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DD FORM 1423-2, AUG 96

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 220 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

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

14. DISTRIBUTION

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

Page ____ of ____ Pages

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.

DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify 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 conformance with Government requirements, and the administration 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, 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 item 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 does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

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

Item 18. 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 estimated data prices 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.

DD FORM 1423-2 (BACK), AUG 96

line_item: 0001 exhibit: C xtdp: Off xtm: Off othercat: X system: Paramedic and Ambulance Services ctr_no: F3Y0AF4170AW01 contr: TBD data_item1: CDRLA003 title1: Records sub1: N/A auth1: DI-MGMT-80368A ref1: 1.11 req_ofc1: 72 ABW/CE dd250_1: N/A appcode1: N/A dist1: B freq1: As Required asof1: See Blk 16 firstsub1: See Blk 16 subsub1: See Blk 16 addr1_1: 72 ABW/CE draft1_1:

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totaldraft1: 0 totalreg1: 3 totalrepro1: 0 rmks1: The Contractor shall be responsible for creating, maintaining, and disposing of only those Government required records which are specifically cited in the PWS dated 10 May or as may be required by the provisions of a mandatory directive listed in appendix B of this PWS. If requested by the Government, the Contractor shall provide the original record or a reproducible copy of any such records within five working days of receipt of the request. All run report/dispatch numbers must be emailed to the TFD and the COR at the end of each shift. The Contractor shall integrate patient care reporting forms or automated systems with the Tinker Fire Department in order to affect a comprehensive team approach to patient

Distribution Statement B. Approved for public release; Distribution is unlimited. Ref:

DoD Directive 5230.24 "Distribution Statement on Technical Documents", Enclosure 4.

group1:

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data_item2: CDRLA004 title2:

Safety and Health Plan sub2: N/A auth2: N/A ref2: Appendix C req_ofc2: 72 ABW/CE dd250_2: N/A appcode2: N/A dist2: B freq2: See Blk 16 asof2: See Blk 16 firstsub2: See Blk 16 subsub2: See Blk 16 addr2_1: 72 ABW/CE draft2_1:

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totaldraft2: 0 totalreg2: 3 totalrepro2: 0 rmks2: The Contractor's format is acceptable. Submit electronically. All references to days are business days. Per the PWS paragraph in Blk 5 above:

The Contractor shall provide to the addressees in Block 14 within 10 days of post-award briefing.

Distribution Statement B. Distribution authorized to U.S. Government agencies only.

Report contains contractor performance evaluations and vulnerability information. This determination is effective as of 3 Jan 2017. Other requests for this document shall be referred to 72d Air Base Wing (ABW) Communications Directorate (SC).” Ref: DoD Directive 5230.24 "Distribution Statement on Technical Documents", Enclosure 4.

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MILLSAP.CHRISTOPHER.EARL.1174141424

prep_date: 31 May 2024 app_by:

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SCHOOLING.NATHAN.ALAN.1125002648

app_date: 31 May 2024

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DATA ITEM DESCRIPTION

Title: Status Report

Number: DI-MGMT-80368A Approval Date: 30 OCT 2006 AMSC Number: 7619 Limitation: N/A DTIC Applicable: No GIDEP Applicable: No Office of Primary Responsibility: NS/DA02 Applicable Forms: N/A

Use/relationship:

The Status Report documents the status of contractor effort towards achieving contract objectives. It identifies accomplishments to date and difficulties encountered, and compare the status achieved to planned goals and the resources expended. It is used by the Government to monitor and evaluate contractor performance.

This Data Item Description (DID) contains format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

It is not intended that all requirements herein should be applied to every program.

Portions of the DID are subject to tailoring by deletion depending on the specific status reporting requirements of the project.

This DID is related to DI-FNCL-80331, Funds and Man-Hour Expenditure Report which can be used in conjunction with this report if paragraph 3.2.3 below is deleted.

This DID supersede DI-MGMT-80368.

Requirements:

1. Reference documents. None.

2. Format. The Status Report shall be in contractor format.

2.1 Identification. The data indicated below shall be contained on a title page or on the first page of the report.

a. Title/identification of the system/component/program/project.

