Exhibit A - Contract Data Requirements List(s) CDRLs DD Form 1423 10.25.22.pdf

SAN DIEGO PRIVATE SECTOR MAINTENANCE (SD PSM)

CONTRACT DATA REQUIREMENTS LIST (CDRL)

GENERAL DD FORM 1423 GLOSSARY

A. The following information is keyed to and provides explanations for entries in Blocks A through J of the DD Form 1423 Exhibit(s):

Block A. CONTRACT LINE ITEM NO.

The contract Line Item Number (CLIN) that is associated with this Contract Data Requirements List (CDRL).

Block B. EXHIBIT The exhibit identified for this CDRL (see DFARS 204.7105-3 for exhibit identifiers).

NOTE: DFARS 204.7105-2 specifies that the DD Form 1423 shall always be an exhibit.

Block C. CATEGORY The appropriate category (i.e., Technical Data Package (TDP), Technical Manual (TM), or “Other” data (OTHER)) for the data item. Types of data which comprise a TDP are defined in MIL-STD-31000 series and types of manuals included under the TM category are defined in Part IX, Section B, of DoDI 5000.2. “Other” data may be further categorized, such as Administrative Data, Provision Data, Configuration Management Data, etc., per the functional area assignments contained in the ASSIST.

Block D. SYSTEM/ITEM The system, item, project designator or name, or title of services being acquired that the data will support.

Block E. CONTRACT/PR NO.

The Procurement Instrument Identification Number (PIIN) (i.e., the contract number, the Purchase Request (PR) number, the Request for Proposal (RFP) number, or other appropriate designator).

Block F. CONTRACTOR The contractor’s name. Following the name, a slash (“/”) and the contractor’s Commercial and Government Entity (CAGE) code may be inserted.

(The next four items appear at the bottom of the form, i.e., after Blocks 1 through 16.)

Block G. PREPARED BY The preparer’s name and organization responsible for preparation of the CDRL. The signature of the preparer will be on the last page of the exhibit.

Block H. DATE The date the CDRL was prepared.

Block I. APPROVED BY The name of the individual responsible for approving the CDRL. The approving official’s signature will be on the last page of the exhibit.

Block J. DATE The date the CDRL was approved.

NOTE: Blocks G through J need only be signed on the last page of each CDRL exhibit when the preparer and the approving official are the same throughout the entire exhibit. All other pages should contain the typed name and date entered on the last page.

B. The following information is keyed to and provides explanations for entries in Blocks 1 through 16 of the DD Form 1423 Exhibit(s):

Block 1. DATA ITEM NO.

The 4-character Exhibit Line Item Number (ELIN). The first and/or second positions consist of the exhibit identifier, and the remaining positions are assigned sequentially. The letters “I” and “O” are not used. ELIN sequencing order can be found in DFARS 204.7106. All ELINs between the first and last ELIN will be accounted for in the exhibit.

Block 2. TITLE OF DATA ITEM The exact title of the Data Item Description (DID) cited in Block 4. When the ELIN is used to acquire technical manuals (TMs), a Technical Manual Contract Requirements (TMCR) document will be cited in Block 4, and the entry in Block 2 will be the title of the specific type of TM being acquired.

Block 3. SUBTITLE Further identification of the data item to supplement the title, if required (optional entry).

Block 4. AUTHORITY (DATA ACQUISITION DOCUMENT NO.)

The DID identification number, One-Time DID number, or Technical Manual Contract Requirements (TMCR) number of the document which defines data content and format requirements. If a TMCR is used, this block will state “See TMCR ” and the TMCR will be attached to the CDRL. The TMCR will list the applicable military specifications and/or standards which provide the data preparation instructions. With the exception of One-Time DID, the document(s) cited in this block (or listed in the TMCR, when used) will have been cleared for listing in the ASSIST.

Block 5. CONTRACT REFERENCE The specific paragraph number of the applicable contractual document which contains the tasking that generates a requirement for the data item. Normally, this will be a Statement of Work (SOW) paragraph.

Block 6. REQURING OFFICE The technical office having responsibility for ensuring the technical adequacy of the data.

