A03 R001 DI-MGMT-82041B SB Utilization Report signed.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

Contractor's Format (compatibility MS Office 2013 products and PDF) is acceptable as long as the file is searchable and in a non-imaged format. The contractor shall include the following elements:

1. Business category total contract value (include totals for Prime contractor, Small Business (SB) and socio-economic categories (SDB, WOSB, Hubzone, VOSB, SDVOSB))

2. Dollar value for each business category

3. Percent of total contract value for each business category

4. Company name

5. Small business socio-economic categories (SB, SDB, WOSB, Hubzone, VOSB, SDVOSB)

6. List of principle products/services to be performed by Small Businesses (including type and variety of work)

7. North American Industry Classification System (NAICS) codes as applicable by offeror

8. The nature of the commitment with the Small Business concern (i.e., letter of commitment, joint ventures, mentor protege agreements, others)

9. Performance Work Statement paragraph reference and description of work performed

The contract is relieved from including DID para 3.b) and 3.c) in the report.

Block(s) 10, 11, 12 and 13: Item shall be submitted 180 days ADAD initially,then due every 180 days.

Block 14: Distribution shall consist of submission of electronic copies via secure means; notification shall be provided to the Government points of contact.