Source: http://assist.dla.mil -- Downloaded: 2024-07-09T20:48Z Check the source to verify that this is the current version before use.

DI-MGMT-80368A

b. Type of report (e.g., monthly, interim, final).

c. Period covered by the report.

d. Contract number.

e. Preparing activity or contractor’s title.

f. Security classification, when required.

g. Distribution Statement.

2.2 Page size. The report shall be on 8 ½ by 11 inch (metric A4) paper.

3. Content. The report shall contain the following:

3.1 Summary. The summary shall include a brief statement of the overall project status , covering the accomplished technical activities and development, objectives of efforts, summary results of efforts, identification of major problems/deficiencies with impact, and recommended solutions.

3.2 Body of report. The Status Report shall contain the following items, where applicable:

3.2.1 Milestone/task status. The status of each milestone/task as defined by the statement of work or contract, as applicable:

a. A statement as to whether or not the program/project/task is on schedule; if not, the effort planned to meet the schedule shall be indicated. Include an overall status of each milestone, task, or unit of work. Include update schedule sheets, milestone charts, or task synopsis sheets identifying phase of task and percentage of completion of each task, technical instruction, or order.

b. A comparison of achieved end-product performance capabilities projected against contract baseline values, requirements, or allocations.

c. Effort expended on each task to date, and a brief description of technical developments and accomplishments.

d. Key dates in any testing program and description of tests performed and significant test results. If applicable, a description of the amount and type of down time on the equipment or system under test.

e. A list of all designs completed and a brief description of each item. For designs in process, provide estimated dates for design and drawing completion.

f. A narrative of outstanding problems existing as of the previous status report, and their resolution status. 2

DI-MGMT-80368A

g. New problem areas encountered or anticipated, their effect on the overall work effort/project and steps being taken to remedy problem situations.

h. Significant results of conferences, trips, or directives for the Contracting officer’s representatives.

i. Any other information which may cause significant changes in the program schedule.

3.2.2 Future plans. Summary of future plans, recommendations and proposals both for the next reporting period and for any long term plans.

3.2.3 Itemized man-hours and costs. Itemized man-hour and cost expenditure incurred for the reporting period by category and task, total contractual expenditures, and funds remaining as of the reporting date.

3.2.4 Contract deliveries status. The status of each deliverable end item, including data deliverables, as required by the contract. Provide item and contract identification, shipping/transmittal data, acceptance status, security classification, and schedule due date information.

3.2.5 Report preparer. Name of person(s) preparing report and telephone number(s).

3.3 Appendices. Appendices where applicable, for tables, references, charts, or other descriptive material. Each appendix shall be identified and referenced in the appropriate area of the report.

4. END OF DI-MGMT-80368A

DATA ITEM DESCRIPTION

Requirements:

DATA ITEM DESCRIPTION

Title: QUALITY MANAGEMENT SYSTEM (QMS) DOCUMENT LIBRARY REPORT

Number: DI-MGMT-82199 Approval Date: 20180417

AMSC Number: N9918 Limitation: N/A

DTIC Applicable: N/A GIDEP Applicable: N/A

Preparing Activity: SH Project Number: MGMT-2018-025

Applicable Forms: N/A

Use/Relationship: The QMS Document Library Report provides the changes and status of the

Quality Management System (QMS) documents in the library (plans, procedures, work instructions, job quality standards, and tier IV). This information is used by the government to assess status and control configuration management of the document library.

This data item description (DID) contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

Requirements:

Format. The QMS Document Library Report shall be in contractor’s format.

Content. The QMS Document Library Report shall contain the status of the QMS document library. The report shall specify the following:

Count of documents in the library by type at the beginning of the contract year. Note that this count is used as a baseline and should not change.

Count of documents by type in the reporting period.

Identify all changes made to the library and include the following:

Document Title

Document Identification Number (function, series, no.)

Document Type

Location

Functional Area

Revision Number

Revision Date

Identify the reason for the change (new document, archive, revision, bi-annual review, audit finding, etc.).