Block 7. DD 250 REQUIRED The applicable code, extracted from Table 1, designating the requirements for inspection and acceptance of the data. The DD Form 250 shall be delivered to the first addressee in Block 14, unless otherwise indicated in Block 16.

Block 8. APP CODE Identification, by entry of an “A”, of a requirement for advanced written approval prior to final distribution of an item of critical data (i.e., test plans, test procedures, program plans, or any other documentation that requires Government approval prior to the contractor taking an action).

An “A” in this block indicates in Block 14 that a preliminary draft is required. Block 16 of the ELIN will show the length of time required for Government approval/disapproval and the subsequent turn-around time for the contractor to resubmit the data after Government approval/disapproval has been issued. Block 16 will provide all information regarding submittal of this draft; entries in Blocks 10, 12, and 13 refer only to submittal of the final data deliverable.

Block 16 will also indicate the approval requirement, e.g., approval of technical content and/or format.

TABLE 1. DATA INSPECTION AND ACCEPTANCE CODES

CODE DEFINITION

DD 250 CODE INSPECTION ACCEPTANCE

SS Source* Source* DD Destination Destination SD Source* Destination DS Destination Source* LT** Letter of transmittal only.

NO** No inspection, acceptance or letter of transmittal required.

XX Inspection and acceptance requirements specified elsewhere in the contract.

* Source indicates contractor facility

** These codes are not authorized for data comprising final delivery of Technical Data Packages or for final delivery of Technical Manuals. (LT may, however, be used for delivery of preliminary TDPs or TMs.)

LT is not authorized for use when inspection is required. LT is used when the contracting agency does not desire to have a DD Form 250 for each and every piece of data developed by the contractor. The only other authorized use of LT is the special case where the contracting agency does not desire to have separate DD Forms 250, but desires to have a Government Quality Assurance (QA) representative perform inspection. The Government QA representative shall be listed on the distribution in Block 14 and requested, via the QA letter of instruction, to provide comments.

Block 9. DISTRIBUTION STATEMENT REQUIRED The code letter (i.e., A, B, C, D, E, F, or X) corresponding to the distribution statement to be marked on the data item by the contractor, in accordance with DoDD 5230.24. Block 16 of the ELIN will reflect the appropriate statement and will include the reason, date of determination, and controlling DoD office. The Program office will be responsible for selection and placement of the seven authorized statements. If the appropriate statement is not known, or if it may vary among specific submissions under this item, “See Block 16” will be entered in this block and explanatory information in Block 16. If the data item is not technical in nature and does not require a distribution statement, enter “N/A” for “Not Applicable” will be entered in this block.

Block 10. FREQUENCY The frequency of data submittal. Entries in this block are explained in Table 2. If the data is of a recurring type, it is to be submitted at the end of the reporting period established in this block unless otherwise indicated in Block 16.

TABLE 2. DATA SUBMITTAL FREQUENCY CODES

CODE FREQUENCY

ANNLY Annually ASGEN* As generated ASREQ* As required BI-MO Every two months BI-WE Every two weeks CP/RQ* Change pages as required DAILY Daily DFDEL Deferred delivery (See DFARS 252.227-7026) MTHLY Monthly ONE/R One time with revisions OTIME One time (Does not include draft submissions) QRTLY Quarterly R/ASR* Revisions as required SEMIA Every six months WEKLY Weekly XTIME Multiple separate submittals

(2TIME, 3TIME, etc.) (Does not include draft submissions)

See Block 16* Requirement is fully described in Block 16.

Used in lieu of other codes where such as inadequate to define requirement, or used in addition to other codes requiring amplification in Block 16.

NOTE: The codes are limited to five (d) digits for automation purposes.

*The ELINs citing these codes will have an additional explanation in Block 16 to provide the contractor with guidance necessary to accurately price the deliverable data item.

Block 11. AS OF DATE Date for cutting off collection of the data. If the data is to be submitted multiple times, a numeral will be entered in this block to indicate the number of calendar days prior to the end of the reporting period, established in Block 10, that data collection will be cut off. For example, “15” would place the “as of” date for the data at 15 days before the end of the month, quarter, or year, depending on the frequency established in Block 10; a “0” would place the “as of” date at the end of each month, quarter, etc. If the data is submitted only once, the “as of” date will be as follows: year/month/day, e.g., 03/MAY/02. In stances where an “as of” entry is appropriate, but cannot be numerically expressed because it is contingent upon a specific event, “See Block 16” will be entered in this block and explanatory information will be provided in Block 16. If an “as of” date is not applicable, an entry of “N/A” will be made in this block.

