ /
AU-10 / ☐ / ☐ / ☐ /
AU-11 / ☐ / ☐ / ☐ /
CA-01 / ☐ / ☐ / ☐ /
CA-03 (05) / ☐ / ☐ / ☐ /
CM-01 / ☐ / ☐ / ☐ /
CM-02 (03) / ☐ / ☐ / ☐ /
CP-01 / ☐ / ☐ / ☐ /
CP-04 / ☐ / ☐ / ☐ /
CP-09 (01) / ☐ / ☐ / ☐ /
IA-01 / ☐ / ☐ / ☐ /
IA-04 / ☐ / ☐ / ☐ /
IA-05 (01) / ☐ / ☐ / ☐ /
IA-05 (04) / ☐ / ☐ / ☐ /
IR-01 / ☐ / ☐ / ☐ /
IR-02 / ☐ / ☐ / ☐ /
IR-03 / ☐ / ☐ / ☐ /
IR-09 (02) / ☐ / ☐ / ☐ /
MA-01 / ☐ / ☐ / ☐ /
MP-01 / ☐ / ☐ / ☐ /
MP-02 / ☐ / ☐ / ☐ /
MP-03 / ☐ / ☐ / ☐ /
MP-06 / ☐ / ☐ / ☐ /
MP-06 (02) / ☐ / ☐ / ☐ /
PE-01 / ☐ / ☐ / ☐ /
PE-02 / ☐ / ☐ / ☐ /
PL-01 / ☐ / ☐ / ☐ /
PL-04 / ☐ / ☐ / ☐ /
PS-01 / ☐ / ☐ / ☐ /
PS-02 / ☐ / ☐ / ☐ /
PS-04 / ☐ / ☐ / ☐ /
PS-05 / ☐ / ☐ / ☐ /
PS-06 / ☐ / ☐ / ☐ /
PS-07 / ☐ / ☐ / ☐ /
PS-08 / ☐ / ☐ / ☐ /
RA-01 / ☐ / ☐ / ☐ /
RA-03 / ☐ / ☐ / ☐ /
SA-01 / ☐ / ☐ / ☐ /
SA-04 (02) / ☐ / ☐ / ☐ /
SA-05 / ☐ / ☐ / ☐ /
SC-01 / ☐ / ☐ / ☐ /
SC-07 (04) / ☐ / ☐ / ☐ /
SC-07 (12) / ☐ / ☐ / ☐ /
SC-28 (01) / ☐ / ☐ / ☐ /
SI-01 / ☐ / ☐ / ☐ /
SI-03 / ☐ / ☐ / ☐ /
SI-07 (01) / ☐ / ☐ / ☐ /

1Form Version 1.0