The report shall identify the following when documents are archived:

Archive Date

Justification and Notes

Source: http://assist.dla.mil -- Downloaded: 2024-07-03T12:27Z

DI-MGMT-82199

Managers approval

Impacted documents

Status

End of DI-MGMT-82199

Source: http://assist.dla.mil -- Downloaded: 2024-07-03T12:27Z

DD FORM 1423-2, AUG 96

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 220 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

11. AS OF DATE 13. DATE OF SUBSEQUENT

12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

14. DISTRIBUTION

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

Page ____ of ____ Pages

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref.

DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13;

Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify 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 conformance with Government requirements, and the administration 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, 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

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

Estimated Price - Costs to be included under Group III are the

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

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

Item 18. 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 estimated data prices 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.

DD FORM 1423-2 (BACK), AUG 96

line_item: 0001 exhibit: A xtdp: Off xtm: Off othercat: X system: Paramedic and Ambulance Services ctr_no: F3Y0AF4170AW01 contr: TBD data_item1: CDRLA001 title1: Quality Control Plan sub1: N/A auth1: DI-MGMT-82199 ref1: PWS Para 1.22 req_ofc1: 72 ABW/CE dd250_1: N/A appcode1: N/A dist1: B freq1: NLT Pre-Performance asof1: See Blk 16 firstsub1: See Blk 16 subsub1: See Blk 16 addr1_1: 72 ABW/CE draft1_1:

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totaldraft1: 0 totalreg1: 3 totalrepro1: 0 rmks1: The Contractor's format is acceptable. Submit electronically. All references to days are business days. Per the PWS paragraph in Blk 5 above:

- The Contractor shall provide a written description of the Quality Control System (QCS) in the QCP to include identification of the commercial practices and procedures to be used to include the inspection system requirements of FAR 52.246-4 “Inspection of Services – Fixed-Price.”

- A written Quality Control Plan (QCP) shall be submitted to the CO for review, feedback, and approval. The plan shall be submitted NLT the post-award conference and annually thereafter. The QCP shall specifically address the Contractor’s strategy to provide quality workmanship, continual process improvement, and for correcting deficiencies as required.

- The Contractor shall ensure all records of all audits/inspections are maintained and make them available to the Government for review upon request.

Distribution Statement A. Approved for public release; Distribution is unlimited. Ref:

DoD Directive 5230.24 "Distribution Statement on Technical Documents", Enclosure 4.

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data_item2: CDRLA002 title2:

Transport Documentation sub2: N/A auth2: N/A ref2: PWS Para 1.9.1, 1.9.2 req_ofc2: 72 ABW/CE dd250_2: N/A appcode2: N/A dist2: A freq2: As Required asof2: See Blk 16 firstsub2: See Blk 16 subsub2: See Blk 16 addr2_1: 72 ABW/CE draft2_1:

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totaldraft2: 0 totalreg2: 3 totalrepro2: 0 rmks2: IAW PWS 1.10.1.the Contractor will provide monthly documentation to the MTF relating to all transports NLT the 5th of each month for the previous month, example: September's info will be submitted NLT 5 October. This information will include: date, time dispatched/enroute/on scene/first pt contact/depart pickup location/hand off to hospital personnel, run number,, type of run (BLS or ALS), available patient information (full name, military (last 4 of SSN) or civilian, DOB). Patient condition, all patient care rendered, complete incident and destination location addresses, and an explanation of any exceptions to response time or reasonable patient care by local and national standards contained in public release; Distribution is unlimited. Ref:

Distribution Statement A. Approved for public release; Distribution is unlimited. Ref:

DoD Directive 5230.24 "Distribution Statement on Technical Documents", Enclosure 4.

group2:

totalprice2:

prep_by:

2024-06-05T07:58:08-0500

MILLSAP.CHRISTOPHER.EARL.1174141424

prep_date: 31 May 2024 app_by:

2024-06-05T08:07:58-0500

SCHOOLING.NATHAN.ALAN.1125002648

app_date: 31 May 2024

Page:

of_pages:

app: Adobe Professional 8.0

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