Attachment 2-DD1423-1 CDRL A001.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved 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 this burden, to Department of Defense, Washington Headquarters Service, Directorate for Information Operations and Reports, 1215 Jefferson Davis 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.

B. EXHIBIT

C. CATEGORY

TDP_________ TM___________ OTHER_______X__________

D. SYSTEM/ITEM

E. CONTRACT / PR NO.

TBD

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM:

STATUS REPORT

3. SUBTITLE

Report of RX Safety Glasses Purchased

17. PRICE GROUP

4. AUTHORITY (Date Acquisition Document No.)

DI-MGMT-80368A

5. CONTRACT REFERENCE

4.0

6. REQUIRING OFFICE

NUWCDIVNPT Code 1024

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ

LT

9. DIST STATEMNT

REQUIRED

10. FREQUENCY

MTHLY

12. DATE OF FIRST

SUBMISSION

14. DISTRIBUTION

D SEE BLK 16 b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQNT

SUBMISSION

a. ADDRESSEE Draft Final

A N/A MTHLY Reg Repro

16. REMARKS Code 1024 1 1

Report to detail each individual purchase of prescription safety eyewear. Specifically, the report to include the following: date of service, procurement request number, employee’s name and code, item(s) description, quantity, and total dollar amount.

Blocks 10-12: Estimated submittal 12 per year. Contractor to provide report by the 10th of each month.

15. TOTAL

G. PREPARED BY:

Elizabeth Servant

H. DATE

3/1/2022

I. APPROVED BY

J. DATE

3/1/2022

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page ____ of __ Pages