Attach 4 - Contract Data Requirements List (CDRL) DD Form 1423 A001 - A014.pdf

CONTRACT DATA REQUIREMENTS LIST (Data Item) Form Approval OMB No. 0704-0188

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

EXHIBIT .......................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

CATEGORY .................................... : OTHER F. CONTRACTOR : PRESOLICITATION

1. DATA ITEM NO. ....................... : A001

2. TITLE OF DATA ITEM ........... : Presentation Materials

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-ADMN-81373 (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9.DIST. STATEMENT REQUIRED ........ : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10.FREQUENCY ......................................... : (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE ........................................ : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/ RDHP 1

AFRL/RDKP Lt

15.TOTAL: 2

16. REMARKS

Block 4: Format of materials will be in accordance with paragraphs 3.1 and 10.1.

Block 9: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland

AFB, NM 87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM

OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Control Export Act. (Title 22, U.S. C. Sec 2751 et. seq) or the Export Administration Act of 1979, as amended, Title 50, US. C., App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisionsOper of DOD Directive 5230.25.” (ADD THIS ENTIRE DISTRIBUTION

STATEMENT TO THE BOTTOM OF EACH PAGE.)

DESTRUCTION NOTICE – For unclassified, limited documents, destroy by any method that will prevent disclosure of content or reconstruction of the document.

Block 10, 12 and 13: The contractor will submit formal briefing presentation materials three (3) working days prior to the presentation. No data item is required for informal briefings.

Block 14: Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a hard copy to the PM and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

17. PRICE GROUP: 18. ESTIMATED TOTAL PRICE:

G. PREPARED BY: Robert Achenbach I. APPROVED BY: ASO; M. Mendoza

H. DATE: 16 June 2020 J. DATE: 19 June 2020

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 1 of 14 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

EXHIBIT .......................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

CATEGORY .................................... : OTHER F. CONTRACTOR ....... : PRESOLICITATION

1. DATA ITEM NO. ....................... : A002

2. TITLE OF DATA ITEM ........... : Status Report

3. SUBTITLE .................................. : Technical Status Report (TSR)

4. AUTHORITY .............................. : DI-MGMT-80368A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : (See Block 16) 10. FREQUENCY……………………...: (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/RDHP 1

15. TOTAL: 2

Tailored:

Para 3.2.3 Itemized man-hours and costs. Itemized man-hour and cost expenditure incurred for the reporting period by category and task, and ACRN;

total contractual expenditures, and fund remaining as of the reporting date.

Block 7: Normally, only a letter of transmittal is required. However, a DD 250Z shall accompany the closeout TSR.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement E if containing Proprietary Information:

"Distribution authorized to DoD components only; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air

Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. Sec. 2751, et seq.)

or the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

TO THE BOTTOM OF EACH PAGE OF THE REPORT.)

Or the Distribution Statement F if containing no proprietary information:

“Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM 87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. Sec. 2751, et seq.)

or the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD THIS ENTIRE DISTRIBUTION STATEMENT

DESTRUCTION NOTICE – For unclassified, limited documents, destroy by any method that will prevent disclosure of content or reconstruction of the document.

Block 10, 12 and 13: Provide monthly status reports NLT fifteen (15) calendar days following the close of the contractor’s monthly accounting period through completion of the contract technical period of performance, with a final status report at contract completion. Reports shall be summarized by contract through contract completion.

Block 14: Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a hard copy to the MP and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

G. PREPARED BY: Robert Achenbach I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 2 of 14 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

EXHIBIT .......................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

CATEGORY .................................... : OTHER F. CONTRACTOR ....... : PRESOLICITATION

1. DATA ITEM NO. ....................... : A003

2. TITLE OF DATA ITEM ........... : Scientific and Technical Report (S&T)

3. SUBTITLE .................................. : Final Report

4. AUTHORITY .............................. : DI-MISC-80711A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ....... : (See (Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : DD 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : A 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

Final CRC

AFRL/RDH Business Office 1 1

AFRL/ RDHP 1 1

AFRL / RDKP Lt Lt

15.TOTAL: 2 2

THE REPORT WILL BE PUBLISHED WITH THE DEFENSE TECHNICAL INFORMATION CENTER (DTIC) BY AFRL/RDO. Under no circumstances shall the contractor submit either the draft or the final technical report to DTIC.

