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

PDF 896 KB Posted Jul 2, 2021

Attached to: Advanced Electromagnetic Technology (AET) Federal contract opportunity
Solicitation number: FA9451-21-S-0002
Issued by: Department of the Air Force Materiel Command Research Laboratory

About this file

Written by GovTribe AI · Dec 27, 2023

This is a Contract Data Requirements List (CDRL) specifying 14 data items required under a Broad Agency Announcement (BAA) from the Air Force Research Laboratory for proposals related to Advanced Electromagnetic Technology. Key deliverables include presentation materials due 3 days prior to briefings, monthly technical status reports due 15 days after each monthly period of performance, developmental design drawings and associated lists as specified in individual task orders, a test plan due 30 days before experiment start, computer program documentation and software manuals within 30 days of validation, and scientific and technical reports and software end items delivered per contract schedules. Safety and program documentation such as hazard analyses and assessments are also required at defined intervals. Additional recurring deliverables comprise program funding status reports, property inventories, and operations/maintenance instructions for research equipment.

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Other files for this federal contract opportunity

Other files attached to Advanced Electromagnetic Technology (AET), newest first.
File	Type	Posted
AET BAA Solicitation FA9451-21-S-0002 Amendment 1 20210812.pdf	PDF	Aug 16, 2021
QandA BAA FA9451-21-S-0002.pdf	PDF	Aug 10, 2021
Attach 3b - AET Task Order 2 SOO dated 14 July 2021 Amendment 1.pdf	PDF	Jul 22, 2021
Attach 6 - Guide to Preparing Contractor Statement of Work (CSOW).pdf	PDF	Jul 2, 2021
Attach 8 - Cost Proposal Instructions (Non-APC) dated 27 March 20.pdf	PDF	Jul 2, 2021
Attach 10 - Broad Agency Announcement (BAA) Guide for Industry March 2020.pdf	PDF	Jul 2, 2021
AET BAA Solicitation FA9451-21-S-0002 20210702.pdf	PDF	Jul 2, 2021
Attach 2 - AET Statement of Work (SOW) Supplemental Requirements dated 5 May 2021.pdf	PDF	Jul 2, 2021
Attach 3d - AET Task Order 4 SOO dated 5 May 2021.pdf	PDF	Jul 2, 2021
Attach 5a - DD 254 Continuation Sheet.pdf	PDF	Jul 2, 2021
Attach 3e - AET Task Order 5 SOO dated 5 May 2021.pdf	PDF	Jul 2, 2021
Attach 5 - DD 254 Contract Security Classification Specification.pdf	PDF	Jul 2, 2021
Attach 7 - Section K Reps and Certs.pdf	PDF	Jul 2, 2021
Attach 9 - Proposal Adequacy Checklist.pdf	PDF	Jul 2, 2021
Attach 1 - AET Basic IDIQ SOO dated 5 May 2021.pdf	PDF	Jul 2, 2021
Attach 3a - AET Task Order 1 SOO dated 5 May 2021.pdf	PDF	Jul 2, 2021
Attach 3b - AET Task Order 2 SOO dated 5 May 2021.pdf	PDF	Jul 2, 2021
Attach 3c - AET Task Order 3 SOO dated 5 May 2021.pdf	PDF	Jul 2, 2021
Attach 3f - AET Task Order 6 SOO dated 5 May 2021.pdf	PDF	Jul 2, 2021

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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 Electromagnetic Technologies

EXHIBIT .......................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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 ........................................... : 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: 0 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 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.”

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:

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

H. DATE: 27 April 2021 J. DATE: 04 May 2021

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 Electromagnetic Technologies

EXHIBIT ..................................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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/RHDP 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 ........................................... : 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

15. TOTAL: 0 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: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM 87117-5776 or higher DoD

“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: 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 completion of performance. 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 PM and RDH Business Office.

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

G. PREPARED BY: SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

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

CONTRACT DATA REQUIREMENTS LIST (1 Data Item) Form Approval OMB No. 0704-0188

Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.: 0002

B. EXHIBIT....................................: A

C. CATEGORY..............................: OTHER

D. SYSTEM/ITEM........: Advanced Electromagnetic Technologies

E. CONTRACT/PR NO. BAA-FA9451-21-S-0002

F. CONTRACTOR.........: PRESOLICITAION

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

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

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

4. Authority……………………:

DI-MISC-80711A (http://quicksearch.dla.mil)

5. CONTRACT REFERENCE......:

6. REQUIRING OFFICE......: AFRL/RDHP

7. DD250 REQ................................: DD

8. APP CODE.................................: A

9. DIST. STATEMENT REQUIRED......: See Blk. 16

10. FREQUENCY......................................: See Blk. 16

11. AS OF DATE........................................: See Blk. 16

12. DATE OF FIRST SUBMISSION……: See Blk. 16

13. DATE OF SUBSEQUENT SUBM…...: See Blk. 16

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

- Addressee identified by “Lt”, send only a copy of the transmittal letter

DRAFT FINAL

AFRL/RDHP 1 1

AFRL/RDKP Lt Lt

15. TOTAL: 1 1

THE REPORT WILL BE PUBLISHED WITH THE DEFENSE TECHNICAL INFORMATION CENTER (DTIC) BY AFRL STINFO OFFICE. Under no circumstances shall the contractor submit any version of the scientific and technical report to DTIC.

Blk. 4: GUIDANCE FOR PREPARATION OF THE REPORT: The Scientific and Technical Report shall be prepared I.A.W. the most current ANSI/NISO Standard Z39.18-2005, or most current AFRL ANSI report preparation guidance. The contractor shall complete the most current SF 298: Blocks 2-5a, 6, 7, 8 and 13 (if applicable), and 14-16c, and submit it with the report. 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 and SF 298 are available at: https://www.kirtland.af.mil/Units/AFRL-Directed-Energy-Directorate/

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. Submission via unencrypted or unsecure email is not permitted. If encrypted email is not available, please use: https://safe.apps.mil/.

Blk. 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.

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

“Distribution authorized to Department of Defense and US DoD contractors only; Critical Technology, Export Controlled [contractor fill in date of report (dd mmm yy)]. Other requests for this document shall be referred to AFRL/RD 3550 Aberdeen Avenue, SE, Kirtland AFB, NM 87117-5776.” (ADD THIS ENTIRE DISTRIBUTION STATEMENT TO THE

BOTTOM OF EVERY PAGE OF THE REPORT EXCEPT THE SF 298.)

“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—CUI documents may be destroyed by means approved for destroying classified information or by any other means making it unreadable, indecipherable, and unrecoverable.

Blk. 10 - 13: The contractor shall deliver the Scientific and Technical Report, in final format, no later than the date specified in the Contract Schedule. The USAF will review and, if necessary, return the report with comments no later than the date specified in the Contract Schedule. If the report is returned to the contractor with comments, the contractor shall deliver the final copy of the report no later than the date specified in the Contract Schedule.

17. PRICE GROUP: 18. ESTIMATED TOTAL PRICE :

G. PREPARED BY: SUSAN HEIDGER

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 3 of 14 Pages http://quicksearch.dla.mil/ https://www.kirtland.af.mil/Units/AFRL-Directed-Energy-Directorate/ https://safe.apps.mil/

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 Electromagnetic Technologies

B. EXHIBIT ............................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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/RHDP 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 ........................................... : 11. AS OF DATE .......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

15.TOTAL: 2

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: DISTRIBUTION STATEMENT F: “Further dissemination authorized only as directed by AFRL/RD, 3550 Aberdeen Ave. SE, Kirtland AFB, NM 87117-5776 or higher DoD

“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 by Procurement Contracting Officer (PCO) approved Contract/Task Order.

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.

17. PRICE GROUP: 18.ESTIMATED TOTAL PRICE:

SUSAN HEIDGER

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

A. CONTRACT LINE ITEM NO. : 0002 D. SYSTEM/ITEM : Advanced Electromagnetic Technologies

B. EXHIBIT ..................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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/RHDP 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 .................................. : 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

“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: 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.

G. PREPARED BY: SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

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

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced Electromagnetic Technologies

B. EXHIBIT ............................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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/RHDP 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 ........................................... : 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, call 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

“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: Submitted once for each uniquely identified computer software product; within 30 calendar days following completion of validation and acceptance 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.

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

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

A. CONTRACT LINE ITEM NO. .... : 0002 I. SYSTEM/ITEM : Advanced Electromagnetic Technologies

B. EXHIBIT ............................................... : A J. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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/RHDP 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 ........................................... : 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.

THIS ENTIRE DISTRIBUTION STATEMENT TO THE BOTTOM OF EACH PAGE.)

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.”

Block 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.

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:

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

M. DATE: 27 April 2021 J. DATE: 04 May 2021

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

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced Electromagnetic Technologies

B. EXHIBIT ............................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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/RHDP 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 ........................................... : 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.

“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: 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.

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

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

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced Electromagnetic Technologies

B. EXHIBIT ............................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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 (http://www.assistdocs.com)

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

6. REQUIRING OFFICE ........................ : AFRL/RHDP 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 ........................................... : 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.

“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: 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.

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

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

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced Electromagnetic Technologies

B. EXHIBIT ............................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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 ........................................... : A 11. AS OF DATE ........................................ : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/RDHP 1 1

15.TOTAL: 1 2

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

Block 10: Once with updates.

Block 8, 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.

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

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

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 Electromagnetic Technologies

B. EXHIBIT ............................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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 ........................................... : A 11. AS OF DATE ......................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

AFRL/RDHP 1 1

AFRL/SE 1

15.TOTAL: 1 3

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: Once with updates

Blocks 8, 11, 12: The draft SAR shall be delivered within 60 calendar days following the 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.

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

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

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced Electromagnetic Technologies

B. EXHIBIT ............................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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-81468A (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 ........................................... : 11. AS OF DATE ......................................... : (See Block 16)

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

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 of the document.”

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 with submitted 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.

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

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

A. CONTRACT LINE ITEM NO. .... : 0002 D. SYSTEM/ITEM : Advanced Electromagnetic Technologies

B. EXHIBIT ............................................... : A E. CONTRACT/PR NO. : BAA-FA9451-21-S-0002

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

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

2. TITLE OF DATA ITEM ....................... : Operations and Maintenance Instructions of R&D equipment.

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

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

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 ............................................. : 11. AS OF DATE ...................................... : None

14. DISTRIBUTION

A. ADDRESSEES

B. COPIES

DRAFT FINAL

AFRL/RDH Business Office 1

15. TOTAL: 2

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.”

Block 10, 12 & 13: As required by Procuring Manager (PM) approved Contract/Call.

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.

SUSAN HEIDGER

I. APPROVED BY: ASO; M. Mendoza

DD Form 1423-1, SEP 97 (EG) (Computer Generated) PREVIOUS EDITIONS ARE OBSOLETE Page 13 of 14 Pages

CONTRACT DATA REQUIREMENTS LIST (1 Data Item) Form Approval OMB No.

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 Jul 2, 2021.