TOS II Exhibit A CDRLs.pdf

FA9101-22-R-B001

Exhibit A

Contract Data Requirement List

Test Operations and Sustainment (TOS) II

7 February 2023

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A001 Personnel Strength Report

OT-2022-30070 2.2.3. AFTC/PZZ (Arnold)

NO

N/A C

MTHLY

See 16

See 16

See 16 AFTC/PZZ (Arnold) 1

0 1 0

Blocks 10-13: Monthly updated report shall be current as of the last day of each month. Submissions are due to AFTC/PZZ (Arnold) by the 10th day of the following month.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 09:45:13 -06'00'

GARDNER.REBECCA.J

EAN.1102097862

Digitally signed by

GARDNER.REBECCA.JEAN.1102097862

Date: 2023.01.12 10:51:07 -06'00'

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 administrative and other expenses related to reproducing and delivering such data item to the Government.

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 1423-1 (BACK), FEB 2001

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(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A003 Rough Order of Magnitude Estimate

OT-2022-30076 3.1.1. AEDC 804 TG / 704 TG

NO

A B

ASREQ

SEE 16

SEE 16

SEE 16

SEE 16

0 0 0

Block 8: Approval by requesting Test Branch Chief / Squadron Commander. The Government will comment within 5 days of draft submittal and the final submittal is due within 5 days of Government comment.

Block 10-14: Submit electronically to the requesting Test Branch / Squadron Project Manager (PM). Submittal data will be negotiated and agreed to by the requesting Test Branch / Squadron PM based on the complexity of test or engineering service request.

1 1

TRACEY.NICOLE.ELAINE.

1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 10:01:02 -06'00'

GARDNER.REBECCA.

JEAN.1102097862

Dig tally s gned by GARDNER REBECCA JEAN 1102097862 Date 2023 01 13 13 12 14 06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A004 Statement of Capability (SOC) Report

OT-2022-30093 3.1.2. AEDC 804 TG / 704 TG

NO

A B

ASREQ

SEE 16

SEE 16

SEE 16

SEE 16

0 0 0

Block 8: Approval by the requesting Test Branch Chief / Squadron Commander and 804 TG or 704 TG Commander in succession. The Government will comment within 10 calendar days of draft submittal and the final submittal is due within 5 calendar days of Government comment unless timelines are otherwise negotiated.

Block 10-13: Submit electronically to the requesting Test Branch / Squadron Project Manager (PM). Approval required before execution of any change.

Submittal dates will be negotiated and agreed to by the requesting Test Branch / Squadron PM based upon the complexity of test or engineering service request.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 10:02:06 -06'00'

GARDNER.REBECCA.JE

AN.1102097862

Digitally signed by

Date: 2023.01.13 13:14:48 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A005 Test Plan

DI-NDTI-80566A 3.1.3 AEDC 804 TG

No

A B

ASREQ

See 16

See 16

See 16 See 16

0 0 0

Block 8: Approval by requesting Test Branch / Squadron Project Manager (PM) and Technical Director in succession. The Government will provide review comments within 10 days of receipt. Any subsequent submission shall be delivered within 15 days of the request.

Blocks 10-14: Submit electronically to the Test Branch / Squadron PM. Approval required before execution of any change. Submission dates shall be negotiated and agreed to by the Test Branch / Squadron PM.

1 1

TRACEY.NICOLE.ELAI

NE.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:07:18 -06'00'

GARDNER.REBECCA.J

EAN.1102097862

Digitally signed by

Date: 2023.01.13 13:16:24 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A006 Test and Analysis Project Plan

OT-2022-30100 3.1.4.1., 3.1.4.2., 3.1.4.3., 3.1.4.5. AEDC 804 TG

NO

A B

ASREQ

SEE 16

SEE 16

SEE 16

SEE 16

SharePoint

0 0 0

Block 8: Approval by the requesting Test Branch / Squadron Project Manager (PM) and Test Branch / Squadron Chief in succession. The Government will comment within 10 calendar days of draft submittal and the final submittal is due within 5 calendar days of government comment unless timelines are otherwise negotiated.