Block 4: GUIDANCE FOR PREPARATION OF THE REPORT: The Scientific and Technical Report shall be prepared I.A.W. the most current AFRL

ANSI/NISO Standard Z39.18-2005, or other most current report preparation guidance. The contractor shall complete the most current SF 298 Report Documentation

Page, and submit it with the report. The contractor shall complete the following blocks of the SF 298: Blocks 2-5a, 6, 7, 8 and 13 (if applicable), and 14-16c. The contractor shall complete and sign the most current AFRL Form 25, AFRL Quality Final Technical Report Checklist, and submit it with the report as part of the report deliverable IAW CLIN 0002. If the completed and signed AFRL Form 25 does not accompany the report, the deliverable is considered incomplete. Incomplete reports will be immediately returned to the contractor. Following AFRL technical and STINFO reviews, any revisions required will be returned to the contractor. NOTE: The report preparation guidance, SF 298, and AFRL Form 25 are available at: http://www.kirtland.af.mil/prs.

The contractor shall deliver two editable electronic copies of the report. The electronic copies shall be an editable .pdf file and the most current version of Microsoft Word. A CD-

ROM (CD-R) is the acceptable media for submittal (CD-RWs are not acceptable). Electronic media shall be marked I.A.W. the AFRL ANSI/NISO Standard Z39.18-2005 guidelines, or other most current report preparation guidance. Submission via unencrypted or unsecure email is not permitted.

Block 7: UPON NOTIFICATION OF ACCEPTANCE OF THE SCIENTIFIC AND TECHNICAL REPORT FROM THE PROGRAM OFFICE, the contractor shall submit the final Receiving Report (DD Form 250) in WAWF. In preparing the final DD Form 250, code the shipment number with a “Z.” Do not upload the Scientific and Technical Report into WAWF or DTIC. NOTE: SUBMITTAL OF THE DD FORM 250Z PRIOR TO ACCEPTANCE NOTIFICATION WILL RESULT IN REJECTION OF THE DD FORM

250Z FINAL RECEIVING REPORT.

Block 9: All technical data (including electronic media/CD-R) shall be marked I.A.W. DoDI 5230.24 with Distribution Statement F, and other required markings, shown indented below:

“Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM 87117-5776 or higher DoD authority, date of submission”. (ADD THIS ENTIRE

DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec. 2751, et seq.) or the Export

Administration Act of 1979, as amended. Title 50 U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate I.A.W. the provisions of the DoD Directive 5230.25.” (ADD “WARNING: EXPORT CONTROLLED” TO THE BOTTOM OF EVERY PG OF THE REPORT EXCEPT THE SF

298.)

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.”

Blocks 8, 10 - 13: The contractor shall deliver the Final Scientific and Technical Report, in draft, no later than the date specified in the Schedule, CLIN 0002. The USAF will review, edit and return the draft no later than the date specified in the Schedule, CLIN 0002. Upon receipt of the reviewed and edited draft, the contractor shall deliver the final version of the report no later than the date specified in the Schedule, CLIN 0002.

Block 14: The contractor shall distribute the Scientific and Technical Report (final/CRC version(s)) in accordance with Block 14. When the addressee’s copy is identified by “Ltr”, send only a copy of the transmittal letter to that addressee.

17. PRICE GROUP: 18.ESTIMATED TOTAL PRICE:

I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 3 of 14 Pages http://www.kirtland.af.mil/prs

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR ....... : PRESOLICITATION

1. DATA ITEM NO. ....................... : A004

2. TITLE OF DATA ITEM ........... : Developmental Design Drawings and Associated Lists

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-SESS-81002F (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

Block 4: Paragraph 3. Format. Developmental Design Drawings/Models and Associated Lists shall be in the contractor's format. Tailor will be specified in the task order/contract.

Block 9: All documentation shall be marked in accordance with by the National Industrial Security Program Operating Manual (NISPOM), DoD

5200.22-M, Feb 2006 and its supplements and contain the following Distribution Statement and Export Control Warnings:

Distribution Statement E if containing Proprietary Information:

"Distribution authorized to DoD components only; Critical Technology; (date of submittal). Other requests for this document shall be referred to Air

Force Research Laboratory/(PM’s office symbol), 3550 Aberdeen Ave SE, Kirtland AFB, NM 87117-5776.

“WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. Sec. 2751, et seq.)

or the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 240 I et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25."

Or the Distribution Statement F if containing no proprietary information:

“Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM 87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. Sec. 2751, et seq.)

or the Export Administration Act of 1979, as amended, Title 50, U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." (ADD “WARNING: EXPORT CONTROLLED” TO THE

BOTTOM OF EVERY PG OF THE REPORT.)

