Small_Business_Participation_CDRL.doc

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 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 Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY:

TDP _ _ TM _ _ OTHER __X__

D. SYSTEM/ITEM

A-10

E. CONTRACT/PR NO.

F. CONTRACTOR

1. DATA ITEM NO.

A100

2. TITLE OF DATA ITEM

Small Business Participation Status Report

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

See Block 16

5. CONTRACT REFERENCE

PWS, Para 2.0

6. REQUIRING OFFICE

SEE BLK 16

7. DD 250 REQ

LT

9. DIST

STATEMENT

C

10. FREQUENCY

Semi-Annually

12. DATE OF 1ST SUBMISSION

SEE BLK 16

14. DISTRIBUTION

8. APP CODE

A

11. AS OF DATE

13. DATE OF SUBSEQUENT

See Block 16

16. REMARKS

Block 4:

Fill out attached Excel Spreadsheet.

Block 6: 504 ACSS/CC, 6067 Box Elder Lane, Bldg 1284, Hill AFB UT 84056-5811 Block 8: The government shall have 7 working days after reciept of the Report to review and approve or dissaprove the report.

Block 9: The following information shall be included on the deliverable:

DISTRBUTION STATEMENT C. Distribution authorized to U.S. Government agencies and their contractors for Administrative or Operational Use. (Date of Determination was 4 Jan 90) Other requests for this document shall be referred to OO ALC/504 ACSS/CC.

DESTRUCTION NOTICE: For classified documents, follow the procedures in DOD 5220.22 M, Industrial Security Manual, Section 11 19 or DOD 5200.1 R, Information Security Program Regulation, Chapter IX. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

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 Executive Order 12470. Violations of these export laws are subject to severe criminal penalties.

Block 12: 6 months after Contract Award Block 13: Every 6 months thereafter Block 14:

A) Deliver one copy to:

Government: TBD

B) The submittal shall be delivered in a digital format compatable with Microsoft Office Profesional 2003 (or newer).

SEE BLK 16

15. TOTAL ---------(

G. PREPARED BY

17. PRICE GROUP

18. ESTIMATED TOTAL PRICE