A03 - CDRL A001_Site Survey Report (SSR).pdf

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SATCOM Terminal Maintenance Support STMS
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This document is a Contract Data Requirements List (CDRL) for a Site Survey Report (SSR) under the Satellite Communications (SATCOM) Terminal Maintenance Support (STMS) contract.

The SSR is required to be submitted within 30 calendar days after completion of a site survey. The report shall be prepared in contractor format in accordance with the cited Data Item Description (DID) and Performance Work Statement (PWS) requirements. On-site visits shall be no more than two days. The SSR shall be submitted electronically in MS Office and PDF formats to the Contracting Officer's Representative and Contracting Officer. The distribution of the SSR is limited to authorized US Government agencies.

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18. ESTIMATED

TOTAL

PRICE

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of Pages

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188).

Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

17. PRICE

GROUP

Contract Line Item No: TBD
TM: Off
Exhibit: A
TDP: Off
Other: MISC
System/Item: STMS
Contractor: TBD
Contract No: TBD
2024-02-16T08:27:21-0500
MAZURICK.JAMES.A.1290391985
Prepared Date:
Approved Date_af_date:
Page: 1
Of Pages:
ETP:
PG:
Block 16: PREPARATION INSTRUCTIONS: Prepare the required document, in contractor format, in accordance with the cited Data Item Description (DID) and PWS paragraph. On-site visits shall be no more than two (2) days.

Block 9: DISTRIBUTION B: Distribution to authorize US Government agencies, Critical Technology, 21 Feb 2010. Other requests for this document shall be referred to PdL CSTP, BDLG 6010, APG MD.

Blocks 11, 12 and 13: Submit within 30 calendar days after completion of a site survey.

SUBMISSION: All submissions shall be by secure electronic means (email) in both MS Office document compliant and Searchable Portable Document Format (PDF) form.

DISTRIBUTION: Electronic copies shall be submitted to the Contracting Officer’s Representative and Contracting Officer.

Data Item Number: A001
Title: Site Survey Reports (SSR)
Subtitle:
Authority: DI-MISC-82104
Contract Reference: PWS Para. 3.8.1,3.8.2
Requiring Office: SFAE-CCC-TNC
DD 250: [LT]
Approval Code: [N/A]
Dist Statement: [A]
Frequency: [ASRQ]
As of Date: SEE BLK 16
First Sub: SEE BLK 16
Sub sub: SEE BLK 16
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