Appendix F – FAC-COR Certification Action and Training Request Form

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PART A – APPLICANT IDENTIFICATION

Enter the required following information:

Name (Last, First, Middle Initial) ____________________________________________  

E-mail Address __________________  Phone _____________  Fax ______________

Organization Name _____________________________________________________

Organization Address   __________________________________________________

Title, Series, Grade    ___________________________________________________    

FAC-COR Certification Type:

□ Information Technology
□ Construction
□ Advanced Research and Development
□ Other (Please Specify): _____________________________________

PART B – CERTIFICATION ACTION TYPE

Indicate the type of certification action requested by checking the appropriate blocks. (NOTE: This form cannot be used to request certification through fulfillment or waiver – use the FAC-COR Certification through Fulfillment Form in Appendix H or the FAC-COR Waiver Request form in Appendix I.)

1.  □  Initial Certification
□ FAC-COR Level I – Entry/Apprentice   
□ FAC-COR Level II – Mid-level/Journeyman   
□ FAC-COR Level III – Senior/Expert 

2.  □  Recertification
□ FAC-COR Level I – Entry/Apprentice   
□ FAC-COR Level II – Mid-level/Journeyman   
□ FAC-COR Level III – Senior/Expert 

Previously held FAC-COTR □, FAC-C □, and/or FAC-P/PM □ certification(s) from another Federal agency (Attach a copy of certification):

• Name of Agency:_______________________________________
• Date Certification Issued:________________________________

PART C – INITIAL CERTIFICATION TRAINING

NOTE: Course title, date(s), and training sponsor are required for each minimum core training area listed below (including professional certification where applicable). 

□ Professional Training Profile for FAC-COR Level I (certification/documentation attached):

Minimum Basic Core Training:

• 16 hours Appropriations Law Training
• 08 hours Contracting Officer’s Representative Training
• StaffDiv/OPDIV specific training (e.g., invoice processing, green procurement)

 □ Professional Training Profile for FAC-COR Level II (certification/documentation attached):

Minimum Intermediate Core Training:

• 40 hours Contracting Officer’s Representative Training
• 16 hours Appropriations Law Training
• 1 Acquisition-Related Elective
• StaffDiv/OPDIV specific training (e.g., invoice processing, green procurement)

□ Professional Training Profile for FAC-COR Level III (certification/documentation attached):

Minimum Advanced Core Training:

• 40 hours Contracting Officer’s Representative Training
• 16 hours Appropriations Law Training
• 16 hours Introduction to Project/Program Management Training
• 08 hours EVM and Cost Estimating Training
• 08 hours Risk Management Training
• 08 hours IT, Construction, or R&D Acquisition Training

PART D –RECERTIFICATION TRAINING

□ Recertification Training for FAC-COR Level I (at least 16 hours)
(certification/documentation attached):

Training Requirements

• 1 day Contracting Officer’s Representative Refresher Training
• Appropriations Law Refresher Training
• 1 Acquisition-related elective

□ Recertification Training for FAC-COR Level II (at least 40 hours)
(certification/documentation attached):

Training Requirements:

• 1 day Contracting Officer’s Representative Refresher Training
• Appropriations Law Refresher Training
• 1 Acquisition-related elective
• 1 Contracting course elective

□ Recertification Training for FAC-COR Level III (at least 80 hours)
(certification/documentation attached):

Training Requirements:

• 1 day Contracting Officer’s Representative Refresher Training
• Appropriations Law Refresher Training
• 1 Acquisition-related elective
• 1 Contracting course elective
• 1 Ethics and Fraud Awareness Course

PART E –INFORMATION SUPPORTING THE CERTIFICATION ACTION

Indicate, by checking the appropriate blocks, the information completed and provided as attachments to support the certification action request:

□ Appendix G – Federal Acquisition Certification – Contracting Officer’s Representative – Functional Experience Transcript Form, (include copies of certificates, diplomas, transcripts, or other forms of experience and training documentation) (Required for FAC-COR Levels II and III)

□ Copy of current FAC-COR certification

□ Copy of other types of certifications currently held:

□ FAC-C   □ FAC-P/PM   □ Other (specify): ________________________

PART F – SIGNATURES

1. Applicant’s certification (Levels I, II, and III):

I certify that the information provided is accurate, current, complete, and fully supports the certification action request.

Applicant’s signature ________________________________Date_______________

2. Immediate supervisor’s concurrence/non-concurrence (Levels I, II, and III):

I have reviewed and discussed with [applicant’s name] the certification action request and the information provided in support thereof.  Based on pertinent job performance (if any), a critical element in the applicants performance standards, and the information provided, I

□ concur with the certification action   q do not concur with the certification action

□ Rationale for non-concurrence, if applicable: 

Typed or printed name ___________________________________________________

Signature _________________________________          Date ______________________

3. STAFFDIV/OPDIV Acquisition Career Manager concurrence/non-concurrence

(Levels I, II, and III):

I have reviewed the certification action request and the information provided in support thereof. Based on the information provided, I

□ concur with the certification action     q  do not concur with the certification action

□   Rationale for non-concurrence, if applicable: 

Typed or printed name ___________________________________________________

Signature _________________________________          Date ______________________

Links to the FAC-COR Handbook:

• FAC-COR Handbook (PDF-53 pages)
  • Executive Summary of the FAC-COR Handbook
  • Chapter 1: Implementation of HHS’ FAC-COR Program
  • Chapter 2: Requirements and Performance Accountability
  • Chapter 3: Application and Certification Procedures
  • Chapter 4: Certification Management
    • Appendix A: HHS’ COR Responsibilities
    • Appendix B: FAI’s Key Competencies for CORs
    • Appendix C: FAC-COR Curriculum Guidance
    • Appendix D: FAC-COR Guidance on Meeting Requirements for Continuous Learning Points
    • Appendix E: FAC-COR Appointment Letter Template
    • Appendix F: FAC-COR Certification Action and Training Request Form
    • Appendix G: FAC-COR Functional Experience Transcript Form
    • Appendix H: FAC-COR Certification through Fulfillment Form
    • Appendix I: FAC-COR Certification Waiver Request Form