Att 10 - CDRL Portfolio PSP.pdf
PDF 575 KB Posted
- Solicitation number
- HT001124R0080
- Issued by
-
Defense Health Agency
About this file
This document is a Contract Data Requirements List (CDRL) that specifies the data items required under a federal contract for Patient Safety Program Services at Military Medical Treatment Facilities. The CDRL lists 1 data item titled "Patient Safety Program (PSP) Services" and provides details on the authority, contract reference, requiring office, delivery requirements, distribution, and estimated pricing. The data item supports a federal contract for the Defense Health Agency Deputy Assistant Director for Medical Affairs Patient Safety Program. The CDRL indicates this data item is classified as "Other" and requires 1 draft copy and 1 final regular copy to be delivered. The government points of contact, a description of the overall contract opportunity, and instructions for responding to the solicitation are provided in a separate referenced document.
View the file
Other files
Show all 21
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
For the best experience, open this PDF portfolio in
Acrobat X or Adobe Reader X, or later.
Get Adobe Reader Now!
http://www.adobe.com/go/reader
PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, FEB 2001 PagesPage of
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130
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
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
16. REMARKS
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15.TOTAL
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
16. REMARKS (Continued)
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
DD FORM 1423-1 (BACK), FEB 2001
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.
DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;
Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.
DRAFT
SAMPLE
PREVIOUS EDITION MAY BE USED.
DD FORM 1423-1, FEB 2001
Pages
PREVIOUS EDITION MAY BE USED.
DD FORM 1423-1, FEB 2001
Pages
DRAFT
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
DD FORM 1423-1 (BACK), FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130
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.
C. CATEGORY:
14. DISTRIBUTION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft
Final
Reg
Repro
15.TOTAL
G. PREPARED BY
I. APPROVED BY
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
C. CATEGORY:
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data
Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.
DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in
Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in
Item 4; Clarification of submittal dates in Items 12 and 13;
Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.
9.0.0.2.20120627.2.874785
DD Form 1423-1, "CONTRACT DATA REQUIREMENTS LIST (1 Data Item) "
Click this button to save this form.:
Click this button to print this form.:
Click this Reset button to erase data from all fields.:
Enter total page numbers.:
A. CONTRACT LINE ITEM NUMBER:
EXHIB: 1
Select for "TDP.": 0
Select for "TM.": 0
Enter specification for "Other.": X-ADMN
SYS: Patient Safety Program Services
PR:
CONF:
TextField2: CDRL 002
TextField2: Management Plan
TextField2: Reports and Tasks
TextField2: DI-MGMT-80004
TextField2: PWS 5.4.8
TextField2: DHA/MA
TextField2: LT
TextField2: N/A
TextField2: N/A
TextField2: Monthly
TextField2: See Block 16
TextField2: See Block 16
TextField2: See Block 16
TextField2: Event and Near Miss Reporting: PSSs must comply with DoD-mandated analysis and patient reporting systems (DHA Product or DHA selected CSA tool) and Joint Patient Safety Reporting (JPSR) system and provide consultation on how MTFs should use this data to identify system and process issues that could have or did result in harm. Contractor personnel shall assist MTFs in identifying the classification of each reported event; then advise on the level of assessment and investigation that is required. Additionally, the Contractor shall assist MTF personnel in education of the handler reviewer rules of the JPSR. Reports should be produced for the MTF leadership in a timely manner and PSRs overdue rates should meet the DHA PM 6025.13 guidelines.
Delivery is via JPSR. .
TextField2: See Block 16
Total draft copies is automatically calculated.:
Total final regular copies is automatically calculated.:
Total final reproducible copies is automatically calculated.:
DecimalField1:
G. PREPARED BY (Signature):
I. APPROVED BY (Signature):
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
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.
DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;
conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any
PREVIOUS EDITION MAY BE USED.
DD FORM 1423-1, FEB 2001
Pages
PREVIOUS EDITION MAY BE USED.
DD FORM 1423-1, FEB 2001
Pages
DRAFT
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
DD FORM 1423-1 (BACK), FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130
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.