Block 10-13: Submit electronically to the requesting Test Branch PM. Approval required before execution of any change. The first submittal shall be no later than 15 calendar days from the approval of the final submittal of the Statement of Capability (SOC) report unless the timeline is otherwise negotiated.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:08:29 -06'00'

GARDNER.REBECCA.JE

AN.1102097862

Digitally signed by

Date: 2023.01.13 13:18:22 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A007 Test Period Run Plan

OT-2022-30102 3.1.4.4. AEDC 804 TG

NO

N/A B

ASREQ

SEE 16

SEE 16

SEE 16

SEE 16

0 0 0

Blocks 10-14: Submit electronically to the requesting Test Branch / Squadron Project Manager (PM). Submission shall be 24 hours prior to the start of the test period.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:09:44 -06'00'

GARDNER.REBECCA.

JEAN.1102097862

Digitally signed by

Date: 2023.01.13 13:20:13 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A008 Integrated Program Management Report

DI-MGMT-81861C 3.1.5.1., 3.8.1.4.3., 3.25.3 AEDC 804 TSS

No

N/A C

MTHLY

See 16

See 16

See 16 See 16

0 0 0

Block 4: DI-MGMT-81861C Formats 1, 3, and 5 are required for WBS 1.0 and

2.0 projects as required by the Government. Multi-year data for each project shall be provided for WBS 1.0 projects. Data specific to the current fiscal year as well as mult-year data for each project shall be provided for WBS 2.0 projects.

Blocks 11-14: Projects added during the contract year will be incorporated into current month's earned value reporting. Data shall be current as of the end of the previous month. Format 1 (CSSR data current to the end of the prior month) shall be provided NLT the 7th of the month. Formats 1, 3, and 5 shall be provided NLT the 18th of the month. Deliver to the requesting office (804 TG, 704 TG, 804 TSS, 704 TSS) as appropriate.

1 1

TRACEY.NICOLE.ELAI

NE.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:10:56 -06'00'

GARDNER.REBECCA.

JEAN.1102097862

Digitally signed by

Date: 2023.01.13 13:21:55 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A009 Project Change Agreement

OT-2022-30074 3.1.5.2., 3.6.9., 3.8.1.4.1 AEDC 804 TG

NO

A C

ASREQ

SEE 16

SEE 16

SEE 16

0 0 0

Blocks 8 and 14: Submit to TSD (or equivalent) for WBS 4.3, 804 TSS (or equivalent) for WBS 2.1, and 804 TG (or equivalent) for WBS 1.X. Ten calendar days for Government comment and 10 calendar days from contractor re-submittal unless otherwise negotiated.

Blocks 10-13: Submit electronically to AF PM. Contractor electronic format is acceptable including revisions. Approval required before execution of any change. Submitted as required to document proposed deviation in project cost, schedule, or performance.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:12:13 -06'00'

GARDNER.REBECCA.JE

AN.1102097862

Digitally signed by

Date: 2023.01.13 13:23:21 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A010 Technical Reports

OT-2022-30098 3.1.6. AEDC 804 TG

NO

A C

ASREQ

SEE 16

SEE 16

SEE 16

See 16

0 0 0

Blocks 8 and 14: Approval by requesting Test Branch / Squadron Project Manager (PM) and Technical Director in succession. The Government will provide review comments within 10 days of receipt. Any subsequent submission shall be delivered within 5 days of the request.

Blocks 10-13: Submit electronically to AF PM. Approval required before execution of any change. Submission dates shall be as agreed to and documented in the Statement of Capability (SOC) report.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:13:24 -06'00'

GARDNER.REBECCA.JE

AN.1102097862

Digitally signed by

Date: 2023.01.13 13:26:27 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A011 ITIP Candidate Topic List

OT-2022-30054 3.1.9. AEDC 804 TG

NO

N/A C

ANNLY

1 Nov 24

SEE 16

AEDC 804 TG

0 0 0

Blocks 12-13: Submit electronically to AF PM. The ITIP topic list is to be submitted 1 November of each year.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:14:37 -06'00'

GARDNER.REBECCA.J

EAN.1102097862

Digitally signed by

Date: 2023.01.13 13:27:30 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A012 Technology Progress Report

OT-2022-30099 3.1.9. AEDC/TDA

NO

N/A C

ANNLY

Nov 1

ASREQ

AEDC/TDA

0 0 0

Blocks 11-13: Submit electronically to AF PM. The progress report is to be submitted annually on 1 November, and shall be current as of 30 September of the current calendar year. Contractor will be required to brief AEDC management on contents of report.

1 1

TRACEY.NICOLE.ELAINE

.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:15:50 -06'00'

GARDNER.REBECCA.JE

AN.1102097862

Digitally signed by

Date: 2023.01.13 13:30:05 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A013 SBIR Topic Candidate List

OT-2022-30090 3.1.12. AEDC/TDA

NO

N/A C

ASREQ

See 16

See 16

See 16 SharePoint (See 16)

0 0 0

Block 10-13: Contractor to submit electronically NLT four weeks from date of request by the AF Project Manager.

Block 14a: Upload program management plan data to Government-directed network locations.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:16:55 -06'00'

GARDNER.REBECCA.J

EAN.1102097862

Digitally signed by

Date: 2023.01.13 13:31:53 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A014 Daily Operating Time Log (OTL)

OT-2022-30017 3.3.4., 3.3.5. AEDC 804 TSS

NO

N/A C

ASGEN

See 16

See 16

See 16 See 16

0 0 0

Blocks 10-13: OTL shall be prepared each day for every test unit performing test buildup and installation, test removal, or test operations and checkouts.

Block 14: OTL shall be accessible to all AEDC personnel from NIPRNet-connected workstations.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:18:01 -06'00'

GARDNER.REBECCA.J

EAN.1102097862

Digitally signed by

Date: 2023.01.13 13:33:21 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A015 Title V Major Source Operations Log

OT-2022-30104 3.3.4. AEDC/TSD

NO

N/A C

See 16

See 16

See 16

See 16 SharePoint

0 0 0

Blocks 10-13: This log will need to be submitted twice per year: 21 January and once on 21 July. Each submission will include data from the six months prior to the submission date. The log for July through December will be due 21 January, and the log for January through June will be due 21 July.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:19:09 -06'00'

GARDNER.REBECCA.JE

AN.1102097862

Digitally signed by

Date: 2023.01.13 13:36:52 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A016 Test Unit Status Log (TUSL)

OT-2022-30103 3.3.5. AEDC 804 TSS

NO

N/A C

ASREQ

See 16

See 16

See 16 See 16

0 0 0

Block 10-13: A TUSL will be prepared each day for each test unit conducting test preparation, operations, removal, modification, and sustainment.

Block 14: The TUSL shall be in the contractor's electronic format and accessible to all AEDC personnel from NIPRNet-connected workstations.

1 1

TRACEY.NICOLE.ELAINE

.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:20:18 -06'00'

GARDNER.REBECCA.J

EAN.1102097862

Digitally signed by

Date: 2023.01.13 13:38:03 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A017 Test Article Activity Log (TAAL)

OT-2022-30101 3.3.5., 3.3.7., 3.3.8., 3.3.10. AEDC 804 TG

NO

A C

ASREQ

See 16

See 16

See 16 See 16 SharePoint

0 0 0

Block 10-13: A TAAL shall be prepared and updated each day for every test article in build-up, installation, removal or operations and checkouts.

Block 14: The TAAL shall be in the contractor's electronic format or an off-line log book and accessible to all AEDC personnel on NIPRNet-connected workstations or through access to the off-line log books.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:21:30 -06'00'

GARDNER.REBECCA.J

EAN.1102097862

Digitally signed by

Date: 2023.01.13 13:39:04 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A018 Operations and Maintenance Work Instructions

OT-2022-30068 3.3.6., 3.8.1.5., 3.9.14., 3.19.27.3. AEDC 804 TSS

NO

N/A C

ASREQ

See 16

See 16

See 16

AEDC 804 TSS

AEDC 704 TSS

AEDC 804 TG

AEDC 704 TG

AEDC/TSD

0 0 0

Block 10-13: Upload new and revised contractor-approved work instructions to Government-directed network locations prior to first use.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:22:40 -06'00'

GARDNER.REBECCA.J

EAN.1102097862

Digitally signed by

Date: 2023.01.13 13:40:21 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 and Communications 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

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

See Section B of the Contract A X

AEDC See Standard Form 33 See Standard Form 33

A019 Schedule Deviation Report

OT-2022-30091 3.4.1. AEDC 804 TG

NO

N/A C

WEEKLY

See 16

See 16

See 16

AEDC 804 TG

AEDC 704 TG

0 0 0

Blocks 10-13: Submit electronically to AF PM each week.

1 1

TRACEY.NICOLE.ELAIN

E.1233557745

Digitally signed by

TRACEY.NICOLE.ELAINE.1233557745

Date: 2023.01.10 13:23:58 -06'00'

GARDNER.REBECCA.JE

AN.1102097862

Digitally signed by

Date: 2023.01.13 13:41:48 -06'00'

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

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