Block 12. DATE OF FIRST SUBMISSION The due date for initial data submission. This is normally the postage date or date the data is delivered to the ACO, entered as year/month/day (e.g., 03/MAY/02) or keyed to a specific event or milestone, using a code from Table 3.

NOTE: No classified dates are cited in the CDRL.

TABLE 3. DATA SUBMISSION CODES

CODE FREQUENCY

ASGEN* As generated ASREQ* As required DFDEL* Deferred delivery XDAC** Days after contract award XDACM** Days after contract modification XDARC** Days after receipt of comments XDARP** Days after reporting period XDATC** Days after test completion XDPTT** Days prior to testing EOC End of contract EOQ End of quarter NLT No later than See Block 16* Used to indicate requirement is fully described in Block 16.

Used in lieu of other codes where such as inadequate to define requirement, or used in addition to other codes requiring amplification in Block 16.

* The ELINs citing these codes will have in Block 16 additional specific instructions relative to data submissions.

** The “X” is assigned a value indicating the number of days, e.g., 30DAC.

Block 13. DATE OF SUBSEQUENT SUBMISSION The due date(s) for subsequent data submission(s), if data is to be submitted more than once. If submittal is constrained by a specific event or milestone, the constraint will be given using a code from Table 3.

NOTE: No classified dates are cited in the CDRL.

Block 14. DISTRIBUTION The addressees and the number of draft copies and final copies (regular and reproducible) to be provided to each. DoD component designators and office symbols/codes, or Unit Identification Codes (UICs); may be used; however an explanation of these will be provided in the Addressee List. The first addressee will be the acceptance activity for the data if acceptance by DD 250 is to be accomplished at destination (see Block 7). When reproducible copies (e.g., magnetic tape, vellum, negative, etc.) are required, an explanation will be provided in Block 16. If the data is not to be delivered to the Government or associated contractors, an explanation will be given in Block 16. If deferred delivery is required, “DFDEL” will be entered in this block and amplification will be given in Block 16.

The electronic mail addresses for the addressees cited are as follows:

SWRMC ACO (Anthony Ramos) david.a.ramos6.civ@us.navy.mil PMS 312E (CDR Johnathan Walker) johnathan.c.walker.mil@us.navy.mil PMS 312E (Dave Rodriguez) david.f.rodriguez3.civ@us.navy.mil PMS 312L (Chris Buckley) christopher.c.buckley.civ@us.navy.mil CNAP, N431 (CDR William Taft) william.t.taft.mil@us.navy.mil CNAP (Mark Warner) mark.e.warner@navy.mil SWRMC (Vince Murray) vincent.r.murray.civ@us.navy.mil

NOTE: No classified dates are cited in the CDRL.

Block 15. TOTAL The total number of draft and final (regular/reproducible) copies required by Block 14.

Block 16. REMARKS Contains all pertinent data information not specified elsewhere on this DD Form 1423 and any amplification of other blocks on this form (e.g., DID tailoring, use of contractor format, approval criteria and authority, inspection and acceptable clarification, distribution statements, specific submission instructions, explanation of reproducible copy and delivery requirements, designed medium for delivery of the data item, etc.)

C. The following instructions apply to completion of Blocks 17 and 18 by contractor personnel:

Block 17. PRICE GROUP Specify the appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition – Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price – Costs to be included under Group I are those applicable to preparing and assembling the data item in conformation with Government requirements, and the administrative and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition – Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, and frequency of submittal, preparation, control, or quality of the data item.

Estimated Price – Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements and the administrative and other expenses related to reproducing and delivering such data items to the Government.

c. Group III. Definition – Data which the contractor must develop for his internal use in performance of the primary contracted effort and which does not required and substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price – Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data items to the Government.

d. Group IV. Definition – Data which is developed by the contractor as port of his normal operating procedures and his effort in supply this data to the Government is minimal.

Estimated Price – Group IV items should normally be shown on the DD Form 1423 at no cost.