C. CATEGORY:
14. DISTRIBUTION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft
Final
Reg
Repro
15.TOTAL
G. PREPARED BY
I. APPROVED BY
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
C. CATEGORY:
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data
Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.
DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in
Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in
Item 4; Clarification of submittal dates in Items 12 and 13;
Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.
9.0.0.2.20120627.2.874785
DD Form 1423-1, "CONTRACT DATA REQUIREMENTS LIST (1 Data Item) "
Click this button to save this form.:
Click this button to print this form.:
Click this Reset button to erase data from all fields.:
Enter total page numbers.:
A. CONTRACT LINE ITEM NUMBER:
EXHIB: 1
Select for "TDP.": 0
Select for "TM.": 0
Enter specification for "Other.": X-ADMN
SYS: Patient Safety Program Services
PR:
CONF:
TextField2: CDRL 003
TextField2: Management Plan
TextField2: JPSR
TextField2: DI-MGMT-80004
TextField2: PWS 5.4.8
TextField2: DHA/MA
TextField2: LT
TextField2: N/A
TextField2: N/A
TextField2: As Directed by DHA PM
TextField2: See Block 16
TextField2: See Block 16
TextField2: See Block 16
TextField2: Event and Near Miss Reporting: PSSs must comply with DoD-mandated analysis and patient reporting systems (DHA Product or DHA selected CSA tool) and Joint Patient Safety Reporting (JPSR) system and provide consultation on how MTFs should use this data to identify system and process issues that could have or did result in harm. Contractor personnel shall assist MTFs in identifying the classification of each reported event; then advise on the level of assessment and investigation that is required. Additionally, the Contractor shall assist MTF personnel in education of the handler reviewer rules of the JPSR. Reports should be produced for the MTF leadership in a timely manner and PSRs overdue rates should meet the DHA PM 6025.13 guidelines.
Delivery via JPSR and electronic e-mail.
TextField2: See Block 16
Total draft copies is automatically calculated.:
Total final regular copies is automatically calculated.:
Total final reproducible copies is automatically calculated.:
DecimalField1:
G. PREPARED BY (Signature):
I. APPROVED BY (Signature):
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
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.
DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;
conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any
PREVIOUS EDITION MAY BE USED.
DD FORM 1423-1, FEB 2001
Pages
PREVIOUS EDITION MAY BE USED.
DD FORM 1423-1, FEB 2001
Pages
DRAFT
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
DD FORM 1423-1 (BACK), FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130
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.
C. CATEGORY:
14. DISTRIBUTION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft
Final
Reg
Repro
15.TOTAL
G. PREPARED BY
I. APPROVED BY
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
C. CATEGORY:
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data
Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.
DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in
Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in
Item 4; Clarification of submittal dates in Items 12 and 13;
Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.
9.0.0.2.20120627.2.874785
DD Form 1423-1, "CONTRACT DATA REQUIREMENTS LIST (1 Data Item) "
Click this button to save this form.:
Click this button to print this form.:
Click this Reset button to erase data from all fields.:
Enter total page numbers.:
A. CONTRACT LINE ITEM NUMBER:
EXHIB: 1
Select for "TDP.": 0
Select for "TM.": 0
Enter specification for "Other.": X-ADMN
SYS: Patient Safety Program Services
PR:
CONF:
TextField2: CDRL 004
TextField2: Management Plan
TextField2: HRO
TextField2: DI-MGMT-80004
TextField2: PWS 5.4.35
TextField2: DHA/MA
TextField2: LT
TextField2: N/A
TextField2: N/A
TextField2: As Directed by DHA PM
TextField2: See Block 16
TextField2: See Block 16
TextField2: See Block 16
TextField2: Safety Coach: Serve as the Safety Coach with responsibility for performing duties as the Safety Coach under HRO. The contractor will not function as the HRO Coordinator however, they will assist in the collect of HRO data such as; Ready, Reliable Care Safety Communication Bundle or as the name may change under different HRO titles.
Delivery is electronic via designated DHA system.
TextField2: See Block 16
Total draft copies is automatically calculated.:
Total final regular copies is automatically calculated.:
Total final reproducible copies is automatically calculated.:
DecimalField1:
G. PREPARED BY (Signature):
I. APPROVED BY (Signature):
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
Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.
DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;
conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any
PREVIOUS EDITION MAY BE USED.
DD FORM 1423-1, FEB 2001
Pages
PREVIOUS EDITION MAY BE USED.
DD FORM 1423-1, FEB 2001
Pages
DRAFT
INSTRUCTIONS FOR COMPLETING DD FORM 1423
(See DoD 5010.12-M for detailed instructions.)
DD FORM 1423-1 (BACK), FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
Form Approved OMB No. 0704-0188 OMB Approval Expires 20221130
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.
C. CATEGORY:
14. DISTRIBUTION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft
Final
Reg
Repro
15.TOTAL
G. PREPARED BY
I. APPROVED BY
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
C. CATEGORY:
FOR GOVERNMENT PERSONNEL
Item A. Self-explanatory.
Item B. Self-explanatory.
Item C. Mark (X) appropriate category: TDP - Technical Data
Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.
Item D. Enter name of system/item being acquired that data will support.
Item E. Self-explanatory (to be filled in after contract award).
Item F. Self-explanatory (to be filled in after contract award).
Item G. Signature of preparer of CDRL.
Item H. Date CDRL was prepared.
Item I. Signature of CDRL approval authority.
Item J. Date CDRL was approved.
Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.
Item 2. Enter title as it appears on data acquisition document cited in Item 4.
Item 3. Enter subtitle of data item for further definition of data item (optional entry).
Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.
Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).
Item 6. Enter technical office responsible for ensuring adequacy of the data item.
Item 7. Specify requirement for inspection/acceptance of the data item by the Government.
Item 8. Specify requirement for approval of a draft before preparation of the final data item.
Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.
DoDD 5230.24).
Item 10. Specify number of times data items are to be delivered.
Item 11. Specify as-of date of data item, when applicable.
Item 12. Specify when first submittal is required.
Item 13. Specify when subsequent submittals are required, when applicable.
Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in
Item 16.
Item 15. Enter total number of draft/final copies to be delivered.
Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in
Item 4; Clarification of submittal dates in Items 12 and 13;
Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.
FOR THE CONTRACTOR
Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.
a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.
Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.
b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.
Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.
c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.
Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.
d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.
Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.
Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.
These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.
9.0.0.2.20120627.2.874785
DD Form 1423-1, "CONTRACT DATA REQUIREMENTS LIST (1 Data Item) "
Click this button to save this form.:
Click this button to print this form.:
Click this Reset button to erase data from all fields.:
Enter total page numbers.:
A. CONTRACT LINE ITEM NUMBER:
EXHIB: 1
Select for "TDP.": 0
Select for "TM.": 0
Enter specification for "Other.": X-ADMN
SYS: Patient Safety Program Services
PR:
CONF:
TextField2: CDRL 005
TextField2: Management Plan
TextField2: Weekly bullets
TextField2: DI-MGMT-80004
TextField2: PWS 5.3.5
TextField2: DHA/MA
TextField2: LT
TextField2: N/A
TextField2: N/A
TextField2: Every Week
TextField2: See Block 16
TextField2: See Block 16
TextField2: See Block 16
TextField2: The Contractor’s (Program Manager)/Focal Point shall meet with the Government team at least weekly, and additional meetings may be requested by the Government or the Contractor as necessary. The Contracting Officer (CO), CORs, and/or other designated representative will provide performance feedback to the Contractor as necessary. The Contractor’s Program Manager will be responsible to manage the task order to ensure that requirements and deadlines are met. The Contractor shall provide an agenda and minutes, in addition to a summary of bullet statements of work completed by each identified MTF. The summary of bullets statements of should include, but not limited to: major job performance topics, overdue PSRs, and most current MTF/Network Leadership. Program manager will summarize and submit to the COR
Delivery is electronic via e-mail.
TextField2: See Block 16
Total draft copies is automatically calculated.:
Total final regular copies is automatically calculated.:
Total final reproducible copies is automatically calculated.:
DecimalField1:
G. PREPARED BY (Signature):
I. APPROVED BY (Signature):
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).
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .