Att J.5 - CDRL A001 - Small Business Part Q Rpt.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

Tailored to permit contractor's format.

Submit electronically no later than the the tenth (10th) working day after the end of each quarter. The following are the Quarterly end dates applicable to each year during the life of the contract: March 31st, June 30th, September 30th, December 31st.

Contract shall include the actual small business participation during the reporting period to include the following information: Company name, Cage Code, business category(ies), description of products or services, and NAICS code for each Small Business Concern (SBC) and the current commitment with the SBC. The contractor shall include their original proposed Small Business Participation information. The contractor shall provide rationale for differences between what was proposed and the contractor's actuals.

In addition, the contractor shall include a table identifying the proposed dollar value and proposed percent of total contract value and the contractor's actual dollar value and percent of total contract value for the reporting period for each category below. The table shall also provide a column with the difference (percentage) between what the contractor proposed and the actual data for the reporting period. The contractor shall include rationale for differences between what was proposed and the contractor's actuals.

Business Category:

Total Proposed Contract Value – Prime Offeror Total Small Business Small Disadvantaged Business Woman-Owned Small Business HUBZone Small Business Veteran-Owned Small Business Service-Disabled Veteran-Owned Small Business

Block 7-Inspection and acceptance requirements:

The KO will review and accept CDRL A001.

Block 14-Distribution-Contractor to submit original to the Contract Specialist and copy to the COR.