A03 - CDRL A002_Government Property Report.pdf

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

Block 4 - Contractor format acceptable per the Data Item Description, except as tailored herein. Include the following:

- Item Name

- Serial Number

- Part Number

- Associated Equipment

- Date Received

- Date Shipped

- Shipment Destination (DODAAC)

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

Block 11: First report is due on the 15th day after the first month of full performance.

Blocks 12 and 13 Submit NLT 15 calendar days after receipt or shipment of Government Furnished Equipment / Material. Submit quarterly if no GFE has been shipped or received.

E-mail addresses for Block 14 Distribution:

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

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.