CDRL A001_Certificate of Completion_CDMCert.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 the burden, to Department of Defense, Washington Headquarters Services, 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 Contractor Officer for the Contract/PR No. Listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY:

TDP _________ TM- _________ OTHER DI-PSSS

D. SYSTEM / ITEM

Oxygen Cleaning School

E. CONTRACT / PR NO.

TBD

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

COURSE CONDUCT INFORMATION PACKAGE

3. SUBTITLE

Certificate of Completion Training Report

4. AUTHORITY (Data Acquisition Document No.)

DI-PSSS-81522C

5. CONTRACT REFERENCE

SOW PARA 5.0

6. REQUIRING OFFICER

NSWC, CORONA – MS31

7. DD 250 REQ.

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

12. DATE OF FIRST SUBMISSION

14. DISTRIBUTION

LT MNTHLY SEE BLK 16 b. COPIES

8. APP CODE

C 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE

Draft

Final N/A N/A SEE BLK 16 Reg Repr o

16. REMARKS

Block 4/5: DI-PSSS-81522C and SOW paragraph 5.6.1 shall be used as guidance and are provided for reference.

Block 9: "DISTRIBUTION STATEMENT C”: Distribution authorized to U. S.

Government agencies and their contractors only (Administrative Use). (09 July 2020). Other requests for this document shall be referred to the Naval Surface Warfare Center, Corona Division, California, Code MS02."

Block 12: First submission of Certificate of Completion Training Report(s) (CDRL A001 subtitle) shall be submitted to the Government 30 days after the start of each training course.

Block 13: Subsequent submissions shall be provided monthly thereafter.

Block 14: Submission in contractor format is acceptable. Electronic copy is preferred by e-mail in Microsoft Excel format. Quantity and copies shall be provided in accordance with (IAW) CDRL distribution (Block 14).

NSWCCOR, MS31

NSWCCOR, COR 1

15. TOTAL 2

G. PREPARED BY

Stephen VanWaus, ARP, MS02

H. DATE

6/23/2020

I. APPROVED BY

K. Bergland, NSWCCOR, MS35

J. DATE

07/20/2020

DD Form 1423–1, FEB 2001 Previous editions are obsolete Page __1__ of __1__ Pages