Block 18. ESTIMATED TOTAL PRICE For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The entry “N/C” for “no charge” will be acceptable. The estimated price shall not include any amount for rights in data.

The Government’s right to use the data shall be governed by the pertinent provisions of the contract.

SAN DIEGO PRIVATE SECTOR MAINTENANCE (SD PSM)

N00024-R-23-4107

ITEM TITLE SUBTITLE

A001 REQUEST FOR ENGINEERING OR TECHNICAL

ASSISTANCE

REQUEST FOR GUIDANCE CLARIFICATION

(DLARs/LARs/ELARs/RLARs)

A002 WEIGHT AND STABILITY REPORT FOR IN-

SERVICE SURFACE SHIPS

ACTUAL WEIGHT AND MOVEMENT REPORT

A003 PROGRAM UNIQUE SPECIFICATION

DOCUMENTS

COST DATA ESTIMATING SHEETS

A004 SMALL BUSINESS SUBCONTRACTING

REPORT

A005 REVISIONS TO EXISTING GOVERNMENT

DOCUMENTS

ENGINEERING DRAWINGS

A006 INTERNAL CONTRACTOR TECHNICAL DATA

REPORT

LIST/SCHEDULE OF SYSTEMS CERTIFICATION

A007 INTERNAL CONTRACTOR TECHNICAL DATA

REPORT

MATERIAL STATUS REPORTS

A008 CONDITION FOUND REPORT WALK THROUGH INSPECTION

A009 INTERNAL CONTRACTOR TECHNICAL DATA

REPORT

WORK SPECIFICATIONS

A010 INTERNAL CONTRACTOR TECHNICAL DATA QUALIFICATION AND CERTIFICATION OF NON-NUCLEAR WORK

ON NUCLEAR POWERED VESSELS

A011 PERFORMANCE COST REPORT CONTRACT FUNDS STATUS REPORT (CFSR)

A012 CONTRACTOR’S PROGRESS, STATUS, AND

MANAGEMENT REPORT

CONTRACTOR PERFORMANCE REPORT (CPR)

A013 INTERNAL CONTRACTOR TECHNICAL DATA

REPORT

ELECTRONIC FORMAT DISCREPANCY ADJUDICATION RECORD

A014 TECHNICAL DATA PACKAGE COPIES OF PURCHASE ORDER, VENDOR RECEIPTS AND

TECHNICAL SPECIFICATIONS

A015 INTERNAL CONTRACTOR TECHNICAL

REPORT

DEPARTURE REPORT

A016 INTEGRATED PROGRAM MANAGEMENT

DATA AND ANALYSIS REPORT (IPMDAR)

A017 SPECIAL EQUIPMENT LONG LEAD TIME ITEM

LIST

A018 REQUEST FOR VARIANCE (RFV) REQUEST FOR WAIVERS

A019 CONTRACT COST REPORT FOR AVAILS 12

WEEKS OR LESS

A020 CONTRACT COST REPORT FOR AVAILS

GREATER THAN 12 WEEKS

A021 REVISIONS TO EXISTING GOVERNMENT

DOCUMENTS

ILS CERTIFICATION FORM

A022 INTERNAL CONTRACTOR TECHNICAL DATA

REPORT

REQUIRED DOCUMENTATION FOR INSTALLATION FOR GFM

ITEMS

A023 COMMERCIAL OFF-THE-SHELF (COTS)

MANUALS AND ASSOCIATED

SUPPLEMENTAL DATA

COMMERCIAL OFF-THE-SHELF (COTS) MANUALS AND

ASSOCIATED SUPPLEMENTAL DATA

A024 MAINTENANCE MANUAL CHANGES MANUAL CHANGE REQUESTS (MCRs)

A025 REVISIONS TO EXISTING GOVERNMENT

DOCUMENTS

DIGITAL TECHNICAL LIBRARY

A026 INTERACTIVE COMPUTER AIDED

PROVISIONING SYSTEM (ICAPS) DATA

EXCHANGE

PROVISIONING TECHNICAL DOCUMENTATION (PTD)

A027 CONFIGURATION STATUS ACCOUNTING

(CSA) INFORMATION

SCLSIS/CDMD-OA REPORTING

A028 ENGINEERING DATA FOR PROVISIONING

(EDFP)

