I __________________________ (Security Officer name) have carefully reviewed the attached computer system security plan together with the findings and recommendations of a documented risk assessment; analysis of threats, vulnerabilities, and safeguards; or security evaluation performed within the past [variable: time period].

Based on my authority and judgment, and weighing the residual risks against operational requirements, I authorize continued operations of:

___________________ (Name of covered system or application) under the following circumstances:

• [variable: Restriction 1]
• [variable: Restriction 2]
• […]

I further authorize initiation of the following corrective actions, to be completed within the next calendar year:

• [variable: Required corrective action 1]
• [variable: Required corrective action 2]
• […]

Signature:

___________________________________

• [variable: Title of signing officer or director or manager]
• [variable: Covered Organization]
• [variable: Date]

References

Related Templates(s)

• Deferral of System Security Certification or Accreditation, Annual (Form)

Content Model(s)

• Federal Agency Security Practices, National Institute of Standards and Technology (NIST)