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.”

Block 10, 12 and 13: As required.

Block 14: Submit an electronic version (Microsoft format) on CD-R along with a hard copy to the PM and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 4 of 14 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR ....... : PRESOLICITATION

1. DATA ITEM NO. ....................... : A005

2. TITLE OF DATA ITEM ........... : Test Plan

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-NDTI-80566A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

Block 4: The test plan (with attached appendices for safety, security, transportation, etc, as needed) shall be written IAW the template provided by the AFRL/RDH Test Director.

Block 9: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM

87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec. 2751, et seq.)

or the Export Administration Action of 1979, as amended. Title 50 U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate I.A.W. the provisions of the DoD Directive 5230.25.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO

THE BOTTOM OF EACH PAGE OF THE REPORT.)

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 10, 12 and 13: The document will be due 30 calendar days before the start of an experiment or demonstration to the PM and RDH Business

Office. The document needs to be generated only once per Task, unless testing parameters or type change.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 5 of 14 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR ...... : PRESOLICITATION

1. DATA ITEM NO. ....................... : A006

2. TITLE OF DATA ITEM ........... : Computer Program End Item Documentation

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-IPSC-80590B (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10.FFRREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

Block 4: Paragraph 3.1.3, format/media for executables and databases shall be specified in the contract, order, and/or as directed by the PM.

Block 9: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM

87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec. 2751, et seq.)

or the Export Administration Action of 1979, as amended. Title 50 U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate I.A.W. the provisions of the DoD Directive 5230.25.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO

THE BOTTOM OF EACH PAGE OF THE REPORT.)

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 10, 12 and 13: Submitted once for each uniquely identified computer software product; within 30 calendar days following completion of validation and acceptable of the software product.

Block 14: Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a hard copy to the PM and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

G. PREPARED BY:

Robert Achenbach

I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page _6 of 14 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 I. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A J. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER K. CONTRACTOR ...... : PRESOLICITATION

1. DATA ITEM NO. ....................... : A007

2. TITLE OF DATA ITEM ........... : Software User's Manual

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-IPSC-81443A (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

Block 4: Contractor format. Tailoring will be specified in the Contract/Task.

Block 9: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM

87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec. 2751, et seq.)

or the Export Administration Action of 1979, as amended. Title 50 U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate I.A.W. the provisions of the DoD Directive 5230.25.”(ADD THIS ENTIRE DISTRIBUTION STATEMENT TO

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 10, 12 and 13: Submitted once for each uniquely identified computer software product; within 30 calendar days following completion of validation and acceptable of the software product.

Block 14 Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a hard copy to the PM and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

L. PREPARED BY: Robert Achenbach I. APPROVED BY: ASO; M. Mendoza

M. DATE: 16 June 2020 J. DATE: 19 June 2020

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page _7 of 14 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR ...... : PRESOLICITATION

1. DATA ITEM NO. ....................... : A008

2. TITLE OF DATA ITEM ........... : Technical Report

3. SUBTITLE .................................. : Study Services

4. AUTHORITY .............................. : DI-MISC-80508B (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

Block 4: Contractor Format. Tailoring will be specified in the Contract/Task.

Block 9: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM

87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec. 2751, et seq.)

or the Export Administration Action of 1979, as amended. Title 50 U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate I.A.W. the provisions of the DoD Directive 5230.25.”(ADD THIS ENTIRE DISTRIBUTION STATEMENT TO

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 10, 12 and 13: Submitted once for each uniquely identified study; within 30 calendar days following completion of the analysis.

Block 14: Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a hard copy to the PM and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page_ 8 of 14 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA- FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR ...... : PRESOLICITATION

1. DATA ITEM NO. ....................... : A009

2. TITLE OF DATA ITEM ........... : Computer Software Product End Items

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-AVCS-80700A

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ....... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10.FREQUENCY……………………...: (See Block 16) 13.DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE .......................................... : N/A

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

15. TOTAL: 2

Block 4: Contractor format. Tailoring will be specified in the Contract/Task.

Block 9: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM

87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec. 2751, et seq.)

or the Export Administration Action of 1979, as amended. Title 50 U.S.C. App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate I.A.W. the provisions of the DoD Directive 5230.25.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Blocks 10, 12, and 13: Submitted once for each uniquely identified computer software product; within 30 calendar days following completion of validation and acceptance of the software product.