A029 PRELIMINARY ALLOWANCE LIST (PAL)

A030 SUPPLEMENTARY PROVISIONING

TECHNICAL DOCUMENTATION

COMPONENT IDENTIFICATION DATA (CID) FOR STATEMENT OF

PRIOR SUBMISSION (SPS)

A031 STATUS REPORT ILS STATUS REPORT

A032 KEY EVENT SCHEDULE TANK IMPACT SCHEDULE

A033 DEMAND ONLY TRANSACTION REPORT SUPPLIES AND SERVICES

(1 Data Item)

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page of Pages

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final Reg Repro

16. REMARKS

15. TOTAL ▬▬▬▬►

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page of Pages

CLIN 0004 A X

SAN DIEGO PRIVATE SECTOR MAINTENANCE (SD PSM) N00024-23-R-4107 TBD

A004 SMALL BUSINESS SUBCONTRACTING REPORT

DI-MGMT-81642 J-7, AF & SBSIF PMS 312

LT

D (SEE BLK 16)

ASREQ SEE BLK 16

N/A N/A SEE BLK 16

SWRMC

PMS 312

1CNAP

4 33

BLK 4: DI-MGMT-81642 - SECTION 2.2 SHALL BE

DELIVERED FOR EACH DELIVERY ORDER.

BLK 9: DISTRIBUTION STATEMENT D. DISTRIBUTION

AUTHORIZED TO THE DEPARTMENT OF DEFENSE AND

U.S. DOD CONTRACTORS ONLY (CRITICAL

TECHNOLOGY) (01 AUGUST 2016). OTHER REQUESTS

SHALL BE REFERRED TO PEO CARRIERS, PMS 312.

BLKs 12 AND 13: AS MUTUALLY AGREED TO BETWEEN

THE GOVERNMENT AND CONTRACTOR.

BLK 14: DISTRIBUTION MAY BE MODIFIED BY THE

GOVERNMENT AT THE TIME OF TASKING.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

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16. REMARKS

15. TOTAL

SAN DIEGO CVN IDIQ CONTRACT

TABLE OF CONTENTS CONTRACT/

PR NO: N00024- - -4

CDRL A0 CONTRACT FUNDS STATUS REPORT (CFSR) CON’T - ATTACHMENT

FU N D S A N D M A N HOU R EX PEN D I TU R E

S U M M A R Y TOTA L C ON TR A C T

D a t e P re p a re d : S ummary/ Wo rk Pac kag e Tit le : A i rc ra f t C a rri e r Eng i ne e ring C o nt ra c t Numb e r: N 0 0 0 2 4 - - - R e p o rt ing P e rio d : M o nt h End ing :

C o nt ra c t o r:

A B C D E F Negotiated Authorized Repo rti n g Perio d Cumulative E s t imated L ates t Contract T ask ing Valu es Expenditures E x p en ditu res to Date Co s t t o Cost

A1 (1 ) A2 (1 ) B1 B2 C1 C2 D1 D2 D3 Complete E s t imate MH Dollars MH Do ll ars MH Do ll ars MH % M H V alu e Do ll ars %$ V alu e B2 -D2 D2 +E

1 Dire ct L ab o r 2 Overhead

3 ODLC

4 T o t al L ab o r & O H & O DL C

6 ITS

7 Travel 8 N- R M ateri al < $ 50 K 9 M is cell aneo u s

10 T o t al M ate ri al 11 Sub-Total

12 COFC

13 T o t al 14 Fixed

To tal Contract Amount $ T o t al

No te : (1 ) T h is CD RL T o tal Pag e In clu d es T o tal Co n tract/ TI Valu es f r

DistributionStatement D:Distribution authorized to theDepartment of DefenseandU.S.DoDContractorsonly.Contains critical technology information.Other WARNING: Document contains technicald atawhoseexport is rest rictedby theArms ExportControlAct (Title22 ,U.S.C.Sect2751,et seq) or the (Title50, U.S .C.,App. 2401 et seq)as amended.Violations oftheseexport laws aresubject to severecriminalpenalties. Disseminate inaccordance

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final

Reg Repro

16. REMARKS

15. TOTAL

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188).