Block14: Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a hard copy to the PM and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 9 of 14 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR : PRESOLICITATION

1. DATA ITEM NO. ....................... : A010

2. TITLE OF DATA ITEM ........... : System Safety Hazard Analysis Report (SSHA)

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-SAFT-80101C (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ........ : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10. FREQUENCY ........................................ : (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE ........................................ : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

Block 9: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM

87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Control Export Act. (Title 22, U.S. C. Sec 2751 et. seq) or the Export Administration Act of 1979, as amended, Title 50, US. C., App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DOD Directive 5230.25.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or

Block 10: Once with updates.

Blocks 11-12: The draft SSHA shall be delivered within 60 calendar days following Authorization to Proceed (ATP). The government will review and provide comments to the draft plan within 30 calendar days after receipt of the draft. Upon receipt of the comments, the contractor shall take no more than 15 calendar days to incorporate all required changes and deliver the final version of the report.

Block 13: Updates shall be delivered within 30 calendar days of any major finding that drives a subsequent analysis

Block14: Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a hard copy to the PM and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

G. PREPARED BY: Robert Achenbach I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 10 of 14 Pages

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 Department of

Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR : PRESOLICITATION

1. DATA ITEM NO. ....................... : A011

2. TITLE OF DATA ITEM ........... : Safety Assessment Report (SAR)

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-SAFT-80102C (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ...... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10. FREQUENCY ....................................... : (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/ RDHP 1

AFRL/SE 1

15.TOTAL: 3

Block 9: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM

87117-5776 or higher DoD authority, date of submission.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

“WARNING: This document contains technical data whose export is restricted by the Arms Control Export Act. (Title 22, U.S. C. Sec 2751 et. seq) or the Export Administration Act of 1979, as amended, Title 50, US. C., App 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DOD Directive 5230.25.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE

BOTTOM OF EACH PAGE OF THE REPORT.)

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.”

Blocks 10, 12, and 13: As required.

Block14: Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a hard copy to the PM and RDH Business Office.

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 11 of 14 Pages

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 Department of

Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR : PRESOLICITATION

1. DATA ITEM NO. ....................... : A012

2. TITLE OF DATA ITEM ........... : Contract Funds Status Report (CFSR)

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-MGMT-81468 (http://www.assistdocs.com)

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ...... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10. FREQUENCY ....................................... : (See Block 16) 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE .................................. : No 11. AS OF DATE ......................................... : (See Block 16)

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/ RDHP 1

DCAA 1

15.TOTAL: 3

Block 9: DISTRIBUTION STATEMENT B: Distribution authorized to US government agencies; Proprietary Information; (date of submittal). Other requests shall be referred to AFRL/RDHP, 3550 Aberdeen SE, Kirtland AFB NM 87117-5776. (ADD THIS ENTIRE DISTRIBUTION

STATEMENT TO THE BOTTOM OF EACH PAGE OF THE REPORT.)

“WARNING: To protect information not owned by the U.S. Government and protected by a contractor’s “limited rights” statement, or received with the understanding that it not be routinely transmitted outside the U.S. Government.

“DESTRUCTION NOTICE—For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction

Block 10, 11, 12 & 13: The CFSR is due quarterly. The first CFSR is due within 25 calendar days after the end of the first calendar quarter after date of contract award (DOA), unless that period is less than 30 calendar days. Subsequent submissions are due within 25 calendar days after the end of each calendar quarter through end of contract performance. A closeout CFSR showing final cost status is due within 25 calendar days after the first full month after the contractor has submitted the final version of the final report.

Block14: Submit an electronic version (Microsoft format) on CD-ROM (CD-R) along with a copy to the PM and RDH Business Office

Electronic versions must be submitted in a manner consistent with protecting export control and limited information.

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 12 of 14 Pages

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 Department of

Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced HPEM Source Research (AHSR)

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0003

C. CATEGORY ............................... : OTHER F. CONTRACTOR : PRESOLICITATION

1. DATA ITEM NO. ....................... : A013

2. TITLE OF DATA ITEM ........... : Operations and Maintenance Instructions

3. SUBTITLE .................................. : N/A

4. AUTHORITY .............................. : DI-MISC-81414A

5. CONTRACT REFERENCE ...... : :

6. REQUIRING OFFICE............... : AFRL/RDHP 9. DIST. STATEMENT REQUIRED ...... : (See Block 16) 12. DATE OF FIRST SUBMISSION: (See Block 16)

7. DD 250 REQ ................................ : Lt 10. FREQUENCY ....................................... : One 13. DATE OF SUBSEQUENT SUBM.: (See Block 16)

8. APP CODE ..................................